The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
Barbara A Sampson - One of the best experts on this subject based on the ideXlab platform.
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genetic testing in sudden unexpected natural death in the young new york city office of chief Medical Examiner s experience and perspective
Forensic Science Medicine and Pathology, 2019Co-Authors: Yingying Tang, Nori Williams, Barbara A SampsonAbstract:Postmortem genetic testing is a diagnostic tool that is becoming increasingly utilized. The benefits and limitations of genetic testing in cases of sudden, unexpected death in the young (≤ 40 years old) are reviewed from the perspective of the Office of Chief Medical Examiner of the City of New York, whose Molecular Genetics Laboratory, accredited by College of American Pathologists, has had 15 years of postmortem testing experience. Challenges to the interpretation and communication of testing results are highlighted, and opportunities for improving testing yield are discussed for age groups across the lifespan, from infancy to adulthood.
Stephen J. Deroux - One of the best experts on this subject based on the ideXlab platform.
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Bath Salts" the New York City Medical Examiner Experience: A 3-Year Retrospective Review.
Journal of Forensic Sciences, 2016Co-Authors: Stephen J. Deroux, William A. DunnAbstract:“Bath salts” are synthetic derivatives of cathinones, compounds found in the leaves of Catha edulis, which possesses ampheta-mine-like properties. At the New York City Office of Chief Medical Examiner, we conducted a 3-year retrospective analysis of deaths in which cathinones were detected. Two categories emerged; those in which cathinones were a contributory cause of death (15 cases) and those in which they were an incidental finding (15 cases). Of the former group, 13 were associated with additional intoxicants; two deaths were attributed solely to cathinone intoxication, both survived 10 h: a man whose postmortem blood methylone concentration was 0.71 mg/L and a woman whose postmortem blood ethylone concentration was 1.7 mg/L. In the latter category, there were several individuals who had higher concentrations of cathinones than the above two, the highest being a blood methylone of 4.8 mg/L. Based upon our data and the literature presented, lethal concentrations of cathinones cannot be established.
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upper and lower gastrointestinal endoscopy mortality the Medical Examiner s perspective
Forensic Science Medicine and Pathology, 2012Co-Authors: Stephen J. Deroux, Anthony SgarlatoAbstract:Fiberoptic endoscopy is utilized to diagnose and treat a wide variety of gastrointestinal tract diseases and is currently one of the most commonly performed invasive Medical procedures. Though generally considered to be safe, the procedure may be associated with serious complications including death. Herein, we correlate the clinical history with the autopsy findings in gastrointestinal endoscopy (GIE) related fatalities that were reported to the New York City Medical Examiner Office over a 5 year period. The complication rate is higher in therapeutic procedures when compared to diagnostic procedures. Though fatalities following iatrogenic complications are four times more common, emphasis is placed on patients who died following a cardiorespiratory event during or immediately following the procedure. Of 41 upper and 36 lower GIE related fatalities, 10 and 9 respectively, fit this category. The comorbidities frequently associated with fatal cardiorespiratory events were: hypertension and obesity with associated cardiac hypertrophy, diabetes mellitus and coronary artery atherosclerosis. For colonoscopies, the approximate incidence of perforation was 0.00625% and the procedure-related fatality rate was 0.014%. The literature on anesthesia for GIE is also discussed.
James R Gill - One of the best experts on this subject based on the ideXlab platform.
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state Medical Examiner systems 2013 staffing autopsies strengths limitations and needs
Academic forensic pathology, 2014Co-Authors: James R GillAbstract:The medicolegal death investigation system of the United States is undergoing a national review aimed at improving it. It currently is a mixture of Medical Examiner and coroner systems organized by...
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9 11 and the new york city office of chief Medical Examiner
Forensic Science Medicine and Pathology, 2006Co-Authors: James R GillAbstract:On September 11, 2001 two hijacked airplanes struck the Twin Towers at the World Trade Center in New York City. All of the remains (19,915) were examined by the Office of Chief Medical Examiner (OCME) of New York City. The major goals of the OCME were to accurately identify the decedents and to promptly issue death certificates. As of September 2005, there were 1594 identifications of a total of 2749 people reported missing. Of these, 976 were identified by a single means, which included DNA analysis in 852 of the victims. Use of legal statues can assist in the timely issuance of death certificates in mass fatalities, which benefit surviving family members. DNA analysis markedly improves the ability to identify remains and has become the standard method for identification in these types of disasters. Certain postmortem tissue samples are better suited for DNA analysis and yield better results than others.
