Accuracy and validity of determined cause of death and manner of death following forensic autopsy prosection.

AIMS: The purpose of this study is to evaluate the accuracy and validity of the determination of cause of death (COD) and manner of death (MOD) at the completion of the forensic autopsy prosection. METHODS: We analysed 952 autopsy cases conducted from 2019 to 2020 and compared every patients COD, other significant contributing factors to death (OSC), and MOD after prosection to their COD, OSC and MOD after completion of the final autopsy report. RESULTS: We found that 83% of cases (790 patients) did not have an unexpected change and 17% of cases (162 patients) exhibited a true change in their final diagnosis; the relationship between age and changes in COD and MOD was significant. CONCLUSIONS: Our findings indicate that in the majority of forensic autopsy cases, medical professionals can reasonably complete death certification after the autopsy prosection. In addition to improving the accuracy of COD and MOD, advances in this field will enhance timely decedent affairs management, timely investigations of crimes and timely closure to families who have lost loved ones. We recommend implementing combined interventional education and consultation with expert pathologists, and a well-followed structured method of death classification as the best course of practice

Age differences in the use of serving size information on food labels: numeracy or attention?

ObjectiveThe ability to use serving size information on food labels is important for managing age-related chronic conditions such as diabetes, obesity and cancer. Past research suggests that older adults are at risk for failing to accurately use this portion of the food label due to numeracy skills. However, the extent to which older adults pay attention to serving size information on packages is unclear. We compared the effects of numeracy and attention on age differences in accurate use of serving size information while individuals evaluated product healthfulness.DesignAccuracy and attention were assessed across two tasks in which participants compared nutrition labels of two products to determine which was more healthful if they were to consume the entire package. Participants' eye movements were monitored as a measure of attention while they compared two products presented side-by-side on a computer screen. Numeracy as well as food label habits and nutrition knowledge were assessed using questionnaires.SettingSacramento area, California, USA, 2013-2014.SubjectsStratified sample of 358 adults, aged 20-78 years.ResultsAccuracy declined with age among those older adults who paid less attention to serving size information. Although numeracy, nutrition knowledge and self-reported food label use supported accuracy, these factors did not influence age differences in accuracy.ConclusionsThe data suggest that older adults are less accurate than younger adults in their use of serving size information. Age differences appear to be more related to lack of attention to serving size information than to numeracy skills

Evaluation of an exercise field test using heart rate monitors to assess cardiorespiratory fitness and heart rate recovery in an asymptomatic population.

PurposeMeasures of cardiorespiratory fitness (CRF) and heart rate recovery (HRR) can improve risk stratification for cardiovascular disease, but these measurements are rarely made in asymptomatic individuals due to cost. An exercise field test (EFT) to assess CRF and HRR would be an inexpensive method for cardiovascular disease risk assessment in large populations. This study assessed 1) the predictive accuracy of a 12-minute run/walk EFT for estimating CRF ([Formula: see text]) and 2) the accuracy of HRR measured after an EFT using a heart rate monitor (HRM) in an asymptomatic population.MethodsFifty subjects (48% women) ages 18-45 years completed a symptom-limited exercise tolerance test (ETT) (Bruce protocol) and an EFT on separate days. During the ETT, [Formula: see text] was measured by a metabolic cart, and heart rate was measured continuously by a HRM and a metabolic cart.ResultsEFT distance and sex independently predicted[Formula: see text]. The average absolute difference between observed and predicted [Formula: see text] was 0.26 ± 3.27 ml·kg-1·min-1 for our model compared to 7.55 ± 3.64 ml·kg-1·min-1 for the Cooper model. HRM HRR data were equivalent to respective metabolic cart values during the ETT. HRR at 1 minute post-exercise during ETT compared to the EFT had a moderate correlation (r=0.75, p<0.001).ConclusionA more accurate model to estimate CRF from a 12-minute run/walk EFT was developed, and HRR can be measured using a HRM in an asymptomatic population outside of clinical settings

Ultrasound May Be An Effective Tool for Predicting Clinical Loss of Resistance in Lumbar Epidural Steroid Injections

Assess the efficacy of ultrasound, a more accessible point of care modality, to describe the dimensions of the epidural space. Determine the reliability of ultrasound for measuring cervical and lumbar epiduralspaces for ESIs in chronic pain patients and compares these to MRI measurement

