Visual inspection problem-solving strategies at different experience levels.

Airport security screening is a visual inspection task comprising search and decision. Problem solving is used to support decision making. However, it is not well understood. This study investigated how airport security screeners employ problem solving during x-ray screening, and how strategies change with experience. Thirty-nine professional security screeners were observed performing x-ray screening in the field at an Australian International Airport. Video and eye-tracking data were collected and analysed to explore activity phases and problem-solving strategies. Less-experienced screeners performed more problem solving and preferred problem-solving strategies that rely on visual examination without decision support or that defer decision making, compared to more-experienced screeners, who performed efficient and independent strategies. Findings also show that screeners need more time to develop problem-solving skills than visual scanning skills. Screeners would benefit from problem-solving support tools and intensified training and mentorship within the first six months of experience to advance problem-solving competencies.

Risk mitigation at train stations: underlying causes of slips, trips, and falls for passengers with reduced mobility.

Slips, trips, and falls (STFs) occur frequently at train stations and on trains, and result in passengers injuries. STFs underlying causes focussing on passengers with reduced mobility (PRM) were investigated. Mixed methods combining observation and retrospective interviews were used. Thirty-seven participants between 24 and 87 years of age completed the protocol. They navigated between three selected stations while wearing the Tobii eye tracker. In retrospective interviews, they were asked to explain their actions in selected video segments. The research identified the dominant risky locations and risk-taking behaviour in risky locations. For example: (i) risky locations were the vicinity of obstacles, (ii) risky behaviour was not looking at the gap between the platform and train. The dominant risky locations and behaviours could be considered as underlying causes of slips, trips, and falls for PRMs. They can be applied during planning and design of rail infrastructure to predict and mitigate STFs.Practitioner summary: A significant number of slips, trips, and falls (STFs) occurs at railway stations, and often result in personal injury. This research identified the dominant risky locations and behaviour as underlying causes of STFs for people with reduced mobility (PRMs). The recommendations presented could be implemented to mitigate such risk.

Proper death certification in the time of the COVID-19 pandemic: Forensic perspective.

It is well known that the quality of death certificates determines the accuracy of public health mortality data. In the light of a pandemic, forensic pathologists must understand the true definition of a COVID-19 death and the requirements for filling out the death certificate, as these are critical for maintaining accurate and trustworthy mortality data. To determine the scope and evolution of the COVID-19 epidemic, accurate death certification is critical. We believe that COVID-19 should be enlisted under part II or section "note" (if it exists in DC form in a particular country) of the DC in all suicide instances and putrefied bodies with positive autopsy swabs for SARS-CoV-2. In addition to our suggestions for the completion of the DC in some COVID-19 instances, we feel that forensic pathologists should follow the WHO criteria for proper DC completion in COVID-19 cases. Better physician education at this stage of the pandemic would increase adherence to existing (WHO and CDC) standards. As a result, forensic pathologists with competence in death certification could help by teaching treating physicians in this area.

Case Report: Post-mortem Histopathological and Molecular Analyses of the Very First Documented COVID-19-Related Death in Europe.

In Europe, the first case of coronavirus disease (COVID-19) and the first COVID-19-related death were reported in France on January 24th and February 15th, 2020, respectively. Officially, the first case of COVID-19 infection in the Republic of Serbia was registered on March 6th. Herein, we presented the first case of retrospective detection of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the post-mortem-obtained vitreous humor (VH), which took place on February 5th, 2020. This is the first death in Europe proven to be caused by COVID-19 by means of post-mortem histopathological and molecular analyses. Based on this finding, it appears that SARS-CoV-2 has been spreading faster and started spreading much earlier than it had been considered and that COVID-19 was probably the cause of the much-reported pneumonia of unknown origin in January and February 2020.

Death due to consumption of ibogaine: case report.

