Medicolegal approach to skin lesions in trafficking victims: A case report.

Trafficking in human beings is an ancient phenomenon. The fight against trafficking in human beings is conceived as a priority by the European Union. Trafficked victims experience many types of abuse and neglect. Indeed, all human beings hold the right to have an identity and an estimated age as an assertion of their existence in the society, as expressly stated in the U.N. Convention on the Rights of the Child. Italy has been the scene of this phenomenon for many years. Since identification represents a fundamental human right and a prerequisite for any other measure of assistance and protection, the Italian procedure provides the execution of an interview and a forensic examination. This process takes time and requires willingness to listen and to create a trusting doctor-patient relationship. Although skin lesions in trafficking victims may be due to torture or other forms of mistreatment or abuse, they may also be related to ethnic practices. Here we demonstrate the importance of conducting a structured interview along with an accurate forensic examination to correctly discriminate the origin of skin lesions in trafficking victims.

A firearm double homicide committed by a paranoid neigh- bor: a psychopathological study.

Abstract: Serious mental illness is associated with a higher risk of violent interpersonal behavior. Characteristic traits denoting a psychopatho-logical picture such as schizophrenia, depression, a borderline, or narcissistic, antisocial, or paranoid personality disorder, are frequently observed in the personality of those who have committed one or more murders. For example, mass murderers are affected by a delusional syndrome with a persecution fixation, that develops in a subject with a paranoid, anacastic personality disorder. An abnormal mental frame-work develops as a consequence of continual experiences interpreted as traumatic. We present a complex case regarding a double murder whose vic-tims were shot by a 50-year-old neighbor, who underwent a psychiatric evaluation for the assessment of criminal responsibility. In the light of the historical reconstruction of his relation sensitive delusional mindset that triggered the final reaction, his life history, the "key event" and the "triggering environment" (constant conflictual and dysfunctional rela-tions with others) led to the violence. The correct understanding of the reported case demands investigation not only of the clinical, diagnostic and psychodiagnostic aspects, but also of the perpetrator-victim/s, their relational context and the situation where the crime evolves, in order to be able to reconstruct the event in a meaningful manner.

From doctor to incendiary nun: the importance of analysing the pathways of trauma.

ABSTRACT: Childhood traumatic experiences have often been associated with the development of severe psychiatric disorders or, at least, with serious impairment in the victims' developing personality. Emotional abuse and neglect can cause gradual damage to Self-image and to models of self-in-relation to Others. We report a case of a woman who underwent psychiatric evaluations for marriage annulment. The issues were the as-sessment of the outcomes of early psychic trauma and the examination of the remaining individual capacities from a judicial standpoint. The examiners found that the memories of the woman's history of childhood abuse had become integrated into her personality organization. The spheres most strongly influenced were those of psycho-sexual/affective maturation and a dysfunctional bond with religion. Psychodiagnostic evaluation diagnosed a Borderline Personality Disorder. The complexity of the case suggests the need of a multi-dimen-sional analysis by an interdisciplinary team including experts in legal medicine, forensic psychiatry and psychology as well as clinical crimi-nology.

A reference database of forensic autosomal and gonosomal STR markers in the Tigray population of Ethiopia.

Allele frequencies of 21 autosomal STR markers (AmpF/STR GlobalFiler) and haplotype frequencies of 27 Y- and 12 X-STR markers (AmpF/STR YFiler Plus and Investigator Argus X-12, respectively) were investigated in the Tigray population of Ethiopia, representing the main population group in the Tigray regional state of Ethiopia and neighboring Eritrea. For autosomal STR allele frequencies, the average random match probability in the Tigray sample was 2.1 × 10-27. The average locus by locus FST distance calculated comparing autosomal STR allele frequencies from Tigray and from a broad regional reference dataset currently available for the Horn of Africa was 0.003. The Tigray male sample displayed high Y-STR diversity, with complete individualization of haplotypes using the AmpF/STR YFiler Plus panel. Analysis of molecular variance did not detect significant heterogeneity between Y-STR haplotypes observed in the present study and those previously reported in the literature for other Tigray population samples from Ethiopia and Eritrea. Study of the X-STR landscape in Tigray evidenced several distinctive features including: the molecular characterization of a novel null allele at locus DXS10146 with frequency > 1%; allele dependency between loci within linkage groups I and III; significant differences in haplotype distribution compared to other Horn of Africa populations, that should be taken into account in kinship analysis. The collected data can be used as a reference STR database by local forensic genetics services and in genetic identification procedures of victims of human trafficking in the Mediterranean Sea, which frequently involve individuals originating from the Horn of Africa.

