BACKGROUND AND OBJECTIVES:Increasing rates of fatal drug overdose (FDO) among youth since 2016 have been driven by fentanyl and polysubstance use. Suicide by youth also increased steadily since 2007. The manner of FDO may be accidental (i.e., unintentional) or suicidal (i.e., intentional). This report examines the rate of youth intentional and unintentional FDO as well as specific drug toxicology in Connecticut, between the years 2019 and 2021, compared to a 2016-2018 report. METHODS:We reviewed N = 286 consecutive FDO files of youth, <26 years of age dated for 2019-2021 from the Connecticut Medical Examiner's office. RESULTS:FDO attributed to fentanyl increased significantly from 2016 to 2018 to 2019 to 2021. Xylazine FDO emerged in 2019 and reached 16% in 2021. Intentional FDO rates doubled between these periods from 3.8% to 7.7%. Most FDOs involved individuals aged 20-25 years, whereas 10% were among those aged 15-19. For the first time since 2018, FDO among 10-14 years old was detected. Analysis of gender found no differences. Within each gender, however, FDO attributed to fentanyl increased significantly between these periods. The FDO rate for Hispanics increased significantly, while the rate for Whites decreased significantly. DISCUSSION AND CONCLUSIONS:The availability of high lethality potential drugs leading to youth FDO including an increasing rate of intentional FDO, is a public health concern. It is prudent to identify modifiable acute high-risk circumstances for intentional FDO and prevention-intervention evidence-based approach to reduce FDO. SCIENTIFIC SIGNIFICANCE:This is the first study of FDO among youth examining the manner of death by suicide.

Background Opioids and cocaine are the leading drugs for fatal drug intoxication (FDI). Manner of death may be accidental (i.e., unintentional); suicide (i.e., intentional), or undetermined. Difficulties of the medical examiner (ME) in confirming the manner of death by a standard investigation may result in underreporting of intentional FDI thus limiting efforts to identify, reduce, and prevent it. Objective Examine the rate of youth intentional and undetermined FDI and address the need for closing the gap in the determination of intentional FDI among youths by the addition of a psychological autopsy. Method Two hundred ninety-three (293) consecutive FDI case files from the State of Connecticut Office of the Chief Medical Examiner were reviewed. The case files were those of youths, 10 to 25 years of age, who died between January 1, 2016, and December 31, 2018. Results The annual intentional FDI rates among this group were between 3% and 5%. Undetermined manner of death rates were between 0% and 5% percent, while the remaining cases was reported as accidental. A majority of the FDI cases involved youths 20 to 25.11 years old, while a small percentage were among those ages 15 to 19.11 and none for 10 to 14.11. Male-to-female ratio was approximately 2:1 in all categories of FDI. Conclusion These low rates of intentional FDI among youths support the arguments regarding limitations in the procedures employed by a ME to determine intent. There is a need for an individual-level study of a multipronged approach to identify modifiable acute high-risk circumstances for intentional FDI, including a psychological autopsy.

Diabetes mellitus is a common condition affecting both adults and children. Long-standing diabetes is associated with cardiovascular abnormalities such as coronary artery atherosclerosis, microvascular changes, hypertension, kidney disease, and heart failure. Its association with heart failure in the absence of coronary artery disease and hypertension was termed diabetic cardiomyopathy in the 1970s and is believed to account for some of the cardiac mortality in diabetic patients. This entity may be implicated as the cause of sudden cardiac death in the small percentage of diabetic patients in which the autopsy fails to demonstrate evidence of nonketotic hyperosmolar coma, diabetic ketoacidosis, or atherosclerotic and hypertensive cardiovascular disease. Molecular and metabolic alterations have been studied to explain the pathophysiology of this disease.

Among the numerous etiologies of acute and chronic pancreatitis, several underlying causes (e.g., chronic alcohol abuse, trauma, medical therapy) may result in a death that is reportable to the medical examiner/coroner. As such, forensic pathologists are likely to encounter pancreatitis at autopsy and therefore must be familiar with its etiologies, mechanisms of death, autopsy findings, and medicolegal investigation. This review will focus on the aspects of pancreatitis that may be useful to forensic pathologists in their daily practice. This includes determining if acute or chronic pancreatitis caused or contributed to death as well as determining the etiologically specific proximate cause of death. Current theories of how these various processes result in inflammation of the pancreas are reviewed.

New York City has over 700 miles of bicycle lanes and over half a million residents use a bicycle several times a month. We searched the electronic death certificate database on all bicycling fatalities between April 2006 and August 2012 to study the autopsy findings, toxicological results, and the epidemiological patterns. Of the 146 bicyclists studied, most were male (n=134). The main ethnic group was white (n=48). Recreational use accounted for 40 fatalities. A survival interval occurred in 72 bicyclists (two hours to 33 years). Manhattan had the highest number of bicyclist fatalities per 100 000 population (2.65). Most fatalities occurred during the summer (n=62), or on a Saturday (n=28). Fifty-five cases reported clear weather. The most frequent motor vehicle involved was a four-door sedan (n=34). Fifteen decedents were documented to be wearing a helmet. Postmortem examination included 116 autopsies and 30 external-only examinations. All causes of death were due to blunt trauma and all manners of death were accident. The most commonly injured body region was the head (n=121). Fractures most commonly involved the skull (n=89). Toxicological analysis detected ethanol (n=22), cannabinoids (n=15), cocaine (n=11), and methadone (n=3). Similar to fatalities in motor-vehicle-only collisions, bicyclists also die from blunt injuries and drug/ethanol intoxication is not unusual. The overwhelming male predominance may be a reflection of a higher number of male bicyclists and/or related to increased risk taking among males. This information may be useful for public health considerations when looking for ways to prevent these deaths.

