A structural vulnerability approach to older adult suicides: Trends and potential impacts of the COVID-19 pandemic in Clark County, NV (2017-2021).

The ongoing SARS-CoV-2 (COVID-19) pandemic has affected all aspects of life in the United States and around the world. This is particularly true for marginalized and vulnerable groups who face disproportionate levels of violence and premature death within their communities. While general impacts of the pandemic have been well-studied overall, little has been done to examine the correlation between COVID-19 and the risk of suicide among older adults. Older adults are particularly at risk because they face challenges including ageism, inadequate support systems, unreliable transportation, and frequent social isolation. Medicolegal casework offers a unique vantage of these issues, as it aims to identify manner of death which may be influenced by underlying structural vulnerabilities. The current research draws upon data collected from the Clark County Office of the Coroner/Medical Examiner. A sample of 871 older adults (aged 50+), whose manner of death was deemed a suicide between the years 2017-2021, were included in this analysis. Statistical analyses investigated differences between adults aged 50-64, 65-84, and 85+ years. Results suggest statistically significant changes in mechanism of death between pre-pandemic and pandemic periods, indicating a shift in risk factors related to social isolation and the home environment. Understanding such changes in trends directly affects the interpretation of skeletal data in forensic anthropology and thus, should be taken into consideration when developing structural vulnerability profiles. Furthermore, the inclusion of a structural vulnerability approach in forensic case reports has the potential to provide additional context for deaths by suicide and may help develop policies and procedures for mitigating future risk.

Technical Note: Individuals identified by radiographic comparison: A sample of demographics and the region of body used for identification in Clark County, Nevada, USA (2017-2020).

Radiographs regularly aid in identifications by comparing antemortem and postmortem images. The forensic community has widely accepted this method because radiographic images are low in cost, easily transferable, and generally believed to be uncomplicated to assess. However, there is a dearth of diverse, modern radiographic datasets as well as a deficiency in assessing population frequencies of nonmetric traits via radiographs. Further, radiographic comparisons, although typically required as a core competency of practicing forensic anthropologists, do not have standard training and education requirements. To understand the diversity and representation within an opportunistic dataset, we provide a case study of the demographics of decedents identified via radiographic comparison at the Clark County Office of the Coroner/Medical Examiner (CCOCME) in Las Vegas, NV, USA from 2017 to 2020. Additionally, we examined each region of the body used to make radiographic identifications. The sample was majority Caucasian and male, with a mean and median age at death of 64.9 years and 67.0 years, respectively. Our results indicated that this sample was not representative of the greater Clark County population. The most common body region used for comparisons was the chest, followed by the head and neck, pelvis, dentition, and the extremities. Thus, large generalizations made from these types of datasets must be implemented with caution due to the relative lack of diversity and representation. As well, current discussions regarding training and education of forensic anthropologists as they relate to radiographic comparisons are explored.

Misgendering a transgender woman using FORDISC 3.1: A case study.

•FORDISC was unable to classify a transgender woman despite her extensive gender-affirming medical care, including Facial Feminization Surgeries.•This case study demonstrates that there is a need for forensic anthropologists to educate themselves on cases that may involve transgender people.•The use of a biocultural approach will allow forensic anthropologists to better identify marginalized individuals, including transgender women.

Multi-agent scavenging patterns in Hawai'i: A forensic archaeological and skeletal case study.

Knowledge of the behavior of local fauna can aid forensic investigators in developing awareness of site formation processes. In Hawai'i, little has been published on the effects of feral domestic pig (Sus scrofa) and feral domestic dog (Canis familiaris) scavenging and bone dispersal on field recovery and laboratory observations. In this Pacific tropical setting, the most consequential terrestrial taphonomic agents are pigs and dogs, both in terms of hard tissue modification and dispersal of remains across the landscape. In 2017, an archaeologist discovered the remains of an unidentified decedent on the island of Kaua'i, State of Hawai'i during a cultural resource management survey. Subsequently, a forensic recovery team in conjunction with Kaua'i police and crime scene investigators used archaeological techniques, including pedestrian survey, tape-and-compass, and GPS mapping, to map and recover the remains. A feral pig trail transected various areas of the recovery site and corresponded with the distribution pattern of recovered skeletal material, including both the main concentration more broadly dispersed skeletal elements. While much of the skeleton was present, missing or unrecovered skeletal elements are consistent with expectations based on existing literature. Much of the postmortem bone deformations were characteristic of marks related to feral dog and/or feral pig scavenging. These results assisted local investigators in deciding the manner of death, as well as providing the family with an accounting of the decedent's remains for burial. Thus, forensic anthropologists and archaeologists need to understand and develop knowledge of local animal behavior to recover and interpret human remains of medicolegal significance.

