Advancing research in adult secure mental health services in England

Forensic mental health services in high income countries are typically high cost and low volume, providing care to people with mental illness, personality disorders, learning disability and autism deemed to pose a risk to others. Research into how forensic mental health services work as a whole system is limited. Such research is urgently needed to guide policy makers and ensure that services operate effectively.

Attempted homicide by instilling elemental mercury in the respiratory tract: A two-year follow-up

We describe a case of attempted homicide by instilling elemental mercury through an endotracheal tube into the respiratory tract. Radiographs revealed the presence of metallic mercury in both lungs. During a 2-year follow-up, mercury droplets disappeared from the lungs and only mild clinical symptoms were identified, without evidence of wider toxicity or organ damage.

Research progress in the estimation of postmortem interval (PMI) using non-coding RNA (ncRNA) markers

Postmortem interval (PMI) estimation has always been a crucial focus and challenging issue in forensic pathology. In recent years, specific RNA molecules and their variation have been used worldwide to estimate PMI. In this review, we summarize the methods used to detect non-coding RNAs (ncRNAs) for PMI estimation based on the literature, show the existing problems and development trends, and provide technical references for relevant studies and estimation practices.

Diagnostic accuracies of CTs, X-rays and Lodox to detect blunt force trauma in adults, using a pig model

The accurate radiological detection of skeletal trauma is crucial for the investigation of blunt force trauma (BFT) cases. The sensitivities of CTs, X-rays and Lodox in identifying BFT fractures and minimum number of impacts in pigs, used as proxies for adult humans, were assessed. Ten human sized pig carcasses were struck with a mallet and scanned, after which the number of fractures and minimum number of impacts detected radiologically were recorded. Pig carcasses were then macerated, and the defleshed, skeletonized remains were considered the gold standard as far as number and location of fractures were concerned. CTs were most sensitive in identifying fractures and impacts in all body regions, with overall sensitivities of 55.4% and 71.5% respectively, while X-rays and Lodox had sensitivities of 25.8% and 29.3% for fractures, and 43.5% and 41.1% for impacts, respectively. All modalities were highly specific for identifying fractures (CT: 99.1%; X-ray: 98.9%; Lodox: 99.4%). CTs should be used to analyze blunt force trauma when a radiological assessment is required, but an examination of the defleshed bones remains the gold standard for the deceased whenever feasible. X-rays and Lodox have limited diagnostic value in these cases and relying on them to detect fractures may compromise the accurate forensic investigation of blunt trauma victims. However, the use of Lodox for initial screening of major trauma is still of value. Sensitivities are generally higher for detecting fractures in pigs compared to piglets, indicating that increased diagnostic value is achieved when imaging pigs compared to piglets.

The development and testing of Thai facial soft tissue thickness data in three-dimensional computerized forensic facial reconstruction

Forensic facial reconstruction is a useful tool to assist the public in recognizing human remains, leading to positive forensic investigation outcomes. To reproduce a virtual face, facial soft tissue thickness is one of the major guidelines to reach the accuracy and reliability for three-dimensional computerized facial reconstruction, a method that is making a significant contribution to improving forensic investigation and identification. This study aimed to develop a facial soft tissue thickness dataset for a Thai population, and test its reliability in the context of facial reconstruction. Three-dimensional facial reconstruction was conducted on four skulls (2 males and 2 females, with ages ranging between 51 to 60 years). Two main tools of three-dimensional computer animation and modeling software—Blender and Autodesk Maya—were used to rebuild the three-dimensional virtual face. The three-dimensional coordinate ( x, y, z) cutaneous landmarks on the mesh templates were aligned homologous to the facial soft tissue thickness markers on the three-dimensional skull model. The final three-dimensional virtual face was compared to the target frontal photograph using face pool comparison. Four three-dimensional virtual faces were matched at low to moderate levels, ranging from 30% to 70% accuracy. These results demonstrate that the facial soft tissue thickness database of a Thai population applied in this study could be useful for three-dimensional computerized facial reconstruction purposes.

Estimating age from digital radiographic images of lumbar vertebrae in a Thai population using an image analysis technique

Using the lumbar vertebra for age estimation is helpful in cases when skeletal remains are incomplete and typical skeletal age indicators are absent. This study aimed to apply an image analysis method in extracting black pixel variables for age estimation by using the radiographic images of lumbar vertebra in a Thai population. All lumbar vertebrae L1–L5 of 220 (110 males and 110 females) from Thai individuals of known sex and ages were studied. The variables of Total Percentage of black pixels (TP), Mean Percentage of black pixels (MP), and Ratio of black to white pixels (BW), were calculated to assess the relationship between black pixel variables and aging. Equations were formulated using linear regression analysis. The results of this study indicated three variables of the lumbar vertebrae had significantly positive correlations with age. The correlation between parameters with age in males ranged 0.211–0.419, while the range in females was 0.219–0.458. The appropriate linear regression equation with the total and mean percentages of black pixel variables shows Age = −1.348+0.871 (TP) +0.514 (MP) of L4 for males (SEE; 15.4 years), and Age = 5.338 +0.316 (TP) +0.952 (MP) of L1 for females (SEE; 13.8 years). Age estimation using an image analysis method is an alternative to investigating the trabecular structure. The black pixel variable is not the actual value of bone density. However, it is useful to study its relationship with aging.

Complaints against health care professionals providing police custodial and forensic medical/health care services in England, Wales and Northern Ireland – what do we know?

Awareness of the nature and frequency of complaints against health care professionals working in police custodial health care services could provide opportunities to improve patient safety. To explore this freedom of information requests were sent to police services in England, Wales and Northern Ireland, to professional regulatory bodies and to the Independent Office for Police Conduct. Eighty-seven percent of police services responded but only a minority provided complete responses, with data not being held, or not being held in an easily retrievable format, being provided as reasons. The nature and frequency of complaints were similar to a previous 2017 study, suggesting a failure to learn lessons from the investigation of complaints and implement change in clinical practice. No evidence of an accessible complaints handling and recording procedure was provided across the police services surveyed. Regulatory bodies provided some information on the nature of complaints made against doctors and nurses working in police custodial settings, but that for paramedics was unable to do so. It is recommended that the communication loop between police services, those bodies providing health care and forensic medical services and regulatory bodies needs to be closed. A common reporting system or the application of established complaints handling procedures and reporting structures, which could be achieved by transferring these services to the National Health Service, may enhance patient safety in police custody.