CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / With developing of forensic observations, certain species of insects and microorganisms were described as indicators of periods of the degradation of the body. However, the literature is still scarce in the field of Forensic Mycology. It was investigated the microbiological characteristics of fungi presence in the post mortem change, as well as, it esteemed the value of the mycology exams in the study. 400 collections was accomplished in 60 human bodies (34 of the bloated stage, 06 of the putrefaction stage and 20 of the skeletonization stage) at the Fortaleza city morgue and public cemeteries in the state of CearÃ, The picked material was analyzed through macro/microcharacteristics and specific biochemical tests. Ally to such analyses, was also accomplished the test of the perforation of the hair in vitro in hair of corpses in the bloated stage and in hair of healthy adults. The material gathered was analyzed at the Specialized Medical Mycology Center of the Federal University of CearÃ. With the anthropological results, it was observed that male, in the interval of the 31 to the 40 years, was more commonly attacked, being the capital (Fortaleza) the more involved in the number of deaths. In the bloated stage, among the identified filamentous fungi, the presence of four orders was observed: Order Eurotiales (63 isolated Aspergillus spp and 21 isolated Penicillium spp), Order Mucorales (4 Mucor spp), Order Hypocreales (2 Acremonium spp, 1 Trichoderma spp and 1 Fusarium spp) and Order Saccharomycetales (2 Geotrichum spp). In the yeast distribution, it was observed the orders:Saccharomycetales (44 Candida spp) and Tremellales (5 Trichosporon spp). In the putrefaction stage, it was isolated the following orders: Eurotiales (Penicillium spp 2 and Aspergillus 2) and Hypocreales 1 (Acremonium spp). Regarding the yeasts, it was just isolated the Order Saccharomycetales (Candida spp 3). In the eskeletonization stage, the following orders were observed: Order Eurotiales (Aspergillus spp 22 and Penicillium spp 18), Order Mucorales (Mucor spp 10) and Order Hypocreales (Acremonium spp 2 and Trichoderma spp 1). Regarding the yeasts, two orders were found: Tremellales (Trichosporon spp 1) and Saccharomycetales (Candida spp 1). In the hair perforation test in vitro, it was positive in the bloated stage, differing of healthy adults,where the test was negative. For conclusion, Forensic Micology is still a rich field in data and fungi can come to be a tool in the aid of human post mortem diagnosis. / Com o evoluir das observaÃÃes mÃdico-legais, determinadas espÃcies de insetos e microrganismos foram descritos como indicadores de perÃodos da degradaÃÃo do corpo. Entretanto, a literatura cientÃfica ainda à escassa no campo da Micologia Forense. Assim, investigaram-se as caracterÃsticas microbiolÃgicas dos fungos partÃcipes na mudanÃa de flora post mortem em humanos, bem como estimou-se o valor da realizaÃÃo de exames micolÃgicos no estudo cronotanatolÃgico. Foram realizadas um total de 400 coletas em 60 corpos humanos (34 do perÃodo gasoso, 06 do coliquativo e 20 do esqueletizado) examinados no Instituto MÃdico-Legal de Fortaleza e em cemitÃrios do Estado do CearÃ. Foram realizados estudos macro/micromorfÃlogicos e testes bioquÃmicos especÃficos para cada grupamento fÃngico isolado. Aliado a tais anÃlises, foi tambÃm realizado o teste da perfuraÃÃo do pÃlo in vitro em pÃlos de cadÃveres no perÃodo gasoso e em pÃlos de adultos hÃgidos. Estas identificaÃÃes foram realizadas no Centro Especializado em Micologia MÃdica da Universidade Federal do CearÃ. Com os resultados antropolÃgicos, foi observado que o sexo masculino, dos 31 aos 40 anos, foi o mais comumente acometido, sendo a capital (Fortaleza) a mais envolvida no nÃmero de mortes. No perÃodo gasoso, dentre os fungos filamentosos identificados, foi observada a presenÃa de quatro ordens: Eurotiales (63 isolados de Aspergillus spp e 21 de Penicillium spp), Mucorales (4 Mucor spp) e Hypocreales (2 Acremonium spp, 1 Trichoderma spp e 1 Fusarium spp) e Saccharomycetales (2 Geotrichum spp). No referente Ãs leveduras, verificaram-se as ordens: Saccharomycetales (Candida spp 44) e Tremellales (Trichosporon spp 5). No perÃodo coliquativo, registraram-se as ordens: Eurotiales (Penicillium spp 2 e Aspergillus 2) e Hypocreales 1 (Acremonium spp). No referente Ãs leveduras, isolou-se apenas a Ordem Saccharomycetales (Candida spp 3). No perÃodo de esqueletizaÃÃo, verificaram-se as seguintes ordens: Eurotiales (Aspergillus spp 22 e Penicillium spp 18), Mucorales (Mucor spp 10) e Hypocreales (Acremonium spp 2 e Trichoderma spp 1). No referente Ãs leveduras, registraram-se duas ordens: Tremellales (Trichosporon spp 1) e Saccharomycetales (Candida spp 1). Quanto ao teste de perfuraÃÃo do pÃlo in vitro, a positividade foi observada no perÃodo gasoso, diferindo de adultos hÃgidos, em que foi negativa. Conclui-se que o estudo da Micologia Forense ainda à um campo rico em dados e que os fungos poderÃo vir a ser uma ferramenta complementar no estudo do tempo de morte em Medicina Legal.

