Judges are often reluctant to interact with medical ethics when deciding cases with an inherently ethical content. They sometimes even transfer decision-making responsibilities to medical ethics groups. At times this unwillingness is based on the presumption that medical ethics will be able to perform an effective regulatory function. The problem is there is a wide range of ethical discourse, both official and unofficial; so much it can cancel itself out. Therefore, as a regulatory tool for the medical profession, medical ethics is insufficient for the job. Judges, on the other hand, could arbitrate between competing ethical conclusions. Indeed, there is a strong argument they \(should\). This thesis addresses this timely and complex issue. Judges need to be willing and able to rely on the soundness of their own moral convictions to recognise and deal appropriately with the inherent ethical content in certain cases. In order to do this, they need a decision-making framework that recognises the ethical nature of judicial decision-making, so as to provide judges with confidence in applying moral principles and medical ethics. This thesis will provide such an integrated framework.

The main aim of this thesis is to advocate a more scientifically informed approach towards epidemiological evidence in disease litigation. It analyses the judicial scepticism about epidemiology in UK tort law, and finds that the myth of scientific certainty lies at the heart of the devaluation of epidemiology as proof of specific causation. It traces misconceptions about epidemiology to broader misconceptions about science as a whole (including medical science and disease), and confused legal approaches to causation. To explain why legal objections to epidemiology are erroneous, the thesis clarifies fundamental aspects of science and disease causation that lawyers need to better grasp. Scientific reasoning is inherently probabilistic. Further, medical research indicates that disease causation is usually multifactorial and stochastic. Rigid and deterministic ‘but for’ questions are thus fundamentally unsuited for assessing disease causation. The mismatch between legal and medical causal models makes courts resort to normative, ‘backwards’ causal reasoning or haphazard exceptional approaches to disease causation, where the most difficult dilemmas around causation arise. This thesis argues that courts need a better test for causation for disease that can take account of probabilistic scientific and epidemiological evidence, and suggests one such principled approach. Epidemiology can be invaluable in such an assessment of disease causation.

Dialectical Behaviour Therapy (DBT) is a type of “talking therapy”, developed from cognitive behavioural therapy; it has been adapted to help people who experience emotions, often females diagnosed with Borderline Personality Disorder (BPD). With its growth in popularity, DBT has been adapted and used with other populations - not just adult females with BPD – to include forensic populations (i.e. people who are in contact with services due to criminal behaviour) and adolescent populations. This thesis contains a systematic literature review investigating the use of DBT in Forensic Services and an empirical study that utilised a qualitative design to explore adolescents and parents’ experiences of DBT.

Forensic science is defined as the application of scientific or technical practices to the recognition, collection, analysis, and interpretation of evidence for criminal and civil law or regulatory issues. A combination of computer science in the field of 3D reconstruction and molecular biology science and techniques were employed in this research aims to document and record a complete picture of the body decomposition process including the changes of the microbiome over the decomposition process. In this thesis, the possibility to reconstruct the crime scene and the decomposition process was investigated. In addition, a 3D model aiming to integrate the biological and thanatological information was generated. The possibility of utilising Autodesk 123D Catch software as a new tool for 3D reconstruction of a crime scene was thoroughly evaluated. First experiments demonstrated that the number of photos required to obtain the best result was specified to be from 20 to 30 photos as a minimum. In addition, significant experiments were performed in different conditions of sizes, locations, and different involved materials. The measurements were obtained from the models using the same software were compared with the real measurements of the tested objects. The result of the correlation between real and estimated measurements showed a very strong agreement ranging from 0.994 to 1.000. With reference to the documentation of the decomposition process, there are different factors, intrinsic and extrinsic, have been reported affecting the decomposition of a carrion/body. These factors mainly interact with the rates of the biological and chemical reaction happening after death. The biological reactions are mainly due to the activity of microorganism and insects. Pigs (Sus scrofa domesticus) were used as a model for human studies and the results obtained have been applied to other mammals without considering the effect of fur on the decomposition process and on the insect and microbial colonisation. In order to investigate this point, rabbits (Oryctolagus cuniculus) with and without fur were used in two sets of experiments at Huddersfield in summer 2014 and in spring 2015. The results obtained in this study showed a similarity of the decomposition stages