EPI 390 Lecture 11Outline of Last Lecture I. Properties of Smallpox virusII. Transmission and ProgressionIII. History of SmallpoxIV. Attempts at Preventiona. Variolationb. VaccinationV. Smallpox in the 20th CenturyVI. Eradication CampaignVII. Recent pox concernsOutline of Current Lecture I. Forensic Epidemiologya. Forensic DentistryII. Field Epidemiology Case StudiesIII. DefinitionsIV. Creating a Biological ProfileV. Means of categorizing remains (i.e. Time of death, etc.)Current LectureI. Forensic Epidemiology – application of epidemiological methods to issues of potential law enforcement importancea. Forensic Dentistry i. There is a field of forensic dentistry – individuals go to dental school but also have epidemiological/forensics focus. Mostly do F.D. as a side jobii. Working with dental remains, trying to identify matches to bite marksb. 9/11 – CDC got involved in Forensic epidemiology. The CDC now gives many statejurisdictions money to deal with issues if/when they arise; these issues are those that have the potential to harm the health of public, and the state alone doesn’t have the resources to handle them.i. Federal CDC money funnels to state level – b/c the CDC doesn’t know what individual states need. The state could control the money allotted aslong as it was used for the good of community health (States can use however they see fit)These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.ii. Most states, i.e. MI, went to local universities (research pool with Wayne State, UM, MSU, and Vanderbilt), prestigious schools of public health. They created training programs in the schools to train for occurrence of these issuesII. Field Epidemiology Case Studiesa. Epidemiologic history of trying to understand relation between exposure and disease (silicone breast implants and disease; tobacco use and lung cancer; tampon use and TSS)i. Silicone breast implants and Breast cancer – Studies looked at women without implants who got breast cancer, people w/ implants that didn’t get breast cancer, women whose silicone implants leaked but didn’t have any serious adverse effects, etc.1. How do you figure out connection in so complex a situation? Determine variables and controls2. Look at women doing it for aesthetic reasons vs. women doing it for reconstruction post-mastectomya. 3 decades worth of cases and studies. The lawyers got rich off of this.b. E. coli food poisoning from restaurants – where does the liability begin and where does it end. i. If you get sick who should be responsible? The chef? The restaurant? The consumer? (This is why you see the warnings at the bottom of menus advising against consuming undercooked foods; it reduces the liability of the restaurant)c. Tampon Use and Toxic Shock Syndromei. TSS ultimately solved in the court; this required tampon companies to include inserts informing users of TSS risk.d. Tobacco use and lung cancer – because the connection between tobacco use andlung cancer, damages have been awarded to smokers who developed lung cancer.III. Definitionsa. Investigation of Deathi. 1979 Definition – T. Dale Stewart, at the Smithsonian, was the first personwho defined a scientific/precise way to identify remains of a missing person1. This involved a twofold determination: 1. Who is it? 2. Why so? (What are the circumstances around the person’s death? Are they suspicious and if they’re suspicious, to what degree should legal personnel be involved?)ii. Investigation of death includes identification of “more or less” skeletonized human remains for legal purposes; elimination of non-human elements; establish age, sex, stature, race; “other” characteristics that may lead to one’s recognitioniii. Forensics used to send remains in cases to the Smithsonian for identification but work load/case load became too much so around 2009, the definition changed to determine who should be in charge of unidentified individuals1. AAFS have the best tools to get at the first question. Sometimes when the person is identified, then the case may pass elsewhere for further investigation.a. States have established a state version of AAFS.b. D-Mort: disaster mortuary team (a team often consisting of a forensic anthropologist, epidemiologist, blood spatter expert, forensic dentist, hand writing specialist, psychologist, etc.). i. Individual’s experience is at different levels.c. Difference between Cause and Manner of Deathi. Epidemiologists don’t typically get involved in cause. Work w/ Manner.d. Medico-legal System (MLS) – The Coroner or Medical Examiner (ME) who is in charge of unifying a case to make sure it’s coherent. i. The main difference between a coroner and ME is in training and state requirements.ii. Compare Coroner and MEe. Clinical vs. Forensic pathologists. Pathologists require med schoolIV. Creating a Biological Profilea. A case could be epi-legal, health-legal… but it has to be related to legal system. There must be some suspicion that allows inclusion of the legal system, going outside of just a medical office or lab. i. This creates a complex relationship between who has the authority.b. Process i. Epidemiologists write a report, give it to the police, and the police give to prosecuting attorney.ii. The attorney will decide whether to take the case to court or not. iii. This process takes weeks. If the epidemiologist thinks there’s a threat to public health, though, this process takes minutes to get to the department of public health. c. The specificity of report determines speed of responseV. Means of categorizing remains (i.e. Time of death, etc.)a. NOTE: this section relates to a sensitive case mentioned in class. Refer to angel for details on this case, as they will not be included here.b. Need to try to determine gender, age, time of death, SES (socio-economic status),ethnicity/race, etc. These will all help determine an identity.c. When remains are found, the response team needs to start thinking about how long the individual has been dead to determine how much of a threat to public health there is.d. Analysis of dental records/healthi. The response team can use details like tooth loss to determine details about the remains.1. Ante-mortem tooth loss – teeth lost during the individual’s life, prior to death. In these teeth, the socket has had time to seal overand heal.2. Peri-mortem tooth loss –