Stepwise development and expansion of an abdominal normothermic regional perfusion program for donation after circulatory determination of death organ procurement.

Introduction: Normothermic regional perfusion (NRP) represents an innovative technology that improves the outcomes for liver and kidney recipients of donation after circulatory determination of death (DCD) organs but protocols for abdominal-only NRP (A-NRP) DCD are lacking in the US.

Methods: We describe the implementation and expansion strategies of a transplant-center-based A-NRP DCD program that has grown in volume, geographical reach, and donor acceptance parameters, presented as four eras.

Results: In the implementation era, two donors were attempted, and one liver graft was transplanted.

The American Society of Transplant Surgeons Consensus Statement on Normothermic Regional Perfusion.

On June 3, 2023, the American Society of Transplant Surgeons convened a meeting in San Diego, California to (1) develop a consensus statement with supporting data on the ethical tenets of thoracoabdominal normothermic regional perfusion (NRP) and abdominal NRP; (2) provide guidelines for the standards of practice that should govern thoracoabdominal NRP and abdominal NRP; and (3) develop and implement a central database for the collection of NRP donor and recipient data in the United States. National and international leaders in the fields of neuroscience, transplantation, critical care, NRP, Organ Procurement Organizations, transplant centers, and donor families participated. The conference was designed to focus on the controversial issues of neurological flow and function in donation after circulatory death donors during NRP and propose technical standards necessary to ensure that this procedure is performed safely and effectively.

Radiographic age estimation based on degenerative changes of vertebrae.

Age estimation is an important component of decedent identification. When assessing adult remains, anthropologists frequently use gross examination of skeletal elements, such as clavicles, ribs, and pubic symphyses. For fleshed bodies, this requires the removal of these elements and maceration prior to analysis.

Short Report: Evaluating the Effects of Automated Donor Referral Technology on Deceased Donor Referrals.

Unlabelled: Automation of deceased donor referrals with standardized clinical triggers allows organ procurement organizations to be rapidly aware of medically eligible potential donors without the need for manual reporting and subjective decision-making of otherwise very busy hospital staff. In October 2018, 3 Texas hospitals (pilot hospitals) began using an automated referral system; our goal was to evaluate the impact of this system on eligible donor referral.

Methods: We studied ventilated referrals (n = 28 034) in a single organ procurement organization from January 2015 to March 2021.

Victim identification from the September 11, 2001 attack on the World Trade Center: Past trends and future projections.

Victim identification following mass fatality events is critically important. Extensive traumatic injuries and body fragmentation add complexity to this process. World Trade Center (WTC) identification efforts have been ongoing for over 20 years and this study tracks identification trends from the 2753 known WTC victims and the 21,905 recovered remains.

Maximizing the use of potential donors through increased rates of family approach for authorization.

In the United States, a small proportion of potential deceased organ donor referrals lead to donation and recovery. Understanding variation in the processes involved between organ procurement organizations (OPOs) may help increase deceased donation and reduce the organ shortage. We studied 103 923 referrals from 10 OPOs from 2018 to 2019, of which 14.

Victim identification and body completeness based on last known location at the World Trade Center.

This analysis focuses on the identification efforts conducted by the New York City Office of Chief Medical Examiner (NYC OCME) over a 20-year period from September 11, 2001 to September 11, 2021. Due to this unprecedented level of commitment to victim identification, a wealth of data has been collected over the two-decade period and is still being collected as identification efforts are ongoing. The results of this data analysis are not only informative for the World Trade Center (WTC) victims, but may also be instructional for other large-scale, protracted victim identification efforts.

cDCDD-NRP is consistent with US legal standards for determining death.

Donation after circulatory determination of death (DCDD) has increased organ donation rates in the US over the past decade within an established legal framework, which is consistent with and supports individual and family decisions regarding organ donation in the context of end-of-life care. A new application, controlled DCDD donation utilizing thoracoabdominal normothermic regional perfusion (NRP) protocols (cDCDD-NRP), provides the opportunity to maximize a donation decision by recovering additional organs for transplant, including the heart, and to limit the detrimental impact of warm ischemic time by perfusing organs in situ following the declaration of circulatory death. In this viewpoint, we narrate our rationale for why cDCDD-NRP is consistent within the existing legal framework for organ donation in the United States and recommend no changes to the Uniform Determination of Death Act.