A para-religious setting for financial exploitation of the mentally incapacitated: when the habit doesn't make a monk.

ABSTRACT: Exploitation and circumvention of the mentally incapacitated is a criminal offence listed in the Italian penal code (Penal Code Art. 643). It involves the exploitation and circumvention of people who are fragile and vulnerable owing to their health conditions and/or mental status, and fits into the grey area between such subjects' freedom to make decisions about their physical conditions and economic assets, and the abuse of their trust perpetrated by third parties for personal gain. The authors describe a case of financial exploitation and circumven-tion of a married couple that is remarkable in view of both the huge sums extorted from the victims and the duration of the peculiar illicit activities (that lasted more than 10 years). These were perpetrated by a charismatic figure leading a "para-religious" group. He claimed to be a prophet, but his private life was highly questionable. The method of ascertainment used to verify the victims' mentally incapacitated state is described, analyzed and commented; the diagnosis could not be deferred in view of the characteristics of the prolonged penal offences committed.

Measuring particle size distribution and mass concentration of nanoplastics and microplastics: addressing some analytical challenges in the sub-micron size range.

HYPOTHESIS: The implementation of the proposal from the European Chemical Agency (ECHA) to restrict the use of nanoplastics (NP) and microplastics (MP) in consumer products will require reliable methods to perform size and mass-based concentration measurements. Analytical challenges arise at the nanometre to micrometre interface, e.g., 800 nm-10 µm, where techniques applicable at the nanometre scale reach their upper limit of applicability and approaches applicable at the micrometre scale must be pushed to their lower limits of detection. EXPERIMENTS: Herein, we compared the performances of nine analytical techniques by measuring the particle size distribution and mass-based concentration of polystyrene mixtures containing both nano and microparticles, with the educational aim to underline applicability and limitations of each technique. FINDINGS: Light scattering-based measurements do not have the resolution to distinguish multiple populations in polydisperse samples. Nanoparticle tracking analysis (NTA), nano-flowcytometry (nFCM) and asymmetric flow field flow fractionation hyphenated with multiangle light scattering (AF4-MALS) cannot measure particles in the micrometre range. Static light scattering (SLS) is not able to accurately detect particles below 200 nm, and similarly to transmission electron microscopy (TEM) and flow cytometry (FCM), is not suitable for accurate mass-based concentration measurements. Alternatives for high-resolution sizing and concentration measurements in the size range between 60 nm and 5 µm are tunable resistive pulse sensing (TRPS) and centrifugal liquid sedimentation (CLS), that can bridge the gap between the nanometre and micrometre range.

Geometric morphometric analysis of sexual dimorphism in the mandible from panoramic X-ray images.

The human mandible is routinely utilised as part of the assessment of biological identity in forensic anthropological and odontological practice. The research introduces a novel geometric morphometric technique to investigate and quantify shape variation in the morphology of the mandibular corpus and ascending ramus and consequently highlights the potential for forensic purposes. Human mandibles from digital clinical orthopantomogram X-ray images, based on a sample of 50 male and 50 female adults from a modern Italian population, were examined. Three fixed landmarks were applied to the symphysis and condyle and 50 semi-landmarks re-sampled along the inferior corpus and the posterior ramus. Symmetrical reflection was applied yielding 200 configurations of 53 landmarks. Shape analyses were undertaken via: Procrustes superimposition; principal components analysis to investigate patterns of variation; classification using linear discriminant analysis with leave-one-out cross-validation; partial least squares (PLS) to test for structural modularity; and finally, retitle page sampling and re-analysis following PLS to optimize shape classification criteria. Stepwise re-sampling of landmarks reached an optimum cross-validated classification of 94.0% based on 25 landmarks; the results are strongly significant and suggest that the shape relationship between the mandibular corpus and ramus offers significant potential for forensic identification purposes using this method.

