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Employees of forensic medical service organizations are exposed to occupational trauma during their clinical, pathology, scientific and corporate duties. Adverse impacts, associated with occupational trauma exposure, can illicit negative outcomes that may influence a person's professional practice as well as their physical, behavioural and psychological reactions. Research exploring the impact of trauma exposure has typically focused on reduction of exposure, failing to address workplaces where exposure to trauma is a core activity for employees. This study explored the experiences of staff working at a state-wide forensic medical and scientific institution in Australia. Thematic analysis of 25 key-informant interviews identified that 1) trauma exposure is common and multifactorial in nature; 2) impacts of trauma exposure varies by personal characteristics and case circumstances; and 3) trauma exposure can be better managed when organizational and individual responsibility align. Awareness that a strong sense of purpose and contribution derived from the important nature of the work delivered, allows individuals to remain employed. The study also identified that facilitating a culture of openness regarding trauma exposure can lead to improved workplace wellbeing and retention of this dedicated workforce. [ABSTRACT FROM AUTHOR]

One-punch deaths draw considerable legal and media attention due to the nature of catastrophic events and their impact on victims and families. Empirical research on the sentencing outcomes and offence categories faced by the perpetrators is non-existent. This Australian study examined judicial sentencing reviews to unpack perpetrator characteristics, offence patterns and sentencing outcomes for one-punch fatalities over a 30-year period. Two hundred and eighty-seven perpetrator convictions were reported by various parameters such as median sentencing length, injury mechanism and maximum sentencing categories. Secondary outcomes were details of concentrations of alcohol and illicit drug usage and usage of one-punch specific laws, hitherto unelucidated for one-punch assaults. Nearly all perpetrators were male with a median age of 26 years, with 61% charged in New South Wales and Victoria alone. The median sentence length of imprisonment was 3.8-11.5 years for a manslaughter conviction. Median sentence length when categorized by injury mechanism demonstrated variation in both life sentence and one-punch offence categories. About 40% of Australian perpetrators were convicted under one-punch laws in states where these were introduced. The study will increase knowledge and public awareness regarding the impact of one-punch violence and outcomes., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Associate Professor Jennifer Schumann is a board member of the Coward Punch Limited, an Australian Charity (funding body) since December 2023. Professor Schumann was not a board member when the research was completed.

Medicolegal systems investigate the cause and manner of death, particularly differentiating between unintentional and intentional deaths. The examination of remains from unlawfully killed individuals is critical in exposing human rights violations. However, forensic medical investigations of these human remains can face multiple challenges, especially in contexts marked by limited resources, political influence, and sub-optimal investigative procedures. When killings are state-sanctioned or facilitated by well-resourced non-state actors, the clandestine disposal of remains can create a culture of impunity, leaving affected families and communities without recourse or resolution. This study aggregates articles in English and Spanish, examining the current state of how forensic medical research on extrajudicial executions and forced disappearances informs practice. It highlights critical gaps in the empirical literature, particularly in the reporting of the scientific findings that impact the investigation of victims of these unlawful killings. These cases' inherently non-linear and unpredictable nature, often influenced by chaotic and unstable conditions, can create disproportionate challenges for forensics practitioners. To address these gaps, this review suggests leveraging epidemiological frameworks to track data trends in these unlawful killings, supporting public health initiatives in prevention and policy. It emphasises the need for comprehensive documentation, robust databases, and adaptive forensic methodologies to navigate uncertainties and systemic limitations inherent in this complex and unpredictable domain of medicolegal death investigation., Competing Interests: Declarations. Ethics approval: NA. Consent to participate: NA. Consent for publication: Falls under the ethics approval as stated above. Conflicts of interest: The authors wish to declare that they have no affiliation or involvement with any organisations/financial interests regarding this manuscript's subject matter and content., (© 2025. The Author(s).)

Mortality data systems are upstream determinants of health, providing critical information on causes of death and population health trends and influencing health outcomes by shaping policies, research, and resource allocation. Moreover, the gender-related deaths of women and girls are significantly underrepresented or underrecognized in mortality data across many countries. This paper seeks to identify potential barriers and facilitators to improving the representation of femicide data. The primary barriers affecting data representation of femicide are related to definitions, data collection, coding, comparability, access, and systemic challenges. Key recommendations include establishing a nationwide consensus on the definition of femicide, updating training modules for medicolegal professionals, improving pathology reporting processes, ensuring quality assurance in documentation, refining coding practices, developing new analytic methods, and providing deidentified access to cases still under investigation., Competing Interests: Declarations. Conflicts of interest: The authors declare no conflict of interest., (© 2025. The Author(s).)