Habitat and exposure modelling for ecological risk assessment: A

Contamination has a dramatic impact on the health of ecosystem and habitat suitability for the inhabited flora and fauna. The Environmental Protection Agency (EPA) mandates an ecological risk assessment (ERA) that evaluates the potential adverse impact of any anthropogenic activities on the ecosystem (US Environmental Protection Agency, 1997. Ecological Risk Assessment Guidance for Superfund: Process for Designing and Conducting Ecological Risk Assessment. EPA/630/R-021011, Washington, DC). This study provides a general framework and specific procedures to predict the contaminant exposure of midsized mammals using a geographical information system (GIS)-based Monte Carlo simulation model. The model was applied to the raccoons (Procyon lotor) on the Savannah River Site (SRS), a former nuclear production and current research facility. Habitat behavioral data of 13 radiocollared male raccoons were used to determine home range and core areas. Combined with other geographic data layers, such as distance to water, number of wetlands, and class landscape metrics, a logistic regression model was used to inductively derive the resource selection functions that define the occurrence of raccoon. The cross validation consistently revealed a high accuracy. A Monte Carlo simulation was then performed to estimate the likelihood of exposure and contaminant uptake of the species weighted by the resource selection probability. This model adopted conservative assumptions and spatial parameters. The proposed model served the purpose of assessing ecological risk and supporting decision-making. Implementation issues for a GIS-based ecological risk assessment model are discussed

Relationships among food label use, motivation, and dietary quality.

Nutrition information on packaged foods supplies information that aids consumers in meeting the recommendations put forth in the US Dietary Guidelines for Americans such as reducing intake of solid fats and added sugars. It is important to understand how food label use is related to dietary intake. However, prior work is based only on self-reported use of food labels, making it unclear if subjective assessments are biased toward motivational influences. We assessed food label use using both self-reported and objective measures, the stage of change, and dietary quality in a sample of 392 stratified by income. Self-reported food label use was assessed using a questionnaire. Objective use was assessed using a mock shopping task in which participants viewed food labels and decided which foods to purchase. Eye movements were monitored to assess attention to nutrition information on the food labels. Individuals paid attention to nutrition information when selecting foods to buy. Self-reported and objective measures of label use showed some overlap with each other (r=0.29, p<0.001), and both predicted dietary quality (p<0.001 for both). The stage of change diminished the predictive power of subjective (p<0.09), but not objective (p<0.01), food label use. These data show both self-reported and objective measures of food label use are positively associated with dietary quality. However, self-reported measures appear to capture a greater motivational component of food label use than do more objective measures

Misunderstanding of Front-Of-Package Nutrition Information on US Food Products.

Front-of-package nutrition symbols (FOPs) are presumably readily noticeable and require minimal prior nutrition knowledge to use. Although there is evidence to support this notion, few studies have focused on Facts Up Front type symbols which are used in the US. Participants with varying levels of prior knowledge were asked to view two products and decide which was more healthful. FOPs on packages were manipulated so that one product was more healthful, allowing us to assess accuracy. Attention to nutrition information was assessed via eye tracking to determine what if any FOP information was used to make their decisions. Results showed that accuracy was below chance on half of the comparisons despite consulting FOPs. Negative correlations between attention to calories, fat, and sodium and accuracy indicated that consumers over-relied on these nutrients. Although relatively little attention was allocated to fiber and sugar, associations between attention and accuracy were positive. Attention to vitamin D showed no association to accuracy, indicating confusion surrounding what constitutes a meaningful change across products. Greater nutrition knowledge was associated with greater accuracy, even when less attention was paid. Individuals, particularly those with less knowledge, are misled by calorie, sodium, and fat information on FOPs

Habitat and exposure modelling for ecological risk assessment: A

Contamination has a dramatic impact on the health of ecosystem and habitat suitability for the inhabited flora and fauna. The Environmental Protection Agency (EPA) mandates an ecological risk assessment (ERA) that evaluates the potential adverse impact of any anthropogenic activities on the ecosystem (US Environmental Protection Agency, 1997. Ecological Risk Assessment Guidance for Superfund: Process for Designing and Conducting Ecological Risk Assessment. EPA/630/R-021011, Washington, DC). This study provides a general framework and specific procedures to predict the contaminant exposure of midsized mammals using a geographical information system (GIS)-based Monte Carlo simulation model. The model was applied to the raccoons (Procyon lotor) on the Savannah River Site (SRS), a former nuclear production and current research facility. Habitat behavioral data of 13 radiocollared male raccoons were used to determine home range and core areas. Combined with other geographic data layers, such as distance to water, number of wetlands, and class landscape metrics, a logistic regression model was used to inductively derive the resource selection functions that define the occurrence of raccoon. The cross validation consistently revealed a high accuracy. A Monte Carlo simulation was then performed to estimate the likelihood of exposure and contaminant uptake of the species weighted by the resource selection probability. This model adopted conservative assumptions and spatial parameters. The proposed model served the purpose of assessing ecological risk and supporting decision-making. Implementation issues for a GIS-based ecological risk assessment model are discussed

OpenNotes and Perceptions of Care Among Patients with Chronic Rhinosinusitis

The 21st Century Cures Act mandates patientaccess and electronic viewability of physiciannotes. Improved transparency may facilitatepatient-physician communication andmedication compliance which are criticalaspects of chronic rhinosinusitis (CRS) care