DNA Identification Tests and the Courts

This Comment assesses the current state of forensic DNA tests and analyzes whether courts should admit the results of these tests as evidence. Section I provides a background discussion of how DNA tests work. This knowledge is essential for attorneys and courts seeking to evaluate expert testimony and analyze important issues concerning the reliability and admissibility of DNA test results. Section I also proposes safeguards and standards to facilitate the judicial acceptance of forensic DNA tests. Section II discusses judicial approaches to the admissibility of novel scientific techniques such as DNA tests, and concludes that courts should admit the results of DNA tests

DNA Identification Tests and the Courts

This Comment assesses the current state of forensic DNA tests and analyzes whether courts should admit the results of these tests as evidence. Section I provides a background discussion of how DNA tests work. This knowledge is essential for attorneys and courts seeking to evaluate expert testimony and analyze important issues concerning the reliability and admissibility of DNA test results. Section I also proposes safeguards and standards to facilitate the judicial acceptance of forensic DNA tests. Section II discusses judicial approaches to the admissibility of novel scientific techniques such as DNA tests, and concludes that courts should admit the results of DNA tests

Change in Estimated GFR and Risk of Allograft Failure in Patients Diagnosed With Late Active Antibody-mediated Rejection Following Kidney Transplantation

Malaltia renal en fase terminal; Trasplantament de ronyóEnfermedad renal en etapa terminal; Transplante de riñónEnd-stage renal disease; Kidney TransplantBackground. There are challenges in designing adequate, well-controlled studies of patients with active antibody-mediated rejection (AMR) after kidney transplantation (KTx). Methods. We assessed the functional relationship between change in estimated glomerular filtration rate (eGFR) following the diagnosis of AMR and the risk of subsequent death-censored graft failure using the joint modeling framework. We included recipients of solitary KTx between 1995 and 2013 at 4 transplant centers diagnosed with biopsy-proven active AMR at least 1 year post-KTx, who had a minimum of 3-year follow-up. Results. A total of 91 patients across participating centers were included in the analysis. Of the 91 patients, n = 54 patients (59%) met the death-censored graft failure endpoint and n = 62 patients (68%) met the all-cause graft failure composite endpoint. Kaplan-Meier death-censored graft survival rates at 12, 36, and 60 months postdiagnosis of AMR pooled across centers were 88.9%, 58.9%, and 36.4%, respectively. Spaghetti plots indicated a linear trend in the change in eGFR, especially in the first 12 months postdiagnosis of active AMR. A significant change in eGFR was observed within the first 12 months postdiagnosis of active AMR, getting worse by a factor of −0.757 mL/min/1.73 m2 per month during the 12-month analysis period (a delta of −9.084 mL/min/1.73 m2 at 1 y). Notably, an extrapolated 30% improvement in the slope of eGFR in the first 12 months was associated with a 10% improvement in death-censored graft failure at 5 years. Conclusions. If prospectively validated, this study may inform the design of pivotal clinical trials for therapies for late AMR

Does the marine biosphere mix the ocean?

Author Posting. © Sears Foundation for Marine Research, 2006. This article is posted here by permission of Sears Foundation for Marine Research for personal use, not for redistribution. The definitive version was published in Journal of Marine Research 64 (2006): 541-561, doi:10.1357/002224006778715720.Ocean mixing is thought to control the climatically important oceanic overturning circulation. Here we argue the marine biosphere, by a mechanism like the bioturbation occurring in marine sediments, mixes the oceans as effectively as the winds and tides. This statement is derived ultimately from an estimated 62.7 TeraWatts of chemical power provided to the marine environment in net primary production. Various approaches argue something like 1% (.63 TeraWatts) of this power is invested in aphotic ocean mechanical energy, a rate comparable to wind and tidal inputs

Association of sex with adolescent soccer concussion incidence and characteristics

Importance: Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-dependent variations in concussion presentation and management, with the potential that this information might inform sex-specific rules directed toward risk reduction within sports. Objective: To compare sex-associated differences in epidemiology and concussion management in adolescent soccer players within a prospective, longitudinal high school injury surveillance project. Design, Setting, and Participants: This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019. Exposures: Sport-related concussion captured in the MHSAA Head Injury Reporting System. Main Outcomes and Measures: Outcomes included details regarding each documented SRC event, including injury mechanism, immediate management, and return-to-play time. Multiple comparisons were made between male and female athletes regarding SRC risk, mechanism, short-term management, and outcomes. Results: A total of 43 741 male and 39 637 female soccer athletes participated in MHSAA soccer during the 3 consecutive academic years of study (2016-2017: n = 751 schools; 2017-2018: n = 750 schools; and 2018-2019: n = 747 schools). During the 3 years of surveillance, 1507 of the 83 378 soccer athletes (1.8%) were reported to have SRC during soccer participation, including 557 boys (37.0%) and 950 girls (63.0%). Documented SRC risk in female soccer participants was greater than in male soccer participants (risk ratio, 1.88; 95% CI, 1.69-2.09; P < .001). Male soccer athletes most often sustained SRC from contact with another player (48.4%), whereas SRCs in female soccer players recorded in the Head Injury Reporting System were most often from nonplayer contact events (41.9%; P < .001). Adolescent male soccer players with a documented SRC were more likely to be removed from play on the day of injury (odds ratio, 1.54; 95% CI, 1.15-2.06; P = .004). Although the overall median time to return to play was 11 days (interquartile range [IQR], 7-15 days), male athletes typically returned 2 days earlier than female athletes (median, 10 [IQR, 7-14] days vs 12 [IQR, 7-16] days; Peto test P < .001). Conclusions and Relevance: In this cohort study, sex-associated differences were revealed among adolescent soccer athletes in SRC risk, mechanism of injury, immediate management, and outcomes in injuries documented in a statewide injury reporting system. Thus, consideration might be given to sex-specific approaches to participation and concussion management in the sport

Advancing data collection of hospital-related harms: Results from hospital discharges dually coded with ICD-10 and ICD-11

Introduction Hospital safety performance is difficult to monitor when under-coding of hospital harms is common. The beta version of ICD-11 includes a 3-part model for coding harms to enhance adverse event descriptions. This method includes code clusters to detail each condition/event (e.g. bleed), cause (e.g. anticoagulant drug), and mode (over-dose). Objectives and Approach The study objective was to compare the proportion of adverse events captured using different classification systems. A large field trial of inpatient charts, previously coded in ICD-10 were coded with ICD-11. Coding training for the new ICD-11 focused on new codes, code clustering, and extension codes for cause and mode of the harm. Sensitivity, Specificity, NPV and PPV were reported for ICD-10 compared to ICD-11. Results Of the 1,009 records reviewed and coded using ICD-11 to date, 128 cases were coded as a harm in ICD-10 using our previously published PSI work. Coders identified 88 cases with the new ICD-11. Sensitivity and specificity were as follows: 31.3% and 94.6%. ICD-11 had NPV and PPV of 45.5% and 90.5% respectively compared to ICD-10. Detailed clinical comparison of mismatched codes will be completed. Study case examples will demonstrate advanced features of ICD-11, the coding rules being collaboratively developed by our team, CIHI, and WHO representatives, and potential analytic challenges. Conclusion/Implications The new ICD-11 found 8% of hospital admission were associated with a harm. Although the sensitivity was modest, specificity is quite high and correctly Identifies those cases without a harm. Clinical review of mismatched codes will provide further detailed code comparisons