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Biomedical subjects

D T Reay

Publications and source records attributed to D T Reay.

At least 19 recordsLinked to original sources
PubMed1992

Suicide in the home in relation to gun ownership.

BACKGROUND: It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period. METHODS: For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods. RESULTS: During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5). CONCLUSIONS: Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.

Adult↗
PubMed1992

Positional asphyxia during law enforcement transport.

Three cases of positional asphyxia are described that occurred while victims were in a prone position in rear compartments of police patrol cars. These deaths are attributed to positional asphyxia. Autopsy findings and specific scene and circumstantial correlations of the investigation are discussed with emphasis placed on the limitations of interpretation of the anatomic changes at autopsy.

Adult↗
PubMed1992

The perils of investigating and certifying deaths in police custody.

Procedures leading to the proper investigation and certification of deaths occurring in police custody are discussed. The importance of training and experience, of interchange of information between investigator and forensic pathologist, and of common sense in the pursuit of fairness toward this end is emphasized.

Asphyxia↗
PubMed1992

Predictors of survival and severity of disability after severe brain injury in children.

Seventy-five children, 16 years of age or younger, consecutively admitted to a level I trauma center over a 2-year period with severe nonpenetrating traumatic brain injuries were studied to assess factors predictive of survival and level of disability. The mortality rate was 33%; 31% had good recovery, 12% had moderate disability, 19% had severe disability, and 5% remained in a vegetative state. Factors were analyzed separately for potential effects on survival and, with fatalities excluded, for potential effects on the level of disability in survivors. Clinical status in the field and emergency room, although highly associated with survival, was less predictive of the level of disability in survivors. Glasgow Coma Scale scores 72 hours after injury, especially the motor component, were significantly better predictors of quality of survival. The severity of the brain injury and the presence and severity of extracranial injuries were strongly related both to survival and quality of survival. Chest injuries, in particular, were associated with increased mortality and morbidity, as was level of oxygenation; these factors were highly correlated. Factors most significantly predictive of survival were severity of total injuries as assessed with the Injury Severity Score and pupillary responses in the emergency room; factors most predictive of disability were Glasgow Coma Scale motor responses 72 hours after injury and level of oxygenation in the emergency room. These findings of differential predictive factors for outcomes of survival versus quality of survival have implications relevant both to clinical care and to research involving severely brain-injured children.

Adolescent↗
PubMed1991

Use of facial approximation techniques in identification of Green River serial murder victims.

Since 1982, the remains of 41 victims of the Green River Serial Murderer have been recovered. The majority were discovered as skeletal remains, and 24 facial approximations have been used in attempts to develop leads for identification of nine of these victims. Nine different artists were used. Interpretations of the same victim varied greatly. For those victims subsequently identified, resemblance of the facial approximation to the deceased showed considerable variation, but in some cases was quite accurate. This experience created a unique opportunity to compare different methods of facial approximation techniques and artists, and to comment on their efficacy in aiding identification.

Face↗
PubMed1990

Firearm regulations and rates of suicide. A comparison of two metropolitan areas.

To investigate a possible association between firearm regulations and suicide, we compared the incidence of suicide from 1985 through 1987 in King County, Washington, with that in the Vancouver metropolitan area, British Columbia, where firearm regulations are more restrictive. The risk of death from suicide was not found to differ significantly between King County and the Vancouver area (relative risk, 0.97; 95 percent confidence interval, 0.87 to 1.09). The rate of suicide by firearms, however, was higher in King County (relative risk, 2.34; 95 percent confidence interval, 1.90 to 2.88), because the rate of suicide by handguns was 5.7 times higher there. The difference in the rates of suicide by firearms was offset by a 1.5-fold higher rate of suicide by other means in the Vancouver area. Persons 15 to 24 years old had a higher suicide rate in King County than in the Vancouver area (relative risk, 1.38; 95 percent confidence interval, 1.02 to 1.86). Virtually all the difference was due to an almost 10-fold higher rate of suicide by handguns in King County. We conclude that restricting access to handguns might be expected to reduce the suicide rate in persons 15 to 24 years old, but that it probably would not reduce the overall suicide rate.

Adolescent↗
PubMed1990

Recovery of decomposed and skeletal human remains in the "Green River Murder" Investigation. Implications for medical examiner/coroner and police.

The Green River Murder Investigation in King County, Washington, is currently the longest active serial murder investigation in U.S. history. During its course, over 26 separate scenes with from one to five victims each have been processed. The experience of the authors is presented in order to acquaint other agencies with techniques of outdoor scene processing that have evolved during recovery of remains from Green River and other skeletal cases.

Bone and Bones↗
PubMed1990

Atlanto-occipital disarticulation. Accident characteristics.

A retrospective study of cases of atlanto-occipital disarticulation was conducted to describe incident characteristics: 24 cases were identified, including nine motor vehicle drivers, two passengers, seven pedestrians, and five motorcyclists; one other person had fallen four stories. The highest rates were found among motorcyclists and pedestrians. Atlanto-occipital disarticulations occur in high-energy impacts and collisions and are associated with aortic laceration in 25% and basilar skull fracture in 21% of such cases. Current restraint systems and motorcycle helmets do not appear to prevent this generally rapidly fatal injury.