The remains of unlawfully killed individuals can provide evidence concerning human rights violations. The intricate challenges of extrajudicial killings and forced disappearances can complicate legal and procedural processes. These cases often present indicators of suspicious circumstances, necessitating specialised investigative approaches to ascertain the circumstance and cause of death as well as potential human rights violations. This review explores the legal and procedural dimensions of handling the remains of individuals who have been unlawfully killed, critically examining the implementation of legal instruments and their impact on the socio-cultural and political landscape regarding cases of extrajudicial killings and forced disappearances. This study utilised a Python-based web scraper, with an HTML parsing library to aggregate articles on three themes of 1) International law, humanitarian law and laws protecting human remains 2), protection of human remains in cases of extrajudicial killings and forced disappearances and 3), Considerations of socio-cultural, psychosocial factors in the protection of human remains and institutional failures. The programming-based method for locating articles is innovative, and the search covered both English and Spanish languages. This review establishes the tension between psychosocial/cultural requirements and legal practice, and describes community mechanisms such as social services, mental health support for affected families, and citizen initiatives. By emphasising the gap between legal standards and practical execution, the study highlights the need to refine legal guidance and strengthen procedural compliance to uphold the dignity of the deceased and ensure accountability for violations of the right to life., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Reference data for dental age estimate is sparse in New Zealand (NZ), with only two contemporary studies. Te Moananui et al. (J For Sci. 53(2), 2008) presented modified Demirjian percentile curves to estimate dental age of Pasifika, Māori, and European males and females (n = 1383), while Timmins et al. (Forensic Sci Med Pathol. 8:101-8, 2012) found the Demirjian method (1973) was valid for a smaller sample (n = 200) of unknown ancestry. The study presented here sought to validate the Demirjian and the Te Moananui methods for a sample of the NZ population of unknown ancestry and a subgroup of known ancestry i.e., Pasifika, Māori and European, for males and females. The Demirjian method (1976) was applied to the current study's sample consisting of 3523 individuals aged 4 to < 20 years. The seven left mandibular teeth (third molar excluded) and tooth scores were summed for each individual, with the Te Moananui methods applied to this subgroup. The results revealed these methods to be less than ideal for estimating dental age of the NZ sample, for both males and females. The probit regression form of Transition Analysis (TA) was employed to calculate the mean age entering each tooth stage, for the seven teeth, to reduce age mimicry that is commonly associated with traditional regression analysis. TA results revealed Pasifika and Māori individuals to be more advanced than Caucasian individuals. The sex groups were also compared to the mean ages presented by Demirjian and Levesque with mixed results (J Dent Res. 59(7):1110-22, 1980), highlighting the need for more research in this area., Competing Interests: Declarations. Ethics approval: This research study was conducted retrospectively from data obtained for clinical purposes and considered low risk. Ethics approval was sought from and approved by Auckland Health Research Ethics Committee (NZ). Reference number: 000110. Consent: N/A. Conflict of interests: The authors have no financial or proprietary interests in any material discussed in this article., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Forensic investigation is a complex procedure involving experts working together to establish cause of death and report findings to legal authorities. While new technologies are being developed to provide better post-mortem imaging capabilities-including mixed-reality (MR) tools to support 3D visualisation of such data-these tools do not integrate seamlessly into their existing collaborative workflow and report authoring process, requiring extra steps, e.g. to extract imagery from the MR tool and combine with physical autopsy findings for inclusion in the report. Therefore, in this work we design and evaluate a new forensic autopsy report generation workflow and present a novel documentation system using hybrid mixed-reality approaches to integrate visualisation, voice and hand interaction, as well as collaboration and procedure recording. Our preliminary findings indicate that this approach has the potential to improve data management, aid reviewability, and thus, achieve more robust standards. Further, it potentially streamlines report generation and minimise dependency on external tools and assistance, reducing autopsy time and related costs. This system also offers significant potential for education. A free copy of this paper and all supplemental materials are available at https://osf.io/ygfzx.

Femicide, the killing of women, girls, and infants, is a pervasive problem affecting all global societies. Policy and research are impeded by inaccurate and missing prevalence data, gaps in understanding of femicide, especially for hard-to-reach marginalized populations, and conflicting perceptions between jurisdictions. Leveraging on a combined socio-ecologic model and Public Health approach, the paper spans the methods of a computed tomography-based injury study, an in-depth media-analysis, a legislation evaluation study, and a data barriers' study. Injury patterns, media depiction, and end-user consultations will close the loop on residual problems such as implementation, data gaps, and cultural perceptions. By mixed methods research representing multiple regions, and stakeholders, this project will enhance knowledge on interpersonal, institutional, and societal factors of femicide, advancing the humanitarian forensic discipline. The research method will identify emerging trends and facilitate improvements in tertiary prevention of femicide, specific to resource settings., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Mass disaster events can result in high levels of casualties that need to be identified. Whilst disaster victim identification (DVI) relies on primary identifiers of DNA, fingerprints, and dental, these require ante-mortem data that may not exist or be easily obtainable. Facial recognition technology may be able to assist. Automated facial recognition has advanced considerably and access to ante-mortem facial images are readily available. Facial recognition could therefore be used to expedite the DVI process by narrowing down leads before primary identifiers are made available. This research explores the feasibility of using automated facial recognition technology to support DVI. We evaluated the performance of a commercial-off-the-self facial recognition algorithm on post-mortem images (representing images taken after a mass disaster) against ante-mortem images (representing a database that may exist within agencies who hold face databases for identity documents (such as passports or driver's licenses). We explored facial recognition performance for different operational scenarios, with different levels of face image quality, and by cause of death. Our research is the largest facial recognition evaluation of post-mortem and ante-mortem images to date. We demonstrated that facial recognition technology would be valuable for DVI and that the performance varies by image quality and cause of death. We provide recommendations for future research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.)

Much has been written about bite mark comparisons and bite mark analysis. It has largely been written for, and remained within the domain of, the forensic odontologist despite the limited number of such specialists and the even smaller subset who have expertise in this area. For those health professionals who work in the field of clinical forensic medicine, most will not have access to a forensic odontologist. Courts can be reticent about the costs involved in obtaining another expert opinion. For health professionals, who will likely encounter more bite marks in their career than forensic odontologists, the difficulty is knowing what can legitimately be opined about such injuries., Competing Interests: Declaration of Competing interest There are no declarations of interest., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Pericardial effusion can be a sign of significant underlying diease and, in some cases, may lead to death. Post-mortem computed tomography (PMCT) is a well-established tool to assist death investigation processes in the forensic setting. In practice, the scarcity of well-trained radiologists is a challenge in processing raw whole-body PMCT images for pericardial effusion detection. In this work, we propose a Pericardial Effusion Automatic Detection (PEAD) framework to automatically process raw whole-body PMCT images to filter out the irrelevant images with heart organ absent and focus on pericardial effusion detection. In PEAD, the standard convolutional neural network architectures of VGG and ResNet are carefully modified to fit the specific characteristics of PMCT images. The experimental results prove the effectiveness of the proposed framework and modified models. The modified VGG and ResNet models achieved superior detection accuracy than the standard architecture with reduced processing speed.

