Research Doctorate - Doctor of Philosophy (PhD) / Identification of the victims of a mass fatality incident is considered a basic human right.Forensic odontology frequently makes a significant contribution to the identification process following major disasters, and is considered a primary identifier in the Interpol Disaster Victim Identification (DVI) Guidelines. Many authors have indicated that to achieve identification with dignity and respect requires practical guidelines and standard operating procedures. No internationally accepted guidelines currently exist for the practice of forensic odontology in DVI situations. This report documents the development of a comprehensive practice guide for use by Australian forensic odontologists in a mass fatality incident. To understand the value of this document in a professional context the project also looked at the development and application of forensic odontology in multiple fatality incidents in Australia. This evolution has seen forensic odontology grow from a spasmodically used ad-hoc service to the consistent professional service delivered by practitioners today. The research question addressed in this project was “Is the Delphi technique is an appropriate tool to assist the Australian Society of Forensic Odontology to develop a set of guidelines and Standard Operating Procedures for Disaster Victim Identification practices”? Thirty one members of the Australian Society of Forensic Odontology and four members of various Australian police services and the private disaster management sector participated in the project. The participants set the level of consensus against which they wished to work and took 4 rounds to reach agreement on the contents of the document. The resultant document, the “Disaster Victim Identification Forensic Odontology Guide” is comprehensive in coverage, meets many of the criteria established to define quality and places the Australian Society of Forensic Odontology at the vanguard of professionalism in the forensic odontology community, and confirms the Delphi technique was an appropriate tool to assist in the development of a set of guidelines and Standard Operating Procedures for Disaster Victim Identification practices.

Research Doctorate - Doctor of Philosophy (PhD) / Identification of the victims of a mass fatality incident is considered a basic human right.Forensic odontology frequently makes a significant contribution to the identification process following major disasters, and is considered a primary identifier in the Interpol Disaster Victim Identification (DVI) Guidelines. Many authors have indicated that to achieve identification with dignity and respect requires practical guidelines and standard operating procedures. No internationally accepted guidelines currently exist for the practice of forensic odontology in DVI situations. This report documents the development of a comprehensive practice guide for use by Australian forensic odontologists in a mass fatality incident. To understand the value of this document in a professional context the project also looked at the development and application of forensic odontology in multiple fatality incidents in Australia. This evolution has seen forensic odontology grow from a spasmodically used ad-hoc service to the consistent professional service delivered by practitioners today. The research question addressed in this project was “Is the Delphi technique is an appropriate tool to assist the Australian Society of Forensic Odontology to develop a set of guidelines and Standard Operating Procedures for Disaster Victim Identification practices”? Thirty one members of the Australian Society of Forensic Odontology and four members of various Australian police services and the private disaster management sector participated in the project. The participants set the level of consensus against which they wished to work and took 4 rounds to reach agreement on the contents of the document. The resultant document, the “Disaster Victim Identification Forensic Odontology Guide” is comprehensive in coverage, meets many of the criteria established to define quality and places the Australian Society of Forensic Odontology at the vanguard of professionalism in the forensic odontology community, and confirms the Delphi technique was an appropriate tool to assist in the development of a set of guidelines and Standard Operating Procedures for Disaster Victim Identification practices.

Human trafficking is a global issue with every country being affected. Victims of human trafficking endure extreme and prolonged psychological, physical, and sexual trauma, which often lead to healthcare facility visits while in captivity. It is estimated that 28% of human trafficking victims come into contact with a healthcare professional, yet few victims are detected in the healthcare setting. The aims of this study were, therefore, to summarize and compare English screening protocol literature, disseminate the most effective screening questions in a format easily accessible to healthcare providers, and to identify gaps in the literature. Research about utilizing trafficking screening protocols in a healthcare setting is a relatively new phenomenon since trafficking has been traditionally framed as a security matter rather than a health matter. A scoping review was conducted using the five-stage Arksey and O’Malley (2005) framework with revisions from Daudt, van Mossel, and Scott (2013), and Levac, Colquhoun and O’Brien (2010). Findings were summarized thematically: 1) pre-screening, 2) screening questions, 3) post-screening, and 4) training. Twenty-nine sources were included of 325 identified with most (68.97%) being published in the United States. There was only one validated screening protocol: 94.12% of screening protocols lacked scientific reasoning for chosen questions. With limited access to evidence-based screening protocols, healthcare professionals globally may be using outdated screening questions that are less effective when trying to identify trafficking victims. / Thesis / Master of Science (MSc) / Victims of trafficking sustain psychological, physical, and sexual injuries, which often lead to healthcare facility visits. Although trafficking victims do come into contact with healthcare professionals while in captivity, few victims are identified in the healthcare setting. This study, therefore, aims to uncover English human trafficking screening protocols, to compare the protocols, and to share the most effective questions for healthcare professionals when trying to identify a victim of trafficking. Previous studies have failed to address this issue globally since trafficking has traditionally been framed as a security matter rather than a health matter. Electronic databases were searched using defined keywords for screening protocol literature, revealing 29 relevant documents after review. Only one, recently developed screening tool was validated, meaning that healthcare professionals globally may be using outdated screening questions that are less effective when trying to identifying trafficking victims.