Ibogaine is a psychotropic indole alkaloid extracted from the roots of the Tabernanthe iboga shrub from the Apocynaceae family. Depending on the taken dose, it can lead to stimulant effects, euphoria, visual and auditory hallucinations, along with auditory, olfactory, and gustatory synesthesia. In addition to its historical usage in spiritual rituals of African tribes, these days iboga extract presents a prohibited, alternative drug widely used as a part of addiction treatment. Ibogaine used in opioid withdrawal is associated with serious side effects and sudden deaths. Besides its main use as an anti-addiction medication in alternative medicine, in moderate doses (from 100mg to 1g) ibogaine most commonly causes a "trance-like state".In this paper, we report the case of a heroin addict who died suddenly 5-12 hours after oral ingestion of powder labeled Tabernanthe iboga which had been bought online and used in the process of detoxification during an addiction treatment. The man was found dead in a rented apartment, where he was undergoing the addiction treatment.External examination revealed no lesions other than nonspecific injuries on the legs. The autopsy showed congestion of internal organs and pulmonary edema. Histopathological analysis of the heart showed neither macroscopic nor microscopic abnormalities. The concentration of ibogaine was 3.26mg/L. Moreover, systematic toxicological analyses of biological samples showed the presence of morphine and codeine. These data suggest that death, which occurred unnaturally after initiation of the "treatment", was probably the result of the cardiovascular effects caused by the ibogaine powder.The presented case highlights the worldwide problem of various products being widely available over the internet and the danger associated with consumption thereof.

Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy.

Several Serratia species are widely distributed in nature, but Serratia marcescens is the only species frequently isolated in hospitals. This pathogen is mainly responsible for nosocomial infection, mostly in immunocompromised hosts. A 26-year-old woman with a twin pregnancy, regularly controlled, was hospitalized at 24 + 5 weeks of gestation due to scant vaginal bleeding, lower abdominal pain, and body temperature up to 37.5°C. Gynecological examination revealed bleeding accompanied by dilatation of the cervix. The laboratory analyses revealed leukocytosis with elevated C-reactive protein (CRP). Treatment was initiated with intravenous antibiotic administration. After admission, fetal membranes spontaneously ruptured, and an extremely preterm dichorionic female twin birth occurred at 25 + 0 weeks of gestation. Both infants died two days after labor. Pathological and microbiological analyses revealed chorioamnionitis caused by S. marcescens. According to the antibiogram, antibiotic treatment was continued for the next 7 days. The examination of cervical and vaginal discharge samples was negative three days and two weeks after therapy. S. marcescens may cause spontaneous miscarriages and, in this important case, caused loss of discordant twins in an extremely preterm birth by an immunocompetent patient. Infection by S. marcescens cannot be excluded as a cause of discordant growth and needs to be confirmed by further research.

Is the role of forensic medicine in the covid-19 pandemic underestimated?

We believe that forensic medicine should play a significant role in the COVID-19 pandemic. Forensic pathologists should ask and answer various questions through autopsy cases during the COVID-19 period, thus providing a significant contribution to science. Some of the potential roles of forensic medicine in this issue include: determining the exact cause of death among the deceased who were SARS-CoV-2 positive, contribution to the accuracy of mortality statistics, understanding pathological mechanisms of COVID-19, tracking the presence of the virus over time, survival of the virus after death as well as dealing with medicolegal issues. A detailed multidisciplinary analysis of autopsy samples would undoubtedly help understand this new illness and its clinical management. Therefore, autopsies during the COVID-19 pandemic should not be an exception, but certainly a rule.

Safe trip: Factors contributing to slip, trip and fall risk at train stations.

Public transport systems are vital services in urban environments. The design of these complex socio-technical systems is continuously evolving to accommodate larger populations, and their adaptation is essential in supporting the successful and sustainable development of cities and regions. An essential part of this adaptation includes working to increase passenger safety and to minimise their risk of injury. With this focus, key objectives of the current study were to identify the causes of slip, trip and fall (STF) incidents attributable to the rail user and to train and station characteristics. An investigation of historical STF records of 1247 train and station incidents in two Australian jurisdictions was conducted. Various contributing factors to STF events were identified, including locations such as stairs, ramps, escalators, the train's entry and exit step, doorway areas, and passenger running or rushing. A mixed-method field study was then conducted at three train stations and on trains. To further investigate the contributing factors, participants (N = 40) wore an eye tracker as they navigated the stations and trains. The research illustrates that their continuous search for information, and a disconnect between the information needed and the information provided, might be a cause of passenger distraction and an increase in their risky behaviour. Therefore, we suggest that improvements in information design to reduce the high visual workload for passengers might also reduce the incidence of STFs.

Safe Composite Calf Augmentation: A Staged Procedure.