between animals with and without fur. However, the decomposition process was faster during the summer due to the fast of insect colonisation and activity. In addition, the entomological data collected during the summer and spring experiments were demonstrated that the same taxa nearly were present in both seasons, except Hydrotaea (Diptera, Muscidae), which was presented only in the summer experiment, moreover, only one sample of Lucilia sericata (Calliphoridae) was detected in the spring season. Differences in colonisation time were observed only in spring experiment; animals without fur were colonised two days before animals with fur. The season could have affected the insect’s activity and the spread of the decomposition volatiles. The microbial communities during the decomposition process were investigated using BIOLOG EcoPlateTM and the hypervariable V1-3 region of 16S rRNA gene was used for their molecular identification based on pyrosequencing. Eurofins Genomic Operon using 454-GS Junior pyrosequencing platform (Roche) carried out these analyses. The functional diversity of the bacterial communities on all carcasses samples showed a considerable variability depending on the stage of the decomposition and the sampling region (Oral cavity, skin and interface-sand-carrion) in both seasons. Furthermore, over the molecular analyses of bacterial communities at the phylum level, four main phyla of bacteria were detected among analysed carrion during the decomposition process. These phyla were changed significantly during the stages of the decomposition and between sampling regions. While no difference was observed due to presence or absence of fur. On the other hand, the analysis at the family level was able to highlight differences at the temporal scale but as well as carrion with and without fur. The statistical analysis results showed a significant difference in the bacterial community family distribution among the presence of fur and among the decomposition stages, with significant differences among sampling regions and seasons.

This thesis explores the work carried out by forensic specialists employed by the International Commission on Missing Persons (ICMP). Headquartered in Sarajevo, Bosnia and Herzegovina (BiH), ICMP assists the work of local governments around the world in addressing the issue of missing persons following armed conflict, atrocities, and natural disasters. This thesis focuses on ICMP's efforts to aid the Bosnian government in locating, exhuming, and identifying the remains of the individuals who went missing during the country's recent war (1992-1995). Utilising data obtained via interviews with and observations of ICMP staff members, it primarily represents a study of the management of professional identity in emotionally charged situations, examining the experiences of the forensic specialists who work in the organisation's three mortuary facilities throughout BiH. It explores forensic specialists' work with human remains, their interactions with victims' family members, and their attendance at events in which victims are commemorated and/or buried. Discussion of forensic specialists' experiences with the deceased brings into consideration their varying responses to the remains, emphasising the prevalence and perceived importance of emotional detachment. Situations in which emotional detachment from the remains may prove challenging are considered, as are the varying techniques forensic specialists utilise in managing emotional responses to their work. Examination of forensic specialists' interactions with the living suggests their general dislike of these encounters, although the positive aspects of these interactions are also examined. Exploration of forensic specialists' opinions of attending burials and/or commemorations brings into further consideration the balance between emotional attachment and detachment. While respondents noted the importance of maintaining an emotional connection to their work, they nevertheless emphasised the importance of avoiding such responses while in the mortuary. Commemorations and/or burials become ‘safe spaces' for forensic specialists to express and experience emotional responses to their work that are not overtly professional.

A identificação humana é algo que vem sendo estudado desde o século XIV e a cada dia vem se aperfeiçoando mais. Desta forma este estudo tem como proposta um método de identificação auxiliar aos já existentes, obtido por meio das rugas palatinas, que são estruturas localizadas na mucosa do palato duro, envolvendo papila incisiva, rafe mediana e rugas palatinas. Este estudo objetivou criar uma metodologia mais simples no uso deste método de identificação, por meio do uso de imagens digitalizadas e programas específicos para tal fim. A amostra foi constituída por 100 modelos e os respectivos prontuários. Inicialmente foram delimitadas as rugas palatinas, a papila incisiva e a rafe mediana com lapiseira 0,1 mm de espessura e grafite tipo HB, nos modelos dos sujeitos da pesquisa. Participaram da pesquisa três avaliadores, para que o estudo fosse cego: o avaliador 1 foi responsável pela seleção dos modelos iniciais; o avaliador 2 fez as cópias em scanner (para criar banco de dados); e o avaliador 3 re-numerou os modelos para que fossem sobrepostos pelo avaliador 2 e na seqüência fosse analisada a coincidência de pontos, para a possível identificação. Os modelos foram digitalizados e analisados por meio do programa Photoshop 7.0.1. Os resultados, encontrados por meio de análise de concordância de pontos não coincidentes, permitiram um percentual de 100 % de