A model was developed to provide a tool to forecast demographic trends in populations of people with traumatic spinal cord injury at the national and state level. This information is critical to planning for the allocation and distribution of resources to care for people with spinal cord injury. The literature on incidence, mortality, and prevalence of spinal cord injury in the United States was reviewed and reported values were evaluated for incorporation into the model. A linear relationship between age specific survival rates of the spinal cord injury population, and expected survival rates in the absence of spinal cord injury was established and this provided the basis for projections using age cohort survival methodology. The model's projections indicate a need for future expansion of capacity to treat traumatic spinal cord injury in the private sector, and a need to prepare for an aging disabled population. The annual number of traumatic spinal cord injury cases admitted to hospitals is projected to increase from approximately 11 500 in 1994 to almost 13 400 in 2010. Age adjusted post-hospitalization incidence rate in 1994 is estimated at approximately 38 per million (23 per million for females and 55 per million for males). A 20% increase in the US spinal cord injury prevalence can be expected over the next 10 years, going from approximately 207000 estimated in 1994, to 247 000. During this time, the veteran segment, which currently comprises 22% of the spinal cord injury population, is projected to decline. Increases in the number of people aged 65 or more with spinal cord injury, currently estimated to be around 11% of the total spinal cord injury population, can be expected to grow more than 24% by 2025 to almost 73 000.

Laboratory procedures used in short tandem repeat (STR) analysis were subjected to various scenarios that assessed reliability and identified potential limitations. These validation studies were designed as recommended by the Technical Working Group on DNA Analysis Methods (TWGDAM) and the DNA Advisory Board (DAB) (17,18). Various DNA samples were amplified by the polymerase chain reaction (PCR) using AmpFᐉSTR™ PCR Amplification Kits (i.e., AmpFᐉSTR Green I, Profiler™, Profiler Plus™, and COfiler™ kits), detected with ABI Prism instrumentation, and analyzed using GeneScan and Genotyper software. Data acquired in these studies reinforced an existing body of knowledge and expertise regarding application and interpretation of STR typing in the forensic science community. Consistent STR genotypes were detected in various body tissues and fluids. Inter-laboratory comparisons produced concordant genotype results. Quantitative interpretational aids for DNA mixtures were characterized. Ability of the typing systems to type potentially compromised samples reliably was evaluated. Nonprobative case evidentiary DNA was successfully amplified, genotyped, and interpreted. Potential limitations or cautionary factors in the interpretation of minimal fluorescence intensity were demonstrated. Differential amplification between loci was observed when PCR was inhibited; preferential amplification typically was not. Single AmpFᐉSTR locus amplification did not offer consistent benefit over AmpFᐉSTR multiplexing, even in cases of DNA degradation or PCR inhibition. During rigorous evaluation, AmpFᐉSTR PCR Amplification Kits reproducibly yielded sensitive and locusspecific results, as required in routine forensic analyses.

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Analysis of length polymorphisms at STR loci in the human genome has become a standard approach for comparative genotyping in many areas including disease research and diagnostics, parentage assessment, investigations of human diversity, and forensic science. The simultaneous analysis of multiple STR loci through multiplex PCR and multicolor fluorescence detection offers sample conservation, high throughput, and automated genetic analysis. Careful design and optimization of tetranucleotide STR multiplexes has led to reliable, standardized systems that powerfully differentiate and distinguish individual human DNA profiles. The development of these multiplex systems involved a rigorous experimental strategy that included careful selection of PCR primer sequences (for yield, specificity, and multiplex compatability), along with optimization of PCR component concentrations, thermal cycling parameters, and fluorescence detection conditions. This developmental approach rendered well-characterized DNA typing systems that are high performing (sensitive, specific, and balanced), optimized to universal parameters (same reaction conditions), resilient to fluctuations in reaction conditions, and simple to implement and use routinely.

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