Dynamic Risk Factors and their Utilisation in Case Formulation: A New Conceptual Framework

<p>The social pressure on policy makers and clinicians working with sexual offenders to reduce recidivism is extreme. A result of this pressure is the amount of research investigating risk-related features that has surged over the last few decades. Risk assessment has progressed from unstructured clinical judgement to development of risk factors that correlate with recidivism to predict levels of risk, and more recently, to forensic case formulation. This thesis concentrates on two key issues with forensic case formulation that has been largely neglected thus far. First, forensic case formulations rely heavily on the use of dynamic risk factors as causes of offending. The concern is that dynamic risk factors are composite constructs not causal mechanisms. Second, forensic case formulation models do not explain how to use an offender’s information and their risk factors to hypothesise about the cause of their offending leading to issues of reliability. To address these issues, the RECFM consists of five phases that guides clinicians on how to appropriately use forensic case formulation. The Risk Etiology Case Formulation Model (RECFM) aims to incorporate a reconceptualised version of dynamic risk factors using an Agency Model to identify the interaction of agent and context that causes offending behaviour. By using the RECFM, treatment can be targeted to the individual and their specific causes of offending, which will lead to better results in reducing recidivism. The aim of this thesis is to provide a forensic case formulation model is comprehensible for clinicians and that targets the causes of offending.</p>

Dynamic Risk Factors and their Utilisation in Case Formulation: A New Conceptual Framework

<p>The social pressure on policy makers and clinicians working with sexual offenders to reduce recidivism is extreme. A result of this pressure is the amount of research investigating risk-related features that has surged over the last few decades. Risk assessment has progressed from unstructured clinical judgement to development of risk factors that correlate with recidivism to predict levels of risk, and more recently, to forensic case formulation. This thesis concentrates on two key issues with forensic case formulation that has been largely neglected thus far. First, forensic case formulations rely heavily on the use of dynamic risk factors as causes of offending. The concern is that dynamic risk factors are composite constructs not causal mechanisms. Second, forensic case formulation models do not explain how to use an offender’s information and their risk factors to hypothesise about the cause of their offending leading to issues of reliability. To address these issues, the RECFM consists of five phases that guides clinicians on how to appropriately use forensic case formulation. The Risk Etiology Case Formulation Model (RECFM) aims to incorporate a reconceptualised version of dynamic risk factors using an Agency Model to identify the interaction of agent and context that causes offending behaviour. By using the RECFM, treatment can be targeted to the individual and their specific causes of offending, which will lead to better results in reducing recidivism. The aim of this thesis is to provide a forensic case formulation model is comprehensible for clinicians and that targets the causes of offending.</p>

The population genetics characteristics of a 90 locus panel of microhaplotypes

Single-nucleotide polymorphisms (SNPs) and small genomic regions with multiple SNPs (microhaplotypes, MHs) are rapidly emerging as novel forensic investigative tools to assist in individual identification, kinship analyses, ancestry inference, and deconvolution of DNA mixtures. Here, we analyzed information for 90 microhaplotype loci in 4009 individuals from 79 world populations in 6 major biogeographic regions. The study included multiplex microhaplotype sequencing (mMHseq) data analyzed for 524 individuals from 16 populations and genotype data for 3485 individuals from 63 populations curated from public repositories. Analyses of the 79 populations revealed excellent characteristics for this 90-plex MH panel for various forensic applications achieving an overall average effective number of allele values (Ae) of 4.55 (range 1.04–19.27) for individualization and mixture deconvolution. Population-specific random match probabilities ranged from a low of 10–115 to a maximum of 10–66. Mean informativeness (In) for ancestry inference was 0.355 (range 0.117–0.883). 65 novel SNPs were detected in 39 of the MHs using mMHseq. Of the 3018 different microhaplotype alleles identified, 1337 occurred at frequencies > 5% in at least one of the populations studied. The 90-plex MH panel enables effective differentiation of population groupings for major biogeographic regions as well as delineation of distinct subgroupings within regions. Open-source, web-based software is available to support validation of this technology for forensic case work analysis and to tailor MH analysis for specific geographical regions.

It is all about the insects: a retrospective on 20 years of forensic entomology highlights the importance of insects in legal investigations

This study highlights the importance of insect evidence by evaluating 949 insect-associated cases, including 139 entomological reports, from 2001 to 2019 at the Institute of Legal Medicine Frankfurt/Germany. With a high number of cases in the summer months and a low number in the colder season, 78.5% of the bodies were found indoors, regardless of year or month. In more than 80% of the cases, where PMI information was available (n = 704), the presumed PMI ranged from 1 to 21 days, a period during which entomological evidence can provide a day-specific estimate of PMImin. In cases where insects have been identified to species level (n = 279), most bodies were infested by one or two species with a maximum of 10 different species. Overall, a total of 55 insect species were found. Information on biology, activity and distribution of the most abundant taxa is given and applied for 5 case histories estimating different PMImins of up to over 6 months. Despite proved importance and scientific development of forensic entomology, insects are still rarely considered as a tool in forensic case work. The main reasons are a lack of awareness and (too) late involvement of a forensic entomologist. Our work shows that forensic entomology is an independent discipline that requires specialist expertise.

