Dissertations / Theses on the topic 'Forensic pathology'

Includes bibliographical references<br>Deaths in police custody are a global phenomenon which continues to beset policing services worldwide. Research into these deaths has provided insight into the complexity of detention and led to the institution of preventative strategies which have seen a reduction in mortality internationally. An improved understanding of the South African detention milieu may similarly assist in reducing the mortality burden in this country. This study retrospectively reviewed deaths in custody in the Cape Town Western Metropole between 2000 and 2009, with the aim of identifying local, modifiable factors to aid in death prevention. Sixty two (62) cases were reviewed. Males predominated (90.3%) in the sample, with the racial profile mirroring that of the general population. The median age of the detainees was 30.5 years. Unnatural causes of death accounted for 82% (n=51) of cases, with suicidal hanging the commonest cause (n=40). Items of clothing were used as ligatures in 80% of hangings, with gate and window bars the most common points of suspension. Time in detention averaged 863 minutes for the sample. Clinical signs of intoxication at the time of arrest was identified as a statistically significant determinant (p=0.02) of a shorter detention time (446 minutes). Ten (10) detainees were identified as either injured at the time of arrest or physically ill during detention, of which 9 succumbed to their injuries or disease. Only three of these detainees received medical attention. These findings highlight the need for urgent review of local police cell architecture to ensure an environment conducive to safe detention, with particular attention to reducing potential points of suspension for hangings. Further, the healthcare needs of detainees must be prioritised through effective training of police personnel with regard to the assessment and management of ill detainees, particularly those intoxicated at the time of arrest.

Background: Violence against women (VAW) is the most pervasive human rights abuse and a global health threat. The most extreme forms of physical and sexual violence are the intentional killing of a woman (femicide) and rape, or the combination of both in the form of r ape homicide, preferably termed 'sexual homicide' in this study. Motivation: Martin's research in 1999 reported a rape homicide incidence rate of 12.3/1000 female rapes reported to the police in Cape Town while the National study performed by Abrahams et al in 1999 reported an incidence rate of 10.9/1000 female rapes reported to the police in South Africa (SA). These high incidence rates, definitional problems, methodological limitations, changes in the law, and inconsistent management of suspected sexual homicides motivated the author to undertake this follow - up study. Objectives: To describe the epidemiology and pathology of femicides in Cape Town and thereby identify risk factors, magnitude and criteria for suspected sexual homicides. Design and Methodology : This is a retrospective descriptive study. Data was collected from autopsy reports of female bodies admitted at Salt River Forensic Pathology Laboratory in Cape Town from the years 2000 to 2009. A 10 - year period improves the sample size and the validity of the results. Limitations : Time constraints led to inadequate information on perpetrators of femicides and therefore a report on intimate femicide is limited in this study. Main findings and Discussion: Results showed an average femicide incidence rate of 12.4/100,000 female population in Cape Town Western Metropole which is half the South African national incidence for 1999, equates to the 2009 national rate and is almost five times the global average. Sexual homicide was suspected in 19.9% of all femicides, slightly higher than the 16.3% previously reported by Martin for Cape Town. The median age of victims was 32 years. Most femicide victims died from gunshot injuries (35.2%) followed by those who were stabbed (29.6%), while the majority (35.7 %) of victims of suspected sexual homicide died from asphyxial deaths, including strangulation. Taking specimens for the Sexual Assault Evidence Collection Kit correlated significantly with genital (77.7%) and anal injuries (64.5%), and 41% of femicide victims had alcohol levels above 0.05g%. Conclusion: The incidence of femicide and sexual homicide in Cape Town is higher than previously reported. Gun violence and alcohol abuse are persistent problems. Recommendations : Findings should be used to motivate for intersectoral collaboration in the form of female homicidal death review (FHDR) teams. These teams should aim to develop standardised guidelines for the forensic management, prosecution, prevention and monitoring strategies for femicides and sexual homicides in South Africa.

Post mortem imaging (PMI) is increasingly being adopted as an alternative to invasive autopsies in forensic pathology. PMI can be used as a sole technique or adjunct to an autopsy. The Lodox Xmplar-dr is an X-ray imaging system that has been adopted for use in PMI. The purpose of this study was to evaluate the perceived usability of this imaging system by focusing on the satisfaction of forensic pathologists in use of the system. Assessment of satisfaction was guided by the subjective satisfaction characteristics of likability, pleasure, comfort and trust. Incorporation of user needs into updated system designs may lead to greater perceived ease of use, acceptance and adoption, resulting in increased device utilisation. The study location was the Lodox Xmplar-dr installation site at the Salt River Forensic Laboratory, Cape Town. Five forensic pathologists were observed using the Xmplar-dr system and four were interviewed on their experience using the system. A qualitative research design which used thematic analysis with the aid of NVIVO11 qualitative data analysis software was used to extract key usability and satisfaction themes emerging from the data, to show the extent of user satisfaction. Two key themes emerged. These were categorised as forensic pathologist-related, which focused on the hedonistic and subjective aspects of their satisfaction with the system, and systemrelated, which centred on the satisfaction users derived from the system’s ability to meet their pragmatic and objective expectations in their use of the system. In general, the forensic pathologists were satisfied with the Xmplar-dr system and it exceeded their expectations. Pleasure was derived from the ability of the system to increase work throughput by reducing the need to perform a dissectional post-mortem unless it was deemed absolutely necessary, i.e. when cause of death could not be determined from the X-ray images generated by the system. Participants felt that the system was an indispensable device when performing post mortems. Likability came from the ease of learning to use the basic functions of the system; the study participants stated that the system aided them in determining cause of death and saved time, in line with the definition of the likability characteristic that is centred on the extent to which a user is satisfied with perceived achievements of pragmatic goals. Trust was derived from participants’ views that the system worked as intended, although there could be improvements in terms of robustness, reliability and the imaging system`s support services. Image manipulation on the human-computer interface (HCI) and image representation were concerns highlighted. Most functions could be performed through the system’s HCI rather than by manipulation of the body being examined; this increased the physical comfort satisfaction characteristic. The need for manual placement of bodies on the system`s table by assistants and the associated health consequences were however raised as a concern that diminished the comfort-in-use characteristic of satisfaction. Understanding the user experience of the forensic pathologists who use the Lodox Xmplar-dr system to perform post mortems enabled the identification of areas for improvement. The improvements may increase user satisfaction resulting in better utilisation of the imaging system. The insights gained may be useful for the design of other imaging systems used in forensic pathology.

Introduction: In South Africa (SA), the forensic sector faces significant challenges including how to meet increasing public expectations for high quality, reliable and valid scientific and medico legal results, whilst dealing with increasing caseloads and restricted resources in a developing country. Internationally, lean six-sigma and/or business-based frameworks have been developed to define, measure and analyse the efficiency, effectiveness and output of forensic laboratories, so as to assess performance to meet such challenges. Aim: This pilot project aimed to investigate the effectiveness and efficiency of forensic pathology practice at Salt River Mortuary (SRM) by applying lean six sigma principles (define, measure, analyse and improve) and FORESIGHT metric analyses to retrospective case and staffing data, as well as prospective observational analyses. Methods: A retrospective analysis of cases admitted to Salt River Mortuary in 2015 was conducted to define and measure a snapshot of forensic pathology practice in Cape Town. In addition, observations of autopsy processes were conducted to identify bottlenecks in the system and provide suggestions for improvement. Results: An analysis of post-mortem report turn-around for 3567 cases admitted to SRM in 2015 showed that approximately 10% of cases were closed (cause of death was determined) on the day of the post-mortem, 65% within 14 days and 80% closed within a 30 day period. Certain requested ancillary investigations delayed the finalisation of cause of death; for example, only 8.33% of carbon monoxide testing and 30.31% of histological examinations were completed within the year. A process map outlining autopsy practices at SRM was generated through observational data, which also identified key bottlenecks in the process (e.g.: equipment issues). Preliminary financial data suggested that it cost on average R16 155.03 per case. Staff data demonstrated a lack of pathologists compared to other staff categories and high case load requirements. Discussion: This pilot study investigates the utilization of metrics and strategic frameworks to assess forensic pathology processes in Cape Town. This study offers a cross-sectional insight into financial performance, efficiency and effectiveness of post-mortem investigations at SRM, highlighting bottlenecks and inefficiencies, and providing suggestions for improvement. The findings will assist in forming a basis for future work into the development of a framework for monitoring performance and progress, and developing benchmark standards for the death investigation system in South Africa

Forensic science is growing rapidly in the world today. During the past decade, medico-legal investigations have been highly expanded to include all areas of forensic science. The present study investigated three important aspects of forensic biology. First, this present project investigated, a total number of 5,703 reported medico-legal cases diagnosed as un-natural deaths by The Forensic Department in Kuwait, during the year 2003-2009. The results show that accidental, homicidal and suicidal deaths accounted for 86%, 8% and 6%, respectively. The results showed that most people who died of unnatural deaths were more predominant in the age group 20-29 years (third decade). Road Traffic Accidents accounted for 65% of accidental deaths, and 4% out of them were related to alcohol consumption. The results also illustrated that the highest rate of homicide in Kuwait was due to stab wound injuries (38%) compared to the lower rate of homicidal pattern for infanticides (3%). Similarly, the study showed that the most common method of suicide in Kuwait was death by hanging and this accounted for (60%). This study further demonstrated the effectiveness of virtual autopsy technique as a new tool in forensic investigations to determine various un-natural death causes. A total of thirty (30) male forensic cadavers were employed in this project. The cases were RTA (11), firearm injuries (10), drowning (4), head injuries (3) and lastly strangulation (2). All these cases were compared to the findings of traditional autopsy. The results show similar findings for virtopsy compared to traditional autopsy. This study clearly revealed that virtopsy could be an effective alternative in certain situation, being noninvasive and rapid. The present project also investigated 28 samples of human blood, saliva or semen. The experiments were done at four different temperatures (55°C, 37°C, 24°C and 4°C) and four different humidity ranges (41%, 55%, 58% and 61%), respectively. The results showed that, DNA quantity in blood, saliva and semen samples remained more or less the same at temperatures of 4°C, 24°C and 37°C compared to values for day one with all other days. In contrast, when the temperature was raised to 55 °C, the DNA started to degrade with time until it reached zero at day 12 for saliva and day 15 for blood, but not for semen. The results clearly show that DNA in saliva and blood samples is extremely sensitive to heat compared to semen. In conclusion, the study reveals the different causes of unnatural deaths, the value of virtual autopsy and the need for early DNA measurement in Kuwait.