Robert S Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Medical Examiner and Medical toxicologist agreement on cause of death
Forensic Science International, 2011Co-Authors: Alex F Manini, Lewis S Nelson, Dean Olsen, David Vlahov, Robert S HoffmanAbstract:Poisoning is a significant public health threat as the second leading cause of injury-related death in the US. Disagreements on cause of death determination may have widespread implications across several realms of public health including policy and prevention efforts, interpretation of the poisoning literature, epidemiologic data analysis, Medical-legal case outcomes, and individualized autopsy interpretation. We aimed to test agreement between the cause of death determined by the Medical Examiner (ME) and a Medical toxicologist (MT) adjudication panel (MTAP) in cases of poisoning. This retrospective 7-year study evaluated all deaths attributed to poisoning in one large urban catchment area. Cross-matched data were obtained from Department of Vital Statistics and the Poison Control Center (PCC). Out of >380,000 deaths in the catchment area over the study period, there were 7050 poisonings in the Vital Statistics database and 414 deaths reported to PCC. Cross-matching yielded 321 cases for analysis. The ME and MTAP concurred on cause of death in 66%, which was only fair agreement (κ 0.25, CI 0.14-0.38). Factors associated with the likelihood of agreement were peri-mortem fire exposures, prehospital cardiac arrest, and timing of drug toxicity (chronic versus acute). In conclusion, agreement for poisoning cause of death between specialties was much lower than expected. We recommend an improved formal process of information sharing and consultation between specialties to assure that all existing information is analyzed thoroughly to enhance cause of death certainty.
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testing positive for methadone and either a tricyclic antidepressant or a benzodiazepine is associated with an accidental overdose death analysis of Medical Examiner data
Academic Emergency Medicine, 2006Co-Authors: Gar Ming Chan, Marina Stajic, Elizabeth Marker, Robert S Hoffman, Lewis S NelsonAbstract:Objectives: Patients in emergency departments who use methadone frequently use tricyclic antidepressants (TCAs) and/or benzodiazepines (BZDs). This is a potentially dangerous drug combination. The authors hypothesized that the presence of methadone and a TCA, a BZD, or both is associated with an “accidental” overdose (AOD) death more often than a death from any other cause. Methods: A retrospective chart review of New York City Office of Chief Medical Examiner data for 2003 was performed. Decedents who tested positive for methadone that were classified as an AOD death, as determined by the Medical Examiner, were compared with deaths from all other causes for the presence of a TCA, a BZD, or both. A logistical regression was performed to develop a multivariate model identifying additional variables associated with a methadone-positive AOD death. A p-value of <0.05 was considered significant, and 95% confidence intervals (CIs) were calculated. Results: In 2003, there were 5,817 Medical Examiner cases, of which 500 (8.6%) were methadone positive. Of the methadone-positive cases, 493 were available for analysis; 95 (19.3%) were TCA positive and 158 (32.0%) were BZD positive. The odds of having an AOD death in methadone-positive decedents testing TCA positive, BZD positive, or both were 2.11 (95% CI = 1.32 to 3.37; p < 0.01) for TCAs, 1.66 (95% CI = 1.12 to 2.45; p < 0.02) for BZDs, and 4.34 (95% CI = 1.97 to 9.56; p < 0.001) for both. The multivariate logistic regression of analytes revealed the following covariates associated with an AOD death as well: amitriptyline, cocaine, morphine, or opiates. Conclusions: Among the methadone-positive cases, testing positive for a TCA, a BZD, or both was associated with an AOD death.
Randy Hanzlick - One of the best experts on this subject based on the ideXlab platform.
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Coroner versus Medical Examiner Systems: Can We End the Debate?:
Academic Forensic Pathology, 2014Co-Authors: Randy Hanzlick, John FudenbergAbstract:This article is a discussion and comparison of coroner systems and Medical Examiner systems. Each type of system has potential merits and drawbacks, and virtually all systems face certain problems ...
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A Synopsis of the 1928 National Research Council's Bulletin on “The Coroner and the Medical Examiner”:
Academic Forensic Pathology, 2014Co-Authors: Randy HanzlickAbstract:The 1928 National Research Council (NRC) Bulletin on “The Coroner and the Medical Examiner” is an often-referenced report because it compares the two system types and recommends that coroner system...
