Medico-legal Practices Research Articles

The Precision, Inter-Rater Reliability, and Accuracy of a Handheld Scanner Equipped with a Light Detection and Ranging Sensor in Measuring Parts of the Body-A Preliminary Validation Study.

Anthropometric measurements play a crucial role in medico-legal practices. Actually, several scanning technologies are employed in post-mortem investigations for forensic anthropological measurements. This study aims to evaluate the precision, inter-rater reliability, and accuracy of a handheld scanner in measuring various body parts. Three independent raters measured seven longitudinal distances using an iPad Pro equipped with a LiDAR sensor and specific software. These measurements were statistically compared to manual measurements conducted by an operator using a laser level and a meterstick (considered the gold standard). The Friedman test revealed minimal intra-rater variability in digital measurements. Inter-rater variability analysis yielded an ICC = 1, signifying high agreement among the three independent raters. Additionally, the accuracy of digital measurements displayed errors below 1.5%. Preliminary findings demonstrate that the pairing of LiDAR technology with the Polycam app (ver. 3.2.11) and subsequent digital measurements with the MeshLab software (ver. 2022.02) exhibits high precision, inter-rater agreement, and accuracy. Handheld scanners show potential in forensic anthropology due to their simplicity, affordability, and portability. However, further validation studies under real-world conditions are essential to establish the reliability and effectiveness of handheld scanners in medico-legal settings.

Enhancing the Evidence with Algorithms: How Artificial Intelligence Is Transforming Forensic Medicine.

The integration of artificial intelligence (AI) into various fields has ushered in a new era of multidisciplinary progress. Defined as the ability of a system to interpret external data, learn from it, and adapt to specific tasks, AI is poised to revolutionize the world. In forensic medicine and pathology, algorithms play a crucial role in data analysis, pattern recognition, anomaly identification, and decision making. This review explores the diverse applications of AI in forensic medicine, encompassing fields such as forensic identification, ballistics, traumatic injuries, postmortem interval estimation, forensic toxicology, and more. A thorough review of 113 articles revealed a subset of 32 papers directly relevant to the research, covering a wide range of applications. These included forensic identification, ballistics and additional factors of shooting, traumatic injuries, post-mortem interval estimation, forensic toxicology, sexual assaults/rape, crime scene reconstruction, virtual autopsy, and medical act quality evaluation. The studies demonstrated the feasibility and advantages of employing AI technology in various facets of forensic medicine and pathology. The integration of AI in forensic medicine and pathology offers promising prospects for improving accuracy and efficiency in medico-legal practices. From forensic identification to post-mortem interval estimation, AI algorithms have shown the potential to reduce human subjectivity, mitigate errors, and provide cost-effective solutions. While challenges surrounding ethical considerations, data security, and algorithmic correctness persist, continued research and technological advancements hold the key to realizing the full potential of AI in forensic applications. As the field of AI continues to evolve, it is poised to play an increasingly pivotal role in the future of forensic medicine and pathology.

Ethiopian Medico-Legal Practices need to improve to serving Justice

Ethiopian Medico-Legal Practices need to improve to serving Justice

At arm's length: A qualitative study of suicide prevention barriers among those experienced with suicide loss

BackgroundLittle attention has been paid to the experiences of families and carers supporting and accessing support for individuals in the period preceding and following their death by suicide. For many families and carers who have experienced loss and been subjected to a series of unhelpful or harmful encounters with health and emergency services, there is a desire to share their stories so that their experiences might contribute to the improvement of practices and policies. MethodsWe conducted qualitative interviews with 17 participants supporting and accessing support for individuals who died by suicide in the Australian Capital Territory, Australia. Interviews and thematic analysis were guided by the theoretical frameworks of trauma-informed and restorative practice. ResultsKey barriers for those seeking to access support were the difficulties experienced upon entering the health system, inadequate care pathways for ensuring continuity of care, and the lack of trauma-informed, holistic care. Participants described how concerns over their loved one's welfare were minimized by health professionals, and how ineffective communication strategies and the hierarchies of power and control evident in many health care settings were experienced as exclusionary and disempowering. These results provide compelling evidence that emergency services and health workforces require new strategies for effective management and care of people experiencing suicidal distress, their families, and carers. ConclusionsResults support the view that trauma-informed and restorative approaches provide promising strategies for addressing issues of disconnected, fragmented, and exclusionary health care and medico-legal investigative practices, as well as to help resolve conflict and prevent harm.