Multiple stab wounds: understanding the manner of death through the psychological autopsy.

A 48-year-old physical therapist with no history of psychiatric disorders or suicidal tendencies was found dead by his relatives inside his apartment. Multiple stab wounds were present on the chest and the abdomen. Several more superficial cuts were also seen on the neck and the left wrist. At the death scene, there was a large pool of blood in the room, with secondary droplets and stains; a kitchen knife was found beside the body, and a suicide note on a table. Especially the number of wounds raised strong suspicion of a homicide in the first instance but some circumstances (the farewell letter, the absence of clothing injuries, no signs of third-party involvement) and autopsy findings (absence of defense or blunt injuries, the localization of the wounds, the presence of hesitation marks) pointed toward a suicide etiology. Because of the many stab injuries and the lack of a psychiatric history, further forensic investigations were required including a so-called psychological autopsy. This case report highlights that only a comprehensive interpretation of all the elements (circumstances, the scene of death, autopsy findings, and psychological autopsy) can lead to the correct solution of atypical cases of suicide.

The Tragic Tale of a Father and Son: an Unusual Patricide.

Parricide is a category of homicide in which the victims are the parents, and the killers, their children. The authors report a case of a 45-year-old man who killed his 73-year-old widowed father in an extremely violent manner: he struck the father in the head with a wooden wash board, stabbed him with a pair of scissors and several times with a screwdriver. Afterwards, he kicked the victim in the face and jumped up and down on his body, thereby crushing the father's chest with his weight. The case reported here may be classified as an "unusual patricide" when one considers the age of the aggressor, the diagnosis of psychiatric disorders, that the victim was the father, and that the murder was committed in an extremely violent manner.

The Body Worlds Exhibits and Juvenile Understandings of Death: Do We Educate Children to Science or to Voyeurism?

Gunther von Hagens' development of plastination as a method for preserving human remains has enabled his public display of skinless, dissected bodies in a series of popular international exhibitions entitled Body Worlds. These spectacular displays claim to be educative, democratizing the study of anatomy and liberating it from the traditional confines of professional medical study. However, Body Worlds has raised various ethical objections to its commercial purpose, sourcing of some bodies and arrangement of bodies in poses or dissections that some viewers find offensive. Here we consider a different, often overlooked ethical conundrum raised by these exhibitions: the likelihood that the viewing of plastinates posed in 'frozen motion' is ill­suited to the psychological development of young children (5-10 years old) whose understanding of death is still in formation. Often young children mistake corpses for models, even for living beings if they are posed in arrested motion. The educative value of Body Worlds for younger viewers is questionable and the display may even interfere with their understanding of death. If the exhibition of human remains can be justified where their authenticity can be made known to viewers and the remains invested by them with sympathetic emotional meaning, it may be pointless if not unethical to show quasi­lifelike posed plastinates to young children in lieu of replica models.

Evaluation of DNA typing as a positive identification method for soft and hard tissues immersed in strong acids.

Identification of human remains can be hindered by several factors (e.g., traumatic mutilation, carbonization or decomposition). Moreover, in some criminal cases, offenders may purposely adopt various expedients to thwart the victim's identification, including the dissolution of body tissues by the use of corrosive reagents, as repeatedly reported in the past for Mafia-related murders. By means of an animal model, namely porcine samples, we evaluated standard DNA typing as a method for identifying soft (muscle) and hard (bone and teeth) tissues immersed in strong acids (hydrochloric, nitric and sulfuric acid) or in mixtures of acids (aqua regia). Samples were tested at different time intervals, ranging between 2 and 6h (soft tissues) and 2-28 days (hard tissues). It was shown that, in every type of acid, complete degradation of the DNA extracted from soft tissues preceded tissue dissolution and could be observed within 4h of immersion. Conversely, high molecular weight DNA amenable to STR analysis could be isolated from hard tissues as long as cortical bone fragments were still present (28 days for sulfuric acid, 7 days for nitric acid, 2 days for hydrochloric acid and aqua regia), or the integrity of the dental pulp chamber was preserved (7 days, in sulfuric acid only). The results indicate that DNA profiling of acid-treated body parts (in particular, cortical bone) is still feasible at advanced stages of corrosion, even when the morphological methods used in forensic anthropology and odontology can no longer be applied for identification purposes.