Pulmonary thromboembolism (PE) is found commonly in forensic pathology practice, as it typically causes sudden death. It is attributed to a wide variety of predominantly acquired etiologies. Although likely etiologically multifactorial, some common proximate causes include: surgery, pregnancy, injury, inactivity of any cause, cancer, obesity, or serum hyperviscosity. On occasion, no apparent predisposing condition is identified. In these instances, occult hereditary thrombophilias may play a causal role. Deaths referred to the Office of Chief Medical Examiner (OCME) of New York City between December, 2000 and September, 2003 and due to PE were retrospectively reviewed. Molecular analysis (FRET) was performed on selected cases for three common hereditary thrombophilias: mutations in factor V Leiden (FVL), prothrombin G20210A (PT), and methylenetetrahydrofolate reductase (MTHFR).During the study period, 124 of 15,280 deaths were primarily attributable to PE. Of those, 34 were selected for molecular analysis. One or more mutations were detected in 35% of those, five of which were clearly causally related to death. Given the potential benefits to surviving family members, our data indicate that postmortem molecular testing for the common hereditary thrombophilias is warranted in at least selected cases.

A girl 5 years 11 months of age, belonging to an extensive kindred with multiple endocrine neoplasia, type IIA (MEN IIA), was found to have multifocal medullary thyroid carcinoma with metastasis in one paraglandular lymph node after positive findings on a calcium-pentagastrin stimulation test. Her sister, 3 years 8 months of age, also had an elevated calcitonin level, and thyroidectomy revealed C-cell hyperplasia and a focus of medullary thyroid carcinoma. These two cases underscore the need for prophylactic thyroidectomies in MEN IIA patients as young as 5 years of age and strict yearly provocative screening beginning at age 1 year.

Research Article| June 01, 1962 Tertiary Landslides, Northwestern South Dakota and Southeastern Montana JAMES R GILL JAMES R GILL U. S. Geological Survey, Denver, Colo Search for other works by this author on: GSW Google Scholar Author and Article Information JAMES R GILL U. S. Geological Survey, Denver, Colo Publisher: Geological Society of America Received: 20 Mar 1961 First Online: 02 Mar 2017 Online ISSN: 1943-2674 Print ISSN: 0016-7606 Copyright © 1962, The Geological Society of America, Inc. Copyright is not claimed on any material prepared by U.S. government employees within the scope of their employment. GSA Bulletin (1962) 73 (6): 725–735. https://doi.org/10.1130/0016-7606(1962)73[725:TLNSDA]2.0.CO;2 Article history Received: 20 Mar 1961 First Online: 02 Mar 2017 Cite View This Citation Add to Citation Manager Share Icon Share Facebook Twitter LinkedIn Email Permissions Search Site Citation JAMES R GILL; Tertiary Landslides, Northwestern South Dakota and Southeastern Montana. GSA Bulletin 1962;; 73 (6): 725–735. doi: https://doi.org/10.1130/0016-7606(1962)73[725:TLNSDA]2.0.CO;2 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGSA Bulletin Search Advanced Search Abstract Landslide blocks of latest Oligocene or earliest Miocene age are preserved at several localities in northwestern South Dakota and southeastern Montana. These tilted blocks contain Late Cretaceous to late Oligocene rocks and are unconformably overlain by nearly horizontal strata of the Arikaree Formation of Miocene age. Undisturbed rocks of late Oligocene age were completely stripped from the area by pre-Arikaree erosion.More than 100 landslide blocks are preserved in the Slim Buttes, Harding County, South Dakota. Some of the blocks are several miles long, 600 feet wide, and contain a thickness of 300 feet or more of relatively unbroken or unjumbled strata which have been displaced downward as much as 250 feet. The strike of the tilted blocks is about N. 60° W., and the dip of the bedding in the blocks at most places is to the southwest and ranges from a few to more than 60°. Most of the rock in the blocks consists of coarse arkosic sandstone, tuffaceous siltstone, claystone, and thick beds of bentonite of the Chadron and Brule formations of Oligocene age. In a few places, small sections of the underlying Paleocene strata are tilted. The blocks formed along northwest-trendingpre-Arikaree valley walls and escarpments. The major joint system of underlying rocks apparently controlled the orientation of the slides, and the dip of these older rocks facilitated the downward and outward movement of the landslide blocks.The Short Pine Hills, Harding County, South Dakota, and the Long Pine Hills, Carter County, Montana, contain numerous landslide blocks that are similar in orientation and geologic setting to those of the Slim Buttes. In contrast, the Finger Buttes of Carter County, Montana, contain landslide blocks that strike about N. 70° E. and dip to the southeast. This lack of parallelism with blocks of nearby areas is apparently due to the lack of a well-developed joint system in underlying rocks of this area.The presence of the complete sequence of Oligocene rocks in the downdropped blocks indicates that before pre-Arikaree erosion the area was covered by 500 feet or more of beds of the Chadron and Brule formations. These landslide blocks show that the time interval represented by the unconformity at the base of the Arikaree Formation was of relatively short duration. First Page Preview Close Modal You do not have access to this content, please speak to your institutional administrator if you feel you should have access.