Background and Objective: High-resolution histopathology whole slide images (WSIs) contain abundant valuable information for cancer prognosis. However, most computational pathology methods for survival prediction have weak interpretability and cannot explain the decision-making processes reasonably. To address this issue, we propose a highly interpretable neural network termed pattern-perceptive survival transformer (Surformer) for cancer survival prediction from WSIs., Methods: Notably, Surformer can quantify specific histological patterns through bag-level labels without any patch/cell-level auxiliary information. Specifically, the proposed ratio-reserved cross-attention module (RRCA) generates global and local features with the learnable prototypes (p global , p locals ) as detectors and quantifies the patches correlative to each p local in the form of ratio factors (rfs). Afterward, multi-head self&cross-attention modules proceed with the computation for feature enhancement against noise. Eventually, the designed disentangling loss function guides multiple local features to focus on distinct patterns, thereby assisting rfs from RRCA in achieving more explicit histological feature quantification., Results: Extensive experiments on five TCGA datasets illustrate that Surformer outperforms existing state-of-the-art methods. In addition, we highlight its interpretation by visualizing rfs distribution across high-risk and low-risk cohorts and retrieving and analyzing critical histological patterns contributing to the survival prediction., Conclusions: Surformer is expected to be exploited as a useful tool for performing histopathology image data-driven analysis and gaining new insights for interpreting the associations between such images and patient survival states., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Family violence homicide (FVH) is a major public health and social problem in Australia. FVH trend rates are key outcomes that determine the effectiveness of current management practices and policy directions. Data source-related methodological problems affect FVH research and policy and the reliable measurement of homicide trends., Objective: This study aimed to determine data reliability and temporal trends of Victorian FVH rates and sex and relationship patterns., Method: FVH rates per 100,000 persons in Victoria were compared between the National Coronial Information System (NCIS), Coroners Court of Victoria (CCoV) Homicide Register, and the National Homicide Monitoring Program (NHMP). Trends for 2001-2017 were analysed using Joinpoint regression. Crude rates were determined by sex and relationship categories using annual frequencies and Australian Bureau of Statistics population estimates., Results: NCIS closed FVH cases totalled 360, and an apparent downward trend in the FVH rate was identified. However, CCoV and NHMP rates trended upwards. While NCIS and CCoV were case-based, NHMP was incident-based, contributing to rate variations. The NCIS-derived trend was particularly impacted by unavailable case data, potential coding errors and entry backlog. Neither CCoV nor NHMP provided victim-age in their public domain data to enable age-adjusted rate comparison., Conclusion: Current datasets have limitations for FVH trend determination; most notably lag times for NCIS data., Implications: This study identified an indicative upward trend in FVH rates in Victoria, suggesting insufficiency of current management and policy settings for its prevention and control.

One-punch assaults also known as 'coward punches', are characterised by a single severe blow to the head causing the victim to lose consciousness, resulting in a secondary impact between the head and surrounding environment. Such impacts may result in brain injury leading to fatality or permanent neurological impairment. In a previous publication, there were 90 one punch deaths around Australia between 2000 and 2012, mostly involving young men drinking alcohol at a licensed venue at the weekend. This prompted a surge of public education and awareness campaigns around Australia, in addition to regulatory and legislative changes aimed at curbing social violence. This retrospective descriptive study aimed to examine one punch deaths since 2012 in Australia to determine if there has been a decrease in deaths, and whether the demographics and circumstances of these deaths have changed. A search of the National Coronial Information System was undertaken for all closed coronial cases between 1 January 2012 and 31 December 2018. Additional information was collected from medicolegal reports including toxicology, pathology and coronial findings. There were 80 one punch fatalities in Australia, almost exclusively involving males. The median age was 43.5 (range 18-71) years and there was a decreasing trend in the number of deaths annually. Most fatal assaults occurred in the state of New South Wales (28.8%) followed by Queensland (23.8%), and in metropolitan locations (64.6%) rather than regional areas (35.4%). Alcohol was the most commonly detected drug, found in 47 cases of the 71 cases where toxicology results were available (66%), with a median concentration of 0.14 and 0.19 g/100 mL in antemortem and postmortem samples, respectively (range 0.005-0.32 g/100 mL). Five deaths reported methylamphetamine, with THC detected in 21.1% of cases. Assaults more commonly occurred on a footpath or roadside (41.3%), followed by a home or dwelling (32.5%). 8.8% of assaults occurred inside hotels, bars or other licenced venues. Most transpired on a weekday, which differed from the pre-2012 period when these assaults occurred mainly on the weekend. While some trends are positive, there has been a shift in the victim demographic as well as the typical environment for fatal one punch assaults, highlighting the importance of public health surveillance in providing a current evidence base to inform policy and practice., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Motivation: Multiple instance learning (MIL) is a powerful technique to classify whole slide images (WSIs) for diagnostic pathology. The key challenge of MIL on WSI classification is to discover the critical instances that trigger the bag label. However, tumor heterogeneity significantly hinders the algorithm's performance., Results: Here, we propose a novel multiplex-detection-based multiple instance learning (MDMIL) which targets tumor heterogeneity by multiplex detection strategy and feature constraints among samples. Specifically, the internal query generated after the probability distribution analysis and the variational query optimized throughout the training process are utilized to detect potential instances in the form of internal and external assistance, respectively. The multiplex detection strategy significantly improves the instance-mining capacity of the deep neural network. Meanwhile, a memory-based contrastive loss is proposed to reach consistency on various phenotypes in the feature space. The novel network and loss function jointly achieve high robustness towards tumor heterogeneity. We conduct experiments on three computational pathology datasets, e.g. CAMELYON16, TCGA-NSCLC, and TCGA-RCC. Benchmarking experiments on the three datasets illustrate that our proposed MDMIL approach achieves superior performance over several existing state-of-the-art methods., Availability and Implementation: MDMIL is available for academic purposes at https://github.com/ZacharyWang-007/MDMIL., (© The Author(s) 2023. Published by Oxford University Press.)