BACKGROUND: Calf augmentation can be achieved by fat grafting, calf implants, or a combination of both methods (composite augmentation). For safety reasons, it is important to be aware of important calf anatomic features, specific physiologic considerations, and some health conditions that can hinder the outcome of these procedures. OBJECTIVES: The aim of this study was to present our experience with performing composite calf augmentation, and to describe indications, surgical techniques and safety issues. METHODS: We retrospectively analyzed 63 patients who had undergone composite calf augmentation for cosmetic and reconstructive surgery in our practice. We reviewed group demographics, complications, and results, and identified all the pitfalls encountered in our cases. Additionally, dissection of the calf regions in fresh cadavers was performed to obtain more accurate anatomy. We also measured intracompartmental pressures before and after calf augmentation with implants in 6 cases to determine pressure changes. RESULTS: All cases received subfascial implant insertion and fat grafting as a delayed procedure. If there is a need for multiple implants, we recommend a staged procedure. Our study showed high muscle sensitivity to pressure increase after augmentation. Hence, from the standpoint of safety, we advocate subcutaneous fat grafting only. No patients developed compartment syndrome. CONCLUSIONS: Composite calf augmentation surgery is safe and easy to reproduce, with a short recovery period and a low complication rate when done as a staged procedure and respecting specific anatomic and physiologic calf features.

The significance of post-mortem vitreous calcium concentration in forensic practice.

Calcium, as one of the main extracellular ions, maintains a key role in numerous biologic functions. For forensic purposes, it was analyzed mostly for estimation of postmortem interval (PMI). We have designed our experiment with the concept that the repetitive withdrawal of vitreous humor (VH) might clarify the postmortem metabolism of calcium in greater detail to estimate the PMI. Accordingly, 248 samples of VH from 31 autopsy cases were evaluated over three years; samples (0,1 mL of VH) were taken and analyzed at equal time intervals after death-every three hours until 24 h after death. Each sample was centrifuged and analyzed using the ARCHITECT C SYSTEM 8000. Moreover, functional relationship between PMI and calcium concentration was established: PMI (hours) = [Ca2+] × 13.696-7.843. Although the concentration of calcium in VH in the analyzed group increases with time, the coefficient of variation for the regression (CVreg = 46.8%) indicates that this correlation is not so strong, meaning that the level of predictiveness of calcium for estimation of time since death is poor when is not used in combination with other relevant substances.

Airport Security Screener Problem-Solving Knowledge and Implications.

OBJECTIVE: This research investigates security screeners' knowledge and the effect that differences in knowledge have on the performance of problem-solving activities. We argue that the development of problem-solving knowledge enables security screeners to perform effective problem-solving activity, which assists search and decision-making processes. BACKGROUND: Airport security screening research has investigated the many variables that affect security screeners' search and decision making during simulated threat-detection tasks. Although search and decision making are essential aspects of security screening, few studies have investigated the problem-solving knowledge and activities that support security screening task performance. METHOD: Sixteen more-experienced and 24 less-experienced security screeners were observed as they performed x-ray screening in the field at an Australian international airport's departure security checkpoint. Participants wore eye-tracking glasses and delivered concurrent verbal protocol. RESULTS: When interacting with other security screeners, more-experienced screeners demonstrated situational knowledge more than less-experienced screeners, whereas less-experienced screeners experienced more insufficient knowledge. Lag-sequential analysis using combined data from both screener groups showed that situational knowledge facilitated effective problem-solving activity to support search and decision making. Insufficient knowledge led screeners to seek assistance and defer decision making. CONCLUSION: This study expands current understandings of airport security screening. It demonstrates that security screeners develop knowledge that is specific to problem solving. This knowledge assists effective problem-solving activity to support search and decision making, and to mitigate uncertainty during the x-ray screening task. APPLICATION: Findings can inform future security screening processes, screener training, and technology support tools. Furthermore, findings are potentially transferable to other domains.

Late Occurrence of Raccoon Eyes: The Role of the Ligature.

This case represents a planned complex suicide in which the victim combined gunshot to the head and hanging. The most interesting finding in the presented case was pale face, but without any visible injury to it at the time the body was found (more than 24 hours after death), whereas at autopsy (20 hours later), black eyes were prominent. The removal of the ligature led to the decompression of the neck and its blood vessels with consequential blood redistribution, which, alongside the liquid state of blood, resulted in the aforementioned finding. Considering the described postponed appearance of periorbital ecchymosis, this kind of finding suggests that great caution is necessary when interpreting hematomas in terms of their vitality.

Gunshot Suicide: Cherry-Red Discoloration of the Temporal Muscle Beneath the Exit Wound.

