The first step in an investigation of quantitative ultrasound as a technique for evaluating infant bone strength.

This study's purpose is to evaluate whether bone speed of sound (SOS) data, a parameter of quantitative ultrasound, collected from an infant autopsy sample are comparable to data collected from healthy, living infants. We hypothesize that SOS values obtained from deceased term-born infants will fall within the normal range for healthy, living infants. The study sample consists of 351 deceased infants between the ages of 30 weeks gestation at birth to 1 year postnatal at the time of death receiving autopsies at the Harris County Institute of Forensic Sciences or Texas Children's Hospital in Houston, TX. Various multivariate and univariate statistics were used to examine the relationship between SOS and age, prematurity, and chronic illness. The results of an ANOVA comparing the study sample data to published data from healthy, living infants indicate the SOS data are comparable. Additionally, a MANOVA indicated significant differences in SOS related to prematurity (p = 0.001) and age (p < 0.001). Mean SOS was significantly greater among term-born infants (M = 3065.66, SD =165.05) than premature infants (M = 2969.71, SD =192.72). Age had a significant polynomial (cubic) relationship with SOS for both the premature and term groups (p < 0.001). Results suggest that bone from an infant autopsy sample is an appropriate surrogate to examine the relationship between SOS and determinants of bone strength. Therefore, future research will use this study sample to investigate the relationship between SOS and determinants of bone strength in infants.

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse.

In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence-based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma-related and nontrauma-related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).

Progress in the Accreditation of Anthropology Laboratories.

While crime laboratories are commonly accredited under programs utilizing international standards, options for forensic anthropologists to do the same were limited, until recently. The American National Standards Institute-American Society for Quality (ANSI-ASQ) National Accreditation Board (ANAB) and the American Association for Laboratory Accreditation (A2LA) both offer accreditation programs for forensic anthropology services using either the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 17025 or ISO/IEC 17020 standard. The significant efforts made to specifically include forensic anthropology, and also forensic pathology, in these national programs demonstrate the importance for all practitioners in the field of forensic science to develop and maintain quality assurance programs consistent with international standards. Among the requirements for quality assurance is validation of methods, a practice that was previously identified as needing improvement within the forensic anthropology community.

The Utility of Forensic Anthropology in the Medical Examiner's Office.

Over the past few decades, the field of forensic anthropology has seen major advancements and experienced a considerable growth of professionals in medical examiner/coroner offices. Despite this expansion, misconceptions regarding the role and utility of the anthropologist in the medicolegal setting still exist. This article brings together practitioners employed full-time in four medical examiner's offices, with each practitioner providing a unique perspective and emphasis regarding their role as an anthropologist. Discussed is the history of the anthropology division in each office as well as the types of casework and ancillary duties completed by the anthropologists. Consistently, the anthropologists are involved in the search and recovery of human remains, managing long-term unidentified cases, facilitating disposition of unclaimed decedents, and developing mass disaster protocols for their respective agency. Also consistent across the four offices is the fact that the anthropologists receive far more consult requests for trauma evaluation of nonskeletonized cases than any other type of case.

Evolution of Forensic Anthropological Methods of Identification.

Forensic identification of human remains has long been a core contribution of forensic anthropologists to death investigations. The array and scientific robusticity of the identification methods employed by the anthropologist has evolved in the last several decades, and as with other nonidentification methods, anthropologists have embraced the progression toward the use of validated and statistically defensible methods for identification. This article presents an overview of the role that the forensic anthropologist plays in the identification of human remains and the evolution of anthropological methods of identification.

The Forensic Anthropologist in the Mass Fatality Context.

Mass fatality incidents require a multi-agency, multidisciplinary response to effectively and efficiently manage the recovery and identification of human remains. The forensic anthropologist is uniquely suited for a significant role in the disaster response, demonstrated in the recovery and triage of human remains, interpretation of skeletal trauma, and identification of victims. However, the majority of published literature discusses these response operations in the context of large-scale incidents with significant numbers of highly fragmented and commingled human remains, which does not reflect the operational reality of mass fatality incidents in the United States. This article provides a realistic definition of the term "mass fatality incident" for medicolegal jurisdictions and provides the contributions of the forensic anthropologist for all types of incidents.

Skeletal Trauma: An Anthropological Review.

As anthropologists take on a larger role in medical examiner's offices, the incorporation of bone trauma analysis into the autopsy increases. The purpose of this invited review is to summarize recent anthropological literature that exemplifies the value of forensic anthropology in medicolegal death investigation, concentrating in the area of skeletal trauma analysis. Forensic anthropologists have a strong understanding of bone's response to trauma, gained through research and case studies. With this body of knowledge they are able to examine and interpret skeletal injury resulting from blunt, sharp, firearm, and thermal trauma. For example, toolmark class characteristics are recognized through sharp force injury examination, and fracture pattern analysis provides details of the impacting surface area. Interpretation of skeletal trauma allows for reconstruction of events surrounding death, and may inform the manner of death classification.

