Protecting the Public’s Health-Except in Tennessee

No abstract available. Article truncated after 150 words. State regulatory boards that regulate professionals such as doctors, nurses, psychologists, etc. are often appointed by politicians and headed by lawyers. Under this category has been most Medical Boards and their parent organization the Federation of State Medical Boards. Although they claim to be protecting the public, they seem more concerned with identifying “disruptive” physicians and blacklisting them through the National Practitioner Data Bank (1). However, in July the Federation issued a warning to physicians against propagating COVID-19 vaccine misinformation and disinformation citing a "dramatic increase" by physicians (2). The statement gave some hope that the Federation was striving to maintain some degree of professional standards by saying that spreading disinformation to the public was dangerous because physicians enjoy a high degree of public credibility. The Tennessee Board of Medical Examiners followed the Federation’s lead by issuing a verbatim restatement warning that physicians who spread false information about COVID-19 vaccinations …

Ancestry Estimation in Practice

The medicolegal system relies on forensic anthropologists to construct accurate biological profiles from skeletal remainsto narrow the pool of potential missing persons and provide support for positive identifications. The ancestry estimation component of theprofile offers physical descriptions of decedents through a combination of metric analysis and the interpretation of discrete traits believedto correlate with visible physical features. Forensic anthropologists employed in medical examiners’ offices in the United States regularlyconstruct these profiles in casework. However, ancestry estimation methods have been questioned in their ability to accurately describe theracial classification of the deceased. Although validation studies have documented the accuracy of ancestry estimation methods on skeletalcollections, it is unknown how well they operate in forensic casework and the assumption that methods mirror the results observed inacademic research studies remains unproven. In an effort to understand how well methods preform, this research was designed to evaluatethe accuracy ancestry estimation practices within three medical examiners’ offices in the United States. The results show an accuracy rateof 99% among 177 cases when both definitive and ambiguous ancestral and racial terminology was used to describe remains. Becauseunidentified cases lack antemortem information, it remains unknown if the ancestral assessments of the 280 unidentified individualsincluded in this study confer the same level of accuracy shown in resolved cases. The results presented here are informative not only forthe vital statistics obtained, but also for what this data reveals about the factors influencing ancestry estimation in practice.

The Kidney Diet Challenge: An Experiential Educational Experience

Background: Healthcare providers who care for patients with chronic kidney disease (CKD) must be able to provide effective counseling about a kidney friendly diet. Nutrition is under-emphasized in medical curricula, and the kidney diet is one of the most challenging diets. We hypothesized that participation in an experiential educational program in kidney diet will result in improved knowledge of the underlying principles behind it and provide concrete examples of how to explain this diet to patients. Methods: The first part of this study was a knowledge assessment administered to all United States nephrology fellows during the 2020 National Board of Medical Examiners Nephrology In-Training Exam. We later opened the assessment to a broader, global audience via social media. Respondents included trainees, practicing nephrologists, dieticians, and other health professionals. Participants self-identified willingness to participate in the second part of the study, the Kidney Diet Challenge (KDC). The 5-day challenge included daily webinars by experts in nutrition. Daily surveys captured self-reported adherence to the diet. Social media was used to engage with participants. All participants received a follow-up knowledge assessment. Results: Among the nephrology fellows (n=317), the median pre-test score was 2 out of 5 (40%) questions correct, and results did not differ by year of training (p=0.310). Of the participants (n=70) who completed the 5-day challenge and responded to the post-challenge survey, the post-test score was significantly higher (p<0.01) and 'ability to advise patients about kidney diet' improved (p<0.01). Analyzing stats from our official hashtag for this study (#kidneydietchallenge) showed that we achieved 406,241 reaches, 1,004,799 impressions with a total of 974 posts using this hashtag. Conclusions: The KDC is an immersive, experiential educational tool that enabled a global population to learn how to better counsel their patients about adherence to a complex kidney diet.

Suicide and drug toxicity mortality in the first year of the COVID-19 pandemic: use of medical examiner data for public health in Nova Scotia

Introduction The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. Methods Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. Results There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. Conclusion Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.

What Are the Expectations of Legal Operators and Forensic Experts Regarding Photographic Documentation of Violent Death Autopsies?