Unidentified bodies in the forensic setting constitute a global problem. Though this should be of great concern to many governments, very little data on the extent of this phenomenon is available in international literature and few countries require that statistics on the number of unidentified deceased be kept. To determine the extent of this phenomenon in South Africa, a study into the number of unidentified deceased at the Pretoria Medico-Legal Laboratory and their demographic profile was undertaken. The study has indicated that between 7% and 10% of bodies remain unidentified at the Medico-Legal Laboratory in Pretoria. Publications further indicate that a total of 846 bodies remained unidentified at Medico-Legal Laboratories in Gauteng for the period January 2010 to August 2010. This number is very high when compared to international literature. Of great concern is the fact that these statistics do not include the cases in which persons die in hospital facilities from natural causes without an identity, which are not referred to the Forensic Pathology Service for investigation. The true extent of the problem may thus be far greater than imagined. Determining the true extent of this phenomenon in South Africa is therefore important, as these unidentified bodies have many social and economic consequences. Not only are families unaware that their loved ones have passed away, but they are also unable to bury and mourn them. Unidentified bodies at Medico-Legal Laboratory facilities also impacts on the service delivery capability of the government departments involved in the investigation of such cases. The drafting of additional legislation for the management of unidentified bodies is therefore required. A need to establish and enforce specific protocols to be followed in the event of unidentified bodies has also been identified. The creation of a National Unidentified Decedent website and DNA database is recommended as they will greatly assist in reducing the number of unidentified bodies throughout South Africa. It is however only through coordinated efforts and interdepartmental cooperation that these proposals will be successful. AFRIKAANS : Ongeïdentifiseerde liggame in die forensiese omgewing is ‘n wêreldwye probleem. Alhoewel dit ‘n bron van kommer vir meeste regerings behoort te wees, is baie min data oor die omvang van hierdie verskynsel beskikbaar in die internationale literatuur, met min lande wat vereis dat amptelike statistieke oor onbekende oorledenes versamel word. Om die omvang van hierdie verskynsel in Suid Afrika te bepaal, is ‘n studie na die aantal onbekende liggame by die Regsgeneeskundige Laboratorium in Pretoria en hul demografies profiel onderneem . Die studie het getoon dat tussen 7% en 10% van alle liggame wat deur die Regsgeneeskundige Laboratorium in Pretoria opgeneem word, onuitgeken bly. Publikasies dui ook aan dat 846 liggame ongeïdentifiseerd was by Regsgeneeskundige Laboratoriums vir die tydperk Januarie 2010 to Augustus 2010. Hierdie getal is aansienlik hoër as díe wat in die internasionale literatuur gesien word. ‘n Groot bron van kommer is die feit dat hierdie statistieke nie gevalle insluit waar die oorledene in ‘n hospitaal gesterf het as gevolg van natuurlike oorsake, sonder dat hul identiteit bekend is. Die ware omvang van die problem kan dus veel groter as geskat wees. Die bepaling van die omvang van hierdie verskynsel in Suid Afrika is belangrik, omdat ongeïdentifiseerde liggame beide sosiale en ekonomiese gevolge het. Nie net is families onbewus daarvan dat hul geliefdes gesterf het nie, maar kry hul ook nie die geleentheid om hul geliefdes te begrawe en oor hul afsterwe te rou nie. Ongeïdentifiseerde liggame by Regsgeneeskundige Laboratoriums het ook ‘n invloed op die diensleweringskapasiteit van die verskeie staatsdepartemente wat betrokke is by die ondersoek van sulke gevalle. Die opstel van addisionele wetgewing wat die bestuur van ongeïdentifiseerde liggame reguleer is dus nodig. Die behoefte aan spesifieke protokolle vir die hantering van sulke gevalle is ook geïdentifiseer. Daar word verder aangeraai dat ‘n Nasionale Onuitgekende Liggaam webwerf en DNS databasis geskep word in ‘n poging om die aantal ongeïdentifiseerde liggame in Suid Afrika te verminder. Dit is egter slegs deur middel van gekoördineerde pogings en interdepartmentele samewerking wat hierdie voorstelle sukses sal behaal. Copyright<br>Dissertation (MSc)--University of Pretoria, 2011.<br>Forensic Medicine<br>unrestricted

In forensic pathology is of fundamental importance the diagnosis of time of death. If such an investigation is often complex with a well-preserved corpse, it is even more difficult in the case of a fetus dead in-utero affected by macerative post-mortal phenomena. The criteria currently available in pathological and obstetrical literature date back to the '60s and '70s and focus on macro- and microscopic characteristics of fetus and placenta almost never scientifically validated. They can turn to be inappropriate or useless in clinical practice, where the medical examiner often experience a complete mismatch between morphological and clinical data. The present study therefore arises from the necessity to update these thanatological criteria. The actual validity of thanatological criteria proposed in literature has been assessed through a retrospective review of a selected population of 55 fetuses spontaneously dead in utero. The analysis was conducted for each case by applying the criteria previously analyzed in the literature (photographic documentation; histological evaluation of organs and placenta). It was then verified the actual correspondence between the morphological data, clinical data and estimated time of death based on known criteria, identifying the main problems and the possible influence of intrinsic or extrinsic factors. Thereafter it has been developed an experimental prospective phase, focus the to the most critical phases of death-birth time (death within 12-24 hours). A TEM analysis was then conducted on skin and muscle samples from voluntary interruptions of pregnancy underwent an experimental macerative protocol, in order to identify possible stages of cell organelles degeneration positively correlated to the time of death. The main novelty emerged from the TEM study was a progressive vacuolization of cell structures.

Dialectical Behaviour Therapy (DBT) is a type of “talking therapy”, developed from cognitive behavioural therapy; it has been adapted to help people who experience emotions, often females diagnosed with Borderline Personality Disorder (BPD). With its growth in popularity, DBT has been adapted and used with other populations - not just adult females with BPD – to include forensic populations (i.e. people who are in contact with services due to criminal behaviour) and adolescent populations. This thesis contains a systematic literature review investigating the use of DBT in Forensic Services and an empirical study that utilised a qualitative design to explore adolescents and parents’ experiences of DBT.

The identification and management of individuals with a perceived high risk of future violence is of great priority for mental health professionals and the criminal justice system. The overall aim of this thesis is to examine the validity of the assessment and treatment of violence in forensic populations with a specific focus on the contribution of dynamic risk factors in predicting recidivism. Chapter One presents a conceptual literature review which provides an overview of the development of violence risk assessment approaches, and examines the predictive validity of dynamic factors in predicting violent recidivism. The review demonstrates the ability of dynamic risk factors in predicting future community and institutional violence. Chapter Two provides a critique of the HCR-20 Risk Assessment Scheme and highlights that despite some apparent shortcomings of the HCR-20, the instrument remains the best known and best researched, empirically based guide to violence risk assessment. In Chapter Three a prospective research study examines the predictive validity of the HCR-20 Risk Assessment Scheme in a UK sample of patients under the care of a community forensic mental health service. The study aimed to examine the ability of the HCR-20 total scores and individual sub scale scores to predict future acts of violence. The study demonstrates that the historical factors of the HCR-20 are highly predictive of future re-offending within this population and also highlights the importance of the clinical scale in predicting future violent acts. This work adds to current knowledge and understanding of the risk assessment and management process in UK samples. A case study is presented in chapter Four which evaluates the impact of the ETS programme on the cognitive deficits identified in a violent adult male offender (client A) serving a sentence at HMP Birmingham. By Mariam Azam-Zanganeh.

This thesis aims to provide a detailed understanding of treatment engagement amongst forensic populations. Following an introduction outlining the current theoretical thinking in the area, Chapter 2 presents a systematic literature review exploring reasons for completion/non-completion of treatment from an offender's perspective. Consensus regarding reasons for treatment completion/non-completion was found. Reasons provided supported the majority of factors outlined in the Multifactor Offender Readiness Model (MORM), a model of treatment readiness. Research in this area was limited; no papers exploring adolescents' perspectives were identified. Implications for practice are discussed and areas for future research highlighted. Furthering existing research, Chapter 3 presents a mixed methods research study exploring the reasons why young people, detained in a secure hospital setting choose to attend/not attend sessions. Using thematic analysis several themes were identified. Factors relating to the young person, treatment and the organisation were identified, supporting the MORM. Chapter 4 presents a critical review of the Corrections Victoria Treatment Readiness Questionnaire (CVTRQ), a measure of treatment readiness developed using the internal factors of the MORM. This chapter explores the overall development and psychometric properties of the CVTRQ, highlighting its strengths and limitations. An overall discussion of the work presented is provided in Chapter 5.

Thesis (MMed (Pathology. Forensic Medicine))--University of Stellenbosch, 2010.<br>Bibliography<br>ENGLISH ABSTRACT: Background - The workload of the forensic pathologist and Forensic Pathology Services staff is increased by the referral of potentially unnecessary natural cases to the Forensic Pathology Services. The primary aims of the medico-legal autopsy are limited to establishing a cause of death in presumed unnatural cases, and to exclude criminality or negligence. Objective – To determine the final outcomes of forensic post-mortem examinations in “sudden and unexpected” adult deaths over a 5 year period. Methods - An observational, retrospective, descriptive study was conducted. ”Sudden and unexpected” adult deaths referred to Tygerberg Forensic Pathology Services between 1 January 2001 and 31 December 2005 were reviewed. Data was collected from the autopsy reports, contemporaneous notes and hospital records. Findings – A total of 816 adult cases of sudden and unexpected death were referred to Tygerberg Forensic Pathology Services over the 5 year period studied. Complete autopsies had been performed in 74% (601/816) of cases. The presumed manner of death was natural in 79 % of cases, and an increase in the number of natural cases autopsied per year was noted over the 5-year study period. Diseases of the cardiovascular, respiratory and central nervous systems were responsible for the majority of natural deaths. Infectious diseases were responsible for most deaths in the youngest age group studied (18-29 years). Acute alcohol poisoning was responsible for the deaths of 35 (6%) cases, with an average blood alcohol concentration of 0.38g/100mL in these cases. Eight deaths were drug-/substance related. Waiting times for blood alcohol and toxicology results increased over the 5-year study period. No cause of death was found in 10.6% of cases. Conclusions -The questionnaire and interviewing structure could possibly be improved in order to obtain better pre-autopsy information and to reduce the number of “unnecessary” medicolegal autopsies, thereby reducing the burden of cost on the Forensic Pathology Services.<br>AFRIKAANSE OPSOMMING: Agtergrond – Die werkslading van die forensiese patoloog en ander personeel van die Forensiese Patologie Dienste word vermeerder deur die verwysing van moontlik onnodige natuurlike gevalle na die Forensiese Patologie Dienste. Die primêre doelwitte van die medies-geregtelike nadoodse ondersoek is beperk tot die bepaling van ‘n oorsaak van dood in vermoedelik onnatuurlike gevalle, en om nalatigheid of kriminele aksies uit te skakel. Doelwit – Om die finale uitkomste van medies-geregtelike nadoodse ondersoeke in “skielike en onverwagte” volwasse sterftes oor ‘n 5-jaar tydperk te bepaal. Metodes – ‘n Observasionele, retrospektiewe, beskrywende studie is uitgevoer. “Skielike en onverwagte” volwasse sterftes wat verwys is na Tygerberg Forensiese Patologie Dienste vanaf 1 Januarie 2001 tot 31 Desember 2005 is hersien. Inligting is versamel vanaf die nadoodse ondersoekverslae, kontemporêre notas en hospitaalnotas. Bevindinge – Agthonderd en sestien volwasse gevalle van skielike en onverwagte sterftes is oor die 5-jaar periode verwys na Tygerberg Forensiese Patologie Dienste. Volledige lykskouings is uitgevoer in 74% (601/816) van die gevalle. Die vermoedelike wyse van die sterfte was natuurlik in 79.04% en ‘n toename in die aantal natuurlike gevalle wat lykskouings ondergaan het, is waargeneem oor die 5-jaar studie tydperk. Siektes van die kardiovaskulêre, respiratoriese en sentrale senuweestelsel was verantwoordelik vir die meerderheid natuurlike sterftes. Infektiewe toestande was verantwoordelik vir die meeste sterftes in die jongste ouderdomsgroep (18-29 jaar) wat bestudeer is. Akute alkoholvergiftiging was verantwoordelik vir die sterftes van 35 (6%) gevalle, met ‘n gemiddelde bloed-alkohol-konsentrasie van 0.38g/100mL in hierdie gevalle. Agt sterftes was dwelm-/middelverwant. Die wagtyd vir bloed-alkohol en toksikologie resultate het vermeerder oof die 5-jaar studie tydperk. Die oorsaak van dood was nie gevind in 10.6% van gevalle. Afleidings – Die vraelys en onderhoud-struktuur kan moontlik verbeter word om sodoende beter inligting te verkry voor die uitvoering van ‘n lykskouing, en om die aantal “onnodige” medies-geregtelike nadoodse ondersoeke te verminder, en sodoende die kostedruk te verminder op die Forensiese Patologie Dienste.

