Ecogeographic patterns in fetal limb proportions.

OBJECTIVES: Humans generally comply with the ecological rule of Allen (1877), with populations from tropical environments exhibiting body proportions in which limb segments are long relative to trunk height compared to temperate groups. This study tests whether ecogeographic differences in intralimb proportions are identifiable among two modern fetal samples of differing ancestry. MATERIALS AND METHODS: Data are derived from radiographic measurements of long bone diaphyseal length and crown-heel length (CHL) of contemporary, spontaneously aborted fetuses of African Americans ("black") of assumed African (tropical) ancestry and European Americans ("white") of assumed European (temperate) ancestry (n = 184). Population individual limb elements, brachial, and crural indices are compared via analyses of covariance (ANCOVA). Potential patterns of divergent allometric growth are quantified through principal components analysis (PCA). RESULTS: African ancestral distal limb elements were consistently, albeit slightly, longer than those of European ancestry, relative to CHL. None of the ANCOVA interactions with ancestry are statistically significant for limb indices. The radius was the only single element that displayed a statistically significant ancestry effect (p = 0.0435) equating to a 1 mm difference. PCA highlights that upper limbs demonstrate negative allometry and lower limbs demonstrate positive allometry with sample-specific multivariate growth patterns being nearly identical. Differences in growth allometry late in gestation make little contribution to observed differences in adult limb proportions. DISCUSSION: No statistically significant ecogeographic patterns were appreciated among intralimb proportions between these groups during the fetal period. This study contributes to a greater appreciation of phenotypic plasticity, ecogeographic variation in ontogeny, and the evolution of modern human diversity.

Cervicothoracic junction in disaster victim identification: Idiosyncrasies and relevance of body position for advanced chest radiograph comparisons.

Standard plain film medical radiographs often form a valuable line of evidence to identify individuals in large-scale fatality events. While commonly available, chest radiographs present a challenge that their analysis is somewhat more involved and complex than radiographic records of other body regions. For example, chest radiographs concern subtler morphological varieties of smaller anatomical features across a larger number of skeletal elements in contrast to frontal sinus comparisons that concern a large, (often) single, highly variable void within one bone. This does not detract from or discount chest radiographs as useful identification aids, but it does demand additional prerequisite skills in radiographic interpretation to ensure valid conclusions are attained. When subjects deviate from standardized antemortem (AM) radiographic positions and/or the image quality decreases, the complexity of a chest radiograph comparison is elevated. Generally, the current body of forensic radiographic comparison literature infrequently addresses these more complex circumstances. In this paper, we use real-world radiographic comparison reference images from a military DVI repatriation context to illustrate these factors and outline some procedures that enable these complexities to be easily recognized and appropriately addressed at case examination. A report for an exemplar case that concurrently highlights multiple factors is presented. For novices learning radiographic comparison methods, this case review saliently demonstrates: (1) why the AM reference radiograph(s) drive(s) the radiographic comparison procedure; (2) why care should be taken for correct positioning of the cervicothoracic junction in postmortem radiography of chest elements.

Infracranial radiographic comparison for human identification: A study of image quality and tissue shielding effects.

In this study, we explore how image resolution and tissue shielding can impact correct classification rates (CCRs) of infracranial radiographic comparisons undertaken using small field-of-view radiographs. Thirty-six identification arrays (using clavicles and seventh cervical vertebra) were constructed with each array comprised of five radiographs: one X-ray of a single dry bone (postmortem [PM] skeletal image) and four simulated antemortem [AM] radiographs (radiographs taken pre-skeletization). One AM radiograph in each array represented the ground truth match to the PM radiograph (=25% rate of randomly selecting the correct match). Radiographs were digitally manipulated, so that four varieties of decreasing blur (Gaussian blur = 12-0 pr across 24 arrays), and, for PM clavicles, four varieties of decreasing hard tissue shielding (opacity of 40-0% across 12 arrays) existed. Arrays were evaluated, for their correct PM/AM pair, by 8 anthropologists trained in chest radiograph comparison (CXR; either currently or formerly competency certified by the Defense POW/MIA Accounting Agency CXR training program), 28 current American Board of Forensic Anthropology (ABFA) diplomates and 30 novices. Analysts' CCRs substantially improved when Gaussian blur was <10 pr (55% CCR at >10 pr vs. 89% for <10 pr). Tissue shielding effects increased CCRs on average by +10% for each -10% opacity step (between 40-0% opacity). The CXR anthropologists were the most tolerant of the more challenging identification contexts (highest blur and opacity), reconfirming that analyst training and expertise is an important factor, especially when poorer quality radiographic images are the subject of analysis.