acerto na identificação, sendo então possível a identificação de todos os indivíduos por meio da metodologia proposta. A amostra apresentou 85% de pessoas do fenótipo cor da pele branco, 10 % negro, 5 % amarelo, a faixa etária envolveu indivíduos entre 8 e 30 anos de idade. Os resultados encontrados suportam as seguintes conclusões: que é possível realizar a identificação humana por meio das rugas palatinas, desde que haja um banco de dados prévio; as imagens podem ser arquivadas em CD-ROM, portanto, diminuindo o espaço utilizado para armazenamento dos dados pessoais de cada indivíduo; é um método de identificação seguro, por permitir análise relacionando 5 critérios, o que excluiu as chances de erros, pois nenhum modelo foi coincidente em nenhum ponto com outro, que não com o próprio. / The identification human being is something that comes being studied since century XIV and to each day it comes if perfecting more. In such a way this study a method of identification auxiliary to already the existing ones has as proposal, gotten by means of palatal rugae, that are structures located in the mucosa of the hard palate, involving papila incisive, rafe medium and palatal rugae. Having as objective to create a simpler methodology in the use of this method of identification, through the use of digitalized images and specific programs for such end. The sample was constituted by 100 models and respective handbooks. Initially they had been delimited palatal rugae, papila incisive and rafe medium with pencil 0.1 mm of thickness and graphite type HB, in the models of the citizens of the research. Three appraisers had participated of the research, so that the study he was blind: appraiser 1 was responsible for the election of the initial models; appraiser 2 made the copies in scanner (to reate data base); e appraiser 3 re-numbered the models so that they were overlapped by appraiser 2 and in the sequence the coincidence of points was analyzed, for the possible identification. The models had been digitalized and analyzed by means of the program Photoshop 7.0.1. The results, found by means of analysis of agreement of not coincident points, had allowed to a percentage of 100% of rightness in the identification, being possible the identification of all the individuals by means of the methodology proposal. The sample presented 85% of people of color of the white skin, 10% black, 5% yellow, the aged band involved individuals between 8 and 30 years of age. The joined results support the following conclusions: that she is possible to carry through the identification human being by means of palatal rugae, since that has a previous data base; the images can be filed in CD-ROM, therefore, decreased the space used for storage of the personal datas of each individual; it is a safe method of identification, for allowing to analysis relating 5 criteria, what it excluded the possibilities of errors, therefore no model was coincident in no point with another one, that not with the proper one.

Trata-se de uma pesquisa qualitativa que buscou compreender a vivência dos trabalhadores no universo do Instituto Médico Legal (IML) de Londrina Pr. Teve por objetivos analisar as experiências dos funcionários no IML com morte, identificar os desafios advindos e as percepções sobre a humanização no cotidiano do processo de trabalho em seu ambiente profissional. O referencial teórico adotado foi a Bioética Personalista. Para a coleta de dados optou-se por utilizar a entrevista semiestruturada. A saturação das entrevistas foi atingida com a participação de 12 profissionais do Instituto Médico Legal, incluindo representantes de todos os segmentos funcionais. As entrevistas foram realizadas de abril de 2008 a março de 2009. Para a construção das categorias empíricas foi utilizada a análise de conteúdo proposta por Bardin. Esta análise seguindo um ordenamento conceitual conduziu à definição de três categorias temáticas: (1) o objeto do trabalho no Instituto Médico Legal; (2) a experiência do trabalhador do Instituto Médico Legal com morte e; (3) o cotidiano no processo de trabalho no Instituto Médico Legal. As três categorias versam sobre o processo de trabalho dos funcionários do Instituto Médico Legal de Londrina, cujas atividades laborativas são interdisciplinares. Nela estão incluídas as características do trabalho pericial em cadáveres, a representação do cadáver enquanto objeto de trabalho e os sentimentos vividos pelos funcionários em atuação. O cadáver enquanto objeto de trabalho foi percebido como uma pessoa num corpo calado, resultado de escolhas de vida e como membro de uma família. A família do cadáver também foi percebida como um objeto de trabalho, na perspectiva do atendimento e acolhimento que esta necessita neste momento de morte abrupta, em suas diferentes formas de reação. A segunda categoria versa sobre as percepções do fato da morte em si; seus significados agrupados nas dimensões biológica, religiosa e filosófica e; os sentimentos vivenciados frente ao final da vida. A terceira categoria abrange as características do processo de trabalho pericial e os sentimentos frente a esta prática. Emergem nas características do processo pericial os aspectos legais, o desconhecimento social, a repercussão pública, a ignorância do resultado final, as situações inesperadas e inusitadas, o trabalho em equipe e a carga laborativa. Entre os sentimentos surgem a tristeza, a compaixão, a dor, o medo, a surpresa, a exaustão, a impotência, a realização profissional e o resgate como ser humano. Nesse trabalho insurgiram desafios enquanto pessoas e enquanto profissionais técnicos, no atendimento