Alterations of oligodendrocyte progenitor cells (OPCs) with survival time in humans following high impact brain trauma

BackgroundAs there is a lack of comprehensive literature regarding the molecular environment of the human brain emphasizing on oligodendrocyte progenitor cells (OPCs) following high impact brain trauma. The protagonist of OPCs post severe traumatic brain injury (sTBI) provides a significant thrust towards estimating time elapsed since trauma as well as developing novel therapeutic approaches. The present study was carried out to study post trauma alterations pertaining to myelin sheath and oligodendrocyte response with survival time. Materials and methodsIn the present study, victims (both male and female) of sTBI (n = 64) were recruited and contrasted with age and gender matched controls (n = 12). Post mortem brain samples from corpus callosum and grey white matter interface were collected during autopsy examination. Extent of myelin degradation and response of OPC markers Olig-2 and PDGFR-α were evaluated using immunohistochemistry and qRT-PCR. STATA 14.0 statistical software was used for data analysis with P-value<0.05 considered statistically significant. ResultsTimewise qualitative correlation with extent of demyelination performed using LFB-PAS/IHC-MBP, IHC Olig-2 and mRNA expression revealed tendency towards remyelination in both corpus callosum and grey white matter interface. Number of Olig-2 positive cells was significantly higher in sTBI group as compared to control group (P-value: 0.0001). Moreover, mRNA expression studies of Olig-2 showed significant upregulation in sTBI patients. mRNA expression of Olig-2 and PDGFR-α in sTBI patients showed significant variation with respect to survival time (p value:0.0001). ConclusionDetailed assessment of post TBI changes implementing various immunohistochemical and molecular techniques shall potentially reveal intriguing and important inferences in medicolegal practices and neurotherapeutics.

DETERMINATION OF SEX FROM FOOTPRINT DIMENSIONS AMONG NUPE ETHNIC GROUP IN MINNA NIGER STATE

Determination of personal identity is a basic and pivotal step in forensic investigations and medico legal practices. In anthropological cases, forensic identification is generally carried out through examination of the body or the remains for prints from the body. Thus, the footprint becomes an invaluable index of identification particularly when the whole body is very badly mutilated. This study was carried out to determine the relationship between footprint dimensions and sex among individuals of Nupe ethnic group of Niger State. Sample size of four hundred and twenty one (421) subjects, two hundred and eighty three (283) males and one hundred and thirty eight (138) females were used in this study. The footprints were gotten by placing the volunteers' foot on the ink pad and it was then transferred on anA4 paper, where the footprint dimensions were later measured with a meter rule. The results of this study show that sex differences were highly significant using toe lengths and breadth (P≤ 0.01) but the footprint indices shows no statistical significance. Footprint dimension is sexually dimorphic. Footprint dimensions can be used to determine sex in addition to or in absence of skeletons such as long bones and skull. It can be applied in forensics for medico legal cases, shoe designing, fashion design and industrial design to optimize products.

Medicolegal death investigator workplace safety hazards: A scoping review of the literature.

In the United States, medicolegal death investigation practices and policies pertaining to sudden unexpected deaths are mandated by state government. Practices vary across states, which contributes to inconsistency in job prerequisites and training. In preparation for a study focused on occupational safety and health of medicolegal death investigators in their on-scene and follow-up activities, a scoping review was conducted to document known occupational safety risks and health-related conditions associated with death investigation. Searches used Boolean and subject heading operators both broad and narrow in scope, and search terms included scene responder, hazard, investigator, forensic pathology, injury, and safety. Twenty-five articles met inclusion criteria, which included seventeen survey-mixed method designs, two systematic reviews, five quasi-experimental designs, and one case study. Twelve articles addressed mental health and eleven focused on risks associated with infectious disease. One article addressed the risk of chemical exposure from cyanide among autopsy personnel (including forensic pathologists) and nine included a wide range of employees within the setting of medical examiner or coroner offices. One article, addressing burnout, included employees in a forensic science laboratory setting as well as medicolegal death investigators and two articles included forensic pathologists and medicolegal death investigators. Only one article addressed medicolegal death investigators specifically. Articles addressing occupational and environmental hazards of medicolegal death investigators associated with musculoskeletal, respiratory, cardiovascular, radiological, nuclear, electrical, or explosive threats were not identified. There is little published about safety risks inherent in conducting death investigations. Research is needed to adequately inform health promotion and injury prevention strategies.