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the Medical Examiner coroner s guide for contaminated deceased body management
American Journal of Forensic Medicine and Pathology, 2009Co-Authors: Randy Hanzlick, Kurt B. Nolte, Joyce L. DejongAbstract:In the past few years, a number of publications and other resources have appeared concerning the management of mass fatality incidents. Some are geared toward the general management of incidents while others cover more specific topics such as decontamination procedures. Still others cover selected agents, including chemical, biologic, or radiologic ones. Few publications have been written specifically for Medical Examiners and coroners. The Medical Examiner and Coroner's Guide for Contaminated Deceased Body Management is written specifically for the Medical Examiner or coroner who will be in charge of investigations of fatalities that result from terrorism or other events that result in contaminated remains. In some such cases, agents may be used that will require mitigation of environmental hazards and decontamination of human bodies. To that end, this Guide provides information and suggestions that may be useful in understanding the principles involved in decontamination procedures, recognizing that it may not be the Medical Examiner or coroner staff who actually conducts decontamination procedures. The suggestions in this guide may differ slightly from those in other publications. However, those who have contributed to this guide believe that the recommendations are practical, workable, have a scientific basis, and do not differ much in substance when compared with other relevant publications. The contents of this Guide may be reproduced for practical use but the Guide may not be sold and it may not be cited for advertisement purposes. Reference to specific commercial products is for informational purposes only and does not constitute endorsement of the product or company which produces the product. The recommendations contained in this Guide are not mandated nor are they required by federal, state, or local law. Rather, the recommendations are intended to assist Medical Examiners and coroners for the purposes of planning and providing a set of reasonable practice guidelines for incident response.
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The Medical Examiner/Coroner's Guide for Contaminated Deceased Body Management.
The American journal of forensic medicine and pathology, 2009Co-Authors: Randy Hanzlick, Kurt B. Nolte, Joyce L. DejongAbstract:In the past few years, a number of publications and other resources have appeared concerning the management of mass fatality incidents. Some are geared toward the general management of incidents while others cover more specific topics such as decontamination procedures. Still others cover selected agents, including chemical, biologic, or radiologic ones. Few publications have been written specifically for Medical Examiners and coroners. The Medical Examiner and Coroner's Guide for Contaminated Deceased Body Management is written specifically for the Medical Examiner or coroner who will be in charge of investigations of fatalities that result from terrorism or other events that result in contaminated remains. In some such cases, agents may be used that will require mitigation of environmental hazards and decontamination of human bodies. To that end, this Guide provides information and suggestions that may be useful in understanding the principles involved in decontamination procedures, recognizing that it may not be the Medical Examiner or coroner staff who actually conducts decontamination procedures. The suggestions in this guide may differ slightly from those in other publications. However, those who have contributed to this guide believe that the recommendations are practical, workable, have a scientific basis, and do not differ much in substance when compared with other relevant publications. The contents of this Guide may be reproduced for practical use but the Guide may not be sold and it may not be cited for advertisement purposes. Reference to specific commercial products is for informational purposes only and does not constitute endorsement of the product or company which produces the product. The recommendations contained in this Guide are not mandated nor are they required by federal, state, or local law. Rather, the recommendations are intended to assist Medical Examiners and coroners for the purposes of planning and providing a set of reasonable practice guidelines for incident response.
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The conversion of coroner systems to Medical Examiner systems in the United States: a lull in the action
The American journal of forensic medicine and pathology, 2007Co-Authors: Randy HanzlickAbstract:Coroner and Medical Examiner systems in the United States conduct death investigations for most deaths that are sudden and unexplained, or which involve external causes such as injury and poisoning. They play a very important role in the criminal justice, public health, public safety, and Medical communities, and they also contribute a substantial portion of autopsy-based mortality data to the state and federal mortality statistics systems. Death investigations often involve complex Medical issues and necessarily require the involvement of appropriately trained physicians. Over the years, there has been a trend to replace the elected lay coroner systems with systems run by appointed, physician Medical Examiners. Presently, about 31% of counties in the United States are served by a Medical Examiners at the county, district, or state level. Between 1960 and 1989, there was considerable conversion to Medical Examiner systems, but this trend slowed in the 1990s. Since 2000, only 6 counties in the United States have converted to a Medical Examiner system, no states have converted since 1996, and 1 county has reverted to a sheriff-coroner system. Possible reasons for this decline are discussed, including legislative, political, geographical, financial, population-based, and physician manpower distribution factors. It is important to ensure that all death investigation systems have appropriate access to Medically educated and trained physicians such as forensic pathologists.
