Typical median effective radiation doses using an anthropomorphic bone fracture phantom for initial radiographic skeletal surveys in the investigation of suspected physical abuse.

BACKGROUND: A series of 31 radiographs is recommended by the Royal College of Radiologists (RCR) when investigating suspected physical abuse (SPA). OBJECTIVE: To determine the radiation dose delivered for skeletal surveys performed for SPA in Victorian radiology departments based on their local protocols. MATERIALS AND METHODS: A 5-year-old paediatric bone fracture phantom was radiographed at five radiology sites using both the RCR recommended protocol and, where applicable, the local departmental SPA protocol. The radiation doses were measured and recorded. These were scaled down to estimate the effective radiation doses for a 2-year-old child at each site and the associated radiation risks estimated. RESULTS: The median effective dose for all radiographic projections in the RCR skeletal survey radiographic series was 0.09 mSv. The estimated risk of radiation-induced cancer and radiation-induced death from cancer for 2-year-old children is classified as "very low," with girls having a higher risk than boys. CONCLUSION: The median effective radiation dose for the RCR skeletal survey for imaging in SPA was 0.09 mSv resulting in a "very low" additional risk of radiation-induced cancer. The authors will now aim to ascertain whether whole-body CT skeletal survey can replace the radiographic series for imaging in SPA while maintaining a comparable radiation dose

Differences in the epidemiology of out-of-hospital and in-hospital trauma deaths

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

Potentially preventable trauma deaths: A retrospective review

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. 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. 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. 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

Perceptions of participants of management development programmes in the Gauteng Health Department.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Science (Nursing)Management development has been identified as one of the priorities in the Gauteng Health Department [GHD]. The nature of public service management is changing. There is an emphasis on new and more flexible management approaches in the public sector; this requires public service managers to acquire new kinds of skills. Further to this, the changing nature of management in general, caused by globalization increases the need for new kinds of skills amongst managers. This changing framework is facilitated by various new laws, which provide a watershed in the way that human resource development is undertaken in South Africa. It is necessary to ensure that training and development initiatives in the Department are aligned to the new legislative framework. The Employment Equity Act requires representivity in the workplace; there is a need for management skills development programmes to redress past imbalances. The GHD provides several management development programmes for its employees every year. In keeping with current trends and legislation it is necessary to evaluate these programmes to identify strengths and weaknesses in order to improve future management development programmes in the GHD, and ensure that money is well spent. The main goal of this research is to formulate guidelines for the effective implementation of management development programmes in the GHD. The objective of the study is to explore and describe the perceptions of the participants of management development programmes provided by the Department between 1999 and 2001. The researcher used focus groups for data collection and individual interviews for methodological triangulation. The population (N) in this study comprises of all the people who attended management development programme/s purchased by the Department between 1999 and 2001. Three Hundred and forty eight managers attended the programmes between 1999 to 2001 (N = 348).Purposive samples were used for the focus groups and individual interviews. An independent interviewer was used to conduct the interviews in order to ensure objectivity, and anonymity of the participants. Fields notes were taken and the interviews audio-recorded. Written consent was obtained from the participants for the audio recording of the interviews. The data were transcribed verbatim. The Tesch method was employed to analyse the data. The data were grouped and coded. Emerging themes and sub-themes were identified and contextualised through a literature control. Scrutiny of the study by the Ethics Committee of the University of the Witwatersrand ensured ethical rigor. The findings were used to formulate guidelines for future management development programmes in the GHD. The research report was communicated to the GHD.WHSLYP201

Optimising image and PMCT databases for research at the Victorian Institute of Forensic Medicine

70,000 CT full body scans and multiple high resolution optical photographs associated with each case. This PM-CT database sits alongside a case management system (iCMS) that can currently be searched for keyword causes of death. The opportunities for the application of techniques such as deep learning to facilitate the answering of important research questions is extensive and has important medico-legal consequences. The VIFM is looking for expressions of interest from research groups that can partner in grant applications to provide PhD students and post-doctoral candidates to help use artificial intelligence to solve image analysis, classification and measurement problems associated with our post-mortem databases. The Victorian Institute of Forensic Medicine (VIFM) is tasked with performing the medical investigations and ancillary tests relating to all deaths reported to the Victorian State Coroner. As a part of this investigation process various data is collected, including photographic imagery and CT scan data for every case. Part of the remit for the VIFM is to conduct forensic medical research – learning from the dead to benefit the living. <br>The VIFM now has one of the world’s largest post-mortem computed tomography (PM-CT) databases containing > 70,000 CT full body scans and multiple high resolution optical photographs associated with each case. This PM-CT database sits alongside a case management system (iCMS) that can currently be searched for keyword causes of death. <br>The opportunities for the application of techniques such as deep learning to facilitate the answering of important research questions is extensive and has important medico-legal consequences. <br>The VIFM is looking for expressions of interest from research groups that can partner in grant applications to provide PhD students and post-doctoral candidates to help use artificial intelligence to solve image analysis, classification and measurement problems associated with our post-mortem databases.<br