Legality In Hospitals- Medico-Legal Case Management

The growing number of legal issues in various fields and specialties in the current era has been no different in the healthcare sector. The complexity associated with such issues has been the major concern of practicing doctors/healthcare professionals. In this article, an attempt has been made to focus the legalities in the field of medicine with an emphasis on the Indian set up and existing Laws governing such actions. The article comprises of medico-legal case management, awareness and prevalent practices among the health care professionals especially among those who are directly or indirectly involved with the treatment of patients. As far the awareness is concerned regarding a procedure, the documentation and various other medico-legal issues were studied in detail. Also, various aspects of medico-legal cases admitted in the hospital.

Elevated serum and urine levels of progranulin (PGRN) as a predictor of microglia activation in the early phase of traumatic brain injury: a further link with the development of neurodegenerative diseases.

Traumatic brain injury (TBI) is afrequent finding during forensic autopsies and neuropathological examinations in medico-legal practices. Despite the unprecedented attention currently focused on TBI pathogenesis, there is aneed to improve its diagnostics through the use of novel biomarkers to facilitate detection, treatment, and prognosis. Recently, growth factor progranulin (PGRN) has attracted significant attention because of its neurotrophic and anti-inflammatory activities. The role of PGRN in TBI has not been widely discussed, although PGRN-related neuroinflammatory and neurodegenerative phenomena have been described. The aim of this study was to identify PGRN concentration levels in biofluids and examine PGRN and CD68 protein expression in brain tissue using immunohistochemical staining in individuals with fatal TBI in its early phase. The study was performed using cases (n = 30) of fatal head injury and control cases (n = 30) of sudden death. The serum and urine were collected within ~24 h after death and compared using the ELISA test, where brain specimens were stained with anti-PGRN and anti-CD68 antibodies. In our study, we observed elevated concentration levels of PGRN in the serum and urine of TBI individuals in the early phase of TBI. These changes were accompanied by increased expression of PGRN in the frontal cortex (1st-3rd layers), in which anti-CD68 immunostaining revealed disseminated cortical microglia activation. The possible implementation of performing such assays offers anovel and interesting tool for investigation and research regarding TBI diagnosis and pathogenesis. Furthermore, the above-mentioned surrogate biofluid assays may be useful in clinical prognosis and risk calculation of non-fatal cases of TBI, considering the development of neurodegenerative conditions of TBI individuals.

The care and transport of trauma victims by layperson emergency medical systems: a qualitative study in Delhi, India

IntroductionAmbulance-based emergency medical systems (EMS) are expensive and remain rare in low- and middle-income countries, where trauma victims are usually transported to hospital by passing vehicles. Recent developments in transportation...

Mandible: An Indicator for Sex Determination - A Three-dimensional Cone-Beam Computed Tomography Study.

Background:Mandible is considered as one of the stronger bones of skull available for gender identification. Mandibular measurements can be used for the identification of gender either on dry mandible or through panoramic radiography or cone-beam computed tomography (CBCT).Aim:To determine the gender from mandibular measurement using CBCT.Materials and Methods:The Morphometric analysis was performed on 200 CBCT scans of the subjects using OnDemand 3D software (Seoul, Korea). Morphometry of mandibular is measured by estimation of the angles formed at different locations on mandible to predict the gender. Statistical analysis was performed; independent samples “t-” test was used to compare the mean values between males and females. Discriminant function analysis was used for gender prediction.Results:The subject's age ranged from 18 to 60 years with an equal number of males and females. The mean angle formed by the intersection of lines from the left and right gonion to menton in males was 129.9 ± 11.9 and it was 126.7 ± 12.6 in females. The mean linear distances from the right gonion to menton in both males and females were 86.8 ± 5.3 and 82.6 ± 6.2, respectively. The mean linear distances from the left gonion to menton were 49.5 ± 5.1 in males and 47.7 ± 3.9 in females. The mean linear distance from the right gonion to left gonion was 47.7 ± 4.4 in males and 46.6 ± 4.2 in females. The Box's M statistics was applied to verify the applicability of mandibular measurements in gender prediction. The values indicate that gender can be predicted using these four variables, which is statistically significant (P = 0.000). The overall prediction accuracy of this model was 67%, with 66.7% in males and 67.3% in females being correctly classified.Conclusion:The angle formed by the intersection of lines from the left and right gonion to menton (Gn-M0) helps provide anthropological data, which can be used in dental and medicolegal practices.