The forensic toxicologist faces challenges in the detection of drugs and poisons in biological samples due to transformations which occur both during life and after death. For example, changes can result from drug metabolism during life or from the use of formalin solution for post mortem embalming purposes. The former requires the identification of drug metabolites and the latter the identification of chemical reaction products in order to know which substances had been administered. The work described in this thesis was aimed at providing ways of tackling these challenges and was divided into two parts. Part 1 investigated the use of in vitro drug metabolism by human liver microsomes (HLM) to obtain information on drug metabolites and Part 2 investigated the chemical reactions of drugs and a carbamate pesticide with formalin solution and formalin-blood. The initial aim of part I was to develop an in vitro metabolism method using HLM, based on a literature review of previous studies of this type. MDMA was chosen as a model compound to develop the HLM method because its metabolism was known and standards of its metabolites were commercially available. In addition, a sensitive and selective method was developed for the identification and quantitation of hydrophilic phase I drug metabolites using LC/MS/MS with a conventional reverse-phase (C18) column. In order to obtain suitable retention factors for polar drug metabolites on this column, acetyl derivatives were evaluated for converting the metabolites to more lipophilic compounds and an optimal separation system was developed. Acetate derivatives were found to be stable in the HPLC mobile phase and to provide good chromatographic separation of the target analytes. In vitro metabolism of MDMA and, subsequently, of other drugs involved incubation of 4 µg drug substance in pH 7.4 buffer with an NADPH generating system (NGS) at 37oC for 90 min with addition of more NGS after 30 min. The reaction was stopped at 90 min by the addition of acetonitrile before extraction of the metabolites. Acetate derivatives of MDMA metabolites were identified by LC/MS/MS using multiple reaction monitoring (MRM). Three phase I metabolites (both major and minor metabolites) of MDMA were detected in HLM samples. 3,4-dihydroxy-methamphetamine and 4-hydroxy-3-methoxymethamphetamine were found to be major metabolites of MDMA whereas 3,4-methylenedioxyamphetamine was found to be a minor metabolite. Subsequently, ten MDMA positive urines were analysed to compare the metabolite patterns with those produced by HLM. An LC/MS method for MDMA and its metabolites in urine samples was developed and validated. The method demonstrated good linearity, accuracy and precision and insignificant matrix effects, with limits of quantitation of 0.025 µg/ml. Moreover, derivatives of MDMA and its metabolites were quantified in all 10 positive human urine samples. The urine metabolite pattern was found to be similar to that from HLM. The second aim of Part 1 was to use the HLM system to study the metabolism of some new psychoactive substances, whose misuse worldwide has necessitated the development of analytical methods for these drugs in biological specimens. Methylone and butylone were selected as representative cathinones and para-methoxyamphetamine (PMA) was chosen as a representative ring-substituted amphetamine, because of the involvement of these drugs in recent drug-related deaths, because of a relative lack of information on their metabolism, and because reference standards of their metabolites were not commercially available. An LC/MS/MS method for the analysis of methylone, butylone, PMA and their metabolites was developed. Three phase I metabolites of methylone and butylone were detected in HLM samples. Ketone reduction to β-OH metabolites and demethylenation to dihydroxy-metabolites were found to be major phase I metabolic pathways of butylone and methylone whereas N-demethylation to nor-methylone and nor-butylone were found to be minor pathways. Also, demethylation to para-hydroxyamphetamine was found to be a major phase I metabolic pathway of PMA whereas β-hydroxylation to β-OH-PMA was found to be a minor pathway. Formaldehyde is used for embalming, to reduce decomposition and preserve cadavers, especially in tropical countries such as Thailand. Drugs present in the body can be exposed to formaldehyde resulting in decreasing concentrations of the original compounds and production of new substances. The aim of part II of the study was to evaluate the in vitro reactions of formaldehyde with selected drug groups including amphetamines (amphetamine, methamphetamine and MDMA), benzodiazepines (alprazolam and diazepam), opiates (morphine, hydromorphone, codeine and hydrocodone) and with a carbamate insecticide (carbosulfan). The study would identify degradation products to serve as markers for the parent compounds when these were no longer