Diagnosis of myocarditis as the cause of death in the forensic setting at post-mortem is currently determined by a forensic pathologist. There is no systematic method for diagnosis and thus the determination is subject to inter-observer variability and is often non-reproducible. The primary aim of this study was to investigate the differences in the amount of inflammation between cases where myocarditis was deemed the cause of death, compared to cases where myocardial inflammation was incidentally present at autopsy, but not determined to be the cause of death. Participants were sourced from the Victorian Institute of Forensic Medicine (VIFM) database, from full autopsies conducted on reportable death in Victoria, Australia between the years 2011 and 2021. Cases of fatal myocarditis were significantly more likely to experience infection-like symptoms prior to death, and to be in hospital at the time of death. Histopathological examination revealed fatal cases had a significantly higher inflammatory index compared to the incidental group. Lethal cases were also significantly more likely to have myocyte necrosis, and a diffuse pattern of inflammation. There are significant differences between cases where myocardial inflammation has been determined to be the cause of death and cases where inflammation in the myocardium was an incidental finding. These results could be used in the forensic autopsy to help pathologists determine if inflammation should be considered fatal or incidental., (Copyright © 2022. Published by Elsevier Inc.)

Analyzing and interpreting traumatic injuries is a fundamental aspect of routine forensic case work. As the human skeleton can be impacted through a combination of loading mechanisms and varying impact energies, the analysis and interpretation of skeletal trauma can be complex. Therefore, it is imperative that the reliability of techniques used for analysis are well-established. There is growing interest in machine learning (ML) in medicine (especially radiology) regarding the use of image classification (a subset of ML) to categorize and predict classes of medical images. Therefore, the feasibility of using image classification for skeletal trauma analysis should be explored for its benefits to forensic pathology and anthropology. The method explored in this paper examined the potential for machine learning, using three dimensional (3D) convolutional neural networks (CNNs), to assess whether morphological features of skeletal trauma to the femur can be used to differentiate between impact mechanisms within a forensic population. The objective of this study was to assess if morphological differences in femoral fractures seen in post-mortem-computed tomographic images (PMCT) could be categorized according to mechanism, specifically horizontal impacts resulting from pedestrian motor vehicle impacts (PMVIs) and vertical impact s resulting from high impact falls. Final model results indicated an accuracy between 69.95%-72.86% and 63.08%-66.24% validation. Although these results mean the method could not be practically used in its current form, as a proof of concept, there is potential for it to be developed as a tool to assist in classifying complex fracture states., (© 2022 American Academy of Forensic Sciences.)

Aim: To quantify and characterise sexual assaults occurring after 12-17-year-old children connect with an alleged offender online (technology-facilitated sexual assault: TFSA) examined at a paediatric forensic medical service in Melbourne, Australia between 2014 and 2020. To compare these findings to a previous 7-year audit (2007-2013) to determine if there has been an increase in TFSA over the last 14 years., Methods: A retrospective audit was undertaken of medical records of children aged 12-17 who underwent forensic medical examinations at the Victorian Forensic Paediatric Medical Service following an allegation of sexual assault, between 1 January 2014 and 31 December 2020. Cases identified as being technology facilitated were further analysed. Results from 2014 to 2020 7-year cohort were then compared to an existing audit over the preceding 7-year period (2007-2013)., Results: Of 515 sexual assault cases between 2014 and 2020, 70 (14%) victims reported connecting with the offender on a technological platform, compared to 4% of cases between 2007 and 2013. In 2019 and 2020, TFSA comprised almost one-fifth of caseload. Of the 70 TFSA cases, the majority occurred at the first face-to-face meeting following a variable period of online communication. Approximately one-third of TFSA's occurred at the offender's residence, and another third in a public place (park, public toilets). Technological platforms used evolved over the 14-year study period., Conclusions: The proportion of TFSA caseload seen at an Australian paediatric forensic medical service increased over the last 14 years, with common characteristics to these sexual assaults suggested., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Child family violence homicide (FVH) is a significant public health problem in Australia and globally. Population-wide studies of orofacial injuries in child FVH are uncommon despite their recognized importance. This whole population descriptive study of orofacial injuries in child FVH in Victoria, Australia aims to implement a novel methodological approach to provide an overview of child FVH and describe frequency and patterns of abusive orofacial injuries. Closed cases of child FVH aged 0-17 years, January 2000-December 2018, were identified from screening all Victorian assault deaths for eligible offender relationships. Significant associations of clinical/demographic characteristics were explored using two-step clustering and the Spearman correlation coefficient. Of 895 closed homicide cases, 358 were FV-related. Of the 53 child FVH, 40 were eligible for injury analysis with 36 of these cases (90%) having orofacial injuries. Among these 36 cases, 72% were aged 0-4 years, males predominated (64%) and the injury mechanism was blunt force for 56%. The discrete orofacial injury frequency was associated with the non-orofacial injury frequency (rho: 0.362, 2-tailed p < 0.03). A three-cluster statistical solution was identified, each represented by an injury mechanism. The largest cluster identified a pattern of blunt force trauma in 0-4 years with drug presence, high average non-orofacial injury numbers and parent-offenders. A novel methodological approach was implemented to comprehensively describe the frequency, nature, patterns and risk indicators of orofacial injuries in child FVH. It explored associations between a wide range of clinical and demographic characteristics, which might have otherwise been missed in summary description. These methods will potentially underpin future comparative studies of intentional-unintentional child injuries and fatal-nonfatal child abuse. The study narrows a significant research gap regarding patterns of inflicted injuries, and demographic and clinical indicators in child FVH potentially informing future systematic classification processes, risk assessment tools and pathways to FV intervention., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Analyzing complex skeletal trauma can present a challenge for forensic practitioners to reliably determine the causes and circumstances of traumatic injury. The forensic value of skeletal fracture pattern analysis can be diminished due to obscuration and similarity between injuries associated with various impact mechanisms (e.g., vertical vs horizontal blunt force) and can provide issues when questions arise surrounding circumstances of traumatic injuries. Using the Python coding language, code was written that segments traumatized regions of interest from post-mortem computed tomography (PMCT) scans, allowing the user to calculate percentage of fragmentation in the context of extreme trauma events. Using cases of known trauma which resulted in fragmentation of the femur, the objective was to assess if there were statistical differences in the fragmentation resulting from horizontal pedestrian motor vehicle impacts (PMVIs; n = 44) compared to vertical high impact falls (>3 m; n = 41). Results indicated that percentage differences between the PMVI group and high impact falls group were statistically significant. Although it was possible to develop a standardized method that records fragmentation, and results were significant in distinguishing between the two groups, the outcomes of the data follow an exponential distribution which has implications for how skeletal trauma is modeled., (© 2021 American Academy of Forensic Sciences.)