By working with an anti-human trafficking organization in Sarasota, Florida, and sex-worker activists based in St. Petersburg, Florida, this research focuses on the process by which trafficking victims and sex workers are identified and dealt with by the criminal justice system and NGO rehabilitation programs. The study focused on understanding how stakeholders decide between identifying someone as a criminal or a victim of sex trafficking and how women identify themselves and subjectively experience their interaction with the criminal justice system and a faith-based rehabilitation program. By exploring the victims’ process of going through the criminal justice system, this study problematizes the ideas of victim certification, diversion programming, and the idea that sex work is inherently exploitative and never agentive. Due to anti-prostitution laws in the United States (US), the lack of trauma-informed care within the criminal justice system, and the stigma surrounding sex work that stems from dominant American culture, sex workers and trafficking victims are often further harmed when they become involved with the criminal justice system. My findings reveal narratives produced around the “innocent victim” perpetuate an image of human trafficking that focuses on White women and children in forced prostitution. This image contributes to constructions of ‘deservingness’ for different populations involved in exchanging sex and alters whether or not individuals are identified as victims of sex trafficking depending on their adherence to this narrative. Common narratives surrounding trafficking can also harm sex workers who want to be recognized as agentive adults in the sex industry. I present the multiple realities that exist in the criminal/legal systems surrounding sex trafficking and consensual sex work in Florida and how participants perceive their treatment by various organizations such as law enforcement, the court system, diversion programs, and NGOs by conducting interview analysis, participant observation, and performance ethnography through the production of a fictionalized scene written with research participants and stakeholders.

Magister Chirurgiae Dentium - MChD (Maxillo-Facial & Oral Surgery) / South African dentists have a legal and ethical obligation to maintain complete and comprehensive dental records. In addition to the legal and ethical requirements, dental records are also important in the case of medico-legal issues, quality assurance processes and forensic purposes. Valuable forensic evidence contained in dental records are used in the identification of victims of mass disasters, personal victim identification e.g. in severely decomposed or skeletonized remains where DNA or other biometric data are not available. The victim identification process is highly dependent on complete, legible and accurate dental records. A review of the literature however shows that dental record keeping practices are sub-optimal worldwide. There is a paucity of studies in South Africa regards to dental record keeping practices. The aim of this study was to assess the record keeping practices of a sample of private practicing dentists in Cape Town and surrounding towns, for forensic dental purposes. Knowledge and awareness regards to forensic odontology as well as adherence to the guidelines prescribed by the Health Professional Council of South Africa were also assessed. This was a cross-sectional descriptive study, employing a researcher-administered questionnaire and a dental checklist for forensic valuable items in the dental file. The results were entered in a MS Excel spreadsheet and statistically analysed using IMB SPSS Statistics. This study concluded that most of the dental records kept by Cape Town dentists are near to optimal and would be helpful during forensic odontology investigations. However, shortcomings in record keeping practices exists which may compromise the forensic accuracy of their dental records. The study also shows a significant difference in dental record keeping practices by dentists practicing in lower income areas in Cape Town, compared to those practicing in economic affluent areas. The dentists in this study adhered to most of the guidelines prescribed by the Health Professional Council of South Africa however, important medico-legal information was missing from most dental records. This study hopes to contribute to future comprehensive studies in the broader South Africa to determine the validity of dental records for forensic odontology purposes.

