Low Pressure Nuclear Thermal Rocket (LPNTR) concept

A background and a description of the low pressure nuclear thermal system are presented. Performance, mission analysis, development, critical issues, and some conclusions are discussed. The following subject areas are covered: LPNTR's inherent advantages in critical NTR requirement; reactor trade studies; reference LPNTR; internal configuration and flow of preliminary LPNTR; particle bed fuel assembly; preliminary LPNTR neutronic study results; multiple LPNTR engine concept; tank and engine configuration for mission analysis; LPNTR reliability potential; LPNTR development program; and LPNTR program costs

Body-kun/body-chan style model figures for artists in forensic visualization applications

Posture and body position are often in the focus of forensic medicine. Visualization for the purposes of documentation, teaching, scientific presentation or expert opinion in court is often desired. Plenty of possible tools to support visualization are available. However, there is a significant gap between quick drawings and more complex techniques. Body-chan (female) and body-kun (male) artist’s model figurines (genericized trademark) may provide a useful means to fill this gap. These models, about 12–15 cm in height, are multi-articulated humanoids of realistic proportions, intended to serve as models for manga (japanese comic) drawing. Plenty of different models are available in different quality which usually are equipped with interchangeable hand and feet attachments, a frame for ‘levitating’ positions as well as assorted objects to scale. These inexpensive models may be positioned quickly and intuitively. Photodocumentation from various angles can be performed using a mobile phone camera. Images may be further improved applying digital image manipulation software. Taken together, the process is quick and intuitive and the level of achievable complexity is sufficient for many forensic applications

Relative blood loss in forensic medicine-do we need a change in doctrine?

In forensic medicine, blood loss is encountered frequently, either as a cause of death or as a contributing factor. Here, risk to life and lethality assessment is based on the concept of relative blood loss (absolute loss out of total volume). In emergency medicine, the Advanced Trauma Life Support (ATLS) classification also refers to relative blood loss. We tested the validity of relative blood loss benchmarks with reference to lethality. Depending on the quality of the total blood volume (TBV) estimation formula, relative blood loss rates should be reflected in the case cohort as significantly higher absolute blood loss in heavier individuals since all TBV estimation formulas positively correlate body weight with TBV. Method: 80 autopsy cases with sudden, quantifiable, exclusively internal blood loss were retrospectively analyzed and a total of 8 different formulas for TBV estimation were applied. Results: No statistical correlation between body weight and absolute blood loss was found for any of the tested TBV estimation algorithms. All cases showed a wide spread of both absolute and relative blood loss. Discussion: The principle of relative blood loss is of very limited use in casework. It opens the forensic expert opinion to unnecessary criticism and possible negative legal implications. Conclusion: We challenge the use of relative blood loss benchmarks in textbooks and practical casework and advocate for its elimination from the ATLS’s grading system. If necessary, we recommend the use of BMI-adjusted algorithms for TBV estimation

Application of the "bubbling" procedure to dead body portraits in forensic identification

Purpose A procedure is needed for bodies with disfiguring injuries to the face and the use of their portrait for visual identification. Method We present the application of a simple image processing procedure, otherwise known as ”bubbling,” which is based on the concept of ”perceptual filling-in,” to images for visual identification in the forensic context. The method is straight forward and can be performed using readily available software and hardware.. Results The method is demonstrated and examples are shown. The visual recognition of known persons using “bubbled” images was successfully tested. Conclusion The “bubbling” procedure for visual identification enhancement is quick and straightforward and may be attempted before escalating to more involved identification methods and procedures

"Scalping" in the context of criminal dismemberment and mutilation-a case report and review of the literature

We report on a case of criminal dismemberment and attempted scalping of a homicide victim with a “Mohawk” haircut. Case fndings are presented. A review of the literature was performed for scalping in its historical and cultural context and particularly in criminal dismemberment and mutilation: Historically, scalping was prevalent in many ancient cultures around the world, where scalps were taken as trophies or “proof of kill”, much like shrunken heads, trophy skulls, and other artefacts. Scalping was particularly widespread in Northern America in the context of tribal warfare, both before and after colonization. The iconic “Mohawk” haircut is closely linked with scalping, as it was meant to taunt the enemy. In the modern forensic context, scalping constitutes a form of criminal mutilation. However, cases of criminal dismemberment and mutilation are rare in forensic casework. Our literature review revealed a low number of scalping in criminal dismemberment and mutilation cases. The documentation was overall poor. Positioning scalping within the classifcation of criminal mutilation and dismemberment was difcult. In literature, even though case numbers were small, the majority of “textbook scalping” cases were German. The presented case, to our best knowledge, is the frst modern-day photo-documented case of (attempted) scalping, even more so of a person wearing a “Mohawk”