Microscopic saw mark analysis: an empirical approach.

Microscopic saw mark analysis is a well published and generally accepted qualitative analytical method. However, little research has focused on identifying and mitigating potential sources of error associated with the method. The presented study proposes the use of classification trees and random forest classifiers as an optimal, statistically sound approach to mitigate the potential for error of variability and outcome error in microscopic saw mark analysis. The statistical model was applied to 58 experimental saw marks created with four types of saws. The saw marks were made in fresh human femurs obtained through anatomical gift and were analyzed using a Keyence digital microscope. The statistical approach weighed the variables based on discriminatory value and produced decision trees with an associated outcome error rate of 8.62-17.82%.

A proposed scheme for classifying pediatric rib head fractures using case examples.

Pediatric rib head fractures are typically described as "posterior" or "costovertebral," terms lacking specificity. To resolve this issue, a scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population. The scheme uses three anatomical landmarks, terminus (tip), tubercle, and costovertebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse. Examples of five cases of infants with rib head fractures are presented using this scheme. Forty-eight rib head fractures were observed in these infants with the following frequencies: 56% (three infants) at the terminus; 21% (three infants) in the costovertebral subregion; 21% (one infant) at the costovertebral articular facet; and 2% (one infant) in the costotransverse subregion. Due to the small number of cases assessed, statistical analyses could not be performed; however, the data demonstrate the variation in distribution of pediatric rib head fractures.

Development of a computer-assisted forensic radiographic identification method using the lateral cervical and lumbar spine.

Medical examiners and coroners (ME/C) in the United States hold statutory responsibility to identify deceased individuals who fall under their jurisdiction. The computer-assisted decedent identification (CADI) project was designed to modify software used in diagnosis and treatment of spinal injuries into a mathematically validated tool for ME/C identification of fleshed decedents. CADI software analyzes the shapes of targeted vertebral bodies imaged in an array of standard radiographs and quantifies the likelihood that any two of the radiographs contain matching vertebral bodies. Six validation tests measured the repeatability, reliability, and sensitivity of the method, and the effects of age, sex, and number of radiographs in array composition. CADI returned a 92-100% success rate in identifying the true matching pair of vertebrae within arrays of five to 30 radiographs. Further development of CADI is expected to produce a novel identification method for use in ME/C offices that is reliable, timely, and cost-effective.

Standardized descriptive method for the anthropological evaluation of pediatric skull fractures.

The literature pertaining to pediatric skull fracture is primarily clinically based and thus motivated by the need for effective assessment of both fracture characteristics (type, frequency, location, and mechanics) and context (severity of injury, associated soft tissue damage, and prognosis). From a strictly descriptive standpoint, these schemas employ overlapping levels of detail that confound the nonclinical description of fractures in the forensic context. For this reason, application of these schemas in the forensic anthropological interpretation of skull fractures is inappropriate. We argue that forensic anthropological interpretation of skull fractures requires a standard classification system that reflects fracture morphology alone, and we suggest a three-stepped classification system that conveys increasing detail with each additional step. A retrospective application of the method to a sample of 31 children aged 1 month to 2 years demonstrated its efficacy in the description of pediatric skull fractures.

Novel classification system of rib fractures observed in infants.

Rib fractures are considered highly suspicious for nonaccidental injury in the pediatric clinical literature; however, a rib fracture classification system has not been developed. As an aid and impetus for rib fracture research, we developed a concise schema for classifying rib fracture types and fracture location that is applicable to infants. The system defined four fracture types (sternal end, buckle, transverse, and oblique) and four regions of the rib (posterior, posterolateral, anterolateral, and anterior). It was applied to all rib fractures observed during 85 consecutive infant autopsies. Rib fractures were found in 24 (28%) of the cases. A total of 158 rib fractures were identified. The proposed schema was adequate to classify 153 (97%) of the observed fractures. The results indicate that the classification system is sufficiently robust to classify rib fractures typically observed in infants and should be used by researchers investigating infant rib fractures.

Validation of tool mark analysis of cut costal cartilage.

This study was designed to establish the potential error rate associated with the generally accepted method of tool mark analysis of cut marks in costal cartilage. Three knives with different blade types were used to make experimental cut marks in costal cartilage of pigs. Each cut surface was cast, and each cast was examined by three analysts working independently. The presence of striations, regularity of striations, and presence of a primary and secondary striation pattern were recorded for each cast. The distance between each striation was measured. The results showed that striations were not consistently impressed on the cut surface by the blade's cutting edge. Also, blade type classification by the presence or absence of striations led to a 65% misclassification rate. Use of the classification tree and cross-validation methods and inclusion of the mean interstriation distance decreased the error rate to c. 50%.