Infra-cranial radiographic comparison for human identification: A study of analyst expertise.

Radiographic comparison for identification is widely utilized. However, these methods are qualitative and subject to analyst ability to correctly read and interpret radiographs. With regards to infra-cranial radiographs, few studies have been conducted to explore the role of practitioner expertize on correct classification rates (CCRs). Here, we undertake two such studies using forensic anthropologists [American Board of Forensic Anthropology (ABFA) certified, practicing but not board-certified anthropologists, and chest radiograph comparison (CXR) anthropologists trained via the Defense POW/MIA Accounting Agency CXR competency training program] and compare their results to novices. To ensure participants only referred to the same skeletal morphology, we cropped radiographs to single bones. An array of four simulated antemortem radiographs was presented to each assessor with each postmortem radiograph. Assessors evaluated arrays for a correct match, which was always present, yielding a 25% rate for random correct selections. Study 1 used anteroposterior C7, posteroanterior second metacarpal, and lateral calcaneus radiographs (three arrays each for nine arrays total), which yielded 86, 81, 69, and 68% mean CCRs for CXR experts, ABFA anthropologists, non-ABFA anthropologists and novices, respectively. Study 2 used anteroposterior C7 and left clavicles (three arrays each for six arrays total), yielding mean CCRs of 100, 96, and 84% for CXR experts, ABFA anthropologists and novices, respectively. As reflected by the CCRs, expertise is clearly a factor for radiographic comparisons, evident not just between novices and anthropologists, but also between anthropologists. We recommend all radiographic comparison analysts be subject to competency/proficiency tests prior to their engagement for forensic casework.

Next-generation osteometric sorting: Using 3D shape, elliptical Fourier analysis, and Hausdorff distance to optimize osteological pair-matching.

Determining which bilateral bones belong to the same person based on shape and size similarity is called pair-matching and it is instrumental for sorting commingled skeletons. To date, pair-matching has popularly been accomplished by visual inspection and/or linear caliper measurements; however, attention is turning increasingly to computational analysis. In this paper, we investigate a fast three-dimensional (3D) computerized shape-analysis method for whole-bone pair-matching using a test sample of 14 individuals (23 femora, 26 humeri, and 26 tibiae). Specifically, the method aims to find bilateral pairs using, as the shape signature criterion, a single 3D outline that snakes around each bone's perimeter as described by a 3D elliptical Fourier analysis function. This permits substantial 3D-point-cloud data reduction, that is, to 0.02% of the starting c.500,000 point cloud or just 100 points, while preserving key 3D shape information. The mean Hausdorff distance (Hd) was applied to measure the distance between each mirrored right-side outline to every left-side outline in pairwise fashion (132, 168 and 169 comparisons, respectively). Both thresholds and lowest Hd were investigated as pair-match criteria, with the lowest Hd producing the best performance results for searches jointly utilizing right-left and left-right directions for comparison: true positive rates of 1.00 (10/10), 1.00 (12/12), and 0.92 (11/12) for the femora, humeri, and tibiae, respectively. The computational time to calculate 469 pairwise 3D comparisons on a single stock-standard Intel® Core™ i7-4650U CPU @ 1.70 GHz was 5 s. This short data processing time makes the method viable for real-world application.

Self-reported prevalence and factors associated with nonadherence with glaucoma medications in veteran outpatients.

OBJECTIVE: The purpose of the current study was to determine the self-reported prevalence of and factors associated with nonadherence with glaucoma medications in veteran outpatients. METHODS: This survey study was conducted at a Veterans Affairs (VA) clinic. A survey was administered to patients with glaucoma. We calculated the percentage of self-reported adherence with glaucoma medications in each patient. Logistic regression was used to assess whether patient characteristics and difficulties with using glaucoma medications were related to patients' reporting that they were <100% adherent with their glaucoma medications in the previous week. RESULTS: The survey was completed by 141 patients (men, 91.5%; mean [SD] age, 70.22 [11.60] years [range, 37-93 years]; black race, 45.4%; white race, 44.0%; "other" or data unavailable, 10.6%). Nonwhite patients were significantly less adherent in the previous week than were white patients (27.0% vs 11.3%; P < 0.05). A total of 67.4% patients reported > or =1 difficulty in using their glaucoma medications. The 3 most commonly reported difficulties were "drops fall on cheek" (29.1%), "too many drops come out" (20.6%), and "hard to read print" (17.0%). A total of 19.1% of patients self-reported using <100% of their glaucoma medications in the previous week. The number of difficulties reported was significantly associated with reporting being <100% adherent in the previous week (P<0.05). CONCLUSION: In this small sample of VA patients with glaucoma, adherence to glaucoma medications could be improved, especially among those who reported difficulties using their medications and those who were nonwhite.