[Parricide, abuse and emotional processes: a review starting from some paradigmatic cases]. / Parricidio, abusi e processi emozionali: una rassegna partendo da alcuni casi paradigmatici.

The authors of this study tackle the complex subject of parricide, which is a rare and often brutal form of homicide. Parricide has a high emotional impact on public opinion and on our collective imagination, especially in light of the fact that the perpetrators are often minors.. Three striking cases of parricide, taken from various documented sources and judicial files from the "N. Fornelli" Juvenile Penal Institute (Bari, Italy), are presented here. A review of the literature on the topic has revealed differences between parricides committed by adults and those committed by minors. In the end, the complex issues underlying such an unusual crime are connected to abuses and maltreatment that minor perpetrators of parricide have suffered, especially the emotional processes that are activated.

Digital radiological research in forensic dental investigation: case studies.

The advent of dental digital radiology and new portable X-ray devices allows the execution of periapical X-ray images not only in the dental surgery but also in hitherto difficult locations such as field military hospitals, archaeological excavation sites, morgues and in cases of house arrest. In this work authors evaluated the feasibility of Nomad Examiner (Aribex inc.) handheld X-ray device combined with a digital sensor and a portable pc in forensic odontology applications. Employed for the first time forensically during the 2004 Tsunami victim identification process, the Nomad Examiner has now passed all security and conformity requirements of US and EU regulations. Examples of the practical use and the technical features of this device are seen when employed in odontological assessment of skeletonised and carbonized individuals and the assessment of individuals under house arrest complaining dental lesions. Results from the use this portable device demonstrate the benefits of a dental radiological assessment during an autopsy with the aim of human identification and the importance of a complete dental assessment (clinical and radiological) when evaluating dental traumatic lesions of individuals who cannot visit a dental surgery. In the first example forensic dentist would work alongside a forensic pathologist. On the other hand in the second example an odontologist - dentist could be appointed as an expert witness directly by a Court.

The development of a colorimetric scale as a visual aid for the bruise age determination of bite marks and blunt trauma.

Medical examiners and forensic odontologists are frequently asked to establish the age of a bruise or bitemark on either a living and deceased subjects. The age of bruising has an important medico-legal significance and may be relevant in the investigations related to such crimes as child abuse, domestic violence and homicide. A colorimetric scale for forensic photography based on the colors of the bruise itself, has never been proposed due to the fact that photographic reproduction of color is unreliable and depends on several factors; the camera used, lighting, printer and photo-editing color calibration. The authors propose two colorimetric scales, both with and without linear measurements, and with 90° angulations, six bruise colors, and three circles with black and white calibrators, which are to be used for the forensic photography of injuries involving the epidermis of Caucasian subjects. The two scales could also be employed on living subjects during different stages of the healing process, or on cadavers in order to provide evidential documentation, image verification and analysis. Such an aid would provide a reliable standard condition and allow for color calibration. The colors represented on the scales would be an aid for the interpretation and objectivity required in estimating the age of the bruise, particularly when the analysis is made directly onto computer images prior to printing. The proposed colorimetric scales do not attempt to give a definitive account of the diverse scientific methods available for the assessment of the age of bruising. The observation of a large sample of blunt trauma and bite mark injuries employing the proposed colorimetric scales would be needed in order to verify and validate the use of these scales. It should be borne in mind that bruise age estimation requires an expert opinion with several degrees of accuracy and variability involved. The age of a bruise cannot be determined by color alone.