pericial tanto às vítimas como aos familiares, no momento de morte. Resultados deste estudo evidenciam que os funcionários do IML são impelidos ao resgate de suas crenças e valores enquanto pessoas, desde o momento em que, conceituam morte, recordam-se de suas vivências, trabalham em equipe, relacionam-se com o cadáver e com os familiares deste. / This is a qualitative research that aimed to understand the experience of workers in the universe of the Institute of Forensic Medicine in Londrina-PR. The three objectives were to analyze the experiences of these workers with death, identify the challenges sprung from this work and their perceptions about humanization in their daily work process at the work environment. The Personalistic Bioethics theoretical reference was used. Semi-structured interviews were chosen for data collection. The interviews saturation was reached by the participation of 12 Institute of Forensic Medicine workers, representing all functional sectors. The interviews were conducted from April 2008 to March 2009. The Bardin Content Analysis was used to build empirical categories. By following a conceptual ordering, this analysis led to three thematic categories: (1): the object of work at the Institute of Forensic Medicine; (2) the Institute of Forensic Medicine workers experience with death and; (3) the daily routine in the work process at the Institute of Forensic Medicine. These three categories approach the work process of the Institute of Forensic Medicine workers in Londrina, whose work activities are interdisciplinary. These activities include forensic procedures in corpses, the representation of the corpse as object of work and the feelings expressed by the workers in action. The corpse, as object of work, was acknowledged as a person in a quiet body, the result of choices made in life and as a member of a family. The corpse family was also acknowledged as object of work, regarding reception and acceptance that this family needs in this moment of abrupt death, considering their different reactions towards it. The second category approaches the perceptions about death as a fact; its meanings grouped in the biological, religious and philosophical dimensions; and the feelings experienced towards the end of life. The third category regards the characteristics of forensic work process and the feelings towards this activity. These characteristics include the legal aspects, the social unrecognition, the media repercussion, the ignorance about the final result, the unexpected and peculiar situations, the team work and the work load. Among the feelings there are sadness, compassion, pain, fear, surprise, exhaustion, impotence, professional accomplishment and the recalling as a human being. In this work there were challenges regarding people as human beings and as technical workers, while conducting forensic work in victims or receptioning family members, during the moment of death. The results of this study highlight that the Institute of Forensic Medicine workers are impelled to regain their beliefs and values as people, since they define death, remember their experiences, work as a team, relate to the corpse and to its family members.

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide. The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures. A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy. In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide. Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved. Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation. The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention. This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

This thesis is concerned with computerised forensic 3-D facial reconstruction as a means of identification and involves the restoration of the face on the skull in an attempt to achieve a close likeness of the individual when alive. The reconstruction process begins with the biological identification of the skeletal remains, (age, sex, ancestry and build). Facial reconstruction is then carried out and essentially works by building the “face” up from the skull using soft tissue thicknesses at specific locations from existing data. However, it is used as a last resort on skeletonised, badly decomposed or mutilated corpses, when no other information is available; even then it is only accepted as corroborative evidence in court. It is performed in the hope that it may stimulate recognition, and consequently narrow the field of identification, allowing other tests to be carried out, such as radiographic and/or dental comparisons, DNA analysis or other means, to establish positive identification. The advantages of the computerised method over the manual clay reconstruction are speed, rapid editing capability, production of images that can be stored and reconstructions repeated at any time if required. Furthermore, in many cases, the original skull instead of a cast or model may be used for reconstruction because the 3-D computerised procedure is rapid and non invasive. However, the most significant advantage of this technique with regard to the aims and objectives of the thesis is that a number of alternative reconstructions may be produced sequentially for the same skull by using different facial templates from the database that meet the anthropological/biological criteria of the skull. The issues addressed by the study and therefore its main aims are: a) evaluation and b) improvement of the reliability of facial reconstruction using 3-D computer graphics. The methodology involved initially digitizing a skull using a low-power