A documentação odontológica é utilizada como ferramenta indispensável para identificação humana uma vez que possibilita a comparação entre registros ante mortem (AM) e post mortem (PM), levando a resultados objetivos e confiáveis. A constante evolução tecnológica ocasionou grande avanço na qualidade dos exames por imagens, auxiliando o processo de identificação por arco dentário. Nesse contexto, as imagens radiográficas digitais ganharam espaço frente às convencionais e as tomografias computadorizadas (TC) passaram a ser comumente utilizadas na Odontologia, devido à multiplicidade dos detalhes oferecidos pelas imagens tridimensionais. Estudos recentes revelam as tentativas de se reproduzir imagens semelhantes às intraorais por meio de TC. No entanto, ainda não há estudos efetivos no campo das ciências forenses, utilizando tomografias computadorizadas de feixe cônico (TCFC) com o propósito de identificação. O presente estudo teve como objetivo desenvolver uma metodologia para simulação de imagens radiográficas intraorais em tomografias computadorizadas de feixe cônico, visando repetir a incidência e geometria da radiografia de origem, contemplando os possíveis erros de angulação, além de verificar a eficácia e confiabilidade desse princípio entre os examinadores. Para isso, foi realizada a aquisição de vinte TCFC de crânios secos e os dados do seu odontograma inseridos nas fichas PM do WinID. Para cada crânio, um segundo observador realizou três radiografias periapicais digitais, simulando as AM, uma delas contendo alteração de posicionamento. As 60 radiografias foram randomizadas, três pontos foram selecionados, suas distâncias lineares e angulação mensurados no Photoshop e catalogados em planilha do Microsoft Excel. Os dados odontológicos das radiografias foram incluídos como fichas AM do WinID. O software indicou similaridade ao confrontar os elementos AM com os PM. e os valores tabulados das radiografias conduziram as análises do primeiro, sem o conhecimento prévio dos erros. As regiões de interesse (ROI) das imagens radiográficas foram localizadas nas TCFC e a geometria de incidência simulada, mediante a manipulação dos planos espaciais e ferramentas disponíveis no software Osirix, buscando valores semelhantes aos originais. Por fim, a sobreposição de imagens foi realizada utilizando artifícios do Photoshop, comprovando a similaridade entre as imagens originais e as replicadas na tomografia. Os resultados mostraram que foi possível replicar a geometria das imagens radiográficas nas TCFC em 100% da amostra. Testes estatísticos como o coeficiente de variação, diferenças de médias e coeficiente de Pearson evidenciaram forte correlação para todas as variáveis estudadas e todos os valores foram estatisticamente significantes (p<0.05). O protocolo desenvolvido possibilitou a reprodução da geometria e incidência das radiografias convencionais em TCFC, inclusive na presença de alterações na angulação. As imagens produzidas puderam ser comparadas às originais, assegurando o resultado por sobreposição. Em todas elas ficou comprovada a viabilidade do uso do protocolo para fins de identificação humana e sua aplicação, portanto, foi considerada confiável e segura, visto que a concordância entre os observadores ficou demonstrada pelos testes estatísticos. / Dental Records are used as a necessary tool for human identification, as it enables the comparison of Antemortem (AM) and Postmortem (PM) data, leading to objective and reliable results. The constant evolution of technology brought advances in the quality of images, aiding the dental arch identification process. In this context, the digital radiographic images gained ground among conventional radiographs and Computed Tomography (CT) became usual in dentistry, due to the multiple details available in the tridimensional images. Recent studies shown attempts of reproducing intraoral images from CT. But there was no effective studies in the forensic science field using Cone-Beam Computed Tomography (CBCT) with identification purposes. The present study aims on developing a methodology that could simulate intra-oral images in CBCT exams, in order to repeat the incidence and image geometry of the original radiography, covering possible angulation errors and testing the reliability of the process. To do so, 20 CBCT were acquired from dry skulls and their dental charts were registered in WinID. In each cranium, a second observer made three periapical radiographs, simulating the AM records in WinID, and one should contain and incidence error. The 60 radiographs were randomized and in each three points were selected with linear distances and angle between them were measured in photoshop and recorded in a MS Excel chart. The data from the radiographs were included in WinId as AM records. The Sotware indicated similarities of the records by matching AM and PM, and the values from the radiographs directed the analysis made by the first examiner, with no knowledge of the previous errors and the AM data registered in WinID. The Region of Interest (ROI) in the radiographs were located in the CBCT and the geometry and incidence were simulated using the manipulation of the orientation planes and tools of the software Osirix, in search of similar to the original values. Finally, the superimposition of images was made in Photoshop, to prove the achievement of similarity between the original images and those extracted from the CBCT. The results showed a possible repeatability of image geometry in 100% of the sample. Statistic test of the variance coefficient, average difference and Pearson coefficient highlighted the strong correlation of all variables and significance of all tested values (p<0.05). The developed protocol enabled the reproduction of conventional radiographs geometry and incidence in CBCT exams, including in the presence of incidence errors. The produced images could be compared to the original, assuring a result by superimposition. In every analysis, the use of this protocol has been confirmed as viable for human identification purposes, and its usage was considered reliable and secure, as the concordance between examiners was demonstrated by the statistic analysis.