Thesis (M.S.)--Boston University<br>The following thesis proposes the question if current scientific data supports the hypothesis that an acute myocardial infarction, not identified by gross symptoms, can be visualized by using apoptotic signaling biomarkers as a diagnostic tool to complement a post-mortem autopsy. The biochemistry and mechanisms of irreversible cellular death is presented and supported through published experimental, clinical and case studies. Furthermore, the aforesaid biomarkers have been observed in the cardiac myocyte in elevated levels associated with hypoxic ischemia. In addition, the physical characteristic of DNA fragmentation is addressed to visualize apoptotic injury due to hypoxic ischemic conditions. Although the quality of evidence lacked published data to suggest one immunochemical staining method positively identifies a myocardial infarction, there is adequate data to suggest that a combination of staining methods can be utilized as a tool to positively identify and diagnose an acute myocardial infarction.

In modern society the medico-legal investigation of death is a prerequisite for the administration of justice and for the betterment of public health. These investigations require a high level of skill, professionalism and ethics and have far reaching effects. South Africa’s high level of unnatural deaths, combined with limited human and fiscal resources, specifically a scarcity in practicing Forensic Medical Practitioners, a lack of adequate training of Forensic Officers and members of the South African Police Service, discrepancies in available statistics and a lack of accreditation and quality control, to name a few, leave the South African medico-legal system overburdened. Death investigation needs to evolve and improve constantly and improvements in death investigation need to occur across a wide spectrum of parameters. In the United States of America, to combat systemic issues such as those experienced in South Africa, Death Investigators have been introduced in a supportive capacity and as an extension of services rendered by Forensic Medical Practitioners. These investigators, who are not medical practitioners but may have some level of training or vocational experience within the medical or investigative field, attend and help to analyse death scenes, collect relevant ante-mortem data, assist during autopsies, expedite special investigations, liaise with other stakeholders and provide testimony if warranted. Multiple benefits are associated with the introduction of these death investigators, with the collection of relevant (pre-autopsy) information which will assist and direct the Forensic Medical Practitioner probably being the most pertinent in the context of this research. The aim of this study was to assess the functionality and value of introducing such Death Investigators into forensic pathology service in South Africa. Specifically, this research focused on the nature and scope of information currently being provided to Forensic Medical Practitioners prior to conducting an autopsy and assessed whether the introduction of these investigators would improve the quality of pre-autopsy information. To determine this, participating Forensic Medical Practitioners were asked to evaluate the quality of information currently provided to them prior to conducting an autopsy and to evaluate the quality of information contained in a Death Investigator worksheet that was completed hypothetically for the same case, as an example of the type of information that would be collected by a Death Investigator. Additionally, the disposition of Forensic Medical Practitioners and external stakeholders to the proposed introduction of Death Investigators was assessed through a questionnaire process. Findings of this research showed that there is a significant deficit in the quality of pre-autopsy information being provided to Forensic Medical Practitioners at present. The current pre-autopsy information received an average information quality score of 21.4%. However, the Death Investigator worksheets received and average information quality score of 84.9% representing a marked improvement. Forensic Medical Practitioners had a favourable disposition to the proposed introduction of Death Investigators and agreed that Death Investigators would provide an improved knowledge and understanding of the circumstances and setting of the death, which in turn would , enhance their ability to strategise a post-mortem approach, to request appropriate special investigations and to better interpret their autopsy findings. Overall, the results of this research suggest that the introduction of Death Investigators would add value, specifically by improving the gathering of appropriate information and would be welcomed by Forensic Medical Practitioners. While this research was conducted in Pretoria, it was done on the premise that the poor-quality pre-autopsy information experienced in Pretoria, is probably, to a greater or lesser extent experienced in other medico-legal laboratories in South Africa. It is recommended, that a multi-centre audit of pre-autopsy information quality is undertaken to verify the results found at the Pretoria Medico-legal Laboratory. Furthermore, to facilitate the introduction of Death Investigators as a new professional category, it is recommended that a working group be convened to further interrogate the added-value potential of this introduction as well as to determine prerequisite educational requirements and acceptable recognised prior learning, and to develop guidelines and scope of practice documents. It is also recommended that should this introduction come to fruition, provision be made to accommodate such Death Investigators on a professional board affiliated with the Health Professions Council of South Africa, to guide training and qualification requirements, advise on best practice and professional standards against which Death Investigators can be held accountable.<br>Dissertation (MSc (Medical Criminalistic))--University of Pretoria, 2020.<br>Forensic Medicine<br>MSc (Medical Criminalistic)<br>Unrestricted

The identification of the sex and age-at-death of an individual is of primary importance in the analysis and description of adult human skeletal remains in both forensic and archaeological contexts. Many current methods of sex and age determination have been derived on a very small number of skeletal collections and critical evaluations of their reliability on material of different provenance have been few. The purpose of this investigation was to evaluate the utility of methods (a) in widespread use for age and sex estimation, or (b) even if not in widespread use but offering particular advantages and (c) derived during the course of this investigation with a view designed to improving accuracy of prediction and ease of application. Three European skeletal series of documented age and sex of different temporal origins were used for this evaluation. Only non-destructive tests were evaluated. For sex determination metric and non-metric observations from the innominate were tested, as it is generally considered the most dimorphic area of the adult skeleton. The discriminatory potential of long bone dimensions was also assessed since they tend to survive inhumation better than the innominate and may be the only skeletal material represented in fragmentary remains. Pubic symphyseal metamorphosis is probably the most frequently used method for age-at-death estimation and its utility as a predictor of chronological age was examined as was the degree of degenerative joint disease as evidenced from the long bones. A method was devised based on estimates of bone loss from radiographs and densitometric traces of the humerus. It provided the lowest standard error of estimate in age-at-death assessment. Many of the methods in current use proved less efficient in sex and age identification in the samples investigated than on the material on which they were derived. The reasons for this, and the implications for the reconstruction of biological identity from skeletal remains are discussed and recommendations for age and sex estimations on the innominate and long bones are made.

Drug abuse has always been a world problem. Recently people abuse both controlled and prescribed drugs. Opioids, cocaine, cannabis and amphetamines are the most widely abused drugs. The picture of the drug abuse problem in Scotland can be understood by an extensive study of drug prevalence and characteristics of drug use in the region. In drug-related deaths, post-mortem analysis, which includes autopsy and collecting samples for histological and toxicological analysis, is necessary to be carried out to investigate whether any drug has contributed to the cause of death. The samples which are commonly collected for toxicological analysis are blood and urine. However, when those fluids are not available, body tissues may be taken as alternative samples, such as liver and skeletal muscle. In this case, it is necessary to understand how drugs move and diffuse to these tissues after death. This phenomenon, which is known as post-mortem redistribution, may cause difficulties in the interpretation of post-mortem drug concentrations. Several studies have tried to investigate post- mortem redistribution including how drugs diffuse in the body after death. However, post-mortem redistribution is still not completely understood. This study proceeded by interrogating post-mortem data within the period of 2011-2016 held by Forensic Medicine and Science (FMS), University of Glasgow to review trends of drug-related death in the West of Scotland in which amphetamine-type stimulants (ATS), cocaine and opioids were detected. Opioids were most commonly detected (81.9%) in drug-related deaths in the West of Scotland, followed by cocaine (21.6%) and ATS (9.4%). The interrogation of post- mortem data within the period of 2007-2016 was also carried out to understand certain pathological conditions which are caused by drug abuse. From the results, it is clear that in the West of Scotland people tend to abuse multiple drugs. This trend may apply in the other part of the country and around the world. It is also clear that, even though methadone was prescribed to assist users to stop from drug addiction, especially heroin, many methadone users still abuse other drugs, as methadone was found in most of the cases in addition to other drugs. For this reason, it is important to investigate the results of drug addiction therapy and educate potential users. Subsequently, methods were adapted for analysing liver and muscle samples from the FMS in-house methods for analysing ATS and basic drugs in autopsy blood and validated according to the standard practices for method validation in forensic toxicology (SWGTOX, May 2013). All ATS drugs (amphetamine, methamphetamine, MDA, PMA, PMMA, MDMA and MDEA) and basic drugs (amitriptyline, citalopram, methadone, mirtazapine, sertraline and tramadol) gave acceptable bias, precision, linearity, recovery and stability for analysing liver and muscle samples. An experimental model for drug diffusion in tissues was studied to simulate and understand drug diffusion in humans. The diffusion rate that was used in this model is in accordance with the volume of distribution of each drug. This model is easy and simple to be carried out in any small laboratory. Blood, liver and muscle samples were analysed from 10 cases collected during the period from August 2016 to April 2017 after the next of kin signed the informed consent forms. Four basic drugs (amitriptyline, methadone, mirtazapine and sertraline) were found in 9 cases and analysed to investigate the ratios between blood, muscle, right liver and left liver. The ratios of drug concentrations of muscle:blood, left liver:right liver were found to be lower than 2. As a result, drug concentrations in muscle can be reliable for toxicological interpretation when blood is not available. The ratio of drug concentration in liver and blood has been suggested as a marker of post-mortem redistribution(1) and this study has shown that the ratio of drug concentration in liver and muscle can also be diagnostic in cases where blood is not available.