Evidence for nonlinear reflections in shock-containing noise near high-performance military aircraft.

Skewness values for the pressure time derivative are greater at ground-based measurements near a tactical aircraft than they are at nearby off-ground locations. A possible explanation for this phenomenon is the occurrence of nonlinear, irregular shock reflections at the ground. Propagation angle, source location, and corresponding angle of incidence relative to the ground are estimated using a two-point cross correlation of windowed shock events.

Fascia lata attachment at the iliac crest: refining our diagnostic criteria of injury on magnetic resonance imaging.

Objective: The objective of this study was to determine the prevalence and spectrum of pathology of the fascia lata attachment at the iliac crest (FLAIC) on MRI in asymptomatic patients in order to refine our diagnostic criteria for clinically relevant FLAIC injury.

Methods And Material: Two readers retrospectively evaluated the FLAIC on each side on coronal large field-of-view short tau inversion recovery images on 100 musculoskeletal pelvic MRI exams performed in patients without hip pain (total = 200). Pathology of the FLAIC was graded using a 3-point Likert scale and discrepancies were resolved by consensus.

A Retrospective Study of Intentional Body Dismemberment in New York City: 1996-2017.

A review of New York City dismemberment cases occurring between 1996 and 2017 was conducted, which resulted in a total of 55 dismembered decedents in a 22-year period. Annual trends indicate an average of 2.5 dismembered decedents.

Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance Exposure.

In a retrospective study of 501 neonates with potential in utero substance exposure, the drug detection performance of a commercially available umbilical cord tissue toxicology test was evaluated against a commercially available gold standard meconium toxicology test. Drugs detected in paired meconium and umbilical cord tissue samples were often discordant.

Trends in United States Mass Fatality Incidents and Recommendations for Medical Examiners and Coroners.

It is imperative that medicolegal jurisdictions prepare for the occurrence of a mass fatality incident. Despite the trend to plan for catastrophic and complicated incidents, this analysis of recent mass fatality events seeks to better inform authorities regarding the scale and types of incidents that could potentially impact their jurisdiction. The guidance provided by this study serves as a tool to guide the development of plans, acquisition of appropriate resources, and training of staff.

The Utility of Forensic Anthropology in the Medical Examiner's Office.

Over the past few decades, the field of forensic anthropology has seen major advancements and experienced a considerable growth of professionals in medical examiner/coroner offices. Despite this expansion, misconceptions regarding the role and utility of the anthropologist in the medicolegal setting still exist. This article brings together practitioners employed full-time in four medical examiner's offices, with each practitioner providing a unique perspective and emphasis regarding their role as an anthropologist.

Computerized Dental Comparison: A Critical Review of Dental Coding and Ranking Algorithms Used in Victim Identification.

Comparison of antemortem and postmortem dental records is a leading method of victim identification, especially for incidents involving a large number of decedents. This process may be expedited with computer software that provides a ranked list of best possible matches. This study provides a comparison of the most commonly used conventional coding and sorting algorithms used in the United States (WinID3) with a simplified coding format that utilizes an optimized sorting algorithm.

A step back to the future.

The coalition government announced earlier this year that £1.4 billion would be invested in apprenticeship schemes, in the hope that 100,000 new jobs could be created from the move.

Santeria and Palo Mayombe: skulls, mercury, and artifacts.

Santeria and Palo Mayombe are syncretic religions created in the New World based upon African religious beliefs combined with Christianity. The main worship of Palo Mayombe involves religious receptacles that may contain earth, sticks, varied artifacts, and animal and human remains. Due to the use of human and nonhuman remains, discovery of these items often leads to involvement by the police due to a concern of homicide.

Recruitment strategies for a lung cancer chemoprevention trial involving ex-smokers.

The ability to recruit qualified subjects who are willing to adhere to the study protocol in clinical trials is an essential component of translational research. Such tasks can be particularly challenging for chemoprevention studies when the targeted study population is healthy, at risk individuals who do not have signs or symptoms of the disease, and the study participation involves complex scheduling and invasive procedures such as bronchoscopy. In this report, we describe the recruitment process and evaluated the effectiveness of various recruitment strategies utilized in our National Cancer Institute sponsored lung cancer chemoprevention study with celecoxib.