Postmortem Metabolomics: Strategies to Assess Time-Dependent Postmortem Changes of Diazepam, Nordiazepam, Morphine, Codeine, Mirtazapine and Citalopram

Postmortem redistribution (PMR) can result in artificial drug concentration changes following death and complicate forensic case interpretation. Currently, no accurate methods for PMR prediction exist. Hence, alternative strategies were developed investigating the time-dependent postmortem behavior of diazepam, nordiazepam, morphine, codeine, mirtazapine and citalopram. For 477 authentic postmortem cases, femoral blood samples were collected at two postmortem time-points. All samples were quantified for drugs of abuse (targeted; liquid chromatography-tandem mass spectrometry LC-MS/MS) and characterized for small endogenous molecules (untargeted; gas chromatography-high resolution MS (GC-HRMS). Trends for significant time-dependent concentration decreases (diazepam (n = 137), nordiazepam (n = 126)), increases (mirtazapine (n = 55), citalopram (n = 50)) or minimal median postmortem changes (morphine (n = 122), codeine (n = 92)) could be observed. Robust mathematical mixed effect models were created for the generalized postmortem behavior of diazepam and nordiazepam, which could be used to back-calculate drug concentrations towards a time-point closer to the estimated time of death (caution: inter-individual variability). Significant correlations between time-dependent concentration changes of morphine, mirtazapine and citalopram with individual endogenous molecules could be determined; no correlation was deemed strong enough for successful a posteriori estimation on the occurrence of PMR for specific cases. The current dataset did successfully lead to a significant knowledge gain in further understanding the time-dependent postmortem behavior of the studied drugs (of abuse).

A FORENSIC CASE STUDY: Human Factors Issues Involved in a Fall Down an Elevator Shaft

This case study involves a woman (Mrs. V) who was renting a beach property for a vacation with her family. The rental property included a residential elevator that connected the garage to the three different levels of the property. On the second night of the vacation, Mrs. V fell asleep on the first-floor couch. After waking in the early hours of the night, she went to utilize the first-floor restroom. After opening the door, she believed was the restroom, she stepped across the threshold. Unbeknownst to her, she had been able to open the elevator door and fell down the empty shaft. It was determined that a failed locking mechanism allowed her to access the elevator shaft without the car being at the same level. The Human Factors consultants had to address numerous factors including hazard management, warnings, human capabilities navigating in low-level lighting, and the effect of alcohol.

Clinical case of special legal liability which is the result of a doctor when combination of specialties

We analyzed a forensic case related to an unfavorable outcome of medical care by a pediatrician. One of the reasons for the unfavorable outcome of medical care was the combination of pediatric and pediatric neurology specialties by the doctor, which, according to experts, contributed to an incorrect assessment of the severity of the childs condition and incorrect assessment of general cerebral symptoms and neurological disorders, without proper differentiation. As a result, the diagnostic was not fully provided, and more serious diseases at the time were not excluded. We determined the objective and subjective aspects of liability for combination several specialties. A medical-legal and forensic assessment of a specific unfavorable outcome of medical practice is given. It is concluded that any combination of different specialties by a doctor not only requires additional professional duties but, at the same time, creates additional legal risks in term of criminal law, which should be taken into account by each specialist who has assumed additional obligations.

Identification of 2C-B in Hair by UHPLC-HRMS/MS. A Real Forensic Case

The analysis of drugs of abuse in hair and other biological matrices of forensic interest requires great selectivity and sensitivity. This has been traditionally achieved through target analysis, using one or more analytical methods that include different preanalytical stages, and more complex procedures followed by toxicological laboratories. There is no exception with 2C-series drugs, such as 2C-B, a new psychoactive substance (NPS), which use has emerged and significantly increased, year by year, in the last decades. Continuously new analytical methods are required to selectively detect and identify these new marketed substances at very low concentrations. In this case report, one former case of a polydrug consumer (charged of a crime against public health in Spain) was reanalyzed in hair matrix. In this reanalysis, 2C-B has been positively detected and identified using liquid chromatography coupled to high-resolution mass spectrometry (UHPLC-HRMS/MS). The most selective analytical UHPLC-HRMS/MS method alongside a universal and simpler pretreatment methodology has opened up more possibilities for the detection of substances of different chemical structure and optimization of different HRMS/MS detection approaches allowing the identification of 2-CB in the hair of a real forensic case.