Thesis (MScMedSc)--Stellenbosch University, 2014.<br>ENGLISH ABSTRACT: Background: Sudden infant death syndrome (SIDS) is considered the second most frequent cause of infant mortality worldwide. Research specifically pertaining to SIDS is limited in the South African setting. Identifiable causes for sudden infant death remain challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral infections could contribute to some sudden unexpected death in infancy (SUDI) cases, especially since a multitude of respiratory viruses have been detected from autopsy specimens. The specific contribution of viruses in the events preceding death, including the subsequent involvement of the immature immune response in infants, still warrants deciphering. Infancy is characterised by marked vulnerability to infections due to immaturities of their immune systems that may only resolve as infants grow older when these sudden deaths rarely still occur. In South Africa there is a lack of a standard protocol for investigations into the causes of SIDS, including the lack of standard guidelines as to which specimens should be taken, which viruses should be investigated and which laboratory assays should be utilised. Objectives: In this prospective descriptive study we aimed to investigate the prevalence of viruses in SUDI and SIDS cases at Tygerberg Forensic Pathology Service (FPS) Mortuary over a one year period. The primary aim was to explore possible respiratory viral infections in SUDI and SIDS cases and to determine the usefulness of molecular techniques to detect viruses from SUDI cases. To determine the significance of viruses, we assessed signs of infection from lung histology. The secondary objectives included collecting demographic data to investigate possible risk factors for SUDI and to look for possible similarities between viruses confirmed in living hospitalised infants at Tygerberg, during the study period compared to viruses detected from SUDI cases. Methods: Between May 2012 and May 2013 samples were collected from 148 SUDI cases presenting at Tygerberg FPS Mortuary. As part of the mandatory routine investigations into SUDI, shell vial culture (SVC) results were collected from lung and liver tissue specimens and bacterial culture results were collected from left and right lung and heart swabs at autopsy. To investigate the possibility of viruses implicated in some of the infant deaths we used the Seeplex® RV15 Ace detection multiplex polymerase chain reaction (PCR) assay to establish the frequency of 13 ribonucleic acid (RNA) respiratory viruses (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus) from RNA extracted from tracheal and lower left and right lung lobe swabs. Tissue from the lower left and right lung lobes were also assessed for histology signs of infection. Results: During our study we confirmed multiple known demographic risk factors for SIDS, such as the age peak around 1-3 months, the male predominance, bed-sharing, sleeping in the prone position, heavy wrapping in warm blankets, prenatal smoke exposure, and socio-economic factors. With the Seeplex® RV15 Ace detection assay between one and three viruses were detected in 59.5% (88/148) of cases. Of the 88 cases that had viruses detected, 75% (66/88) had one virus and 25% (22/88) had co-detections of two to three viruses. The most common viruses detected were HRV in 77% (68/88) of cases, RSV in 18% (16/88) of cases and HCoV in 14% (12/88) of cases. Many of the viruses we detected from our cases are included in the SVC test that forms part of the medico-legal laboratory investigation for all SUDI cases at Tygerberg FPS Mortuary. SVCs were positive in 9.5% (14/148) of all cases only. We showed that the SVC method is potentially missing most of the 13 respiratory viruses we investigated that could contribute to death in some of the SUDI cases. Conclusion: In some cases that had a Cause of Death Classification - SIDS, the PCR viruses detected cannot be ignored, especially when it is supported by histological evidence of infection. We thus propose that the use of PCR could alter a Cause of Death Classification from SIDS to Infection in some of these cases. Further research is needed to determine the significance of detecting viruses from SUDI cases wherein no significant histological evidence of infection was observed. This questions whether PCR may be too sensitive and is detecting past and latent viral infections that do not play any role in the cause of death. The histological picture also requires further characterisation to determine if it accurately predicts infections or lethal events and can truly support virology findings, especially in young infants whose immune systems are still maturing. Without determining the true prevalence of viruses in SUDI cases and the viral-specific immune response, the contribution of virus-specific infections to this syndrome will remain largely undetermined.<br>AFRIKAANSE OPSOMMING: Agtergrond: Wiegiedood (“SIDS/SUDI”) word beskou as die tweede mees algemene oorsaak van sterftes in kinders jonger as een jaar wêreldwyd. Toegewyde SIDS-spesifieke navorsing in die Suid-Afrikaanse samelewing is beperk. Dit bly steeds „n uitdaging om oorsake te probeer identifiseer vir hierdie onverwagte sterftes in kinders (SUDI) ten spyte van volledige medies-geregtelike ondersoeke, insluitende die lykskouing, ondersoek van die doodstoneel en aanvullende ondersoeke. Virusinfeksies kan aansienlik bydra tot sommige onverwagte sterftes in kinders, aangesien verskeie respiratoriese virusse alreeds aangetoon is in monsters verkry tydens outopsies. Die spesifieke rol wat virusse speel in die prosesse wat die dood voorafgaan, asook die bydraende rol van „n onder-ontwikkelde immuunrespons in babas, regverdig verdere ondersoek. Die eerste jaar van lewe word gekenmerk deur verhoogde vatbaarheid vir infeksies weens die ontwikkelende immuunstelsels soos wat babas ouer word, en die voorkoms van SUDI neem stelselmatig af met „n toename in ouderdom. In Suid-Afrika bestaan daar tans geen standaard protokol vir die ondersoek van wiegiedood nie en daar is ook nie standaard riglyne oor die tipe monsters wat geneem moet word, watter virusse ondersoek moet word en watter laboratorium toetse uitgevoer moet word nie. Doelstellings: In hierdie prospektiewe beskrywende studie is gepoog om die virusse wat in gevalle van wiegiedood of SUDI voorkom te ondersoek. Die studie is uitgevoer by die Tygerberg Geregtelike Patologie Dienste lykshuis oor 'n tydperk van een jaar. Molekulêre tegnieke om virusse aan te toon in hierdie gevalle is gebruik om spesifieke virusinfeksies te ondersoek. Die resultate is met histologiese tekens van infeksie in longweefsel gekorreleer. Demografiese data is verder versamel om moontlike risikofaktore vir wiegiedood te ondersoek. Dit is verder vergelyk met virusse wat met dieselfde diagnostiese tegnieke in babas geïdentifiseer is wat tydens die studieperiode in Tygerberg Hospitaal opgeneem was met lugweginfeksies. Metodes: Monsters van 148 SUDI gevalle wat by die Tygerberg lykshuis opgeneem is, is versamel tussen Mei 2012 en Mei 2013. As deel van die roetine ondersoeke in SUDI gevalle, was selkultuur resultate verkry van long en lewer weefsel, asook bakteriële kulture van deppers wat van beide longe en hart geneem was tydens die lykskouings. „n Seeplex® RV15 Ace polimerase kettingreaksie (PKR) toets is gebruik om die teenwoordigheid van virusse te ondersoek wat moontlik by die babasterftes betrokke kon wees. Trageale- en longdeppers wat tydens die lykskouings versamel was, was getoets vir 13 ribonukleïensure (RNS) respiratoriese virusse (influenza A and B, human parainfluenza 1-4, human coronavirus [OC43, 229E/NL63], human rhinovirus A, B and C, respiratory syncytial virus A and B, human enterovirus and human metapneumovirus). Resultate: Ons studie het verskeie bekende demografiese risikofaktore vir SUDI bevestig, byvoorbeeld „n ouderdomspiek tussen een en drie maande ouderdom, manlike predominansie, deel van „n bed met ander persone, slaap posisie op die maag, styf toedraai in warm komberse, blootstelling aan sigaretrook voor geboorte en sosio-ekonomiese faktore. Die Seeplex® RV15 Ace toets het tussen een en drie virusse geïdentifiseer in 59.5% (88/148) van die gevalle. Uit die 88 gevalle waarin virusse opgespoor was, was selgs een virus in 75% (66/88) van gevalle gevind en twee en drie virusse in 25% (22/88). Die mees algemene virusse was HRV in 77% (68/88) van gevalle, RSV in 18% (16/88) van gevalle en HCoV in 14% (12/88) van gevalle. Baie van die virusse wat tydens hierdie studie ondersoek was, was ingesluit in die roetine selkultuur toets wat deel vorm van die standaard medies-geregtelike laboratoriumondersoeke in alle SUDI gevalle by die Tygerberg lykshuis, alhoewel die selkulture positief was in slegs 9.5% (14/148) van gevalle. Ons het gevind dat baie respiratoriese virusse potensieel gemisdiagnoseer word wat „n rol kon speel in of bydra tot die dood van sommige SUDI gevalle. Gevolgtrekking: In sommige gevalle waarin SIDS geklassifiseer is as die oorsaak van dood, kan die virusse wat met PKR toetse opgespoor is nie geïgnoreer word nie, veral waar die bevinding ondersteun word deur histologiese bewyse van infeksie. Ons stel dus voor dat die gebruik van PKR toetse die oorsaak van dood klassifikasie kan verander van SIDS na Infeksie in sommige van hierdie gevalle. Verdere navorsing is nodig om die waarde van gelyktydige opsporing van virusse in SUDI gevalle te bepaal wanneer daar geen noemenswaardige histologiese bewyse van infeksie gevind word nie. Dit bevraagteken of die PKR toets dalk te sensitief is en gevolglik vorige en latente virusinfeksies identifiseer wat nie noodwendig 'n rol in die oorsaak van dood speel nie. Die diagnostiese en kliniese waarde van die histologiese beeld in terme van die rol van virusinfeksies as bydraende oorsaak van dood moet verder ondersoek word, veral in jong kinders wie se immuunstelsels nog nie volledig ontwikkel is nie. Indien die werklike voorkoms van virusse in SUDI gevalle en die virus-spesifieke immuunrespons nie bepaal word nie, sal die rol van virus-spesifieke infeksies in hierdie sindroom grootliks onbekend bly.<br>Harry Crossley Foundation<br>Poliomyelitis Research Foundation (PRF)<br>National Health Laboratory Services Research Trust