laser scanner and a video camera interfaced to a computer. From a database of previously scanned faces, ten facial templates were selected that matched the anthropological criteria of each of the skulls, i.e. age, sex, ancestry and build. Landmarks with their corresponding soft tissue thicknesses were then located and placed on the skull and the equivalent ones on the face. The 3-D computer graphics then reconstructed the face by morphing (warping) the facial template over the skull by matching the corresponding landmarks on the skull and face with the appropriate soft tissue thicknesses at those landmark locations. The soft tissue thicknesses used at their specific landmark locations also matched the anthropological criteria of the skulls, since soft tissue depths are dependent on age, sex, ancestry and build. One of the major problems with any reconstruction which affect its reliability for identification is the uncertainty of the shape of some of the individual characteristics of soft tissue structures such as shape of lips, ears and nose/nasal tip since there is not direct information on the skull regarding the shape of some of these features. In addition, with the laser scanning system, the faces within the database all have closed eyes, because of the potential laser hazard to the eyes. Thus it is necessary to add “opened” eyes, head and facial hair (where appropriate) to give a realistic appearance to the face. The software provides the facility to export a 2-D view in a TIFF or JPEG format from the 3-D reconstructed image. The file can then be imported into a police identi-kit system such as E-FIT™, which allows the addition of features. In this study five skulls of known individuals were used for reconstruction in the manner explained. Ten facial templates which fulfilled the anthropological criteria (age, sex, ancestry and build) for each skull were used for the rebuilding process, thus totalling fifty reconstructions. The study employed a psychological resemblance test (experiment 1) where 20 different assessors, were asked to select in each case study, the best three matches of the ten reconstructions with the ante-mortem photograph of the individual during life. The results from these tests were correlated with a mathematical shape analysis assessment using Procrustes Analysis in which, the skull was compared in turn with each of the ten facial templates of each case study (experiment 2).The ranking of the assessors’ reconstruction choice was correlated with the ranking of the Procrustes Analysis by using Spearman’s Rank Order Correlation. The results indicate that although not statistically significant, it would seem however, that in some of the case studies, the mathematical approach using Procrustes Analysis does seems to capture some perceptual similarity in human observers. Experiment 3, similar to experiment 1, was a further psychological resemblance test, which involved implementing E-Fit features on four of the ten reconstructed images per case study. Assessors were asked to select the closest E-Fit image match with the ante-mortem photograph. Again, results indicated that, although not statistically significant, adding E-Fit feature to the images appears to improve perceptual similarity in human observers, provided, the limitations of adding these characteristics are addressed. Furthermore, there also appears to be good agreement in most of the case studies between the two psychological resemblance tests using the two different sets of assessors in experiment 1 and 3 (reconstruction choice and E-Fit choice, respectively). Further work involving anthropometric comparisons and using two methods of assessment (landmark line matching between images and proportion indices) was also carried out (experiment 4). It was found that matching landmark lines between images appeared to be only of limited value due to the images not being aligned at exactly the same viewpoint and magnification. It should be appreciated that because the thesis was based on recognition and was not an anthropometric study, precise alignment of viewpoints was not a requirement. Hence using the same data from the study, although images were in the frontal view, they were not aligned to the accuracy acceptable for an anthropometric study as there was no requirement to so. It would appear that, although there was some correspondence between the discrepant distances and the first and second ranked reconstructions, no firm conclusions could be drawn from this technique and therefore does not assist in understanding the way observers made their choices. Further tests would need to be carried out (beyond the scope of the thesis) to reach any firm conclusions. Undoubtedly, given the complex nature of the recognition process, it would have been desirable to use reconstructions of persons known to the assessors rather than asking them to assess unfamiliar persons, since it is well established that familiar faces are easier to recognize than those that are unfamiliar to observers. It should be appreciated however, that, although the study was designed in this way for practical and ethical reasons, it nevertheless does not truly reflect the real operational forensic scenario. Furthermore, recognition/matching is a much more complex process and even a reconstructed face which may be generally morphologically similar to the person in life may not capture perceptual similarity in human observers, especially in an unfamiliar scenario. It is not certain that identification will always occur even when the facial reconstruction bears good resemblance to the target individual.