Air, Water, and Surface Bacterial Contamination in a University‐Hospital Autopsy Room*

Today, little is known about the bacteriological environment of the autopsy room and its potential interest for medico-legal practices. Seven hundred fifty microbiological samples were taken from surface (n = 660), air (n = 48), and water (n = 42) to evaluate it in a French University Forensic Department. Median bacterial counts were compared before and during autopsy for air samples, and before and after autopsy for surface samples, using Wilcoxon matched pairs signed ranks test. Bacterial identification relied on traditional phenotypic methods. Bacterial counts in the air were low before autopsy, increased significantly during procedure, and seemed more linked to the number of people in the room than to an important production of aerosol-containing bacteria. Despite cleaning, human fecal flora was omnipresent on surfaces, which revealed insufficient disinfection. Bacteriological sampling is an easy way to monitor cleaning practices in postmortem rooms, but chiefly a way to improve the reliability of medico-legal proofs of infectious deaths.

TF-17 Emergency Medicine Medicolegal Curriculum for Fourth Year Medical Students

From formal and informal feedback, fourth year medical students have stated that they do not receive much education on medicolegal matters during their training. The purpose of this self-directed online instructional module is to introduce fourth year medical students to the basics of medicolegal practices in emergency medicine. Many of the concepts taught here will be applicable to other fields of medicine and so will aid all students, not just those going into emergency medicine. Ultimately, the knowledge gained here will assist students throughout their careers and equip them with tools that can help protect them against medicolegal actions such as malpractice.

Impact of Medico-Legal Practices on Mortality Statistics and Their Use in Comparative Research

Homicide data are the most valid and reliable of international crime data. However, assessing lethal intent is complicated, and we can thus question whether mortality statistics reflect lethal behaviors in the living, or are a mirror of the institutional systems that produce them. This question is central for those who study homicide comparatively. A mix-method examination of two medical examiners' offices—one in France, and one in the United States—reveals that definitional issues, regulatory factors, and organizational and medical procedures come into play in the determination of the manner of death. The comparative framework emphasizes the need to consider contexts beyond variables in criminological research—be they cultural, political, or institutional.

How much do junior staff know about common legal situations in paediatrics?

Recent high-profile medico-legal cases such as the death of Victoria Climbie and the subsequent Laming report have highlighted widespread deficiencies in child protection practice. Junior doctors are the frontline staff regularly facing issues with potentially major legal implications, including child protection, Gillick competence, consent, and professional responsibility/accountability. It is therefore important for them to be aware and understand the Children Act, common medico-legal principles and practices, particularly in the current, increasingly litigious climate. (1) To determine junior medical staff's knowledge of legal issues involved in child protection and common basic legal situations, and (2) to assess whether experience and training improved this knowledge. A standardized structured interview was developed exploring common issues with important legal implications for paediatric practice. It focused on: legal issues in child protection, the Children Act, awareness of the General Medical Council (GMC), principles of professional responsibility/accountability, the Bolam principle for good medical practice and Gillick competence. Basic demographic data were recorded. We attempted to contact all 180 paediatric junior medical staff in Wales by telephone. Interviews were conducted with 119/180 (66%) doctors: 46/56 specialist registrars (SpRs; 82%) and 73/124 senior house officers (SHOs; 59%). SpRs scored a median of 6.5 correct responses from a possible of 12 (range 3-11), compared with a median of 5 (range 1-11) by the SHOs (P < 0.0001; Mann-Whitney test). A third of SHOs and a fifth of SpRs were unaware that the GMC was the organization responsible for good medical practice in the UK. Similarly, a fifth of all juniors were ignorant of the legal age for consent. Approximately two-thirds of the SHOs and half of the SpRs were ignorant that the police and social services have the legal power to protect the child in child protection cases. Alarmingly, none of the SHOs and only 11% of the SpRs were aware of the Bolam principle. SpRs scored significantly higher on topics of Gillick competence, legal right to see medical notes, consent, Children Act, burden of proof in civil and criminal court, and on Bolam principle. They also had received training more frequently than SHOs, which, when combined with their greater experience, probably explains these statistically significant differences. Few junior staff have adequate knowledge of the basic legal principles and practice as they relate to children. Widespread deficiencies concerning the understanding of the Children Act and child protection powers exist.

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Injections de toxine botulique et responsabilité médicale : le patient est-il suffisamment informé ?