Accidental Falls↗
PubMed1990

Death notification.

Family notification in sudden, unexpected, and violent death is a major responsibility of law enforcement, medical examiner, and coroner offices. This report reviews and discusses the process and procedures utilized in death notification and provides suggestions to accomplish this difficult task more effectively.

Attitude to Death↗
PubMed1990

The epidemiology of traumatic rupture of the thoracic aorta in children: a 13-year review.

Traumatic rupture of the thoracic aorta (TRA) is a rare but highly lethal injury in children that occurs as a result of car versus pedestrian accidents and motor vehicle accidents. TRA is often associated with life-threatening injuries to other organ systems. Therefore children with TRA like adults sustaining TRA must be treated urgently but systematically. The rarity of this injury makes it all the more important for physicians treating pediatric trauma victims to be cognizant of the importance of the injury and the clinical and radiographic signs. Even when TRA is promptly recognized in children it is associated with a high in-hospital mortality. The proper use of child restraint systems and adherence to the 55 M.P.H. speed limit may be important factors in reducing the mortality of TRA in children after MVA.

Accidents, Traffic↗
PubMed1990

Identification of decomposed human remains by deoxyribonucleic acid (DNA) profiling.

After routine methods failed to establish positive identification of a decomposed homicide victim, deoxyribonucleic acid (DNA) typing techniques using blood from the victim and putative parents of the victim were used. This is the first report in the literature of a case using DNA fingerprinting in a "parentage" context to establish identity of unidentified, decomposed human remains.

DNA↗
PubMed1989

Earlobe creases.

Explore the source record for details and available documents.

Coronary Artery Disease↗
PubMed1989

Drug use in trauma victims.

We examined the prevalence and characteristics of drug use in a large sample of fatally and nonfatally injured trauma victims. Routinely collected urine specimens from 452 emergency room patients and 160 persons autopsied at the Medical Examiner's Office (MEO) were analyzed for the presence of marijuana, cocaine, opiates and benzodiazepines using EMIT enzyme immunoassays. Blood alcohol levels were also measured. Tests were positive for at least one drug in 40.3% of the ER and 18.7% of the MEO samples. Marijuana was the most commonly detected drug in both groups. Specimens were more likely to be positive in younger persons and in males, and in victims of assaults and traffic accidents. Alcohol was present in the blood in more than one third of ER and MEO samples. Only 39.8% of ER samples and 52.3% of MEO samples were negative for both alcohol and drugs.

Adolescent↗
PubMed1989

Canid scavenging/disarticulation sequence of human remains in the Pacific Northwest.

Greater understanding of animal scavenging of human remains can assist forensic science investigators in locating and recovering dispersed skeletal elements, in recognizing damage produced by scavengers, and in making more informed estimates of the postmortem interval. The pattern of skeletal damage can indicate whether the body was scavenged while intact or at some time after other natural processes of disarticulation had begun. This study analyzed thirty partially to fully skeletonized human remains with respect to scavenging at the time of body discovery in order to determine if a patterned consumption sequence existed. The scavengers were primarily coyotes (Canis latrans) and domestic dogs (C. familiaris). Sixteen non-carnivore-scavenged remains were also examined and contrasted with the carnivore-scavenged sample. Observed postmortem intervals from death to recovery ranged from 4 h to 52 months. Results demonstrate that canid scavenging of human remains takes place in sequential stages: Stage 0 = no bony involvement; Stage 1 = ventral thorax damaged and one or both extremities removed; Stage 2 = lower extremity involvement; Stage 3 = only vertebral segments remain articulated; and Stage 4 = total disarticulation. Results revealed a clear correspondence between stages of disarticulation and the postmortem interval.

Adolescent↗
PubMed1988

Handgun regulations, crime, assaults, and homicide. A tale of two cities.

To investigate the associations among handgun regulations, assault and other crimes, and homicide, we studied robberies, burglaries, assaults, and homicides in Seattle, Washington, and Vancouver, British Columbia, from 1980 through 1986. Although similar to Seattle in many ways, Vancouver has adopted a more restrictive approach to the regulation of handguns. During the study period, both cities had similar rates of burglary and robbery. In Seattle, the annual rate of assault was modestly higher than that in Vancouver (simple assault: relative risk, 1.18; 95 percent confidence interval, 1.15 to 1.20; aggravated assault: relative risk, 1.16; 95 percent confidence interval, 1.12 to 1.19). However, the rate of assaults involving firearms was seven times higher in Seattle than in Vancouver. Despite similar overall rates of criminal activity and assault, the relative risk of death from homicide, adjusted for age and sex, was significantly higher in Seattle than in Vancouver (relative risk, 1.63; 95 percent confidence interval, 1.28 to 2.08). Virtually all of this excess risk was explained by a 4.8-fold higher risk of being murdered with a handgun in Seattle as compared with Vancouver. Rates of homicide by means other than guns were not substantially different in the two study communities. We conclude that restricting access to handguns may reduce the rate of homicide in a community.

British Columbia↗