detectable. Drugs standards were spiked in 10% formalin solution and 10% formalin blood. Water and whole blood without formalin were used for controls. Samples were analysed by LC/MS/MS at different times from the start, over periods of up to 30 days. Amphetamine, methamphetamine and MDMA were found to rapidly convert to methamphetamine, DMA and MDDMA respectively, in both formalin solution and formalin blood, confirming the Eschweiler-Clarke reaction between amine-containing compounds and formaldehyde. Alprazolam was found to be unstable whereas diazepam was found to be stable in both formalin solution and water. Both were found to hydrolyse in formalin solution and to give open-ring alprazolam and open-ring diazepam. Other alprazolam conversion products attached to paraformaldehyde were detected in both formalin solution and formalin blood. Morphine and codeine were found to be more stable than hydromorphone and hydrocodone in formalin solution. Conversion products of hydromorphone and hydrocodone attached to paraformaldehyde were tentatively identified in formalin solution. Moreover, hydrocodone and hydromorphone rapidly decreased within 24 h in formalin blood and could not be detected after 7 days. Carbosulfan was found to be unstable in formalin solution and was rapidly hydrolysed within 24 h, whereas in water it was stable up to 48 h. Carbofuran was the major degradation product, plus smaller amounts of other products, 3-ketocarbofuran and 3-hydrocarbofuran. By contrast, carbosulfan slowly hydrolysed in formalin-blood and was still detected after 15 days. It was concluded that HLM provide a useful tool for human drug metabolism studies when ethical considerations preclude their controlled administration to humans. The use of chemical derivatisation for hydrophilic compounds such as polar drug metabolites for analysis by LC/MS/MS with a conventional C18 column is effective and inexpensive, and suitable for routine use in the identification and quantitation of drugs and their metabolites. The detection of parent drugs and their metabolites or conversion and decomposition products is potentially very useful for the interpretation of cases in forensic toxicology, especially when the original compounds cannot be observed.

Abstract Hypothermia deaths pose a difficult challenge from the medico-legal point of view because no specific traces are left on the cadaver to be examined post-mortem. The concentrations of urinary catecholamines, adrenaline and noradrenaline increase in various stressful situations including cold stress, and high levels have been considered to be suggestive of lethal hypothermia. There is, however, a need for a better hypothermia indicator. A potential candidate could be thrombomodulin (TM), an endothelially expressed protein whose plasma concentration has been shown to elevate in response to hypothermia. TM and catecholamine levels were studied in short-term cold exposure (human subjects, n = 7), in mild and severe hypothermia with or without rewarming (rats, n = 96) and in hypothermia deaths compared with deaths from cardiovascular diseases, traumas and other causes (autopsy cases, total n = 552). Myocardial thrombomodulin transcript expression was increased in severely hypothermic rats, but was lower in hypothermia deaths than in other causes. The circulating TM level was transiently reduced in severe hypothermia. The myocardial and urinary TM protein levels were reduced in lethal hypothermia compared with other causes of death. TM and catecholamine levels correlated significantly in blood and urine both in living subjects and post-mortem examination. In severely hypothermic rats, there was an inverse relationship between plasma adrenaline concentration and myocardial thrombomodulin transcript level. The results suggest that TM expression and secretion are altered by hypothermia, possibly linked to the actions of catecholamines. Analysing the post-mortem catecholamine and TM levels provides evidence of ante-mortem cold stress in suspected hypothermia deaths. Further studies should be conducted in order to reveal the exact mechanisms behind the regulation of TM on cell level. / Tiivistelmä Paleltumiskuolemat ovat oikeuslääketieteellisesti haastavia, koska vainajaan ei jää paleltumiseen viittaavia yksiselitteisiä löydöksiä. Virtsan katekoliamiinien, adrenaliinin ja noradrenaliinin, pitoisuudet kasvavat stressitilanteissa kuten kylmäaltistuksessa. Korkeita pitoisuuksia on pidetty paleltumiseen viittaavana tekijänä. Paremmalle paleltumista osoittavalle merkkiaineelle on kuitenkin selkeä tarve. Eräs mahdollinen merkkiaine voisi olla trombomoduliini (TM), joka on endoteelisolujen tuottama proteiini. Sen plasmapitoisuuden on aiemmin osoitettu nousevan alilämpöisyystilassa. TM- ja katekoliamiinitasoja tutkittiin lyhyessä kylmäaltistuksessa (koehenkilöt, n = 7) sekä lievässä ja vaikeassa alilämpöisyystilassa joko lämmityksen