Understanding skeletal trauma characteristics is fundamental for the examination and interpretation of blunt force trauma (BFT). BFT is the most complex type of trauma to interpret based on the analysis of skeletal fractures alone, with comminuted fractures presenting additional complications to assess and interpret. Considerable variation exists within each type of BFT injury dependent on direction, magnitude of force, plus a myriad of biological/environmental factors. Given the complex processes governing the nature of BFT skeletal injuries determining whether differences between impact mechanisms and skeletal trauma can be quantified requires investigation., Aim: this study aims to determine the feasibility of quantifying outcomes between two separate loading conditions by using a formula created from transformed variables recorded from specific trauma cases involving BFT to the femur., Methodology: Displacement, comminution, and femoral midshaft area data were recorded from full body postmortem computed tomography scans of 103 individuals (males, mean age 42.5, and females, mean age 48.9) where cause of death was the result of rapid horizontal deceleration impact events (pedestrian motor vehicular accidents, n = 59) and vertical (>3-metre falls, n = 44). These measurements were standardised and transformed into a continuous variable. Independent t-tests, binary logistic regression and K Nearest- Neighbours (KNN) were used to analyse the data., Results: The standardised values showed mean group differences between falls (9.62) and pedestrian motor vehicular impacts (pedestrian MVAs) (9.53), however, these results were not statistically significant. The results indicate that similarities in variance between types of trauma outcomes and impact mechanisms demonstrate low equivalency (samples have limited differences), and the overall limitations in relying on using single elements to explain complex skeletal trauma outcomes., Competing Interests: Declaration of Competing Interest The authors wish to declare that they have no affiliation or involvement with any organisations/financial interest regarding the subject matter and content in this manuscript., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To examine the evidence base for patterns of oro-facial injuries in physical abuse cases of children and adolescents aged 0-17 years., Data Sources: Systematic searches of Ovid Medline, Ovid Embase, Cochrane Central and grey literature, dating from the oldest entry to August 2017., Review Methods: Search criteria included English language peer reviewed articles and theses on physical abuse cases affecting the age group of 0-17 years. Exclusion criteria were: Case reports and <10 case series; studies involving bite mark injuries elsewhere on the body, sexual, ritualistic or emotional abuse and neglect, exposure to domestic violence; reviews; book chapters and conference proceedings. The following data was extracted: quality and design of study, oro-facial manifestations, new/old injuries, fatalities, coexistent injuries, co-morbidities and radiologic investigations. Each study was subjected to two independent reviews and a third, if reviewers disagreed., Results: The authors identified 51 articles, 26 of which satisfied the inclusion criteria. The oro-facial signs were superficial injuries of face, ears, neck, lips and oral mucosa, burns, torn fraenii and fractured teeth and jaws. A minority of studies stood out due to their well-developed design; expert opinion inclusion; new/old/occult injury investigations and facial bruising/ intraoral injuries as sentinel markers. Overall, the review demonstrated weak study quality and representativeness as well as lacunae in uniform reporting., Conclusions: The available literature does not endorse any pathognomonic signature patterns of child physical abuse to the exposed oro-facial region.

Background: This study describes the prevalence and orofacial injury patterns associated with adult family violence (FV) homicides in Victoria, Australia. It follows a methods study for case selection of all FV homicides and injury measurement. Comprehensive analysis of orofacial injuries in FV homicides and their clinico-demographic context will inform future research on clinical FV indicators and sentinel injuries, and potentially lead to premorbid intervention in health services., Methods: All closed cases of FV homicides aged ≥18 years, January 2006 to December 2018, were identified by screening Victorian fatal assaults, based on victim-offender relationship. Primary data such as post-mortem computed tomography scans and photographs were assessed. Socio-demographic, clinical, interpersonal and incident parameters were descriptively analysed and statistically compared across FV homicides with and without facial injuries using cluster analysis and nonparametric tests., Results: Of 170 adult homicides screened for eligibility, 151 were included for final analysis. Over the 12-year period, 78.1% of all Victorian adult FV homicides had orofacial injuries. Significant cluster patterns of injury mechanism, victim-offender relationship and drug/alcohol impairment were identified in all homicides. Non-facial injuries were significantly higher in facial vs. non-facial injury homicides. Facial abrasion and incised wounds were the most common injury types., Conclusions: This is the first forensic-epidemiologic study evaluating the empirical evidence concerning orofacial injuries associated with population-wide adult Victorian FV homicides. The high level of orofacial injuries in this population during the study period may inform clinical practice and policy in FV intervention in Victoria and globally., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Reducing the need for permanent accommodation in nursing homes (residential aged care services) for young people is a major challenge in Australia and internationally. This study investigated the use of innovative geo-mapping strategies to describe the geographical distribution of young people living in residential aged care services (RACS)., Methods: Geographic Information System software was used to generate 13 choropleth maps using data from the Australian Institute of Health and Welfare. Geographically specific characteristic descriptions of young people living in RACS were completed according to prevalence, remoteness, age (0-49 years and 50-64 years), sex, medical conditions and care requirements., Results: These geospatial visualisations showed that regional areas were over-represented for young people living in RACS and that the distribution has changed over the past decade. Many areas experienced increases in numbers, particularly in south-eastern regional Australia., Conclusion: Geo-mapping provides useful information for the development of targeted programs and services., (© 2020 AJA Inc.)