Evaluation of method performance for osteometric sorting of commingled human remains.

Evaluation of method performance involves the consideration of numerous factors that can contribute to error. A variety of measures of performance can be borrowed from the signal detection literature and others are drawn from statistical science. This article demonstrates the principles of performance evaluation by applying multiple measures to osteometric sorting models for paired elements run against data from known individuals. Results indicate that false positive rates are close, on average, to expected values. As assemblage size grows, the false positive rate becomes unimportant and the false negative rate becomes significant. Size disparity among the commingled individuals plays a significant role in method performance, showing that case-specific circumstances (e.g. assemblage size and size disparity) will determine method power.

The utility of elliptical Fourier analysis for estimating ancestry and sex from lateral skull photographs.

Current quantitative methods for estimating ancestry and sex from skulls typically require substantial manual data collection and specialized recording equipment, which can limit analysis to the laboratory. This limitation could be addressed by establishing a faster, more user-friendly, and automatic data protocol as investigated in the current study using elliptical Fourier analysis (EFA). Ancestry and sex were estimated using outlines acquired from standardized photographs of the skull in norma lateralis (left side). In this investigation, training samples comprised anatomical specimens from five collections: the Hamann-Todd Human Osteological Collection, WM Bass Donated Skeletal Collection, Robert J. Terry Anatomical Skeletal Collection, Khon Kaen Osteological Collection, and Chiba Bone Collection. Groups were defined as Black American female (n=87), Black American male (n=109), Japanese male (n=59), Thai female (n=39), Thai male (n=47), White American female (n=97), and White American male (n=134). EFA was conducted on partial Procrustes-aligned skull outline coordinates, before extracting principal components and using linear discriminant analysis for group assignment. Classification accuracy was determined using the 5-fold cross-validation protocol. Ancestry and sex were classified correctly 73% of the time when all seven reference samples were used. When only Black and White Americans were retained in the reference sample with sex pooled, they were correctly classified 94% of the time. Accuracy of out-of-group ancestry and sex estimation was evaluated using nine White American males from the Defense POW/MIA Accounting Agency Laboratory. A seven-way comparison with all reference samples for estimating both ancestry and sex achieved 89% (8/9) correct classifications, with one misclassification as White American female. These out-of-group results, along with initial training group accuracies, indicate that lateral skull outlines can be used to successfully estimate ancestry and sex with similar accuracy to other methods, and set the basis for future cross-validation testing. Further, the reliance on a single easy-to-take photograph and user-friendly open-source R script facilitates easy application and field use. The protocol is freely available from CRANIOFACIALidentification.com as the SkullProfiler script.

A Large-Sample Test of a Semi-Automated Clavicle Search Engine to Assist Skeletal Identification by Radiograph Comparison.

In 2014, a morphometric capability to search chest radiograph databases by quantified clavicle shape was published to assist skeletal identification. Here, we extend the validation tests conducted by increasing the search universe 18-fold, from 409 to 7361 individuals to determine whether there is any associated decrease in performance under these more challenging circumstances. The number of trials and analysts were also increased, respectively, from 17 to 30 skeletons, and two to four examiners. Elliptical Fourier analysis was conducted on clavicles from each skeleton by each analyst (shadowgrams trimmed from scratch in every instance) and compared to the search universe. Correctly matching individuals were found in shortlists of 10% of the sample 70% of the time. This rate is similar to, although slightly lower than, rates previously found for much smaller samples (80%). Accuracy and reliability are thereby maintained, even when the comparison system is challenged by much larger search universes.

Patient-reported behavior and problems in using glaucoma medications.