Objectives This thesis is based on 4 papers that were all written with the same intent, which was to describe and demonstrate how epidemiologic concepts and data can serve as a basis for improved validity of probabilistic conclusions in forensic medicine (FM). Conclusions based on probability are common in FM, and the validity of probabilistic conclusions is dependant on their foundation, which is often no more than personal experience. Forensic epidemiology (FE) describes the use and application of epidemiologic methods and data to questions encountered in the practice of FM, as a means of providing an evidence-based foundation, and thus increased validity, for certain types of opinions. The 4 papers comprising this thesis describe 4 unique applications of FE that have the common goal of assessing probabilities associated with evidence gathered during the course of the investigation of traumatic injury and death.   Materials and Methods Paper I used a case study of a fatal traffic crash in which the seat position of the surviving occupant was uncertain as an example for describing a probabilistic approach to the investigation of occupant position in a fatal crash. The methods involved the matching of the occupants’ injuries to the vehicular and crash evidence in order to assess the probability that the surviving occupant was either the driver or passenger of the vehicle at the time of the crash. In the second and third papers, epidemiologic data pertaining to traffic crash-related injuries from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) was used to assess the utility and strength of evidence, such as vehicle deformation and occupant injury of a particular severity and pattern, as a means of assessing the probability of an uncertain issue of interest. The issue of interest in Paper II was the seat position of the occupant at the time of a rollover crash (similar to Paper I), and the association that was investigated was the relationship between the degree of downward roof deformation and likelihood of a serious head and neck injury in the occupant. The analysis was directed at the circumstance in which a vehicle has sustained roof deformation on one side but not the other, and only one of the occupants has sustained a serious head or neck injury. In Paper III the issue of interest was whether an occupant was using a seat belt prior to being ejected from a passenger vehicle, when there was evidence that the seat belt could have unlatched during a crash, and thus it was uncertain whether the occupant was restrained and then ejected after the seat belt unlatched, or unrestrained. Of particular interest was the relative frequency of injury to the upper extremity closest to the side window (the outboard upper extremity [OUE]), as several prior authors have postulated that during ejection when the seat belt has become unlatched the retracting seat belt would invariably cinch around the OUE and cause serious injury. In Paper IV the focus of the analysis was the predictability of the distribution of skull and cervical spine fractures associated with fatal falls as a function of the fall circumstances. Swedish autopsy data were used as the source material for this study. Results In Paper I the indifferent pre-crash probability that the survivor was the driver (0.5) was modified by the evidence to arrive at a post-test odds of 19 to 1 that he was driving. In Paper II NASS-CDS data for 960 (unweighted) occupants of rollover crashes were included in the analysis. The association between downward roof deformation and head and neck injury severity (as represented by a composite numerical value [HNISS] ranging from 1 to 75) was as follows: for each unit increase of the HNISS there were increased odds of 4% that the occupant was exposed to >8 cm of roof crush versus <8 cm; 6% for >15 cm compared to <8 cm, and 11% for >30 cm of roof crush compared to <8 cm. In Paper III NASS-CDS data for 232,931 (weighted) ejected occupants were included in the analysis, with 497 coded as seat belt failures, and 232,434 coded as unbelted. Of the 7 injury types included in the analysis, only OUE and serious head injury were found to have a significant adjusted association with seat belt failure, (OR=3.87, [95% CI 1.2, 13.0] and 3.1, [95% CI 1.0, 9.7], respectively). The results were used to construct a table of post-test probabilities that combined the derived sensitivity and (1 - specificity) rates with a range of pre-crash seat belt use rates so that the results could be used in an investigation of a suspected case of belt latch failure. In Paper IV, the circumstances of 1,008 fatal falls were grouped in 3 categories of increasing fall height; falls occurring at ground level, falls from a height of <3 meters or down stairs, and falls from ≥3 meters. Logistic regression modeling revealed significantly increased odds of skull base and lower cervical fracture in the middle (<3 m) and upper (≥3 m) fall height groups, relative to ground level falls, as follows: (lower cervical <3 m falls, OR = 2.55 [1.32, 4.92]; lower cervical ≥3 m falls, OR = 2.23 [0.98, 5.08]; skull base <3 m falls, OR = 1.82 [1.32, 2.50]; skull base ≥3 m falls, OR = 2.30 [1.55, 3.40]). Additionally, C0-C1 dislocations were strongly related to fall height, with an OR of 8.3 for the injury in a ≥3 m fall versus ground level. Conclusions In this thesis 4 applications of FE methodology were described. In all of the applications epidemiologic data resulting from prior FM investigations were analyzed in order to draw probabilistic conclusions that could be reliably applied to the circumstances of a specific investigation. It is hoped that this thesis will serve to demonstrate the utility of FE in enhancing evidence-based practice in FM.