A deep learning pipeline was developed and used to localize and classify a variety of implants in the femur contained in whole-body post-mortem computed tomography (PMCT) scans. The results provide a proof-of-principle approach for labelling content not described in medical/autopsy reports. The pipeline, which incorporated residual networks and an autoencoder, was trained and tested using n = 450 full-body PMCT scans. For the localization component, Dice scores of 0.99, 0.96, and 0.98 and mean absolute errors of 3.2, 7.1, and 4.2 mm were obtained in the axial, coronal, and sagittal views, respectively. A regression analysis found the orientation of the implant to the scanner axis and also the relative positioning of extremities to be statistically significant factors. For the classification component, test cases were properly labelled as nail (N + ), hip replacement (H + ), knee replacement (K + ) or without-implant (I - ) with an accuracy >97%. The recall for I - and H + cases was 1.00, but fell to 0.82 and 0.65 for cases with K + and N + . This semi-automatic approach provides a generalized structure for image-based labelling of features, without requiring time-consuming segmentation., Competing Interests: Declaration of competing interest The authors certify that there is no conflict of interest with any financial organization regarding the materials presented in the manuscript., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

To summarize the published forensic pathology evidence base in deaths concluded to be the result of suicidal ligature strangulation, an uncommon entity. Four electronic bibliographic databases Medline Ovid, Embase, Scopus, HEINonline were screened for relevant literature. No date restrictions were applied. All English language case reports or case series were included. Articles were evaluated and key data extracted according to predefined criteria. A total of 1554 references eventually yielded 24 papers with 31 eligible case reports. The location of the deaths and background circumstances and history mirror broadly those of suicide generally. The range of ligature types was diverse. 19/31 cases reported one or more knots present. In the remaining 12 cases, the ligatures did not lend themselves to knots. In only one case were laryngeal fractures reported, but the available material does not justify confidence in that report given the significance of the finding. This systematic review has identified and synthesized the evidence from 31 case reports of suicidal ligature strangulation. A forensic pathologist faced with a possible case can locate it within the spectrum of reported cases and therefore identify its common and distinguishing features. Inherent difficulties for research in forensic pathology mean that case reports are an important source of learning and evidence for the discipline. Opportunities for improvement exist especially in harmonizing terminology and standardizing techniques generally, and in reports of suicidal ligature strangulation in particular.

Child protection measures are organized into three major themes: laws; service programs; and status of outcomes of these interventions. Contextually, mandatory reporting of child abuse and neglect is governed by a complex system of State legislation across Australia. The purpose of this review was to investigate the evidence base for the legislative obligations of Australian dentists as mandatory reporters; the functionality of dental practice in the determination of orofacial signs of abuse and neglect; and, relevant knowledge and practice demonstrated by the Australian dental work force. Our research question explores the role of Australian dentists in intervention of child physical abuse and dental neglect. Information was sourced from literature and web-based reviews. Peer reviewed articles included reviews and empirical studies. Official websites/databases were accessed for relevant legislation. The study found that child protection laws lack an evidence base for including/excluding dentists as reporters. Child abuse and neglect is associated with strong orofacial signs, thus imparting a key advantage to utilizing dentists as potential notifiers. An action response to child abuse is not seen in the Australian dental service. This review identifies gaps in the dental literature concerning mandatory reporting, calls for optimization of the related evidence base, and uniform Australian child abuse reporting requirements.

This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.

Purpose: The aim of this survey was to determine whether forensic odontology forms part of the basic dental programme in the nine Australian dental schools, which aspects of forensic odontology were taught, and the barriers and issues that prevent forensic odontology being part of any dental curriculum. The survey also examines the teaching of cranio-facial anatomy and dental record-keeping, as these two subjects can play an important role in forensic odontology., Materials and Methods: Study design and participants: A postal questionnaire survey on the teaching of forensic odontology was conducted between November 2016 and April 2017, being sent to the dean of school, head of school, or acting head of school, each representing the nine Australian dental schools. The paper questionnaire consisted of eight questions requesting information concerning whether or not the dental school has faculty staff who are registered forensic odontologists or registered general dentists with a forensic odontology postgraduate qualification, and how many hours of teaching (including lectures and practicals) were dedicated to cranio-facial anatomy and dental record-keeping., Results: Five out of nine dental schools replied to the questionnaire. This gives a response rate of 55.56%. Staff members: Four dental schools had at least one or more forensically trained staff members. Only one dental school did not have a staff member who is trained in forensic odontology. Cranio-facial anatomy: Three out of the five dental schools responded that each of the cranio-facial anatomy lecture and practical programmes were more than 16 hours each throughout the whole dental programme, whereas the other two dental schools responded that each of the lecture and practical programmes were between 7 and 11 hours. Dental record-keeping: All five dental schools responded that the lecture hours dedicated to dental record-keeping are between 1 and 6 hours throughout the whole dental programme. For the practical sessions, three out of the five dental schools responded that the hours dedicated are between 1 and 6 hours. Teaching of forensic odontology: Three out of the five dental schools responded that forensic odontology is taught as part of a dental subject in the dental programme, with the total hours dedicated to the teaching being between 1 and 6 hours, with teaching being delivered in the form of lectures only. Two of the five dental schools that did not teach forensic odontology as part of any dental subjects mentioned that the main reason for not teaching forensic odontology is due to lack of teaching time., Conclusion: This is the first Australian project investigating the teaching of forensic odontology in Australian dental schools. The authors found that three dental schools teach forensic odontology; however, it is limited to only 1 to 6 hours of teaching time. All five dental schools teach extensively into cranio-facial anatomy and dental record-keeping. However, as one of the recognised dental specialities in Australia, and the role it plays in justice, human rights and humanitarianism, all Australian dental schools should provide an opportunity for students to learn and be aware of forensic odontology as part of their training programmes, which include the importance of accurate dental records and its application to forensic odontology., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period., Methods: We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated., Results: Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56)., Conclusions: Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention., Competing Interests: The authors have declared that no competing interests exist.