Incorporation of radio frequency identification tag in dentures to facilitate recognition and forensic human identification.

Forensic identification using odontology is based on the comparison of ante-mortem and post mortem dental records. The insertion of a radio frequency identification (RFId) tag into dentures could be used as an aid to identify decomposed bodies, by storing personal identification data in a small transponder that can be radio-transmitted to a reader connected to a computer. A small passive, 12 x 2,1 mm, read-only RFId-tag was incorporated into the manufacture of three trial complete upper dentures and tested for a signal. The aim of this article is to demonstrate the feasibility of manufacturing such a dental prosthesis, the technical protocols for its implantation in the denture resin and its working principles. Future research and tests are required in order to verify human compatibility of the tagged denture and also to evaluate any potential deterioration in strength when subjected to high temperatures, or for damage resulting from everyday wear and tear. It should also be able to withstand the extreme conditions resulting from major accidents or mass disasters and procedures used to perform a forensic identification.

Occupational asphyxiation by unknown compound(s): environmental and toxicological approach.

During a routine truck-tank washing operation, five healthy workers were found motionless inside an empty tanker. Four of them died inside the tanker while the fifth died the following day in hospital. Since the true nature of the fatal compound(s) were not known, a rigorous environmental and toxicological approach supported by autopsy findings was essential to clarify the cause of death. Environmental results indicated that H(2)S fumes arising from the liquid sulfur previously shipped were responsible for the serial deaths, also confirmed by a simulation performed on two similar truck-tanks. These environmental findings were supported by toxicological analyses through the measurement of thiosulfate, one of the main H(2)S metabolites. Abnormal thiosulfate concentrations from 1.1 to 186.2 mg/kg were revealed in all post-mortem biological samples (blood, lung, liver, kidney, brain and fat). Finally, the cluster analysis performed on thiosulfate body distribution contributed to establishing the time of death according to the accident scene reconstruction. This report presents valuable findings in correctly identifying the cause of death in gas asphyxiation cases by unknown compound(s).

Human factors engineering in healthcare systems: the problem of human error and accident management.

This paper discusses some crucial issues associated with the exploitation of data and information about health care for the improvement of patient safety. In particular, the issues of human factors and safety management are analysed in relation to exploitation of reports about non-conformity events and field observations. A methodology for integrating field observation and theoretical approaches for safety studies is described. Two sample cases are discussed in detail: the first one makes reference to the use of data collected in the aviation domain and shows how these can be utilised to define hazard and risk; the second one concerns a typical ethnographic study in a large hospital structure for the identification of most relevant areas of intervention. The results show that, if national authorities find a way to harmonise and formalize critical aspects, such as the severity of standard events, it is possible to estimate risk and define auditing needs, well before the occurrence of serious incidents, and to indicate practical ways forward for improving safety standards.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.

Forensic sciences and forensic odontology: issues for dental hygienists and therapists.

The scientific literature contains very little about the role of the dental hygienist/therapist in the specific areas of forensic investigations and collection of evidence. The authors examine how the contribution of a highly qualified dental hygienist can be particularly helpful during human forensic identification operations and non-accidental traumas like domestic violence, child abuse, neglect and bitemarks. Forensic dental identification of human remains is a highly complex multidisciplinary challenge. It requires the involvement of several professionals who are expert in forensic science. Among these, one or more adequately trained dental hygienists could be involved. Dental hygienists/therapists may also be asked to record cutaneous lesions in two different situations. The first may be the dental office where she/he may detect oval, elliptic, or semicircular lesions on the skin of the uncovered neck, shoulder and arms of a patient. The second is the crime scene or the morgue (if one is involved), which may require a visit by the forensic odontologist called by the medical examiner or the coroner to perform an odontological autopsy. The purpose of our study is to highlight procedures that should be followed by the dental hygienist/therapist in collecting forensic information in the above-mentioned scenarios. As a valuable resource, the authors recommend training of dental hygienists in the area of forensic sciences, with particular attention to information technology and photography.