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Impact of changing from autopsy to post-mortem CT in an entire HM Coroner region due to a shortage of available pathologists

A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected.

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Anogenital injury following sexual assault and consensual sexual intercourse: a systematic review and meta-analysis

Sexual violence is a grave human rights violation and a serious global public health challenge. Rates of reporting of sexual violence and subsequent passage of cases through the criminal justice system are poor all over the world. The presence or absence of anogenital injury following sexual assault may influence survivors in their willingness to report a crime, and law enforcement officers and jurors in their decision making regarding the laying of charges and/or conviction of offenders. The aim of this systematic review was to compare rates of identification of anogenital injury (AGI) in women following sexual assault and consensual sexual intercourse using the same examination techniques.

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Defining cat mitogenome variation and accounting for numts via multiplex amplification and Nanopore sequencing

Reprinted from University of Leicester website.

Cat hair could be the purr-fect way to catch criminals, according to researchers from the University of Leicester.

They have shown that a single cat hair contains DNA which could link a suspect and a crime-scene, or a victim.

Around 26 percent of UK householders own a cat and with the average feline shedding thousands of hairs annually, it’s inevitable that once you leave, you’ll bear evidence of the furry resident. This is potentially useful in the forensic investigation of criminal activity.

While a human perpetrator may take pains not to leave their own DNA behind, transferred cat hair contains its own DNA that could provide a link between a suspect and a crime-scene, or a victim.

In a paper published in the journal Forensic Science International: Genetics earlier this month, researchers at the University of Leicester describe a sensitive method that can extract maximum DNA information from just one cat hair.

Article link.

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Impact of changing from autopsy to post-mortem CT in an entire HM Coroner region due to a shortage of available pathologists

A significant problem facing routine medicolegal coroner-referred autopsies is a shortfall of pathologists prepared to perform them. This was particularly acute in Lancashire, where the coroner decided to initiate a service that relied on post-mortem computed tomography (PMCT). This involved training anatomical pathology technologists (APTs) to perform external examinations, radiographers to perform scans, and radiologists to interpret them. The service started in 2018 and now examines over 1,500 cases per year. This study outlines the PMCT process using NHS staff, with CT equipment and logistics managed by the commercial sector. It compares the demographics and outcomes of PM investigations for two 6-month periods: the autopsy service prior to 2018, and then the PMCT service. These data were then compared with previous UK PMCT data. Referrals for adult non-suspicious deaths were made in 913 cases of which 793 (87%) had PMCT between 01/10/2018 and 31/03/2019. Fifty-six cases had autopsy after PMCT, so 81% of cases potentially avoided autopsy. The PMCT service did not delay release of bodies to the next-of-kin. Comparing the cause of death given shows no difference in the proportions of natural and unnatural deaths. There was an increase in diagnosis of coronary artery disease for PMCT, with less respiratory diagnoses, a feature not previously demonstrated. These data suggest PMCT is a practical solution for potentially failing autopsy services. By necessity, this involves changes in diagnoses, as PMCT and autopsy have different strengths and weakness, but the ability to pick up unnatural death appears unaffected.

Direct link to the article.

 

The Dark Side of Energy Drinks: A Comprehensive Review ofTheir Impact on the Human Body

In recent years, the consumption of energy drinks by young adults and athletes has risensignificantly, but concerns have been raised about the potential health risks associated with excessiveconsumption. These concerns include cardiovascular problems, nervous system disorders, andthe potential for addiction. This review aims to examine the reported effects of acute or chronicabuse of energy drinks on human health. The analysis shows a significant prevalence of adverseeffects, particularly on the cardiovascular and neurovegetative systems. In particular, the analysisidentified nine cases of cardiac arrest, three of which were fatal. The aetiology of these adverse effectsis attributed to the inherent neurostimulant properties of these beverages, of which caffeine is thepredominant component. A comparison of documented effects in humans with experimental studiesin animal models showed an overlap in results. This review highlights the need for greater rigour inthe assessment of sudden cardiac death, particularly in young people, as legal substances such asenergy drinks may be involved. We propose stricter limits on the consumption of these beveragesthan for caffeine, based on the evidence found and the data in the literature. This review also callsfor the establishment of regulations governing the consumption of these products in view of theirpotential impact on human health.