Background: Reviewing prehospital trauma deaths provides an opportunity to identify system improvements that may reduce trauma mortality. The objective of this study was to identify the number and rate of potentially preventable trauma deaths through expert panel reviews of prehospital and early in-hospital trauma deaths., Methods: We conducted a retrospective review of prehospital and early in-hospital (<24 h) trauma deaths following a traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria (AV) in the state of Victoria, Australia, between 2008 and 2014. Expert panels were used to review cases that had resuscitation attempted by paramedics and underwent a full autopsy. Patients with a mechanism of hanging, drowning or those with anatomical injuries deemed to be unsurvivable were excluded., Results: Of the 1183 cases that underwent full autopsies, resuscitation was attempted by paramedics in 336 (28%) cases. Of these, 113 cases (34%) were deemed to have potentially survivable injuries and underwent expert panel review. There were 90 (80%) deaths that were not preventable, 19 (17%) potentially preventable deaths and 4 (3%) preventable deaths. Potentially preventable or preventable deaths represented 20% of those cases that underwent review and 7% of cases that had attempted resuscitation., Conclusions: The number of potentially preventable or preventable trauma deaths in the pre-hospital and early in-hospital resuscitation phase was low. Specific circumstances were identified in which the trauma system could be further improved., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Little research has been undertaken for the New Zealand population in the field of dental age estimation. This research to date indicates there are differences in dental developmental rates between the New Zealand population and other global population groups, and within the New Zealand population itself. Dental age estimation methods range from dental development charts to complex biometric analysis. Dental development charts are not the most accurate method of dental age estimation, but are time saving in their use. They are an excellent screening tool, particularly for post-mortem identification purposes, and for assessing variation from population norms in living individuals. The aim of this study was to test the precision and accuracy of three dental development charts (Schour and Massler, Blenkin and Taylor, and the London Atlas), used to estimate dental age of a sample of New Zealand juveniles between the ages of 5 and 18 years old (n=875). Percentage 'best fit' to correct age category and to expected chart stage were calculated to determine which chart was the most precise for the sample. Chronological ages were compared to estimated dental ages using a two-tailed paired t-test (P<0.05) for each of the three methods. The mean differences between CA and DA were calculated to determine bias and the absolute mean differences were calculated to indicate accuracy. The results of this study show that while accuracy and precision were low for all charts tested against the New Zealand population sample, the Blenkin and Taylor Australian charts performed best overall., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This is a critical review to discuss the best practice approaches to mortuary operations in preparation for and the response to natural, mass fatality, disaster events, as identified by a review of published articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) Statement guided the identification of potential articles to use in this critical review. Subsequent searches were also conducted to identify articles relating to heat wave, and flood mortality. All identified peer-reviewed studies published in English which discussed the preparation and response of mortuaries to mass fatality natural disasters occurring in developed countries were included. Using the PRISMA-P method of identifying articles, 18 articles were selected for inclusion in this review. Although there are numerous articles which describe the mortuary response to mass fatality incidents, few articles analyzed the response, or discussed the roles which supported and enabled the organization to undertake the task of identifying disaster victims. It is thus difficult to determine objectively if the actions and activities outlined in the articles represent best-practice.

Purpose: Recognition of injury to the hyoid bone is intrinsic to post-mortem examination. Given its superficial location in the neck hyoid fractures are generally associated with some form of compressive neck force although they are well recognized in the peri-mortem period, in the context of manual handling and resuscitation. Hyoid fractures are variably reported to occur in manual strangulation and during hanging., Methods: In this study Computer Tomography (CT) scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years of age (mean age 35.93 ± 24.15) and including 25 victims of hangings were examined to reveal the pattern of age-related change and the types of injury that occurred. Hyoid variants were also documented., Results: The synchondroses between greater cornua and body were found to progressively fuse with age although in the current sample 20% non-fusion was observed beyond 65 years of age. Sex differences were evident in adult hyoid bones and discriminant function analysis correctly confirmed sex in 74.7% of cases., Conclusions: The greatest age-related changes occurred from puberty to post-adolescence and a linear regression equation successfully assessed age into three general categories in 87.7% of cases. Hyoid fractures were documented in 24% of victims of hangings and while previous reports indicate these are more likely in older age, when synchondroses are fused, in this study the average age of victims with fracture was 27 ± 10 years. In the majority of cases the site of ligature was below the hyoid bone and in only one on the hyoid body.

Ludwig angina is a rare but potentially lethal infection of the submandibular space that can cause significant upper airway obstruction. We report a case of undiagnosed Ludwig angina that progressed rapidly to death. Ludwig angina was suspected after post-mortem computed tomography (PMCT) found swollen mylohyoid muscle with stranding in subcutaneous fat, thickening of deep fascia, and local lymphadenopathy. Subsequently, an autopsy revealed woody induration of the submental region and liquefactive necrosis of the mylohyoid muscle, confirming the diagnosis. It is likely that the dental abscess identified on PMCT was the source of infection. Multiple invasive medical procedures were performed on the subject by the ambulance crew prior to his death. PMCT assisted further in determining procedural success.