Left ventricular rigor mortis interferes with postmortem aortic root geometry

Aortic regurgitation is a common valve disease and can be caused by delineated findings such as fenestrations or hardly discernible alterations of the aortic root geometry. Therefore, aortic regurgitation can be a challenging diagnosis during an autopsy. Cardiac surgeons, however, are confronted with comparable problems during surgery and have developed a refined knowledge of the anatomy of the aortic root including its geometry. Transferring this knowledge from the operating room to the dissection would further complement the panel of postmortem diagnostic tools. To foster translation of the clinical anatomy, the present study assessed the impact of postmortem peculiarities (i.e. myocardial rigor mortis, putrefac tion) that might influence aortic root geometry. The aortic root geometry was described by aortic perimeters (basal, sinus, sino-tubular junction, and ascending aorta), effective height (distance from the cusp’s free margin to its nadir), geometric height (cusp height), commissural height (distance from the base of an interleaflet triangle to the end of a commissure), and length of the ascending aorta. Data from 140 cases were analyzed (linear regression, comparative testing). Myocardial rigor mortis was associated with smaller basal rings. Weak positive correlations between the duration of the postmortem interval and aortic root dimensions were observed. In summary, postmortem peculiarities, especially the myocardial cadav eric rigidity, influence postmortem aortic root geometry. Despite these circumstances, the current study demonstrates that aortic root geometric assessment, including effective height, is feasible in a postmortem setting. Further studies are needed to elaborate on aortic root geometry as a diagnostic tool in a necropsy setting

Assessment of cardiac biomarker “point-of-care” testing as postmortem diagnostic tool

In cardiac death, some entities, such as arrhythmia or nonocclusive myocardial ischemia, are not associated with clear and certain macroscopic surrogates of cardiac death. Cardiac biomarker point-of-care testing (POCT) seems suitable for further improving postmortem diagnostics in legal medicine casework. Considering the preanalytic phase, the present study aims to define criteria for blood samples suitable for POCT and assess the diagnostic performance of postmortem cardiac biomarker POCT. A fluorescent immunoassay device was used. The biomarkers assessed were myoglobin, brain-type natriuretic peptide (BNP), N-terminal proBNP, creatine kinase muscle-brain type, and cardiac troponin I. Blood was obtained from the intrapericardial inferior vena cava. In a prestudy, criteria for the selection of blood samples were established and the biomarker stability over time, test reliability and reproducibility of postmortem cardiac biomarker analyses were assessed. Afterward, blood samples from 150 autopsied individuals were evaluated for their diagnostic performance and compared with findings from autopsy as the postmortem diagnostic gold standard. In doing so, the assessed biomarkers provided valid and reproducible results. Cardiac troponin I yielded the highest sensitivity for detecting cardiac death, whereas BNP had the highest specificity and positive predictive value for detecting cardiac death. Markers of myocardial damage had better negative than positive predictive value. NT-proBNP and BNP POCT seem applicable to support diagnosis of death associated with congestive heart failure. Postmortem cardiac biomarker POCT results need to be interpreted in conjunction with all available information, i.e., autopsy findings, medical history, investigatory results, and other test results