Lo scopo del lavoro di tesi è stato quello di valutare l'affidabilità dei metodi entomologici per la stima del PMI, in comparazione con altri approcci investigativi proposti di recente quali: il decadimento delle proteine muscolari unitamente a sistemi di punteggio assegnati alle diverse modificazioni post-mortali. Nella prima parte il progetto di ricerca si è incentrato su alcune fasi critiche dell'indagine entomologica (repertazione, preparazione e conservazione del campione entomologico) per poi proseguire con una indagine in campo aperto con modello animale: • un primo studio ha valutato l’efficacia delle due principali metodiche di repertazione del campione entomologico utilizzato per le stime tanatocronologiche: bollitura degli insetti e loro conservazione in soluzione alcolica vs. conservazione in etanolo senza preventiva bollitura. Tali metodi sono stati testati su due specie di ditteri cadaverici: la Lucilia sericata e la Calliphora vicina. I risultati hanno evidenziato per entrambe le specie che la stima del PMI non è alterata se le misurazioni sono condotte entro una settimana anche in campioni direttamente conservati in etanolo ≥70%, senza preventiva bollitura, privilegiando concentrazioni di etanolo più elevate (es. 96%). Successivamente sono stati confrontati tre diversi metodi di misurazione per la stima della lunghezza larvale di C. vicina. Il confronto tra metodiche ha evidenziato come sia affidabile la misurazione delle larve effettuata mediante un semplice strumento quale un micrometro geometrico; • il secondo studio è stato diretto alla valutazione dei metodi più comuni per la conservazione degli esemplari entomologici nelle 24h che precedono il loro trasferimento in laboratorio. Anche in questo caso, sono state testate due specie di ditteri cadaverici: la L. sericata e la C. vicina. Tutti gli stadi larvali (L1, L2 ed L3) sono stati posti in contenitori privi di un substrato di crescita, con e senza ossigeno per 24h. E’ stato poi esaminato, ogni 24h, il loro grado di sviluppo e il tasso di mortalità (MR). I risultati sono posti a confronto con un gruppo di controllo in cui le larve sono state invece allevate in presenza sia di cibo che di ossigeno ad una temperatura costante di 25°C. L’esito di questo studio ha evidenziato per tutte le larve L3 (72h dopo la schiusa) un alto tasso di mortalità fino al 100%. Questo risultato consente, sulla base di evidenze sperimentali, di raccomandare per la repertazione degli esemplari immaturi di ditteri cadaverici la loro temporanea conservazione, prima del trasferimento in laboratorio, in contenitori aereati al fine di consentire un elevato tasso di sopravvivenza delle larve poi utilizzate nel calcolo del PMI; • un terzo studio è stato caratterizzato da una sperimentazione in “campo aperto” su modello animale. Otto carcasse di maiale di differenti masse corporee sono state lasciate decomporre in condizioni naturali. Durante la decomposizione ogni 24 h sono stati valutati i caratteri di ciascuna modificazione post-mortale mediante l’assegnazione di un punteggio (Total Body Score - TBS) e sono stati raccolti campioni di muscolo scheletrico per l’analisi del decadimento molecolare delle proteine. Contestualmente è stato altresì considerato l’andamento della colonizzazione da parte degli insetti cadaverici. L'obiettivo finale dello studio è stato quello di verificare la potenzialità di un approccio combinato dei diversi metodi (TBS, proteine muscolari scheletriche ed entomologia) nel migliorare l’affidabilità predittiva dei singoli metodi per la stima dell’intervallo post mortale. I dati ottenuti dalla sperimentazione hanno evidenziato come l’affidabilità predittiva delle metodiche utilizzate sia maggiore se utilizzate in associazione. Singolarmente considerate, le proteine muscolari si sono rivelate estremamente utili nei primi 5 giorni di PMI mentre lo studio degli insetti nei primi 15 giorni post-mortem. Il dato morfologico ha fornito importanti informazioni nei cadaveri occultati che presentevano un ritardo nella colonizzazione degli insetti.<br>The application of the entomological method to the estimation of minimum PMI (PMIm) requires that all the standards recommended by the best practice be satisfied, from collection of the entomological evidence to identification of species, reconstruction of thermal history and developmental analysis. Aim of this research study is to assess the reliability of the entomological methods for PMI in comparison with estimation and its complex investigative procedure. The research project has been represented by different experimental studies. In the beginning the research project has focused on some critical steps of the collection and storage of entomological samples useful in PMI estimation. In particular: - the effects of boiling of entomological samples and their storage in alcohol solution have been compared to storage of samples in ethanol without boiling. Two forensically important blow flies have been used: Lucilia sericata and Calliphora vicina. The results showed for both species that the estimation of a PMI by larval length is not biased when performed after a time lag of about one week if specimens are stored in ≥ 70% ethanol. Higher concentration such as 96% is better. Different measuring methods of larval length were also tested on C. vicina larvae. No significant differences were detected among the methods demonstrating that a simple tool like a geometrical micrometer can give accurate results for age estimation of larvae useful for the PMI assessment. - the effects of different temporary storing methods of entomological samples before the arrival in the laboratory have been tested. Samples of L. sericata and C. vicina larvae at different stage of development (L1, L2 and L3) were stored without food supply and with and without air for 24h. The results were then compared with a control group in which larvae were reared in boxes with air-permeable lid on their food substrate at 25°C. All boxes were checked for mortality rate (MR) every 24h. Results showed a high MR for L3 larvae (72h after hatching), developed without oxygen up to 100% thus demonstrating how important is oxygen supply during transportation of entomological evidence; - a field study on animal model (pigs) was finally set up. Eight pig cadavers of different body weight were left to decompose under natural conditions. Morphological changes during decomposition were assessed using the total body score (TBS), muscle samples were collected to analyze protein degradation, and insect colonization was daily evaluated. The final goal of the research study is to answer the novel question whether the combined approach of different methods (TBS, skeletal muscle proteins and entomology) could empower the single methods accuracy in PMI estimation. The data obtained showed that the predictive reliability of the methods is greater when used in combination. Individually considered, muscle proteins proved to be extremely useful in the first 5 days of PMI while forensic entomological method in the first 15 days of PMI. The morphological data (TBS) provided important information in cadavers with a delay in the colonization of insects.

An investigation was carried out into all drug-related deaths that occurred within the Strathclyde Police region of Scotland over the 17-year period, 1985-2001. Deaths involving heroin, methadone, dihydrocodeine or cocaine were the focus of this thesis. In total, more than 1,000 cases were reviewed. By extracting data from the toxicology report and police sudden death report, changes in patterns and trends of drug misuse were highlighted which coincided with concurrent changes to legislation and medical care. This is a novel approach to the investigation of drug-related deaths within this jurisdication. Over the study period 869 heroin positive drug-related deaths were identified, in 95% of which what drug was the sole or the major contributory causal factor. The majority of these deaths involved males. The average age of all individuals increased slightly from 26 years to 29 years over the study period. The individual had a history of drug misuse in 95% of cases and of those, 92% were known to abuse drugs intravenously. Approximately one quarter of individuals resided alone and over one-half resided with other people, primarily their parents or (common law) partners/spouses. The individual was homeless in 14% of cases. Of this group, 70% resided in a hostel. The remainder had no fixed abode. Of cases where the postal code was known, 74% resided within the Greater Glasgow Health Board area. In the last year of the study deaths of individuals residing in the Ayrshire and Arran Health Board area increased sharply compared to a decrease in deaths reported in all other areas. Approximately two-thirds of individuals resided in areas of high deprivation (categories 6 and 7). The locus where the body was found was primarily in a dwelling (73%), usually the individual’s own home. From the circumstances surrounding the deaths it was ascertained that the individual was alone at the time of death in just under half the cases, highlighting the risk of taking drugs in isolation.

Includes abstract.<br>Includes bibliographical references.<br>Death of women whilst pregnant and in the post-partum period is a huge burden of disease in South Africa. All confidential enquiries and research into pregnancy related deaths in South Africa have focused on examining the cases based on the WHO definition of maternal death and have excluded deaths from incidental or accidental causes. Pregnancy related deaths due to suicide, homicide and accidental causes have predominantly only been studied in first world countries. There is minimal data available for developing countries like South Africa.

Thesis (MMed)--Stellenbosch University, 2015.<br>ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which was adapted for medical usage. The LODOX has an established role in the field of Forensic Pathology where it shows high sensitivity and specificity for the detection of skeletal pathology and foreign bodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has not been reported and this study aims to review the radio-pathological correlation and the applicability of LODOX as a viable screening tool in the detection of lung pathology in post mortem cases. Methods: We prospectively reviewed cases which were referred for medico-legal autopsy between November 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town, South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as well as macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959. The macroscopic and microscopic variables were considered the “gold standard” when compared with the results of the LODOX. The sensitivity, specificity, positive and negative predictive values were assessed. Results: One hundred and fifty nine cases (159) were included in the study. The most common radiographic patterns reported were the presence of ground glass opacities and consolidation. Overall, low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopic pathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) was noted. These values were lower than that reported for pneumonia using conventional X-rays. Additionally, these LODOX patterns have a high probability of representing oedema or autolytic/decomposition change. Pneumothorax was the most common pleural pathology detected on LODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with the variables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions in our cohort was low. In general, LODOX predictions were better at excluding pathology which was not present rather than confirming pathology which was present. Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothorax but currently has limited value as a “stand alone” test in the field of Forensic Pathology. However the continued use of the LODOX as an adjunct examination, as well as prospective study of its applicability, is advised.<br>AFRIKAANSE OPSOMMING: Agtergrond: Die LODOX Statscan is ‘n heel-liggaam digitale X-straal skandeer apparaat wat aangepas is vir mediese gebruik. Die LODOX het ‘n gevestigde rol in Geregtelike Patologie, waar dit ‘n hoë sensitiwiteit en spesifisiteit het in die opsporing van skeletale patologie en vreemde voorwerpe. Die rol van die skandeerder in die opspoor van sagte weefsel patologie in die longe van volwassenes is nog nie gerapporteer nie, en hierdie studie ondersoek die radio-patologiese korrelasie en toepaslikheid van LODOX as ‘n doeltreffende siftingsmeganisme om long patologie op te spoor in post-mortale gevalle. Metode: Gevalle wat verwys is na die Tygerberg Geregtelike Patologie Diens lykshuis in Kaapstad, Suid-Afrika vir medies-geregtelike outopsies tussen November 2012 en Maart 2013, is prospektief geëvalueer. Alle gevalle wat die voorgeskrewe insluitingskriteria nagekom het, het LODOX skandering asook makroskopiese en mikroskopiese ondersoek van die longe ondergaan, soos toegelaat deur die Wet op Geregtelike Doodsondersoeke Nr 58 van 1959. Die makroskopiese en mikroskopiese veranderlikes is beskou as die “goud standaard” in vergelyking met die resultate van die LODOX. Die sensitiwiteit, spesifisiteit, positiewe en negatiewe voorspellingswaardes is beoordeel. Resultate: Eenhonderd-nege-en-vyftig gevalle (159) is ingesluit in die studie. Die algemeenste radiografiese pattroon wat gerapporteer is, was die teenwoordigheid van gemaalde glas opasiteit en konsolidasie. In geheel is lae to matige sensitiwiteit van hierdie LODOX beelde waargeneem in die voorspelling van pneumoniese mikroskopiese patologie (edeem, akute en chroniese ontsteking, en eienskappe van diffuse alveolêre skade). Hierdie waardes was laer as die wat gerapporteer is vir pneumonie met konvensionele X-strale. Verder het hierdie LODOX beelde ‘n hoë waarskynlikheid om edeem en/of outolise/ontbinding uit te beeld. Pneumotoraks was die algemeenste pleurale patologie wat waargeneem is met die LODOX, maar outopsie korrelasie kon nie gedoen word nie. Swak tot geen korrelasie is gemerk vir die veranderlikes kaviteit, maligne tumor en brongi-ektase, maar die prevalensie van hierdie toestande in ons kohort was laag. Oor die algemeen was LODOX voorspellings beter om patologie wat nie teenwoordig is nie, uit te skakel, eerder as om patologie wat teenwoordig is, te bevestig. Gevolgtrekking: The LODOX is ‘n uitstekende bewysstuk in die aantoon van ‘n pneumotoraks, maar huidiglik het dit beperkte waarde as onafhanklike toets in die veld van Geregtelike Patologie. Desnieteenstaande word die verdere gebruik van LODOX as bydraende ondersoek, sowel as die prospektiewe studie van sy toepaslikheid aanbeveel.

Thesis (MMED. (Forensic Medicine)) --University of Limpopo, 2019<br>Traumatic intracranial haemorrhages are common, carry a high mortality rate and are therefore commonly known in the practice of forensic pathology as unnatural deaths. Studies have demonstrated a significant decrease in mortality rate among patients who received surgical interventions compared to patients who were treated medically. Missed or mis-diagnoses, which may be apparent during an autopsy procedure, present possible missed treatment opportunities. Aim/objective and methods The study investigated the discrepancy rate and discrepancy pattern of diagnosis between antemortem brain computed tomography (CT) scan findings and autopsy findings in deceased patients with traumatic intracranial haemorrhage (TIH). A quantitative retrospective descriptive study was conducted based on bodies presented with TIH at Pietersburg Hospital Forensic Pathology Department. A total of consecutive 85 cases with antemortem CT (ACT) scan findings were compared to autopsy findings using percentage agreement and Cohen’s kappa statistics. Results and conclusion There was a fair overall agreement (k=0.38) with overall discrepancy rate of 24.74%, ranging from 9.41% to 34.12% for individual TIH between ACT scan and autopsy findings. Subarachnoid haemorrhage had the lowest agreement between the ACT scan and autopsy findings for TIH. Patient and doctor factors associated with the discrepancies were assessed. Those associated factors, if addressed, may have a positive impact on patient outcome. As far as the debate on non-invasive autopsy procedure is concerned, as a result of existing discrepancy rate, we conclude that ACT should not be used alone in the determination of cause of death but may be used in conjunction with autopsy findings.