jälkeen tai ilman lämmitystä (rotat, n = 96). Lisäksi verrattiin paleltumisen, sydän- ja verisuonitautien, vammojen sekä muiden syiden aiheuttamia kuolemia (ruumiinavausaineisto, n = 552). Sydänlihaksen trombomoduliini-transkriptin taso oli kohonnut vaikeasti alilämpöisillä rotilla, mutta se oli matalampi paleltumiskuolemissa kuin muissa kuolemissa. Veren TM-taso oli hetkellisesti alentunut vaikeassa alilämpöisyystilassa. Sydänlihaksen ja virtsan TM-proteiinipitoisuudet olivat matalampia paleltumiskuolemissa kuin muissa kuolemansyissä. TM- ja katekoliamiinitasot korreloivat merkittävästi veressä ja virtsassa sekä koehenkilöillä ja -eläimillä että vainaja-aineistossa. Vaikeasti alilämpöisillä rotilla todettiin käänteinen suhde plasman adrenaliinipitoisuuden ja sydänlihaksen trombomoduliini-transkriptitason välillä. Tulosten perusteella alilämpöisyystila muuttaa TM:n ekspressiota ja erittymistä, mikä voi liittyä katekoliamiinien vaikutuksiin. Kuolemanjälkeisten TM- ja katekoliamiinitasojen määritys tuo lisänäyttöä kuolemaa edeltäneestä kylmävaikutuksesta epäiltäessä paleltumiskuolemaa. Lisätutkimuksia tarvitaan TM:n solutason säätelymekanismien selvittämiseksi.

Drawing on the classification of expertise developed by Collins and Evans, this study explores the expertises held by members of NHS Research Ethics Committees (RECs) and how they differ from the ones described by the regulations. The study used Q methodology followed by ten semi-structured interviews with Lay and Expert REC members. The results show that committee members see themselves as part of a team, with individual members making different contributions to a collective task. Viewing REC members in this way allows their different expertises to be formally recognised and leads to the creation of two new membership categories, specialist and generalist, based on these expertises. Specialists have expertises such as statistics and pharmacy that are required by the current legislation and which would be present on recruitment. Generalists possess the other expertises needed by the committee but which not required by statute. These include the clinical expertises possessed by healthcare professionals and the other professional expertises – legal, academic, IT and so on – that are typically found amongst those currently classed as Lay members. All REC members, be they specialist or generalist, would also be trained in the ethical and regulatory expertises required to deliver an ethical review. Emphasising how all REC members, whether specialist or generalise, have expertises that contribute to the ethical review enables recruitment activities to focus on the skills needed by the committee rather than current concerns with population demographics. This provides a solution to many of the recruitment issues identified by participants. In particular, it enables the replacement of skills on a ‘like for like’ basis using clearly defined person specifications. Not only would such a process comply with the Nolan principles it be more likely to maintain the integrity and function of the committee regardless of personnel changes.

Although forensic biology is a powerful tool in criminal investigations, there are a number of capability gaps; namely, the interpretation of low-level DNA mixtures, associating the DNA profile with a body fluid, and the issue of consent in sexual offences. A research strategy was developed that utilises whole genome amplification (WGA), messenger RNA and microRNA analysis, DNA profiling, and clothing damage analysis. An evaluation of a WGA technique – multiple displacement amplification - with and without a macromolecular crowding agent, indicated that this may be of use for DNA samples containing certain mixing ratios; however, for this to be truly of use, knowledge of the nature of the sample preanalysis is required, which is not feasible in a forensic environment. A SYBR Greenbased mRNA gene expression test was developed that was capable of distinguishing between saliva and blood by using relative quantitation on real-time PCR. However, the low specificity of the SYBR Green meant that a higher number of controls were required for this to work at forensic standard. A single channel simultaneous analytical test for DNA and microRNA was also developed, which meant that it could be possible to definitively identify the body fluid origin of a DNA profile. This represented a significant step forward in improving forensic biology capability. Reconstruction studies were carried out in response to a sexual assault case where consent was an issue. This study demonstrated that it was possible to cause significant damage to a bra without causing damage to the hook and eye fastening; thus, negating a hypothesis offered by the defence. A long term research strategy has been developed and significant progress has been made in improving the capability of the operational forensic biologist.