Retrograde dye perfusion of the proximal aorta - A postmortem technical study

Introduction: Multiple cardiovascular conditions can lead to unexpected fatality, which is defined as sudden cardiac death. One of these potentially underlying conditions is aortic regurgitation, which can be caused by discrete changes of the geometry of the proximal aorta. To analyze aortic valve competency and furthermore to elucidate underlying pathological alterations of the coronary arteries and the vasa vasorum a perfusion method to simulate a diastolic state was designed. Material and methods: A postmortem approach with retrograde perfusion of the ascending aorta with methylene blue was applied to three bodies. The procedure comprised cannulation of the brachiocephalic trunk, clamping of the aortic arch between brachiocephalic trunk and left carotid artery, infusion of 250 ml of methylene blue, and optical clearing of the superficial tissue layers after perfusion. Organs were examined directly following perfusion and after optical clearing. Results: Assessment and visualization of aortic valve competency and the vasa vasorum were possible in all three instances. Visualization of the coronary perfusion was impaired by postmortem thrombus formation. Optical clearing did not provide additional information. Discussion: The method presented here is a time- and cost-efficient way of visualizing aortic valve competency and the vasa vasorum. The visualization of the vasa vasorum highlights the potential of this method in basic research on diseases of the great arteries and coronaries. However, for a time-efficient functional analysis of the coronaries, other methods must be applied

Forensic, legal, and clinical aspects of deaths associated with implanted cardiac devices

As the population ages, the prevalence of heart failure and individuals wearing an implanted cardiac device is increasing. The combination of different underlying pathophysiologies and (the combination of) implanted cardiac devices can become a challenge with regard to the determination of cause and manner of death in such individuals. Additionally, heart disease is frequently associated with mental disease, ranging from anxiety and depression to suicidality and suicide (attempts). At the same time, the correct diagnosis of cause and manner of death is the basis for quality assurance, further therapeutic advances, legal safety, and suicide prevention. By that, an interdisciplinary field between legal medicine, clinicians, and law enforcement opens up. In this field, the different participants can simultaneously benefit from and need each other. For example, legal medicine experts need investigatory results and clinical expertise for the interpretation of readout data of implanted cardiac devices in order to correctly determine the cause of death. A correctly determined cause of death can assist law enforcement and help clinicians to further improve various therapeutic approaches based on correct mortality data collection. In addition, it is the basis for identification of suicides of device carriers, allowing psychological and psychiatric experts to better understand the burden of mental disease in this particular cohort. Against this interdisciplinary background, this manuscript summarizes information about psychiatric comorbidities and suicidality while being on a device. Thereby, basic information on complications and malfunctions of implanted cardiac devices, device-associated deaths with particular emphasis on device manipulation is displayed as basic information needed for correct determination of the cause of death. Also, legal and ethical issues in this field are outlined. The final result is a proposal of an interdisciplinary assessment workflow for a conjoint approach to improve the diagnosis of deaths associated with implanted cardiac devices. It will allow for a differentiation between an individual who died with or due to the device

Forensic, legal, and clinical aspects of deaths associated with implanted cardiac devices

As the population ages, the prevalence of heart failure and individuals wearing an implanted cardiac device is increasing. The combination of different underlying pathophysiologies and (the combination of) implanted cardiac devices can become a challenge with regard to the determination of cause and manner of death in such individuals. Additionally, heart disease is frequently associated with mental disease, ranging from anxiety and depression to suicidality and suicide (attempts). At the same time, the correct diagnosis of cause and manner of death is the basis for quality assurance, further therapeutic advances, legal safety, and suicide prevention. By that, an interdisciplinary field between legal medicine, clinicians, and law enforcement opens up. In this field, the different participants can simultaneously benefit from and need each other. For example, legal medicine experts need investigatory results and clinical expertise for the interpretation of readout data of implanted cardiac devices in order to correctly determine the cause of death. A correctly determined cause of death can assist law enforcement and help clinicians to further improve various therapeutic approaches based on correct mortality data collection. In addition, it is the basis for identification of suicides of device carriers, allowing psychological and psychiatric experts to better understand the burden of mental disease in this particular cohort. Against this interdisciplinary background, this manuscript summarizes information about psychiatric comorbidities and suicidality while being on a device. Thereby, basic information on complications and malfunctions of implanted cardiac devices, device-associated deaths with particular emphasis on device manipulation is displayed as basic information needed for correct determination of the cause of death. Also, legal and ethical issues in this field are outlined. The final result is a proposal of an interdisciplinary assessment workflow for a conjoint approach to improve the diagnosis of deaths associated with implanted cardiac devices. It will allow for a differentiation between an individual who died with or due to the device