This thesis examined the effectiveness of an intensive, community-based intervention for youth presenting with complex psychological needs, and their families, and discussed the need to understand and address the multiple risk and protective factors across several systems associated with aggressive, violent, antisocial and offending behaviour in young people, in order to intervene effectively. The intervention is based on the principles of Multi-Systemic Therapy (MST), a renowned intensive, community-based intervention for aggressive, violent and antisocial young people, which is explored in the literature review (Chapter 1). The available evidence-base on MST demonstrates that the behaviour of young people considered at significant risk to themselves and/or others can be managed safely within the community, while engaging their caregivers and wider ecology to effect positive changes that are sustainable. The research study (Chapter 2) reports on a modest sample of 17 young people and 12 caregivers who completed research measures prior to and following the receipt of the intensive intervention based on MST principles aimed at improving youth and family functioning. Positive changes in both individual functioning and family environment observed were found to be consistent with the existing evidence-base regarding the effectiveness of community based interventions. This provides support for moving away from traditional office-based approaches to engaging these clients in order to prevent further deterioration in behaviour and subsequent placement of the young person away from his/her family and community. A discussion surrounding the use of psychometric measures provides insight into the role of the family environment in assessing and intervening with this client group in Chapter 3. Finally, the importance of recognising families as the key to a successful system of care is further explored in the case study in Chapter 4. Overall, this thesis provides support for the abandonment of a simplistic superficial understanding of social, emotional, and behavioural difficulties in young people to a more ecological, dynamic approach, which has implications for prevention of the detrimental and long lasting costs of youth social, emotional and behavioural difficulties.

Para a execução da etapa inicial da identificação médico-legal de restos humanos (antropometria e exame dos arcos dentários), faz-se necessária uma limpeza prévia da ossada, para a remoção de tecidos moles putrefeitos. Os casos não identificados por esses métodos tradicionais, poderão ser submetidos ao exame de DNA. No entanto, apesar do grande avanço da biologia molecular, utilizando a amplificação de DNA pela PCR, algumas limitações que afetam a habilidade de se obter DNA em restos humanos, permanecem. Dessa forma, o objetivo deste trabalho foi fornecer subsídios morfológicos para os analistas forenses, com ênfase na prática médico-legal, visando uma utilização mais eficiente do DNA obtido de osso compacto de restos humanos em decomposição ou já esqueletizados, sem tecidos moles aderidos. Foi realizado o estudo da microestrutura do tecido ósseo compacto femoral, de restos humanos em decomposição, ainda com tecidos moles, que foram limpos pela fervura em água (n = 7) e ossadas já esqueletizadas pela decomposição natural, que não foram fervidas (n = 8). Destes, seis ossadas foram provenientes de cemitério público regular, após 3 anos de inumação, 1 ossada proveniente da região amazônica, e 1 ossada de origem desconhecida. Estas duas ultimas, apresentado-se porosas ou quebradiças. As análises morfológicas de cortes histológicos foram coradas com hematoxilina e eosina e o DNA amplificado pela PCR para os loci CSF1PO, TPOX, TH01, F13A0, FESFPS, vWA, D16S539, D7S820, D13S317 e amelogenina. Os resultados da análise desses dois grupos foram comparados com os de cadáveres frescos (n = 5) do Serviço de Verificação de Óbitos da Capital. A fervura dos ossos, do modo como é realizada no Instituto Médico Legal de São Paulo, pode aumentar a eosinofilia da matriz óssea e, em alguns casos, pode promover a desagregação dos ósteons. Tal procedimento pode remover células, mas pode também remover possíveis inibidores da PCR, favorecendo a análise do DNA obtido destas amostras. O fator limitante para a obtenção e análise de DNA, em amostras de ossos limpos por fervura, é a quantidade exígua de células. Ossos não submetidos à fervura, após inumação por três anos ou há mais tempo em contato com a terra, podem apresentar alterações da microestrutura. No entanto, a presença de hemácias preservadas e núcleos de osteócitos nestas amostras, indica melhor preservação de células em relação às amostras de ossos fervidos. O fator limitante para a análise de DNA nestas amostras é a presença sugestiva de inibidores da reação de amplificação pela PCR. Restos humanos, sem tecidos moles, macroscópicamente não preservados (porosos e quebradiços), e não submetidos à fervura, apresentam alterações de perda de matriz mineralizada; no entanto, nestas amostras ainda é possível encontrar células preservadas. Os resultados obtidos no neste trabalho permitem traçar algumas estratégias para uma melhor utilização nos protocolos de extração e análise do DNA em osso compacto de restos humanos.<br>To the first essential step to forensic identification of human remains (anthropological study of race, sex, age, etc) it is necessary a previous cleaning of the bones, to remove decomposing soft tissues. Medico-legal inconclusive or non identified cases, by using these traditional methods, could be subjected to DNA analysis. However, in spite of advances in human identification techniques, specially by PCR amplified DNA, some limitations that affect the ability to obtain DNA in human remains still persist. Therefore, the aim of this study was to provide additional support from morphological analysis, to help forensic analysts personnel to utilise more efficiently the DNA, extracted from compact bones of human remains in decomposition or already skeletonized corpse, it means without soft tissues, with special emphasis in the legal-medicine practice. Femoral compact bones were obtained from: 7 human remains found on the ground, in different degree of decomposition which were cleaned by boiling to remove soft tissues; also studied were collections of bones from 8 corpses having undergone natural decomposition: 6 human remains exhumed after 3 years from a common public cemetery in São Paulo City; 1 case from amazon region and 1 case with no information, both cases remained from long time (more than 3 years) in contact with soil. All eight cases, were not boiled as no soft tissue were adhered. As a control, five cadavers 12 to 16 hours post mortem were also used. The compact bones histological sections were stained by haematoxilin and eosin and the loci CSF1PO, TPOX, TH01, F13A01,FESFPS, vWA, D16S539, D7S820, D13S317 and amelogenin were amplified by PCR.The procedure for boiling the human remains utilised in the Legal Medicine Institute of São Paulo would have increased the eosinophily of bone matrix and, in some cases, promoted the desaggregation of the osteons. In addition these procedures would have removed the cells, but in some cases would have removed possible inhibitors of the PCR, favouring in this way the analysis of DNA obtained from these samples. The limiting factor to obtain successful analysis in bones submitted to boiling seem to be the low quantity of nuclei present in these samples. For the other hand, in bones not cleaned by boiling, the presence of preserved red cells and oscteocyte nuclei inside the lacunae indicates better preservation of cells in relation to those bones cleaned by boiling. The limiting factor to obtain successful DNA analysis in bones exhumed or in contact of soil, is the suggestive presence of inhibitors of PCR. Porous and brittle bones from human remains, without soft tissues that are not processed by boiling, present alterations through loss of mineralised matrix, although it is still possible to found preserved cells in these samples. The results presented in this work clarify concerns about viability of DNA for identification analysis. They also help to establish better strategies for optimisation of DNA extraction and analysis in compact bones of human remains.

High Performance Liguid Chromatography was used to measure degradation of nucleotides in human cadavers for the purpose of prediction of post mortem interval. Endogenous nucleotides were extracted from integumentary tissue of six(6) human cadavers using six percent(6%) tricholoacetic acid. Linear regression statistical techniques were used to determine linearity of degradation of various nucleotide pools.

En la presente investigación se dan a conocer los resultados del estudio realizado con muestras obtenidas en la clínica de exodoncia de la Facultad de Odontología de la Universidad Autónoma del Estado de México, de las cuales 44 especímenes cumplieron con los criterios correspondientes. Estos fueron evaluados con distintas variables cuantitativas y cualitativas como: sexo, edad, presencia de enfermedad sistémica, presencia de caries, forma, tamaño y localización de la lesión, tipo y grado de inflamación, entre otras.<br>El presente trabajo, tiene como objetivo ser una herramienta para los alumnos, cirujanos dentistas y especialistas, para dar a conocer las diferentes características clínicas, radiográficas e histopatológicas de las lesiones periapicales y la relación que tienen entre éstas para poder realizar un diagnóstico y tratamiento correcto. De inicio se deben tomar en cuenta diferentes aspectos como la realización de una buena anamnesis mediante la historia clínica y un examen clínico y radiográfico completo para poder llegar a un pre – diagnóstico procurando que éste sea lo más cercano al diagnóstico final, el cuál solamente será determinado mediante el examen histopatológico. A su vez se debe de tomar en cuenta el manejo del tejido dependiendo de las características propias de la lesión mediante procedimientos como: apicectomía, marsupialización, enucleación o por medio de la extracción dental.Es importante conocer que las lesiones periapicales son entidades inflamatorias de los tejidos que rodean a los órganos dentarios, suelen ser precedidos por problemas pulpares, por lo general provienen de un trasvase de endotoxinas, bacterias y restos necróticos que se derivan de una necrosis pulpar no tratada, provocando granulomas y quistes, los cuales se caracterizan por un crecimiento lento con tendencia expansiva y que a pesar de ser lesiones con comportamiento benigno, pueden alcanzar un tamaño considerable si no se tratan o diagnostican a tiempo.

Análise semiquantitativa do parênquima distal de pulmões obtidos em autópsia de vítimas de morte por ação do fogo e por sufocação, foi feita para avaliar as alterações em bronquíolos e tecido alveolar (ductos e alvéolos). A análise discriminante dos parâmetros obtidos permitiu classificação de 74%<br>A semiquantitative analysis of the distal parenchyma in lung autopsies of victims of death by fire and death by suffocation, was done to evaluate the changes in membranous bronchiolar and alveolar tissue (alveolar ducts and alveoli). The discriminant parameters obtained permitted classification of 74% of cases

How best to approach the successful rehabilitation of sexual offenders remains a very complex and highly debated issue. This is particularly the case for sexual offenders with learning disabilities. Although research findings have supported the efficacy of sexual offender treatment programmes in reducing recidivism, it is important to note that not all sexual offenders successfully engage in treatment and achieve positive change. Models of sexual offender rehabilitation rooted in positive and humanistic psychology view the development of self-worth as having a vital role in engaging sexual offenders in the difficult process of changing their lives. The following thesis aimed to extend on all of these ideas, as summarised below. Chapter 1 details a meta-analytic review on self-esteem in sexual offending. The paper offers strong support for the notion that sexual offenders are characterised by low self-esteem. It recommends that developing sexual offenders' sense of self-worth should form a vital component of sexual offender rehabilitation programmes. Furthermore, it highlights the importance of viewing sexual offenders as a heterogeneous group and encourages services to work flexibly with this complex population in order to meet their individual therapeutic needs. Chapter 2 details a qualitative research study that explored the experiences of six sexual offenders with learning disabilities of a group rehabilitation programme. Using interpretative phenomenological analysis, it provides an in-depth and nuanced account of the subjective impact of the group. Recommendations are made for clinical practice, including the importance of considering group processes in sexual offender rehabilitation. Issues surrounding shame and identity are also discussed. Chapter 3 provides a reflective account of engaging sexual offenders with learning disabilities in qualitative research. It addresses the importance of subjectivity and how the researchers' position may have impacted on the research process.