A documentação odontológica é utilizada como ferramenta indispensável para identificação humana uma vez que possibilita a comparação entre registros ante mortem (AM) e post mortem (PM), levando a resultados objetivos e confiáveis. A constante evolução tecnológica ocasionou grande avanço na qualidade dos exames por imagens, auxiliando o processo de identificação por arco dentário. Nesse contexto, as imagens radiográficas digitais ganharam espaço frente às convencionais e as tomografias computadorizadas (TC) passaram a ser comumente utilizadas na Odontologia, devido à multiplicidade dos detalhes oferecidos pelas imagens tridimensionais. Estudos recentes revelam as tentativas de se reproduzir imagens semelhantes às intraorais por meio de TC. No entanto, ainda não há estudos efetivos no campo das ciências forenses, utilizando tomografias computadorizadas de feixe cônico (TCFC) com o propósito de identificação. O presente estudo teve como objetivo desenvolver uma metodologia para simulação de imagens radiográficas intraorais em tomografias computadorizadas de feixe cônico, visando repetir a incidência e geometria da radiografia de origem, contemplando os possíveis erros de angulação, além de verificar a eficácia e confiabilidade desse princípio entre os examinadores. Para isso, foi realizada a aquisição de vinte TCFC de crânios secos e os dados do seu odontograma inseridos nas fichas PM do WinID. Para cada crânio, um segundo observador realizou três radiografias periapicais digitais, simulando as AM, uma delas contendo alteração de posicionamento. As 60 radiografias foram randomizadas, três pontos foram selecionados, suas distâncias lineares e angulação mensurados no Photoshop e catalogados em planilha do Microsoft Excel. Os dados odontológicos das radiografias foram incluídos como fichas AM do WinID. O software indicou similaridade ao confrontar os elementos AM com os PM. e os valores tabulados das radiografias conduziram as análises do primeiro, sem o conhecimento prévio dos erros. As regiões de interesse (ROI) das imagens radiográficas foram localizadas nas TCFC e a geometria de incidência simulada, mediante a manipulação dos planos espaciais e ferramentas disponíveis no software Osirix, buscando valores semelhantes aos originais. Por fim, a sobreposição de imagens foi realizada utilizando artifícios do Photoshop, comprovando a similaridade entre as imagens originais e as replicadas na tomografia. Os resultados mostraram que foi possível replicar a geometria das imagens radiográficas nas TCFC em 100% da amostra. Testes estatísticos como o coeficiente de variação, diferenças de médias e coeficiente de Pearson evidenciaram forte correlação para todas as variáveis estudadas e todos os valores foram estatisticamente significantes (p<0.05). O protocolo desenvolvido possibilitou a reprodução da geometria e incidência das radiografias convencionais em TCFC, inclusive na presença de alterações na angulação. As imagens produzidas puderam ser comparadas às originais, assegurando o resultado por sobreposição. Em todas elas ficou comprovada a viabilidade do uso do protocolo para fins de identificação humana e sua aplicação, portanto, foi considerada confiável e segura, visto que a concordância entre os observadores ficou demonstrada pelos testes estatísticos. / Dental Records are used as a necessary tool for human identification, as it enables the comparison of Antemortem (AM) and Postmortem (PM) data, leading to objective and reliable results. The constant evolution of technology brought advances in the quality of images, aiding the dental arch identification process. In this context, the digital radiographic images gained ground among conventional radiographs and Computed Tomography (CT) became usual in dentistry, due to the multiple details available in the tridimensional images. Recent studies shown attempts of reproducing intraoral images from CT. But there was no effective studies in the forensic science field using Cone-Beam Computed Tomography (CBCT) with identification purposes. The present study aims on developing a methodology that could simulate intra-oral images in CBCT exams, in order to repeat the incidence and image geometry of the original radiography, covering possible angulation errors and testing the reliability of the process. To do so, 20 CBCT were acquired from dry skulls and their dental charts were registered in WinID. In each cranium, a second observer made three periapical radiographs, simulating the AM records in WinID, and one should contain and incidence error. The 60 radiographs were randomized and in each three points were selected with linear distances and angle between them were measured in photoshop and recorded in a MS Excel chart. The data from the radiographs were included in WinId as AM records. The Sotware indicated similarities of the records by matching AM and PM, and the values from the radiographs directed the analysis made by the first examiner, with no knowledge of the previous errors and the AM data registered in WinID. The Region of Interest (ROI) in the radiographs were located in the CBCT and the geometry and incidence were simulated using the manipulation of the orientation planes and tools of the software Osirix, in search of similar to the original values. Finally, the superimposition of images was made in Photoshop, to prove the achievement of similarity between the original images and those extracted from the CBCT. The results showed a possible repeatability of image geometry in 100% of the sample. Statistic test of the variance coefficient, average difference and Pearson coefficient highlighted the strong correlation of all variables and significance of all tested values (p<0.05). The developed protocol enabled the reproduction of conventional radiographs geometry and incidence in CBCT exams, including in the presence of incidence errors. The produced images could be compared to the original, assuring a result by superimposition. In every analysis, the use of this protocol has been confirmed as viable for human identification purposes, and its usage was considered reliable and secure, as the concordance between examiners was demonstrated by the statistic analysis.