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Wrongful convictions and claims of false or misleading forensic evidence

The results are reported of a study to examine case factors associated with 732 wrongful convictions classified by the National Registry of Exonerations as being associated with “False or Misleading Forensic Evidence.” A forensic error typology has been developed to provide a structure for the categorization and coding of factors relating to misstatements in forensic science reports; errors of individualization or classification; testimony errors; issues relating to trials and officers of the court; and evidence handling and reporting issues. This study, which included the analysis of 1391 forensic examinations, demonstrates that most errors related to forensic evidence are not identification or classification errors by forensic scientists. When such errors are made, they are frequently associated with incompetent or fraudulent examiners, disciplines with an inadequate scientific foundation, or organizational deficiencies in training, management, governance, or resources. More often, forensic reports or testimony miscommunicate results, do not conform to established standards, or fail to provide appropriate limiting information. Just as importantly, actors within the broader criminal justice system—but not under the purview of any forensic science organization—may contribute to errors that may be related to the forensic evidence. System issues include reliance on presumptive tests without confirmation by a forensic laboratory, use of independent experts outside the administrative control of public laboratories, inadequate defense, and suppression or misrepresentation of forensic evidence by investigators or prosecutors. In approximately half of wrongful convictions analyzed, improved technology, testimony standards, or practice standards may have prevented a wrongful conviction at the time of trial.

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Telling us less than what they know: Expert inconclusive reports conceal exculpatory evidence in forensic cartridge-case comparisons.

Cartridge-case comparison experts are tasked with determining whether a reference sample associated with the suspect originated from the same source as the evidence sample found at the crime scene. Same-source reports have strong inculpatory value and different-source reports have strong exculpatory value. Surprisingly, inconclusive reports have strong exculpatory value as they occur much more frequently for actualnon-matches than for actual matches. We used a Signal Detection Model to test our hypothesis that some experts report inconclusive when they detect a non-match. Consistent with this hypothesis, we found that even when examiners were able to perfectly discriminate matches from non-matches, they rendered inconclusive reports on 32% of non-match trials. Experts are biased to avoid rendering different-source reports, which conceals exculpatory information that innocent persons desperately need to establish their innocence. We argue that this biased examiner might result fromanadversarial allegiance bias combined with a flawed response scale.Keywords: forensic science; signal detection theory; bias; feature-comparison methods; cartridge-case comparisons.

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Bitten or struck by dog: A rising number of fatalities in Europe, 1995-2016.

We analyzed fatal dog attacks in Europe 1995-2016 using official death cause data from Eurostat. The data comprised the number of fatalities assigned The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code W54 "bitten or struck by dog", which includes deaths due to direct attacks but which excludes many complications following dog bites, such as rabies. In 2016, dogs killed 45 Europeans, which translates to an incidence of 0.009 per 100,000 inhabitants. This is comparable to estimates from the USA (0.011), and Canada (0.007), but higher than Australia (0.004). The number of European fatalities due to dog attacks increased significantly at a rate of several percent per year. This increase could not be explained by increases in the human or the dog populations. By taking all fatalities reported 1995-2016 into account, we investigated the effects of age, gender and geography. First, children, including infants, were common victims, but also middle-aged and the elderly, while people between ages 10 and 39 were rarely killed by dogs. Second, boys and men were overrepresented, but only in certain age groups and in certain parts of Europe. Third, there were large national and regional differences, both in the effects of gender and in incidences, which ranged from 0 to 0.045 per 100,000 inhabitants. This study of dog-related fatalities at a European level is the first of its kind and forms a basis for more detailed, national studies.

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Is it possible to estimate sex from signatures and handwriting? A review of literature, observations, and future perspectives.

Estimation of sex holds great significance in the field of Forensic Science since it helps establish the identity of an individual during a crime scene investigation. Sex differences in human behaviour are the result of natural selection. Sexually dimorphic stimuli of cognitive and behavioural activities may influence the phenotypic expression of our motor skills. Human traits such as signatures and handwriting are phenotypic manifestation of these skills. These phenotypic biological and behavioural traits have inherent sexual dimorphism and may help to identify sex in different circumstances. For instance, to establish the sex of an individual or deceased, forensic samples of the human body such as voice samples, features of fingerprints and footprints, the skeleton, or its remains are helpful. Similarly, the sex of an individual may also be identified from their corresponding handwriting and signature. Handwriting experts can extract peculiar features from handwriting and signatures which could help establish whether the signatures belong to a male or a female. A female writer may have attractive, rounded, upright, tidy, skilled, well-formed strokes, artistic design, better penmanship, and greater length of the signature compared to the signature of a male. Here, we review the studies related to the identification of sex from signatures and handwriting and present inferences about vital features and methods of sex identification through handwriting. These mainly suggest that the accuracy of sex prediction from signature and handwriting ranges from 45 to 80%. We also present writing examples to show sex-based differences in the signature and handwriting of males and females. The female's handwriting is more decorative, arranged, aligned, neat, and clean as compared to that of the male. Based on the writing samples and the review of literature, we suggest that forensic handwriting experts may eliminate suspects based on the sex of the writer, which can simplify the identification process of disputed or questionable signatures and handwriting.