Examining Interobserver Reliability of Metric and Morphoscopic Characteristics of the Mandible.

Mandibular metric and morphological characteristics have long been used for sex and ancestry estimation. Currently, there are no large-scale studies examining interobserver agreement, particularly examining the role of observer experience. This study examines the interobserver agreement of six morphoscopic and eleven metric mandibular variables. Four observers with varied levels of experience scored 183 mandibles from the William M. Bass Donated Skeletal Collection. Absolute agreement and consistency were evaluated with the intraclass correlation coefficient (ICC). Additionally, technical error of measurement (TEM) and relative TEM (%TEM) were calculated for each metric variable. All analyses were conducted twice-once with all observers and again with only experienced observers. Results show mean morphoscopic agreement of 0.543 among all observers and 0.615 for experienced observers, and mean metric agreement of 0.886 among all observers and 0.911 for experienced observers. Further, no TEM exceeded 2 mm. All results were significant (p < 0.001).

Practical Considerations in Trace Element Analysis of Bone by Portable X-ray Fluorescence.

Forensic anthropologists are more often turning to nondestructive methods to assist with skeletal analyses, specifically for trace elemental analyses. Portable XRF (pXRF) instruments are versatile and are able to be used in diverse settings or for specimens of a shape and size that cannot be accommodated by laboratory-based instruments. Use of XRF requires knowledge of analysis parameters such as X-ray penetration and exit depth. Analysis depth was determined by examining pure elements through known thicknesses of equine bone slices. Correlation between the element's X-ray emission energy and the depth of reading was observed. Bone surfaces from a small unknown historic cemetery were analyzed before and after sanding of the periosteal surface to observe possible changes in XRF readings based on potential diagenesis. Results validate the pXRF device as a powerful and convenient instrument for nondestructive analysis, while highlighting limitations and considerations for the analysis of osseous materials.

Necrotizing fasciitis: a common problem in Darwin.

Necrotizing fasciitis is considered a rare condition, with an incidence rate of 1 in 100,000 persons on average in the worldwide arena. However, at the Royal Darwin Hospital, an average of 10 cases per year with this condition are managed, which appears disproportionately high considering that the population of Darwin is 89,000. A case is presented in this report of a sports tourist to Darwin to indicate the importance of accurate diagnosis and treatment, which are essential to reduce the high mortality (approximately 40%) associated with necrotizing fasciitis. However, early detection relies on appropriate and adequate clinical training.

Information-seeking behavior changes in community-based teaching practices.

A National Library of Medicine information access grant allowed for a collaborative project to provide computer resources in fourteen clinical practice sites that enabled health care professionals to access medical information via PubMed and the Internet. Health care professionals were taught how to access quality, cost-effective information that was user friendly and would result in improved patient care. Selected sites were located in medically underserved areas and received a computer, a printer, and, during year one, a fax machine. Participants were provided dial-up Internet service or were connected to the affiliated hospital's network. Clinicians were trained in how to search PubMed as a tool for practicing evidence-based medicine and to support clinical decision making. Health care providers were also taught how to find patient-education materials and continuing education programs and how to network with other professionals. Prior to the training, participants completed a questionnaire to assess their computer skills and familiarity with searching the Internet, MEDLINE, and other health-related databases. Responses indicated favorable changes in information-seeking behavior, including an increased frequency in conducting MEDLINE searches and Internet searches for work-related information.

Framework for improved communication: the Dermatology Lexicon Project.

A standardized dermatology vocabulary is central to our collective ability to gather clinical information consistently for patient care, to retrieve information for research or disease management, as well as to conduct outcomes analysis for quality improvement. The deficiencies of current classifications have been recognized by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) in their decision to fund the development of a standard complete reference terminology for dermatology. The Dermatology Lexicon will have a major impact both on clinical care and on dermatologic research. Accuracy in medical records and telemedicine communications will be improved. Reliable terminology will provide for more complete and consistent documentation and data aggregation and reporting. In order to create a useful, sustainable lexicon, involvement of the dermatology community is essential.

Medical and dermatology dictionaries: an examination of unstructured definitions and a proposal for the future.

Medical dictionaries serve to describe and clarify the term set used by medical professionals. In this commentary, we analyze a representative set of skin disease definitions from 2 prominent medical dictionaries, Stedman's Medical Dictionary and Dorland's Illustrated Medical Dictionary. We find that there is an apparent lack of stylistic standards with regard to content and form. We advocate a new standard form for the definition of medical terminology, a standard to complement the easy-to-read yet unstructured style of the traditional dictionary entry. This new form offers a reproducible structure, paving the way for the development of a computer readable "dictionary" of medical terminology. Such a dictionary offers immediate update capability and a fundamental improvement in the ability to search for relationships between terms.