OBJECTIVE: The objectives of the current study were to describe the different types of problems patients receiving adjunctive therapy reported having when taking their glaucoma medications and to examine the relationship between patient-reported problems in taking their glaucoma medications and patient adherence. DESIGN: Cross-sectional survey. PARTICIPANTS: A survey was distributed to glaucoma patients in 4 geographically distinct ophthalmology practices. We excluded patients using only 1 glaucoma medication. The survey was completed by 324 patients. METHODS: For each patient, average percent adherence to his or her glaucoma medication regimen was calculated. Logistic regression was used to examine how patient characteristics and problems in using glaucoma medications were related to reported adherence. MAIN OUTCOME MEASURE: Whether patients were less than 100% adherent in the previous week. RESULTS: We found that 60% of patients reported 1 or more problems with taking their glaucoma medications. Fourteen percent of patients reported being less than 100% adherent to their glaucoma regimen medications during the previous week. Patients who had difficulty remembering to take their glaucoma medications and those who reported that they had other problems or concerns with their glaucoma medications were significantly less likely to be 100% adherent. CONCLUSIONS: Patient adherence to a glaucoma medication regimen could be improved among patients receiving adjunctive therapy. Ophthalmologists and their clinical colleagues should make sure to discuss the problems and concerns that patients may have in taking their glaucoma medications in an effort to improve adherence.

Resolution of small-scale commingling: a case report from the Vietnam War.

A case is reported that involves the commingled skeletal remains of two individuals who died in a helicopter crash in 1969 during the Vietnam War. The incomplete portions of two bodies were initially recovered soon after the crash. These portions were identified by personnel at a U.S. Army Mortuary in Saigon and were returned to the next-of-kin. While searching for scrap metal in 2002, a Vietnamese citizen unexpectedly discovered human remains and personal effects interspersed with buried aircraft wreckage. The personal effects correlated with the individuals who died in the 1969 incident. These newly discovered remains and artifacts were subsequently received at the U.S. Army Central Identification Laboratory, Hawaii (CILHI) for analysis. As part of the CILHI analysis it was necessary to segregate the commingled remains into specific individuals for identification purposes. Details regarding various sorting techniques are described that provide a solid framework for systematically dealing with small-scale commingling. The sorting techniques used in the resolution of this case consist of visual pair-matching, articulation, process of elimination, osteometric comparison, and taphonomy. These techniques, when used in conjunction with each other, provided a solid basis for the individualization of most skeletal elements.

Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.

BACKGROUND: Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults. OBJECTIVE: The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use. METHODS: This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected. RESULTS: Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used > or = 1 Beers drug. Compared with individuals who used no Beers drugs, those who used > or = 1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90-0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11-1.97), used more medications (OR, 1.07; 95% CI, 1.01-1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05-2.66), hypertension (OR, 1.58; 95% CI, 1.07-2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09-2.29), and back problems (OR, 1.72; 95% CI, 1.19-2.47). CONCLUSION: As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.

Osteometric sorting of commingled human remains.

This paper describes the method of osteometric sorting. Osteometric sorting is the formal use of size and shape to sort bones from one another. The method relies heavily on measurement data and statistical models and is designed to maximize objectivity. The goal of this paper is to validate the use of osteometric sorting and to provide case examples of its utility. Selected regression models are also presented for use with osteometric sorting. We advocate this technique as one tool among many in the anthropologist's toolkit for sorting commingled skeletal remains.

Interobserver variation of selected postcranial skeletal measurements.

Osteometric data are of great importance for analytical purposes in the field of forensic anthropology, and it is critical that interobserver concordance is high in order for the results of these analyses to be reliable. Significant interobserver variation of skeletal measurements is cause for concern since it may result in conflicting conclusions. The range of interobserver variation of selected postcranial measurements is addressed. Thirteen standard measurements familiar to most forensic anthropologists were examined, as well as nine nonstandard measurements that were unfamiliar to most participants in the study. Sixty-eight individuals participated in the study, the majority of whom considered themselves to be forensic anthropologists with various levels of experience. In general, interobserver variation of the tested standard postcranial measurements was found to be minimal, with the exception of pubis length and subtrochanteric femur measurements. The difficulties that can lead to measurement error are discussed and possible solutions are recommended.

Morphometric comparison of clavicle outlines from 3D bone scans and 2D chest radiographs: a shortlisting tool to assist radiographic identification of human skeletons.

This paper describes a computerized clavicle identification system primarily designed to resolve the identities of unaccounted-for U.S. soldiers who fought in the Korean War. Elliptical Fourier analysis is used to quantify the clavicle outline shape from skeletons and postero-anterior antemortem chest radiographs to rank individuals in terms of metric distance. Similar to leading fingerprint identification systems, shortlists of the top matching candidates are extracted for subsequent human visual assessment. Two independent tests of the computerized system using 17 field-recovered skeletons and 409 chest radiographs demonstrate that true-positive matches are captured within the top 5% of the sample 75% of the time. These results are outstanding given the eroded state of some field-recovered skeletons and the faintness of the 1950's photofluorographs. These methods enhance the capability to resolve several hundred cold cases for which little circumstantial information exists and current DNA and dental record technologies cannot be applied.