Recognition of injury to the hyoid bone and thyroid and cricoid cartilages is intrinsic to post-mortem examination. Due to its increasing brittleness with age the thyroid cartilage is particularly susceptible to injury following neck trauma, although there is inconsistency in the patterns of injury reported. In this study computed tomography scans of the head and neck of 431 deceased persons (235 males and 196 females) between the ages of 1 day and 100 years (mean age 35.93 ± 24.15), and including 25 victims of hangings, were examined to reveal the pattern of age-related change and the types of injury that occurred. Thyroid cartilage anomalies likely to cause confusion and be misinterpreted as trauma-related are documented. Angulation of the thyroid cartilage horns was found to change with age, and it is suggested this may be a significant factor in traumatic neck injury. Unlike in previous reports, the average age of hanging victims with fractures to the thyroid cartilage was 34 years. The base of the superior horn was the most common fracture site and in 50 % of hanging cases was associated with a ligature positioned on the thyrohyoid membrane or thyroid lamina. Although an age-related relationship exists it was not possible to establish narrow age-prediction ranges from calcification of the thyroid cartilage.

This column discusses the issues encountered when courts attempt to determine if an individual who has no reliable age at birth documentation has reached adulthood, or is still a legal minor. This issue has recently received a high level of public interest due to the wrongful imprisonment in Australian adult prisons of Indonesian minors accused of people smuggling following the determination, subsequently shown to be incorrect, that they were adults. The discussion explains current deficits existing in the science of age estimation with reference to the recent Australia Human Rights Commission "Inquiry into the Treatment of Individuals Suspected of People Smuggling Who Say That They are Children". Future research possibilities in the science of age estimation which may help to resolve many of the issues are explored.

At the Victorian Institute of Forensic Medicine the forensic pathologist provides expert medical advice to the Coroner. Cases of natural death from hemopericardium and hemothorax are reasonably common in the forensic setting and are readily identifiable on postmortem CT (PMCT) scanning. The management of these cases raises interesting and challenging issues for the forensic pathologist. We present three cases in which PMCT angiography was useful in the management of each individual case and illustrate the potential of the technique in medico-legal death investigation.

The recognition of a well defined basal layer of radio dense material on the postmortem computed tomography (CT) images, in the setting of typical scene findings of an intentional medication overdose and unremarkable external examination of the deceased's body can, in certain circumstances, permit such cases to be managed without routine full autopsy examination. Preliminary toxicological analysis can be targeted to such cases to provide further supportive evidence of intentional medication overdose. In cases where the scene findings are ambiguous or have been contaminated the postmortem CT images may alert the pathologist of the possibility of overdose in an otherwise apparently natural death. We reviewed 61 cases of documented intentional therapeutic medication overdose and 61 control cases. In the majority of the cases of confirmed intentional therapeutic medication overdose the CT images showed no diagnostic features. However, in many cases a well defined basal layer of radio-opaque material was clearly seen to line the gastric mucosa. The postmortem CT pattern which we believe to be highly suggestive of intentional medication overdose must be differentiated from other causes of increased radio density in the stomach which include CT artefacts.

The February 7th 2009 bushfires in Victoria, Australia, resulted in the deaths of 173 individuals, of whom 164 were included in the subsequent DVI operation. The final stage of the International DVI protocol is a debrief, referred to as Phase 5. The Phase 5 operational debrief process conducted in the wake of this disaster was designed for the purpose of developing new strategies in light of this experience. The agencies involved included the Coroners Court of Victoria, the Victorian Institute of Forensic Medicine, the Department of Justice, and Victoria Police. During the course of this debriefing process strategies and protocols were developed which aim to improve the capacity of all agencies to respond and resolve future incidents. This paper outlines the Phase 5 debrief carried out in the 6 months following the final coronial identification board, and details the findings and recommendations made by the agencies involved., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

The 2009 Victorian Bushfires Disaster started on a record hot day in February 2009 and resulted in over 300 separate fires with a death toll of 173 and over 400 presentations to hospital emergency departments. This occurred a little over a week after a heat wave in which over 400 people were thought to have died prematurely in southeastern Australia. The Victorian Institute of Forensic Medicine in collaboration with the police force and the State Coroner's Office and over 100 colleagues from all over Australia, Indonesia, New Zealand and Japan implemented a DVI process based on Interpol guidelines to identify the deceased persons. CT scanning was conducted on all remains collected and played a pivotal role in the identification processes in conjunction with experts in pathology, anthropology, forensic odontology and molecular biology. This paper outlines the scale of the disaster and the work, from a forensic medical perspective, to identify the deceased., (Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.)

The bodies of socially isolated people may remain undiscovered in their own houses for prolonged periods. Occasionally the body is in situ for sufficient time to become skeletonised, or partially so. Medico-legal investigation of these cases is complicated by degradation and contamination of evidence. Thus, a multidisciplinary forensic investigation is recommended. The potential contributions of forensic pathology, anthropology, odontology and entomology are outlined here with reference to two cases that occurred in Victoria, Australia, in 2003. Forensic pathologists are often unable to determine the cause of death in skeletonised bodies, however, they may find evidence to support either a natural or unnatural mode of death, and they may describe skeletal pathology or trauma, and identify skeletal features to support radiological identification of the deceased. Anthropologists can provide supplementary evidence of skeletal trauma. Additionally, they can assess age, sex, stature and racial affiliation from skeletal remains. Odontologists can identify individuals through comparison with ante-mortem dental records; however, potential difficulties exist in identifying the treating dentist of a socially isolated person. Odontologists may also examine the teeth and oro-facial skeleton for trauma. Entomologists may estimate minimum death time and/or season of death. Entomological examination of insect remains may also confirm that a body has lain in situ for a considerable period.

Positive identification of incinerated human remains can be a perplexing problem, especially when there is no genetic material remaining for DNA analysis. This paper illustrates the importance of a multi-disciplinary approach to the identification of such remains, and explores the processes involved in the various effects of heat upon human bone and teeth, and the implications this has for positive identification. A case study is presented to illustrate the various problems encountered and the importance of discovering comprehensive ante-mortem records of the deceased. It is submitted that forensic odontologists and anthropologists be included in the body recovery process, both to maximise the recovery of evidence, and to ensure that all possible avenues for positive identification are explored, so as to avoid the need to rely upon the less robust method of circumstantial identification.