The purpose of photography in violent death autopsies is to document the material evidence of the offense and guide decisions in the courts of law. The aim of the present study was to obtain the expectations of legal operators and forensic experts regarding what is expected as adequate photographic documentation in violent death forensics. For this purpose, a survey was prepared through an online form available on the “Google Forms” platform, whose link was sent by e-mail and by the WhatsApp Messenger® application. The 102 participants were divided into two distinct groups: legal practitioners, interested in the materialization of evidence (judges, prosecutors, criminal lawyers and police chiefs), and forensic experts, responsible for materializing the evidence (medical examiners, forensic dentists and criminal experts). The research showed that the inclusion of color photographs in the expert reports is essential for all research participants, as well as the marking of evidence in the images and the inclusion of explanatory text in the captions. It was also pointed out as fundamental for most participants to insert an image with simulation of the firearm bullets’ path, when applicable. In relation to the other aspects, it can be observed that the opinions of the participants were divergent between the groups of research professionals, especially regarding the size of the image to be incorporated in the reports. The differences found between the groups can be detrimental to the proper interpretation and judgment of evidence in the courts. Considering the found barriers, the authors suggest a form of photographic documentation that meets all expectations in a consensual way.

Review Paper on Machine learning-based prediction of Corona Virus

Effective contact tracing of SARS-CoV-2 enables quick and efficient diagnosis of COVID-19 and might mitigate the burden on healthcare system. Prediction models that combine several features to approximate the danger of infection are developed. These aim to help medical examiners worldwide in treatment of patients, especially within the context of limited healthcare resources. They established a machine learning approach that trained on records from 51,831 tested individuals (of whom 4769 were confirmed to own COVID-19 coronavirus). Test set contained data from the upcoming week (47,401 tested individuals of whom 3624 were confirmed to own COVID-19 disease). Their model predicted COVID-19 test results with highest accuracy using only eight binary features: sex, age ≥60 years, known contact with infected patients, and also the appearance of 5 initial clinical symptoms appeared. Generally, supported the nationwide data publicly reported by the Israeli Ministry of Health, they developed a model that detects COVID-19 cases by simple features accessed by asking basic inquiries to the affected patient. Their framework may be used, among other considerations, to prioritize testing for COVID-19 when testing resources are limited and important. Keywords: Machine Learning, SARS-COV-2, COVID-19, Coronavirus.

New Death Investigation System in Japan

Since after World War II, the death investigation system in Japan has been a dual system; with or without medical examiners. In areas without medical examiners, death investigation focused on unnatural death suspiciously involved with crime and depended on external postmortem examination for noncriminal cases. As a result, the forensic autopsy rate has been low, and several cases of missed homicide have been discovered. The social impact of the missed homicide of a young sumo player has encouraged the reformation of the death investigation system in Japan. “The Act on the Investigating of Cause of Death and on Identification of Bodies Handled by the Police” and the “Basic Act on Promotion of Death Investigation” were launched in 2013 and 2020, respectively. For noncriminal cases, a new type of autopsy becomes available without the consent of the bereaved family. Moreover, the concept and purpose of death investigation are not only to detect crime involvement, but also to extend respect for life and maintain personal dignity. The responsibility of the central government on death investigation service is stressed, including the establishment of a headquarters in the Ministry of Health, Labour and Welfare. This review aims to understand the background and major changes of the reform of the death investigation system in Japan and discuss the issues affecting forensic pathologists.

Exploring Preparation for the USMLE Step 2 Exams to Inform Best Practices

Introduction: The United States Medical Licensing Examination (USMLE) Step 1 will transition to a pass-fail format in 2022. This is likely to result in an increased focus on Step 2 Clinical Knowledge (CK) scores. Thus, academic advisors must provide evidence-based guidance for preparing students. While prior research has examined the utility of academic indicators to predict student performance on the USMLE exams, no significant scholarly effort has described or evaluated students' study approaches. The research study's goal was to understand what strategies and resources students utilized when preparing for the Step 2 CK exam and investigate the relationship(s) between these approaches and performance. Methods: Students at a single US medical school were surveyed about their Step 2 CK preparation. We analyzed self-reported exam preparation strategies and the use of specific resources to determine their relationship with Step 2 CK score. Results: Student performance on Step 2 CK was correlated with performance on previous exams, including school-specific examinations, National Board of Medical Examiners clerkship shelf exams, and Step 1. Two study strategies were positively correlated with Step 2 CK score in preliminary analyses: completing more working practice questions, and the proportion of a question bank completed. In hierarchical regression, only completing more working questions remained predictive, after controlling for demographic variables and Step 1 performance. Conclusions: Faculty and staff can optimize students' Step 2 CK performance by encouraging them to work through case-based, clinically-focused questions. Further study is needed to describe optimal preparation strategies better.