Study project (M.Med.) -- University of Stellenbosch, 2001.<br>ENGLISH ABSTRACT: The main purpose in doing forensic post mortems is to supply information to the judicial system. Medical personnel involved in doing post mortems seldom get feedback regarding efficiency. Numerous allegations have been made regarding the work of district surgeons in terms of forensic post mortems, often suggesting that the work is substandard. In South Africa district surgeons do post mortems mostly in the rural areas, and training centre personnel do forensic post mortems in urban areas. Training centre personnel include specialized forensic pathologists, registrars and medical officers working in the Departments of Forensic Medicine, affiliated to universities. The South African Police Service mostly manages government mortuaries. The South African forensic medico-legal system is unique, and does not correspond in with the four main systems used worldwide. Research was done by sending 200 questionnaires to a representative group from the legal fraternity of the Western Cape (including judges / magistrates, state prosecutors, private lawyers) and also the South African Police Service investigating officers. The judiciary, as the users of the information generated through forensic post mortems, are therefore in a suitable position to determine the efficacy of forensic post mortem. The questionnaire was structured to determine the general perception, as well as comments, regarding 9 different aspects involved with doing forensic post mortems. These include the thoroughness and completeness of reports, standard of academic knowledge, efficacy of verbal testimony in court, length of time in releasing the report, general attitude, efficacy of sketches and diagrams, efficacy of photography, sufficient taking of toxicology samples and sufficient utilization of special laboratory investigations. The last question was an open question to allow for general comments and anecdotes. For each aspect it was also determined whether there was a difference in efficacy noted between the two groups. The effect of this, if any, on the judicial criminal justice system was also assessed. A different questionnaire was sent out to all forensic pathologists in the Western Cape. The standard of work of the district surgeons was hereby assessed. General comment regarding academic knowledge, and findings at post mortem made by district surgeons was assessed. The pathologists were also questioned regarding the general attitude of district surgeons, and imput were asked regarding continued medical education programs. An area for general comment was also supplied. The main findings were as follows: a. The legal fraternity in the Western Cape is generally satisfied with the efficiency of forensic post mortems, except the use of laboratory investigations and also the length of time to release reports. b. The legal fraternity could determine a difference in the efficiency of post mortems done by district surgeons and training centre personnel. Training centre personnel were generally regarded as more effective. c. The difference between the two groups, due to ineffective district surgeon post mortems, had a negative effect on the criminal justice system. The following recommendations were made: a. Training centre personnel: Serious consideration should be given to appointing qualified forensic pathologists in the rural areas. Training centre personnel should also be more involved in training the district surgeons. b. District surgeons: The training, re-training and continued medical education of district surgeons in the Western Cape should be prioritized. The service conditions should also be reviewed. c. Administrative: Audit of post mortem reports. The efficiency regarding court appearances should be audited through the Department of Justice. Administrative power will be necessary to oversee the above-mentioned recommendations.<br>AFRIKAANSE OPSOMMING: Die hoofdoel met die doen van geregtelike post mortems is om inligting te verskaf aan die regsproses. Medici gemoeid met geregtelike post mortems kry baie seide terugvoer oor die effektiwiteit van werk gelewer in die hof. Daar is ook herhaaldelik suggesties gemaak dat die werk van die distriksgeneeshere met betrekking tot geregtelike post mortems soms suboptimaal is. Regsmediese post mortemdienste in Suid Afrika word verskaf deur distriksgeneeshere in die platteland, en deur personeel verbonde aan opleidingshospitale in die stede. Die opleidingssentra-personeel sluit in gespesialiseerde forensiese patoloe, kliniese assistente en mediese beamptes werksaam in 'n Departement van Geregtelike Geneeskunde verbonde aan 'n universiteit. Staats- Iykshuise word bestuur en beheer deur die Suid-Afrikaanse Polisiediens. Daar bestaan geen soortgelyke model vir die voorsiening van regsmediese dienste in die res van die wereld nie. Navorsing is gedoen deur vraelyste uit te stuur aan 200 verteenwoordigende regslui (wat insluit regters/landdroste, staatsaanklaers, privaat regslui) en aan Suid-Afrikaanse Polisiediens-ondersoekbeamptes in die Wes Kaap. Die reg, as verbruikers van regsmediese dienste is gekies om 'n opinie uit te spreek oor die doeltreffendheid van forensiese post mortems. Die vraelyste is gestruktureer om die algemene tevredenheid en opinies en kommentaar te bekom oor nege verskillende aangeleenthede rakend die forensiese post mortem, nl. deeglikheid en volledigheid van verslae, standaard van akademiese kennis, effektiwiteit van verbale getuienisaflegging in die hof, tydsverloop vir lewering van verslae, houding en gesindheid van medici, doeltreffendheid van sketse en diagram me, effektiewe gebruik van fotografie, effektiewe gebruik van toksikologiese ondersoeke, effektiewe gebruik van spesiale ondersoeke, asook 'n algemene oop vraag vir kommentaar oor probleemareas. Daar word vervolgens vir elke aangeleentheid bepaal of daar 'n verskil in effektiwiteit opgelet word tussen twee mediese subgroepe, en indien wei watter groep meer effektief funksioneer. Verder sal nagegaan word of die regsproses geaffekteer word deur enige van bogenoemde bevindinge. 'n Verskillende vraelys is uitgestuur aan aile geregtelike patoloe in die Wes-Kaap. Hiermee word die standaard van die werk van distriksgeneeshere beoordeel. Kommentaar is gevra oor akademiese kennis met betrekking tot geregtelike post mortems en oor bevindinge gemaak deur distriksgeneeshere by post mortems. Daar word ook gevra oor die algemene houding van distriksgeneeshere, asook vir voorstelle vir voortgesette onderrigsprogramme. 'n Oop vraag is gestel vir kommentaar oor probleemareas. Uit die response is die volgende gevolgtrekkings gemaak: a. Die regslui in die Wes-Kaap is oor die algemeen tevrede met die diens gelewer met betrekking tot geregtelike post mortems, met uitsondering van die effektiwiteit van laboratoriumondersoeke, en ook oor die tydsverloop tussen die doen van post mortem en die vrystel van die verslae. b. Die regslui kon 'n verskil bepaal in die graad van effektiwiteit van post mortems gedoen deur distriksgeneeshere en opleidingssentra-personeel. Opleidingssentra-personeel is deur die meerderheid van respondente identifiseer as meer effektief. c. Die verskil tussen die twee groepe, a.g.v. oneffektiewe distriksgeneesheer post mortems, het 'n negatiewe effek op die regsproses. Aanbevelings is gemaak om die sisteem te verbeter: a. Opleidingssentra-personeel: Die uitplasing van gekwalifiseerde forensiese patoloe in die platteland moet oorweeg word. Opleidingssentrapersoneel kan ook meer betrokke wees by opleiding van distriksgeneeshere. b. Distriksgeneeshere: Aandag moet gegee word aan die opleiding, heropleiding en voortgesette geneeskundige onderrig van distriksgeneeshere in die Wes-Kaap. Die werksomstandighede waaronder hulle diens lewer moet ook aangespreek word. C. Administratief: Ouditering van post mortem verslae. Ouditering van effektiwiteit van hofverskynings, in assosiasie met die Departement van Justisie. Admininistratiewe wilskrag sal ook essensieel wees by implementering van bogenoemde voorstelle.

<p>Bakgrund: Diabetes är en kronisk sjukdom och mer än 150 miljoner i världen har sjukdomen. Diabetessjukdomen försämrar både den allmänna och den orala hälsan. Diabetikernas kunskaper om sjukdomens negativa effekter på munhälsan är bristfällig. Syfte: var att beskriva hur vuxna individers orala hälsa påverkas av diabetes och vad tandhygienister ska beakta vid en tandvårdsbehandling. Frågeställningar: Vilka är de orala komplikationerna hos vuxna individer med diabetes? Kan parodontitbehandling hos diabetiker ha positiva effekter på diabetessjukdomen? Vad bör tandhygienister särskilt ta hänsyn till vid behandling av diabetiker? Metod: Studien har genomförts som en systematisk litteraturstudie. Resultat: Parodontala sjukdomar är den dominerande orala komplikationen hos diabetiker. Diabetiker som är rökare har svårare parodontala sjukdomar än de som inte röker. Liksom parodontit förekommer karies hos diabetiker men är inte lika omfattande studerad som de parodontala sjukdomarna. Diabetiker med bättre metabolismkontroll har bättre oral hälsa. Många diabetiker har dåliga kunskaper om att diabetessjukdomen kan ha negativ effekt på deras orala hälsa. Konklusion: Diabetiker har behov av både parodontala behandlingar och hälsofrämjande och förebyggande insatser. Ett samarbete mellan tandvård och sjukvård är nödvändig.</p>

Medicolegal death investigators (MDIs) are a crucial part of the death investigation process but the profession remains unregulated and lacks a required accreditation or licensing process that many other professions use. Research shows the current medicolegal death investigations system, though a crucial government function, has existing deficits in its functionality that affect service delivery. The current study was based on an educational theory and utilized open ended survey questions. Data from 16 investigators was collected through surveys where relevant information was asked in the context of their situation and questions were specific to the phenomenon being studied. The data was analyzed by identifying individual and group descriptions of the experience to understand the overall meaning of their experience. The investigators interviewed had different experiences and varying beliefs in the importance of their role as an investigator. They were confident in their roles and provided detailed descriptions of their responsibilities. Additionally, investigators do not appear to have any direct issues due to educational differences but did embrace their roles as death investigators with a desire toward ensuring both their personal safety and that of society. Although many have acquired training as a result of their employment, they did not feel that the lack of prior training was a hindrance. This study contributes to the literature by providing data for consideration when developing regulations promoting standards within the system. This includes the health and safety of medicolegal death investigators and filling the gap of recognizing the need for standardized regulations by identifying the need for uniform training and safety practices.

It is the purpose of this, then, to investigate the feasibility of using the changes of concentrations of small iconic decomposition products in bile as indicators of time since death. High pressure liquid chromatography was selected for measurement of these changes.

One of the main aims of the forensic anthropological practice regards the proper identification of human remains. Years of studies and research provided many instruments for the reconstruction of the so-called “biological profile” (e.g. age at death, sex, stature, race); nevertheless, and despite the numerous information that it can provide, the pathological investigation of skeletons still displays many uncertainties. The identification of pathological signs from bones can in fact narrow the field of research in case of the recovery of unknown human remains, and can provide valuable data for the definition of a possible cause of death. However, the difficulties encountered when analyzing skeletal remains, due to taphonomic and environmental variables, non-specificity of the bone reaction and the monotony of bone tissue manifestation to stimuli, make pathological identification of diseases one of the most difficult fields of forensic anthropology. The aim of this research project is that of trying to narrow and clarify some aspects of skeletal pathology and forensic anthropology, by analyzing skeletons from three cemeteries of Milan, which are part of the Milano Cemetery Skeletal Collection. The main feature of this collection regards the availability, for many of its individuals, of ISTAT death certificates that make the observers aware of the main cause of death and related pathological conditions of such subjects. After collecting this information the attention then focused on the macroscopic investigation of specific pathologies, those that were more widespread in the available sample, to include: cancer metastases, diabetes, Cardiovascular Disease (CVD) and Human Immunodeficiency Virus (HIV) related to drug abuse. The skeletons of this research were selected and cleaned in a proper way; subsequently, the specific pathologic investigation was carried on after an accurate literature search, aimed at finding the most characteristic features that permit the correct identification of the pathology from bones. The analyses performed allowed the demonstration of the difficulties encountered in unequivocally describe and identify such diseases, despite the previous studies conducted, mainly due to the aspecific and often altered structures acquired by the stimulated areas on bones. The modifications caused by taphonomy, together with the subjectivity of the responses and the paucity of available reference data made the investigation quite difficult. However, the available causes of death permitted a baseline to better understand the observations in identifying and describing pathologic-related skeletal lesions, and to set the basis for a more detailed and comprehensive macroscopic pathologic investigation. Such macroscopic investigation, however, has it limits, as it can not go over a certain level of certainty; for this reason, additional investigation methods (such as x-rays, biochemistry, histology and so on) or additional antemortem data are necessary for increasing the amount of information we can gain from the examination of bare skeleton.