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.

Healthcare providers in emergency departments encounter victims of violence and crime daily. Such victims of violence and crime enter emergency departments in need of medical attention, and they carry forensic evidence on their bodies. Healthcare providers offer medical attention, but, in the process, they may inadvertently destroy forensic evidence this may later deny a forensic patient the right to justice. The guidance available to healthcare providers in their training is often unclear, and the legislation and policies on forensic care are somewhat ambiguous, and are left open to the interpretation of the healthcare providers. In this context, this research provides insight into how emancipatory practice development transformed forensic care in three level-one emergency departments in Gauteng, South Africa. The research approach used was action research, in a critical realist paradigm. An emancipatory practice development conceptual framework was applied. The study was conducted with the participants, using collaborative, inclusive and participatory processes. The research commenced with an exploration and explanation of the existing forensic care practised in emergency departments. Then the actual and expected forensic roles and responsibilities were explored with healthcare providers. Next, action plans were developed and implemented. Finally, the outcomes of the research were collaboratively evaluated. The findings indicated that limited forensic care was already being provided at the time of the study. The research increased awareness of forensic care in the participating departments, as healthcare providers took the initiative to preserve evidence better, making use of the knowledge and resources acquired while participating in the research. The participants pointed out that the emancipatory practice development process followed required outsider initiation, combined with sustained support and fostering of relationships. Finally, they indicated that the research process had connected the research to the practice for them. This study demonstrated that emancipatory practice development may increase awareness of forensic care, and may encourage the healthcare providers involved to take ownership. It may simultaneously contribute to changes in existing practice. Based on the findings, healthcare providers' forensic roles and responsibilities were structured into a framework to guide their practice. Furthermore, the steps taken to follow a systematic approach, as required by the emancipatory practice development conceptual framework, have been clarified this may provide some guidance to other researchers who wish to use the same process. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

No description available.

Cette recherche porte sur les médecins légistes et les expertises qu’ils effectuent sur réquisitions du procureur. Ni collaborateurs occasionnels du juge, ni détenteurs d’un titre de spécialité spécifique, les médecins légistes constituent un corps professionnel à distance à la fois du modèle de l’expertise judiciaire et de celui des spécialités médicales. Ils exercent l’expertise médico-légale à titre principal dans des services hospitaliers dédiés, après avoir suivi un cursus dans une spécialité médicale allant de la médecine générale à l’anatomopathologie, en passant par la médecine du travail et la santé publique.La thèse explore la tension entre expertise judiciaire et spécialité médicale et l’analyse simultanément comme étant inscrite dans le processus de constitution du groupe professionnel des médecins légistes, et comme résidant au cœur d’activités de coproduction des vérités médicale et judiciaire sur les faits. Cette recherche repose sur la mise en place d’un dispositif d’enquête empirique associant des observations ethnographiques, des entretiens et un travail documentaire. Les différents sites étudiés (salles d’autopsies, cabinets médicaux, directions ministérielles, administrations déconcentrées, permanences-parquet, cours d’assises, congrès de médecine légale) sont constitutifs du dispositif médico-légal étudié selon deux plans distincts : le plan des protocoles qui, des ministères aux services, vise à organiser et cadrer les activités médico-légales ; celui des rapports d’expertise établis par les médecins légistes, qu’il s’est agi de suivre depuis les services de médecine légale jusqu’aux tribunaux. La première partie consiste à explorer le plan des protocoles, en étudiant notamment la genèse, l’élaboration et la mise en œuvre d’une réforme de la médecine légale. Elle montre que l’organisation des activités médico-légales a oscillé entre deux définitions de l’expertise médico-légale qui instituent respectivement une figure du médecin expert judiciaire et une figure du légiste spécialiste. La deuxième partie retrace les carrières de ceux qui s’engagent dans l’expertise médico-légale. Elle montre que les postures des médecins vis-à-vis de l’expertise médico-légale dépendent de la façon dont ils ajustent l’exercice de cette activité à leur formation médicale d’origine. Enfin, la troisième partie traite des pratiques des experts et des magistrats du parquet, au sein des organisations où les expertises médico-légales sont produites et utilisées, de l’hôpital au tribunal. Cette ethnographie de l’élaboration des preuves médico-légales révèle les tensions qui apparaissent dans le flux de l’activité du