Introduction. – The use of botulinum toxin injection therapy is soaring significantly today, with an ever-wider field of applications despite well-known side effects of the treatment. This article aims at analysing the medicolegal practices of practitioners who use this therapy, especially the information given to patients and finding a common practice for providing that information. Methods. – We sent a questionnaire to 340 practitioners who might use the therapy (physiatrists, neurologists, ophthalmologists, ENT specialists, plastic surgeons) working in hospitals and in physical therapy and rehabilitation centres in France. Besides mentioning the possible side effects of the therapy, the questionnaire focused on how such information was transmitted before the injection. Results. – Data collection and analysis were performed by use of a spreadsheet software programme. A total of 124 questionnaires were analysed. We did not analyse the items dealing with side effects. Sixty-five percent of the responders said they did not seek statutory authorisation for injections. Only 31% provided written, detailed information and 12% required a signed consent form. Complaints were rare, approximately 12%, were written or verbal, and were always dismissed. Discussion. – Side effects after botulinum toxin injection are clearly described in the medical literature. Therefore, it is of utmost importance for this product to be used therapeutically and only by experienced therapists who will carefully respect the product’s standard rules of use and inform their patients to the best of their ability. Issuing a detailed letter of information describing all the side effects seems necessary. We suggest a model information letter such as that provided to the patients in our facility. Conclusion. – Botulinum toxin is a very worthwhile product for numerous abnormalities but has side effects, often brief, at the site of the injection. Therefore it is our duty to inform patients effectively.

Justice and the deconstruction of psychological jurisprudence

Critical psychological jurisprudence draws attention to the forces of ideology, power and violence embedded in the narratives of law and psychiatry, criminal justice and mental health. Application work in this area identifies how and for whom justice is served (or denied) by prevailing medicolegal decisions and practices. One method of discursive analysis comes from deconstruction. Indeed, as Derrida has proclaimed, ‘deconstruction is justice.’ To further this perspective, the author deconstructs psychological jurisprudence by examining the competency to stand trial (CST) phenomenon in the United States. To facilitate this investigation the precedent case law on the subject is presented and reviewed. In addition, selected principles from Derridean deconstruction are recounted and then applied to the medicolegal narrative of competency to stand trial. Given these observations, the author concludes by tentatively exploring the meaning(s) of deconstruction as justice in the domain of psychological jurisprudence.

Alcohol in a series of medico-legally autopsied deaths in northern Norway 1973–1992

It is well established that use of alcohol increases the risk of fatal injuries. The presence of blood alcohol in autopsied deaths is regularly encountered in medico-legal practices. The aim of this study was to investigate the prevalence and concentration of alcohol in 1539 medico-legal autopsies in two counties in northern Norway in the period 1973–1992, and the reporting of acute alcohol influence among these deaths to the official cause-of-death statistics. Blood alcohol concentration (BAC) ≥0.5‰ (50 mg/100 ml) was found in 47.6% ( n=456) of violent deaths tested, and in 93% ( n=426) of these the BAC was ≥1.0‰. In 17.4% ( n=55) of tested natural deaths the BAC was ≥0.5‰. Acute alcohol-influenced violent deaths were under-reported to the cause-of-death statistics. Deaths by motor vehicle traffic accidents did not differ from other violent deaths in this respect. The under-reporting among violent deaths was 41% in cases with BAC ≥0.5‰ and 37% where the BAC was ≥1.0‰ during the whole period. It is concluded that post-mortem BAC ≥0.5‰, should be regarded as a possible contributory cause in all violent deaths, and reported accordingly.

Postmortem alcohol analysis of the synovial fluid and its availability in medico-legal practices

Alcohol analyses using the synovial fluid of the knee joint (synovial alcohol concentration, SAC) as well as blood (BAC) and urine (UAC) were performed by the pulse heating-gas chromatographic method in 12 medico-legal autopsy cases. In 11 of the 12 cases, the regression analysis showed that BAC and UAC had a fairly linear relationship with SAC, and the average ratios of the BAC/SAC and UAC/SAC were 0.76±0.12 (range 0.60–0.94) and 1.03±0.11 (range 0.90–1.21), respectively. The measured BACs showed a difference of 11.8±9.4% (0.9–27.1%) when compared with the calculated BACs by means of the average BAC/SAC ratio. Between the measured UACs and the calculated UACs, there was an average difference of 7.9±6.0% (0.3–17.8%). The present study demonstrates that the synovial fluid is one of the available biological specimens for the prediction of BAC or UAC within a range in autopsy cases in which suitable blood and/or urine specimens cannot be obtained.