The article describes a case of gunshot suicide to the head in a 51-year-old man. The entrance wound was located in the left temple and exit wound in the right temple. The entrance wound had the characteristics of a hard-contact gunshot wound. The most interesting finding in this case was cherry-red discoloration of the right temporal muscle surrounding the exit wound. This finding could make the determination of the entrance versus exit gunshot wound challenging, especially if the wounds are of atypical appearance. In addition, the finding described in the presented case could be the proof that carbon monoxide may follow the missile through the body and may be prominent in the soft tissue at the exit.

Age, familiarity, and intuitive use: An empirical investigation.

Research has shown that older adults interact with products less intuitively than younger adults, and that familiarity is an essential element of intuitive interaction. This paper reports on the findings of two empirical studies that examined familiarity in younger and older adults. Each study comprised 32 participants over four age groups. The first study required participants to use their own contemporary products in their homes in order to investigate older adults' familiarity with them, and how this familiarity differed from that of younger adults. Older people were less familiar with their own contemporary products that younger people. The second study aimed to investigate differences in familiarity between younger and older adults while using products that they did not own and were likely to be less familiar with. When using products not already familiar to them, both middle aged and older adults showed significantly lower familiarity than younger people. The significance of this research is in its empirical findings about familiarity differences between age groups. It has been recognised that the identification and understanding of differences in familiarity will enable designers to design more intuitive interfaces and systems for both younger and older cohorts. The implications of the findings from the two studies reported here are discussed in light of this recognition.

Copper-Beaten Skull Appearance as a Response of Chronically Increased Intracranial Pressure.

We present a case of 19-year-old female patient, who was injured in childhood and subsequently developed hydrocephalus, chronic elevation of intracranial pressure (ICP), and a copper-beaten skull appearance. Chronic hydrocephalus leads to an increase in intraventricular pressure, causing ventricular expansion and dislocation of adjacent cerebral structures. According to literature data, it has been hypothesized that chronically elevated ICP in persons with craniosynostosis, and other developmental structural abnormalities of the skull, may induce bone remodeling. In cases with copper-beaten skull appearance, increased ICP should be considered as a cause of death (after exclusion of all other obvious causes), and for that reason, careful examination of the skull appearance is suggested. This finding could be useful in cases with advanced postmortem changes, where it might indicate some medical conditions of the deceased or could even be considered unique feature for body identification, although this rationale should be used with great caution.

Aesthetic Improvement of Undeveloped Calves After Treatment of Congenital Clubfoot Deformity.

BACKGROUND: Even when clubfoot deformity is treated in a timely manner, the consequences observed in adulthood include hypoplasia of the calf muscles, gait impairment, decreases in foot size, and it can also affect the tibial length. These consequences may have negative impacts on the patient's subjective appraisal of long-term outcomes, and can influence the patient's self-esteem in both male and female patients. OBJECTIVES: We present our experience in the treatment of undeveloped calves after surgical treatment of congenital clubfoot. METHODS: In total, 72 patients underwent corrective surgery in order to improve undeveloped calves resulting from a congenital clubfoot deformity. We used calf silicone implants in combination with fat grafting in multistaged procedures, in order to decrease complication rates and improve aesthetic outcome. RESULTS: Amongst our patients there were 54 (75%) females and 18 (25%) males. All of the patients, except one, had unilateral calf hypoplasia. The procedures were divided into several groups: (1) medial calf augmentation with silicone implants; (2) medial calf augmentation with silicone implants and fat grafting; and (3) medial and lateral calf augmentation with silicone implants and fat grafting. We had one case of a hyperpigmented scar and one case of partial scar dehiscence. There were no cases of compartment syndrome. The average follow-up period was 9.8 months. CONCLUSIONS: Calf enhancement surgery in patients with congenital clubfoot deformity is very gratifying. When combining calf implants with fat grafting in multistaged procedures, we can achieve excellent results with low complication rates.

Safety and Efficacy of Subfascial Calf Augmentation.