The scientific analysis of the age of majority using computed tomography

This thesis examines three developing anatomical sites, two skeletal and one dental, in an attempt to devise a method for more accurately estimating the age of unknown age individuals in the age range 15-25 years. Individuals in this age cohort have been the subject of relatively little research since there are few anatomical sites still undergoing development beyond the age of 15 years, and all of these have been reported to be quite variable. The three age markers chosen for this study were the spheno-occipital synchondrosis, the medial clavicular epiphysis and the third molar tooth, being the three most commonly examined development sites for this age cohort. All of these were examined using Multi Detector Computed Tomography (MDCT) scanning as the imaging modality, and the sample was derived from the large database of post-mortem full body CT scans of deceased individuals located at the Victorian Institute of Forensic Medicine, Melbourne, Australia. The study sample consisted of 1006 full body CT scans of individuals aged between 15 and 25 years. Each age marker was examined and a developmental score was applied according to accepted scoring methodology developed by others. Each anatomical site was individually assessed for its relationship with chronological age, and it was found that the third molar tooth and medial clavicle followed expected trends as to variability and developmental timing. The spheno-occipital synchondrosis was found to fuse earlier than expected in this population and had essentially completed development by the age of 17 years in both sexes. An investigation was undertaken to determine if combining the third molar and medial clavicle into one multiple regression analysis, the “multi-factorial approach” would result in an improvement in precision and accuracy of age estimates when compared to age estimations calculated using each age marker individually. It was found that the multi-factorial approach reduced age ranges by approximately half, thus providing higher precision and with no loss of accuracy at the 95% CI level. Further investigations were conducted to assess the effect of socio-economic status on development in the Australian population, with findings suggesting that there is no appreciable effect on development between the highest and lowest socio-economic groups in this country. Ancestry was also investigated, with the conclusion that the high level of racial admixture in this population renders the attribution of any particular racial group to an individual prone to error and somewhat irrelevant. Left/right fluctuating asymmetry was also examined, with results suggesting that in approximately 3.4% of individuals the difference in development between left and right sides will have an appreciable effect upon age estimation calculations, in some cases as much as 3 years. Recommendations to deal with this asymmetry are discussed. The multifactorial model presented in this thesis provides a means to more accurately estimate the age of individuals within the Australian population in this age cohort. This method is applicable to living people as well as the deceased. Future research needs to be directed at assessing the applicability of these formulae to members of other relevant populations, particularly those populations from which Australia receives a high number of asylum seekers, many of whom are in this age cohort and their status as adult or child is unknown

The scientific analysis of the age of majority using computed tomography

This thesis examines three developing anatomical sites, two skeletal and one dental, in an attempt to devise a method for more accurately estimating the age of unknown age individuals in the age range 15-25 years. Individuals in this age cohort have been the subject of relatively little research since there are few anatomical sites still undergoing development beyond the age of 15 years, and all of these have been reported to be quite variable. The three age markers chosen for this study were the spheno-occipital synchondrosis, the medial clavicular epiphysis and the third molar tooth, being the three most commonly examined development sites for this age cohort. All of these were examined using Multi Detector Computed Tomography (MDCT) scanning as the imaging modality, and the sample was derived from the large database of post-mortem full body CT scans of deceased individuals located at the Victorian Institute of Forensic Medicine, Melbourne, Australia. The study sample consisted of 1006 full body CT scans of individuals aged between 15 and 25 years. Each age marker was examined and a developmental score was applied according to accepted scoring methodology developed by others. Each anatomical site was individually assessed for its relationship with chronological age, and it was found that the third molar tooth and medial clavicle followed expected trends as to variability and developmental timing. The spheno-occipital synchondrosis was found to fuse earlier than expected in this population and had essentially completed development by the age of 17 years in both sexes. An investigation was undertaken to determine if combining the third molar and medial clavicle into one multiple regression analysis, the “multi-factorial approach” would result in an improvement in precision and accuracy of age estimates when compared to age estimations calculated using each age marker individually. It was found that the multi-factorial approach reduced age ranges by approximately half, thus providing higher precision and with no loss of accuracy at the 95% CI level. Further investigations were conducted to assess the effect of socio-economic status on development in the Australian population, with findings suggesting that there is no appreciable effect on development between the highest and lowest socio-economic groups in this country. Ancestry was also investigated, with the conclusion that the high level of racial admixture in this population renders the attribution of any particular racial group to an individual prone to error and somewhat irrelevant. Left/right fluctuating asymmetry was also examined, with results suggesting that in approximately 3.4% of individuals the difference in development between left and right sides will have an appreciable effect upon age estimation calculations, in some cases as much as 3 years. Recommendations to deal with this asymmetry are discussed. The multifactorial model presented in this thesis provides a means to more accurately estimate the age of individuals within the Australian population in this age cohort. This method is applicable to living people as well as the deceased. Future research needs to be directed at assessing the applicability of these formulae to members of other relevant populations, particularly those populations from which Australia receives a high number of asylum seekers, many of whom are in this age cohort and their status as adult or child is unknown

Collaborative Forensic Autopsy Documentation and Supervised Report Generation using a Hybrid Mixed-Reality Environment and Generative AI

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 tools to support 3D visualisation of such data---these tools require extra steps for forensic experts and do not integrate seamlessly into their existing collaborative workflow and report authoring process. 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 findings indicate that this approach may improve data management, aid reviewability, and thus achieving more robust standards. Further, it can streamline report generation and minimise dependency on external tools and assistance, reducing autopsy time and related costs. This system also offers significant potential for education