Direct link to the article.

“Considerable Grief”: Dead Bodies, Mortuary Science, and Repatriation after the Great War

In September 1919, Mary McKenney was forced to relive the horrors of her husband Arthur’s death. Sergeant Arthur McKenney was wounded in France and returned to the United States.1 Despite his minor injury, he later died at a US Army hospital in Colonia, New Jersey from shock following an operation. After the autopsy, his body was turned over to an undertaker and then shipped home. The military inspector who cleared the body for travel missed the undertaker’s unsuccessful attempt to close the autopsy incisions. Arthur McKenney arrived in Boston, but the box was poorly nailed and emitted a horrible odor. The body appeared in an “advanced stage of putrefaction…the underclothing was stained and the coat wet from purging,” and fluid “trickled from the mouth and nose.”2 The incident precipitated a wave of correspondence between Arthur’s family and military personnel. It serves as a symbol of the politically charged intersection of deceased service members’ bodies, the state, and the family in modern war.

Read more here on Nursing Clio blog: https://nursingclio.org/2019/04/18/considerable-grief-dead-bodies-mortuary-science-and-repatriation-after-the-great-war/

Serial Killings and Attempted Serial Killings in Hospitals, Nursing Homes, and Nursing Care.

Abstract

BACKGROUND

Serial killing by doctors or nurses is rare. When it occurs, it is generally only detected after multiple homicides by the same perpetrator have escaped detection in the past. The persons at greatest risk are multimorbid elderly patients whose sudden death for natural reasons would not come as a surprise. However, patients' risk of falling victim to homicide is increased only if such vulnerable patients are exposed to perpetrators with certain personality traits. In this situation, homicides can be committed in which little or no evidence of the crime is left behind. In this review, we address the frequency, nature, and circumstances of serial killings and attempted serial killings in hospitals, nursing homes, and nursing care.

METHODS

This review is based on publications retrieved by a selective review of the literature in monographs, medical databases, specialty journals, general-interest media, and the Internet.

RESULTS

An evaluation of searchable, published case descriptions of serial killings and attempted serial killings in hospitals, nursing homes, and nursing care, mainly from Europe and the English-speaking countries, enables identification of the type of patients at risk, the modes of homicide, and the personality traits of the perpetrators. Multimorbid, care-dependent and nursing-dependent persons are the main victims. The perpetrators (men and women) generally act alone and have often been working in patient care for many years. The most common method of homicide is by drug injection; violent physical homicide is rarer. In many cases, irregularities in drug stocks, erratic behavior of a staff member, and/or a cluster of sudden deaths are indeed noticed, but are too slowly acted upon.

CONCLUSION

Irregularities in drug stocks, inexplicably empty drug packages and used syringes, erratic behavior of a staff member before and after a patient's death, or a cluster of unexpected deaths mainly involving elderly, multimorbid patients (detectable from internal mortality statistics) should always lead to further questioning and investigation.

Direct link to the article.

Application of 3D printing in assessment and demonstration of stab injuries

In stabbing related fatalities, the forensic pathologist has to assess the direction of wound track (thus, the direction of the stabbing) and the weapon's possible characteristics by examining the stab wound. The determination of these characteristics can be made only with a high level of uncertainty, and the precise direction of the stabbing is often difficult to assess if only soft tissues are injured. Previously reported techniques used for the assessment of these wound characteristics have substantial limitations. This manuscript presents a method using today's easily accessible three-dimensional (3D) printing technology for blade-wound comparison and wound track determination. Scanning and 3D printing of knives is a useful method to identify weapons and determine the precise stabbing direction in a stabbing incident without compromising the trace evidence or the autopsy results. Identfication of the exact knife is not possible with complete certainty but excluding certain knives will decrease the number of necessary DNA examinations, hence it can lower the burden on forensic genetic laboratories. The method addresses many of the shortcomings of previously used methods of probe insertion or post-mortem CT. Insertion of the printed knife into the wound gives a good visual demonstration of the stabbing direction, thus easing the forensic reconstruction of the stabbing incident. After combining the 3D printing with photogrammetry, the achieved 3D visualization is useful for courtroom demonstration and educational purposes.

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