Facial soft tissue depth statistics and enhanced point estimators for craniofacial identification: the debut of the shorth and the 75-shormax.

Several methods that have customarily been used in craniofacial identification to describe facial soft tissue depths (FSTDs) implore improvement. They include the calculation of arithmetic means for skewed data, omission of concern for measurement uncertainty, oversight of effect size, and misuse of statistical significance tests (e.g., p-values for strength of association). This paper redresses these limitations using FSTDs from 10 prior studies (N = 516). Measurement uncertainty was large (>20% of the FSTD), skewness (≥ 0.8) existed at 11 of the 23 FSTD landmarks examined, and sex and age each explained <4% of the total FSTD variance (η(2) calculated as part of MANOVA). These results call for a new and improved conceptualization of FSTDs, which is attained by the replacement of arithmetic means with shorths and 75-shormaxes. The outcomes of this implementation are dramatic reduction in FSTD complexity; improved data accuracy; and new data-driven standards for casework application of methods.

Tables for the metric evaluation of pair-matching of human skeletal elements.

A common task in forensic anthropology involves pair-matching of left and right skeletal elements. This can be achieved through visual pair-matching by evaluating similarities in morphology, and through osteometric sorting, a quantitative technique. To simplify the process of osteometric sorting, this article explains the use of a statistic (M), which captures the amount of size variation found between homologous bones from single individuals. A database of skeletal measurements for all major paired postcranial bones is used to calculate values of M from a variety of sources. The maximum value and the 90th and 95th percentiles of M are provided in tabular format, and values of M from forensic cases can be compared to these tables as an objective means for determining whether homologous bones could have originated from the same individual. This simple technique can be combined with visual pair-matching to be particularly effective in cases involving commingling of skeletons.

Relationship of the parietal foramen and complexity of the human sagittal suture / Relación del foramen parietal y la complejidad de la sutura sagital humana

The purpose of this paper is to report on the relationship between the parietal foramen and complexity of the human sagittal suture. Examination of 110 Japanese human skulls (males=67, females=43) with at least one parietal foramen revealed that the sagittal suture in the area of the Obelion was the simplest portion (i.e., fewest interdigitations and shortest length) of the suture (paired t-test, P<0.0005), when compared to the outstretched suture length of three established sections: 1. Parietal foramen section (P); 2. Anterior to section P (B); and 3. Posterior to section P (L). Sutural complexity was also compared between individuals with unilateral foramen (n=48) and bilateral foramina (n=62) to see if there was a statistically significant difference. The results revealed a slight difference in section P (ANOVA Bonferroni, P<0.05), denoting that the sagittal suture at the Obelion in individuals with unilateral parietal foramen is more complex than in individuals with bilateral foramina. While no difference in sex was noted, this simplicity in part likely reflects redirected bone stresses around a circular opening resulting in reduced tensile stresses and increased compressive stresses adjacent to the parietal foramen. This phenomenon warrants additional research and has implications for bone biomechanics and development of the cranial sutures.

El propósito de este trabajo es informar sobre la relación entre el foramen parietal y la complejidad de la sutura sagital en humanos. Se examinaron 110 cráneos humanos de individuos japoneses (hombres = 67, mujeres = 43) con al menos un foramen parietal, revelando que la sutura sagital en el área del obelion fue la parte más simple (es decir, menos interdigitaciones y menor longitud) de la sutura (vinculado la prueba t, p <0,0005). Cuando se comparó la extensión de la longitud de la sutura se establecieron tres secciones: 1. Sección foramen parietal (P); 2. Anterior a la sección P (B), y 3. Posterior a la sección P (L). La complejidad de la sutura también fue comparada entre los individuos con foramen unilateral (n = 48) y forámenes bilaterales (n = 62) para ver si había una diferencia estadísticamente significativa. Los resultados revelaron una ligera diferencia en la sección P (ANOVA Bonferroni, P <0,05), que indica que la sutura sagital a nivel del obelion en los individuos con foramen parietal unilateral es más compleja que en los individuos con forámenes bilaterales. Si bien no hubo diferencia según sexo, esta simplicidad en parte, probablemente refleja la redirección de las fuerzas del hueso alrededor de una abertura circular, lo que reduce la resistencia a la tracción y aumenta la fuerza de compresión adyacente al foramen parietal. Este fenómeno justifica la investigación adicional y tiene implicaciones para el desarrollo óseo y biomecánica de las suturas craneales.