This thesis explores facial affect processing in violent offenders, with a specific focus on how patterns of impairment seen in Intimate Partner Violent (IPV) prisoners differ to those of other violent prisoners. Chapter one introduces IPV as a serious public health concern with inadequate treatment efficacy. It discusses the overlap between IPV and non-IPV violence and highlights the need for further research elucidating how the treatment needs of IPV prisoners differ to those of non-IPV prisoners. The role of facial affect processing is then discussed in relation to empathy and violent offending. Chapter two reviews the literature on facial affect processing in violent offenders. The review found deficits in violent offenders’ recognition of negative affect, with deficits in fear, anger and disgust most reliably reported, across indices of accuracy, sensitivity and response bias. Subtleties in processing patterns were observed between violent offenders and non-violent offenders, and between violent offenders and sexually-violent offenders. The review highlighted a dearth of research exploring facial affect processing in IPV prisoners. Chapter three presents a study investigating facial affect processing among IPV and non-IPV violent prisoners and nonoffending controls. It investigated the role of eye-scan paths as a mechanism underpinning recognition deficits in violent offenders and explored the influence of psychopathology on visual scanning behaviour. Groups did not differ in their recognition accuracy but they did differ in their eye-scan paths as a function of intensity and sex of the expression; with nonoffenders demonstrating different visual scanning behaviour relative to offender groups, who did not differ from each other. There was little evidence to suggest that eye-scan paths were influenced by psychopathological profiles of the groups. Chapter four presents a critique of the revised Conflict Tactics Scales (CTS2, Straus, Hamby, Boney-McCoy & Sugarman, 1996), a widely used measure of IPV. The review highlights the objectivity of the measure as both a strength, in terms of its limiting denial, minimisation and cognitive distortions but also a limitation in its failure to take into consideration the context in which the behaviour occurred. The scales’ psychometric properties are also discussed. The thesis conclusions are presented in Chapter five, alongside recommendations for practice and research.

Human organs are the most valuable gifts of life. Until today, through organ transplantation, thousands of lives have been saved and many more blessed with hope and happiness through a better quality of living. However, rapid developments in transplant technology will be meaningless if supply of the needed organs remains scarce and organ transplantation procedures cannot take place accordingly. This global problem of organ shortage is also faced by Malaysia. Despite campaigns and initiatives introduced by the Malaysian authorities, the problem remains unresolved and the situation is worsening. Malaysia is reported to have less than one donor for every one thousand of the population (Lela Yasmin Mansor, 2007). However, statistics from the National Transplant Registry Malaysia confirm a steady increase in the number of registered potential donors each year. This suggests that certain factors must be preventing potential donors from becoming actual donors. Therefore, this study will not only discuss the current scenario of the organ shortage problem in Malaysia, highlighting its underlying factors, but will also scrutinise legal and social factors causing actual donations to remain relatively small, despite the promising number of potential donors registering each year. The study will suggest practical solutions to help solve organ shortages in Malaysia, particularly by utilising brain-dead patients from serious road traffic accidents as a potential source of cadaveric organs. Clarification on the Islamic perspective concerning organ donation is also included, as Islam is the main religion professed in Malaysia.

Thesis (M.A.)--University of Cincinnati, 2009.<br>Advisor: Alan P. Sullivan. Title from electronic thesis title page (viewed Aug. 27, 2009). Includes abstract. Keywords: Osteomyelitis; Civil War; Paleopathology; Osteology. Includes bibliographical references.

Thesis (MMed)--Stellenbosch University, 2015.<br>ENGLISH ABSTRACT: Background: An increase in autopsied cases of community assault fatalities has been observed at the Tygerberg Forensic Pathology Services Facility. A paucity of information exists as to the incidence and prevalence of these cases in a South African context. Objectives: To determine the patterns and trends of injuries sustained in so-called community assault fatalities. Methods: A retrospective and descriptive study was conducted. Fatal community assault cases admitted to the Tygerberg Forensic Pathology Facility over a ten year period, from 1 January 2003 to 31 December 2012 were reviewed. Data was collected from autopsy/post mortem examination reports, contemporaneous notes, attached hospital records, SAPS- 180 form (completed by South African Police Services representative) and other Forensic Pathology Services (FPS) documentation. Results: A total of 424 cases of fatal community assault were admitted during the study period with an annual increase between 2004 and 2008 and a second peak from 2010 to 2012. The cause of death in majority of cases was due to multiple injuries (42%) with blunt force trauma forming the basis of most of the injuries sustained. The most prevalent areas where these assaults occurred was Khayelitsha (166 cases) and Harare (84 cases) - one of the sub-sections in Khayelitsha. Male subjects were predominantly assaulted with only one female fatality recorded. Conclusion: Adequate policing in prevalent areas is essential, to address the unnecessary loss of life and additional burden on the criminal justice system and health care services.<br>AFRIKAANSE OPSOMMING: Agtergrond: „n Toename in die aantal sterftes na beweerde gemeenskapsaanranding is waargeneem by die Tygerberg Forensiese Patologie Dienste Fasiliteit. Min inligting in verband met die insidensie en prevalensie van sulke gevalle in „n Suid-Afrikaanse konteks is beskikbaar. Doelwit: Om die patrone en neigings van beserings geassosieer met beweerde gemeenskapsaanranding-sterftes te bepaal. Metodes: „n Retrospektiewe en beskrywende studie is uitgevoer. Gevalle van sterftes na beweerde gemeenskapsaanranding wat opgeneem is by die Tygerberg Forensiese Patologie Dienste Fasiliteit oor „n tien-jaar tydperk, vanaf 1 Januarie 2003 tot 31 Desember 2012, is hersien. Data is versamel van outopsie/post-mortem verslae, kontemporêre notas, aangehegde hospitaal-rekords, SAPD-180 vorm (wat deur „n verteenwoordiger van die Suid-Afrikaanse Polisiediens ingevul word) en ander Forensiese Patologie Dienste (FPS) dokumentasie. Bevindinge: Oor die tien-jaar studietydperk is 424 gevalle van sterftes na beweerde gemeenskapsaanranding gesien, met „n jaarlike toename in gevalle tussen 2004 en 2008 en ‟n tweede piek in die aantal gevalle gedurende 2010 en 2012. Die oorsaak van dood in die meerderheid gevalle was as gevolg van veelvuldige beserings, met stomp geweld, die mees algemene tipe oorsaak van beserings. Die areas waar hierdie tipe gevalle mees algemeen voorgekom het, was Khayelitsha (166 gevalle) en Harare (84 gevalle) – een van die sub-seksies in Khayelitsha. In die meerderheid van gevalle is mans aangerand, en slegs een vroulike sterfte-geval is gevind. Afleidings: Voldoende polisiëring is nodig in prevalente areas om die onnodige lewensverlies en die addisionele lading op die kriminele regsisteem en gesondheidsorgdienste aan te spreek.

Consent is a concept used frequently and with great significance in a wide array of legal fields. It serves to regulate relationships, legitimize authority, delimit normality, and entrench idealized ways of being in the world. Yet despite the consequence of these functions, there is very little precision within legal scholarship about just what consent is. Few investigations of its definitional content depart from presumptive statements about personal autonomy. These associations are often described as the ‘common sense’ of consent and serve to secure a foundationalist discourse about what consent is, rendering alternative conceptions of its meaning or functions unintelligible. This is perhaps best evidenced in more critical approaches to consent, where despite widespread acknowledgement of the concept as a legal and political fiction, its status as a signifier of autonomy is maintained. This creates an imperative to move beyond the notion of consent as merely an illusion, to an understanding of it as something more operative. Not only does the story of autonomy that is told about consent obscure the social realities of inequality, difference, and subordination that might threaten a notion of a homogenous citizenry (and thus, governmental action made in its name), but it also conceals the historically specific conditions of existence which have brought consent’s ‘common sense’ story of autonomy into being. This thesis explores how this dominant narrative of consent, while producing certain ‘ideal’ subjectivities, also necessarily produces subjectivities which don’t fall within the ambit of consent. Moreover, this project asks what is achieved when the meaning of consent is positioned as a matter of ‘common sense’? What does its apparent transparency keep obscure? In contrast to conventional approaches to consent, this project positions consent as an historical artefact rather than a concept with doctrinal, cognitive, or communicative certainty and seeks to investigate its operations across legal fields rather than strictly within them. This includes an examination of consent to sex, the doctrine of informed consent in medical jurisprudence, and the defence of consent to assault in professional sporting contexts. Further, the project engages in a ‘juridical genealogy’ of consent, studying its use in three vastly different historical periods in search of how it might perform different socio-political functions than understandings of its role within contemporary medical and criminal law suggest it should. How these counter-narratives of consent serve to challenge the dominant autonomy story are investigated for what they reveal about the frames of cultural and legal intelligibility at work in consent law today.

The universally controversial issue of deaths in custody is especially pertinent to South Africa. This study was prompted due to the increasingly diminishing ability for a concerted effort at tackling this issue by all parties involved. The 5 year retrospective, descriptive case audit performed at the Pretoria Medico-Legal Laboratory aimed to evaluate the current medico-legal investigation of deaths in custody in Pretoria, South Africa. Over half of the deaths (52%) occurred as a result of police action, 30% in police custody and 18% in correctional services custody. Gunshot wounds and hangings were the number 1 and 2 most common causes of death, respectively, with homicide and suicide being the 2 most common manners of death, respectively. The principal conclusion from the results is the presence of a flawed and malfunctioning medico-legal investigation system. The introduction of a formal protocol is urgently required to provide a framework for these investigations.<br>Dissertation (MSc)--University of Pretoria, 2013.<br>Forensic Medicine<br>MSc<br>Unrestricted

The thesis consists of two volumes. Volume 1: This volume consists of three chapters. The first chapter is a literature review examining whether there is a link between psychopathy and self-harm. The second chapter is a quantitative study investigating whether scores on the HCR-20 and FAM risk assessment tools predict frequency of self-harm in females within a secure psychiatric hospital. The third chapter comprises a public domain briefing document which provides a plain language summary of the literature review and empirical paper. Volume 2: This volume consists of five Forensic Clinical Practice Reports (FCPRs). The first details the case of a 63-year-old man with depression and paranoid schizophrenia, formulated from both cognitive and psychodynamic perspectives. The second is a service evaluation examining whether scores on the HCR-20 and HoNOS decrease over time for patients detained within a secure psychiatric hospital, and whether individuals’ scores on these measures reflect the level of security in which they reside. The third FCPR documents the case of a 34-year-old man experiencing offence-related anxiety, shame and depression. The fourth FCPR is a single-case experimental design investigating the effectiveness of a trauma-focussed cognitive-behavioural intervention for offence-related PTSD. The fifth FCPR is an abstract of an oral case presentation of a 14-year-old girl experiencing school anxiety. Pseudonyms have been used throughout to ensure anonymity.