In the field of postmortem toxicology, principles from pharmacology and toxicology are combined in order to determine if exogenous substances contributed to ones death. In order to make this determination postmortem and (whenever available) antemortem blood samples may be analyzed. This project focused on evaluating the relationship between postmortem and antemortem blood drug levels, in order to better define an interpretive framework for postmortem toxicology. To do this, it was imperative to evaluate the differences in antemortem and postmortem drug concentrations, determine the role microbial activity and evaluate drug stability. Microbial studies determined that the bacteria Escherichia coli and Pseudomonas aeruginosa could use the carbon structures of drugs as a source of food. This would suggest prior to sample collection, microbial activity could potentially affect drug levels. This process however would stop before toxicologic evaluation, as at autopsy blood samples are stored in tubes containing the antimicrobial agent sodium fluoride. Analysis of preserved blood determined that under the current storage conditions sodium fluoride effectively inhibited microbial growth. Nonetheless, in many instances inconsistent drug concentrations were identified. When comparing antemortem to postmortem results, diphenhydramine, morphine, codeine and methadone, all showed significantly increased postmortem drug levels. In many instances, increased postmortem concentrations correlated with extended postmortem intervals. Other drugs, such as alprazolam, were likely to have concentration discrepancies when short antemortem to death intervals were coupled with extended postmortem intervals. While still others, such as midazolam followed the expected pattern of metabolism and elimination, which often resulted in decreased postmortem concentrations. The importance of drug stability was displayed when reviewing the clonazepam/ 7-aminoclonazepam data, as the parent drug commonly converted to its metabolite even when stored in the presence of a preservative. In instances of decreasing postmortem drug concentrations the effect of refrigerated storage could not be ruled out. A stability experiment, which contained codeine, produced data that indicated concentrations could continue to decline under the current storage conditions. The cumulative data gathered for this experiment was used to identify concentration trends, which subsequently aided in the development of interpretive considerations for the specific analytes examined in the study.

Violence has been found ubiquitously across human societies and throughout time. An act of violence can be defined as purposeful harm brought upon one individual as a direct or indirect result of the actions of another. The purpose of this research is to develop a quantitative approach to examining lethality using frequency distributions for location of trauma on the cranium in order to model patterns of interpersonal violence. This is accomplished through the study of a skeletal sample, from the prehispanic Chachapoya (existing around A.D. 800 – 1535), discovered at the site of Kuelap in the northern Peruvian Andes. Metric data were gathered from 81 individuals including males, females, and subadults. The data consisted of precise location of traumatic injury measured from anatomical landmarks in each of five two-dimensional views of the cranium as well as estimated diameter of impact for all lesions. The lesions were separated between perimortem (lethal) and antemortem (non-lethal) in order to explore patterns of lethality that correlate with location of injury. A statistical difference (p > 0.05) in location could not be determined when the distributions were compared in five standard two-dimensional views or between the sexes. Statistical significance (p > 0.05), however, was encountered when the entire cranium was used for the distribution. This distribution showed that perimortem injuries tend to occur more frequently on the posterior aspect of the cranium while antemortem injuries tend to occur more frequently on the anterior for this sample. These results show that a quantitative approach to location of injuries to the cranial vault can reveal new patterns of violent interactions and aid in the study of violent behavior.

In cases of forensic dental identification, a key factor in the comparison of the dental status of deceased persons with antemortem dental records is the matching of dental restorations in individual teeth. Many studies have been performed showing the prevalence of dental interventions. This has mostly been performed by counting the numbers of decayed, missing and filled teeth (DMFT) in each mouth without detailed data collection on a per-tooth basis. The purpose of this study was to investigate the research question: to what extent would data on the distribution and prevalence of restoration types in the human dentition facilitate forensic identification? A database program was developed to allow efficient collection and collation of dental trait information. Provision was made for storing information relating to a subject's individual teeth, such as restorative materials used and surfaces filled. Other data, such as missing teeth, caries status on a per-individual tooth basis and presence and details of types of prostheses may be stored. iii Data from patients attending a private group practice in Hobart was collected and a system was devised to enable the likelihood of dental trait occurrence to be calculated in cases of forensic dental identification. The capabilities of the system are demonstrated in a series of mock cases of dental identification. An opportunity to make use of the database for which it was designed arose in relation to the analysis of person identification evidence in a murder trial at the Tasmanian Supreme Court. The use of this reference database in evidence invoked lengthy debate involving the judge, crown prosecutor and defence barristers. The resulting voire dire was resolved in favour of conclusions drawn from the use of the database being admitted in evidence. The legal precedent set in the Marlow trial may possibly offer encouragement for practising odontologists to further the concept of establishing and using reference databases of dental traits in population groups in other parts of Australia.

In cases of forensic dental identification, a key factor in the comparison of the dental status of deceased persons with antemortem dental records is the matching of dental restorations in individual teeth. Many studies have been performed showing the prevalence of dental interventions. This has mostly been performed by counting the numbers of decayed, missing and filled teeth (DMFT) in each mouth without detailed data collection on a per-tooth basis. The purpose of this study was to investigate the research question: to what extent would data on the distribution and prevalence of restoration types in the human dentition facilitate forensic identification? A database program was developed to allow efficient collection and collation of dental trait information. Provision was made for storing information relating to a subject's individual teeth, such as restorative materials used and surfaces filled. Other data, such as missing teeth, caries status on a per-individual tooth basis and presence and details of types of prostheses may be stored. iii Data from patients attending a private group practice in Hobart was collected and a system was devised to enable the likelihood of dental trait occurrence to be calculated in cases of forensic dental identification. The capabilities of the system are demonstrated in a series of mock cases of dental identification. An opportunity to make use of the database for which it was designed arose in relation to the analysis of person identification evidence in a murder trial at the Tasmanian Supreme Court. The use of this reference database in evidence invoked lengthy debate involving the judge, crown prosecutor and defence barristers. The resulting voire dire was resolved in favour of conclusions drawn from the use of the database being admitted in evidence. The legal precedent set in the Marlow trial may possibly offer encouragement for practising odontologists to further the concept of establishing and using reference databases of dental traits in population groups in other parts of Australia.