BACKGROUND: Calf augmentation surgery is one of the least popular procedures among plastic surgeons; in contrast, it is by far one of the most gratifying procedures among patients. In this article, the authors present a retrospective analysis of a surgeon's extensive experience with calf implants. METHODS: The authors retrospectively analyzed 134 patients having calf augmentation for cosmetic and reconstructive surgery in their practice from 2003 to 2015. All patients were divided into two groups: primary cases and patients who had previously been operated on and who were referred to our service as patients who had complications after calf augmentation surgery. The subfascial approach was the preferred approach by authors for all primary cases. The authors analyzed indications, complication rates, results, and pitfalls. Secondary cases were further divided into three groups according to the origin of the problem and some possible solutions. RESULTS: Subfascial calf augmentation surgery is safe and easy to reproduce, with a short recovery period and a low complication rate (<1 percent). To achieve the best aesthetic results, surgeons should choose appropriate implants for each case. In secondary cases, fat grafting is a powerful tool and can be used alone or in combination with calf implants. CONCLUSIONS: There are several groups of patients seeking calf augmentation surgery (e.g., bodybuilders, women, those with reconstructive problems). Therefore, treatment should be planned individually. The development of a new implant is necessary and should be based on detailed anatomical findings and in accordance with surgical techniques. The process is intriguing and rewarding. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Anatomical aspects of the gastrocnemius muscles: A study in 47 fresh cadavers.

BACKGROUND: This study offers objective dimensions of the gastrocnemius muscle and analyzes correlations between dimensional variables, with a view to providing guidance on the proportions of a healthy gastrocnemius muscle for both genders. METHODS: This anatomical study was conducted at the Institute of Forensic Medicine Faculty of Medicine University of Belgrade, Serbia, from May until November 2014. We included 47 fresh cadavers (up to 12-h postmortem interval) both male and female. The inclusion criteria were absence of any trauma or degenerative findings in lower limbs, normally weighed, and age between 18 and 60 years. The exclusion criteria were significant difference in dimensions between legs and overweighed cadavers. RESULTS: After statistical analysis of gathered data, we were able to define the exact shape and average measures of the medial and lateral head of gastrocnemius muscle in male and female. Factors affecting muscle dimensions are also defined in this study. CONCLUSION: The method of dissection that we applied could be recommended for exploration of different anatomical structures of calf region. The reported dimensions and correlations are useful guide in planning cosmetic and reconstructive procedures with high accuracy.

Analysis of Closed Soft Tissue Subcutaneous Injuries-"Impact Décollement" in Fatal Free Falls From Height-Forensic Aspect.

The aim of this study was to assess the frequency of "décollement," traumatic lesions of subcutaneous soft tissue, among victims fatally injured because of falls from different heights. Three hundred seventy-five cases of fatalities due to injuries acquired when falling from various heights onto a solid, flat surface, in which the complete forensic autopsy was performed, were analyzed. Décollement was noted in 125 (33%) of the cases. Comparative analysis of groups with and without décollement and observed factors has shown that the height of fall and the manner of death have statistically significant influence on décollement appearance. With regard to suicidal, accidental, or undefined origin of death décollement is statistically more common in accidental deaths. Décollement provides important clues for forensic reconstruction and could be a significant indicator of the body's position at primary impact and the height from which the victim has either jumped or fallen.

Myocardial bridges: a prospective forensic autopsy study.

INTRODUCTION: When the coronary artery, located subepicardially, submerges into the myocardium and appears again subepicardially after a short intramural course, it represents an embedded coronary artery, while the part of the myocardium above is a myocardial bridge. OBJECTIVE: We investigated the frequency of the embedded left coronary artery (LAD) in the autopsy material considering the descending branch of the LAD to be the most important one in the nourishment of the myocardium and myocardial bridges to be the most frequent in its area, as well as clinically important. METHODS: A prospective autopsy study of 975 cases was performed, including both, natural (21.33%) and violent (78.67%) deaths. The sample consisted of 74.56% males and 25.44%females. In order to discover myocardyal bridges and their characteristics, the hearts were examined by both transverse cuts and longitudinal openings of the LAD. RESULTS: Myocardial bridge was found in 78 cases (8.00%), more commonly in males (9.35%) than females (4.03%).The average length of the myocardial bridge was 21.85±16.10mm and thickness 3.744±1.48 mm. The common localization of the myocardial bridge was the proximal half of the LAD (89.74%).The upper part of the artery, proximal to the bridge, was a common site of atherosclerotic changes. Myocardial bridge was found in 12.50% of natural deaths, but in 13.38% out of all cases of sudden cardiac deaths. CONCLUSION: Therefore, the presence of the myocardial bridge by itself is not predominant, but it is certainly a contributing factor to a sudden cardiac death.