fait des différents cadres que les médecins associent dans leurs explorations des corps violentés.Cette approche mobile du dispositif médico-légal permet de soulever deux enjeux théoriques. D’abord, l’articulation entre le niveau micro des pratiques et le niveau méso des organisations conduit à renouveler l’approche par les segments professionnels. L’étude des processus de segmentation permet ici de déterminer si la médecine légale est une activité pilotée depuis la tutelle judiciaire qui finance et consomme des rapports d’expertise, ou si elle tend à devenir une discipline médicale autonome régulée comme une spécialité depuis l’hôpital. Le deuxième enjeu consiste à étudier les processus de socialisation au dispositif et les pratiques des experts de façon dynamique. En définitive, cette thèse propose d’analyser une pratique tendue entre différents cadres mobilisés en situation, tout en analysant certains déterminants sociaux du jugement médico-légal par l’exploration dynamique de trois échelles distinctes : l’organisation de la médecine légale, la socialisation des médecins légistes et l’activité des professionnels qui produisent et se saisissent des rapports médico-légaux. / This research focuses on medical examiners and the reports they provide upon requisition from Public Prosecutors. Neither occasional collaborators of the judge, nor holders of a specific specialty title, forensic scientists and medical examiners form a professional body that is quite distant from both the judicial expert assessment model and the medical specialty model. They mainly practise the medico-legal expertise in dedicated hospital units, and have undergone a medical university curriculum, with medical specialties ranging from general medicine to anatomopathology, and from occupational medicine to public health.This thesis explores the tension between a judicial expert assessment and a medical specialty, and analyses this tension, simultaneously as being enshrined into the formation process of the occupational group, and as a driving force of the coproduction of medical and judicial truths about facts. The research builds on the implementation of an empirical investigation system, associating ethnographic observations, interviews, and documentation. The different locations that were analysed (autopsy rooms, doctors’ offices, Ministerial directions, decentralised administrations, Public Prosecutors’ committee rooms, congress) constitute a two-level analysis of the medico-legal apparatus: on one hand, the protocol level, where medico-legal activities are organised and supervised, from state-level administrations to local departments; on the other hand, the expert assessment level, where medical examiners were studied from medical examination rooms up to courts of law. The first chapter explores the protocol level, by studying, in particular, the genesis, elaboration and implementation of a forensic medicine reform. It highlights how the organisation of medico-legal activities has been oscillating between two definitions of a medico-legal expertise; these two definitions respectively establish the figure of a judicial expert doctor, and the figure of a forensic specialist. The second chapter focuses on the careers of those who embrace the medico-legal expertise field. It reveals how doctors’ positions on medico-legal expertise are reliant on the way they adjust the practising of this activity to their original medical education. Finally, the third chapter analyses the practices of experts and magistrates from the Public Prosecutor’s department, within the organisations where the medico-legal expert assessments are produced and used, from hospitals to courts of law. This ethnography of how medico-legal evidence is created underlines the tensions that come up within this activity stream, as doctors mix up different frameworks in the way they examine assaulted bodies.This mobile approach of the medico-legal apparatus allows the surfacing of two theoretical concerns. First, the logical hierarchy between the micro level of practises and the meso level of organisations leads to renew the approach for professional segments. Studying segmentation processes is a way of determining if forensic medicine is more driven towards being an activity that is piloted by the judicial administration supervision (which funds and consumes the expert assessments), or towards becoming an autonomous medical discipline with the same regulation mechanisms as a regular hospital specialty. This second concern leads to studying the socialization mechanism as well as the practises of experts in a dynamic way. Ultimately, this thesis proposes to analyse a practise that is stretched between different surroundings in concrete situations, while analysing specific social determining factors of the medico-legal assessment, by dynamically exploring three levels: the organisation of forensic medicine, the socialization of the experts, and the actual activity of the professionals that produce and seize medico-legal assessments.

No / The last two decades has seen increased use of imaging in forensic practice. Although radiography has been used historically, the evidence base for the use of computed tomography and magnetic resonance imaging in forensic practice appears to be growing. This article reviews the evidence base for the use of radiography, CT and MRI in an attempt to ascertain the future use of these imaging techniques in forensic medicine.