Thesis (MMED. (Forensic Medicine)) --University of Limpopo, 2019 / 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.

Philosophiae Doctor - PhD / A technique was developed for the assessment of forensic identification using dental radiographs. The technique involved the digitisation of dental radiographs, cutting of a horizontal section from an antemortem radiograph and superimposing it over the same geographic location on the postmortem radiograph. The technique was useful in vitro and in an in vitro mock mass disaster. It was accurate within both the paediatric and permanent dentition and not useful in subjects with changing dentitions (mixed dentition). Image density (with and without optical enhancement) did not prove to be an impediment to the technique although extremes of image contrast did. Within the range of dental xray generators settings, contrast could be altered in a manner to allow matching. Differences in the vertical angulation of the x-ray beam did not influence the technique although horizontal angulation was a critical factor. Alterations in focal-film distance did not adversely affect the use of this technique. The three different scanning systems used were .all adequate for the purpose of the technique and the images could be compressed and transferred with little difficulty. Analysis of a group of actual Coroner's cases proved the technique to be useful in a timely fashion, for actual field identifications with minimal inter and intra operator error.

Als Paläopathologie wird das interdisziplinäre Fachgebiet von Anthropologen, Medizinern und Archäologen bezeichnet, das sich mit der Erforschung der Krankheiten vergangener Generationen beschäftigt. Den Zähnen kommt dabei eine besondere Bedeutung zu, da der Zahnschmelz das härteste Körpergewebe ist und sie deshalb besonders lange für eine Untersuchung zugänglich sind. An Ihnen lassen sich eine Vielzahl von Erkenntnissen in Bezug auf die Lebens- und Ernährungsweise unserer Vorfahren gewinnen. In der vorliegenden Arbeit wurde der Gesundheitszustand der Zähne und des Zahnhalteapparates in der mittelalterlichen Bevölkerung der südniedersächsischen Dorfwüstung Drudewenshusen mit in der Paläopathologie gebräuchlichen Methoden analysiert. Für die Auswertung wurde ein neues mathematisches Verfahren zur Schätzung der Karieshäufigkeit verwendet. Insgesamt wurden 112 Individuen untersucht. Etwa je ein Drittel entfällt auf Männer, Frauen und geschlechtlich Unbestimmbare, zumeist Kinder. Erhoben wurde der Zahnstatus in Bezug auf vorhandene und intravital bzw. postmortal verlorene Zähne. Die Zähne und Alveolarknochen wurden auf Karies, Parodontopathien, apicale Prozesse, Zahnstein, Zahnabrasion und das Auftreten transversaler Schmelzhypoplasien untersucht. Frauen und Männer litten etwa gleich häufig unter einer Karies; bei den weiblichen Individuen waren jedoch mehr Zähne erkrankt als bei den männlichen Individuen ihrer Altersgruppe. Am häufigsten von Karies betroffen zeigte sich der Molarenbereich. Der Einsatz des auf dem DMF-T-Index basierenden Kariesschätzers erweist sich am archäologischen Skeletfund als praktikabel. Die intravitalen Verluste zeigen einen analogen Verlauf zum Kariesbefall, der als deren Hauptursache angesehen wird. Andere Ursachen wie übermäßige Abrasion oder Traumata spielen eine untergeordnete Rolle. Die Häufigkeit intravitaler Verluste steigt mit dem Alter an; Frauen sind häufiger betroffen als Männer. Die entzündliche Veränderung des Parodontiums und der nicht entzündliche Knochenschwund sind in der erwachsenen Bevölkerung von Drudewenshusen weit verbreitet. Das Auftreten und Ausmaß von Zahnstein ist nur eingeschränkt beurteilbar, da dieser sehr leicht postmortal verloren geht. Nahezu alle erwachsene Individuen weisen Zahnstein auf. Apicale Osteolysen konnten nur bei erwachsenen Individuen nachgewiesen werden. Verbindungen zwischen Abszesshöhle und angrenzenden Sinus maxillares mit Zeichen von Entzündung weisen auf eine Ausbreitung der sonst lokal begrenzten Prozesse hin. Die Bewohner von Drudewenshusen zeigen eine interindividuell unterschiedliche, aber insgesamt hohe Abrasion auf, welche mit dem Alter zunimmt. Nur ein Drittel der Population ist von transversalen Schmelzhypoplasien betroffen. Die Veränderungen waren überwiegend leicht ausgeprägt. Insgesamt ergibt sich das Bild einer bäuerlich geprägten Gesellschaft, deren Nahrung weitestgehend auf Kohlenhydraten basierte. Schmerzhafte Erkrankungen der Zähne wie Karies oder dentoalveoläre Abszesse betrafen alle Altersschichten und Geschlechter. Eine hohe Kindersterblichkeit belegt das harte Leben zu dieser Zeit. Phasen des Nahrungsmangels werden durch das Vorkommen von Mangelerkrankungen und das Auftreten von transversalen Schmelzhypoplasien angezeigt. Die vorliegende Arbeit präsentiert neue Ergebnisse zu Zahnerkrankungen in einer mittelalterlichen Dorfwüstung, sowie neue Ansätze zur Interpretation der Karies im paläopathologischen Kontext. Dadurch kann ein weitreichender Einblick in die Gesellschaft und das tägliche Leben im Mittelalter gewonnen werden.