Search results for: forensic audit

Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Ramya P, Lino Abraham Varghese, S. Bose

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By cloud storage services, the data can be stored in the cloud, and can be shared across multiple users. Due to the unexpected hardware/software failures and human errors, which make the data stored in the cloud be lost or corrupted easily it affected the integrity of data in cloud. Some mechanisms have been designed to allow both data owners and public verifiers to efficiently audit cloud data integrity without retrieving the entire data from the cloud server. But public auditing on the integrity of shared data with the existing mechanisms will unavoidably reveal confidential information such as identity of the person, to public verifiers. Here a privacy-preserving mechanism is proposed to support public auditing on shared data stored in the cloud. It uses group signatures to compute verification metadata needed to audit the correctness of shared data. The identity of the signer on each block in shared data is kept confidential from public verifiers, who are easily verifying shared data integrity without retrieving the entire file. But on demand, the signer of the each block is reveal to the owner alone. Group private key is generated once by the owner in the static group, where as in the dynamic group, the group private key is change when the users revoke from the group. When the users leave from the group the already signed blocks are resigned by cloud service provider instead of owner is efficiently handled by efficient proxy re-signature scheme.

Keywords: data integrity, dynamic group, group signature, public auditing

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Authors: Adrian Craig, Jonathan Easaw, Rose Jordan, Ben Hall

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The prescription of intravenous fluids is a fundamental component of inpatient management, but it is one which usually lacks thought. Fluids are a drug, which like any other can cause harm when prescribed inappropriately or wrongly. However, it is well recognised that it is poorly done, especially in the acute portals. The National Institute for Health and Care Excellence (NICE) recommends 1mmol/kg of potassium, sodium, and chloride per day. With various options of fluids, clinicians tend to face difficulty in choosing the most appropriate maintenance fluid, and there is a reluctance to prescribe potassium as part of an intravenous maintenance fluid regime. The aim was to prospectively audit the prescription of the first bag of intravenous maintenance fluids, the use of urea and electrolytes results to guide the choice of fluid and the use of fluid prescription charts, in a busy emergency department of a major trauma centre in Stoke-on-Trent, United Kingdom. This was undertaken over a week in early November 2016. Of those prescribed maintenance fluid only 8.9% were prescribed a fluid which was most appropriate for their daily electrolyte requirements. This audit has helped to highlight further the issues that are faced in busy Emergency Departments within hospitals that are stretched and lack capacity for prompt transfer to a ward. It has supported the findings of NICE, that emergency admission portals such as Emergency Departments poorly prescribed intravenous fluid therapy. The findings have enabled simple steps to be taken to educate clinicians about their fluid of choice. This has included: posters to remind clinicians to consider the urea and electrolyte values before prescription, suggesting the inclusion of a suggested intravenous fluid of choice in the prescription chart of the trust and the inclusion of a session within the introduction programme revising intravenous fluid therapy and daily electrolyte requirements. Moving forward, once the interventions have been implemented then, the data will be reaudited in six months to note any improvement in maintenance fluid choice. Alongside this, an audit of the rate of intravenous maintenance fluid therapy would be proposed to further increase patient safety by avoiding unintentional fluid overload which may cause unnecessary harm to patients within the hospital. In conclusion, prescription of maintenance fluid therapy was poor within the Emergency Department, and there is a great deal of opportunity for improvement. Therefore, the measures listed above will be implemented and the data reaudited.

Keywords: chloride, electrolyte, emergency department, emergency medicine, fluid, fluid therapy, intravenous, maintenance, major trauma, potassium, sodium, trauma

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Authors: Surbhi Mathur, J. M. Vyas

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Although the rapid development of forensic speaker recognition technology has been conducted, there are still many problems to be solved. The biggest problem arises when the cases involving disguised voice samples come across for the purpose of examination and identification. Such type of voice samples of anonymous callers is frequently encountered in crimes involving kidnapping, blackmailing, hoax extortion and many more, where the speaker makes a deliberate effort to manipulate their natural voice in order to conceal their identity due to the fear of being caught. Voice disguise causes serious damage to the natural vocal parameters of the speakers and thus complicates the process of identification. The sole objective of this doctoral project is to find out the possibility of rendering definite opinions in cases involving disguised speech by experimentally determining the effects of different disguise forms on personal identification and percentage rate of speaker recognition for various voice disguise techniques such as raised pitch, lower pitch, increased nasality, covering the mouth, constricting tract, obstacle in mouth etc by analyzing and comparing the amount of phonetic and acoustic variation in of artificial (disguised) and natural sample of an individual, by auditory as well as spectrographic analysis.

Keywords: forensic, speaker recognition, voice, speech, disguise, identification

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Authors: Valerie Isaak

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Background: This study explores the effectiveness of refresher training sessions of an intervention program at reducing the employees’ risk of injury due to patient violence in a forensic psychiatric hospital. Methods: The original safety intervention program that consisted of a 3 days’ workshop was conducted in the maximum-security ward of a psychiatric hospital in Israel. Ever since the original intervention, annual refreshers were conducted, highlighting one of the safety elements covered in the original intervention. The study examines the effect of the intervention program along with the refreshers over a period of 10 years in four wards. Results: Analysis of the data demonstrates that beyond the initial reduction following the original intervention, refreshers seem to have an additional positive long-term effect, reducing both the number of violent incidents and the number of actual employee injuries in a forensic psychiatric hospital. Conclusions: We conclude that such an intervention program followed by refresher training would promote employees’ wellbeing. A healthy work environment is part of management’s commitment to improving employee wellbeing at the workplace.

Keywords: wellbeing, violence at work, intervention program refreshers, public sector mental healthcare

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Authors: Nureni O. Adeboye, Dawud A. Agunbiade

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This research attempts to investigate the effects of heteroscedasticity and periodicity in a Panel Data Regression Model (PDRM) by extending previous works on balanced panel data estimation within the context of fitting PDRM for Banks audit fee. The estimation of such model was achieved through the derivation of Joint Lagrange Multiplier (LM) test for homoscedasticity and zero-serial correlation, a conditional LM test for zero serial correlation given heteroscedasticity of varying degrees as well as conditional LM test for homoscedasticity given first order positive serial correlation via a two-way error component model. Monte Carlo simulations were carried out for 81 different variations, of which its design assumed a uniform distribution under a linear heteroscedasticity function. Each of the variation was iterated 1000 times and the assessment of the three estimators considered are based on Variance, Absolute bias (ABIAS), Mean square error (MSE) and the Root Mean Square (RMSE) of parameters estimates. Eighteen different models at different specified conditions were fitted, and the best-fitted model is that of within estimator when heteroscedasticity is severe at either zero or positive serial correlation value. LM test results showed that the tests have good size and power as all the three tests are significant at 5% for the specified linear form of heteroscedasticity function which established the facts that Banks operations are severely heteroscedastic in nature with little or no periodicity effects.

Keywords: audit fee lagrange multiplier test, heteroscedasticity, lagrange multiplier test, Monte-Carlo scheme, periodicity

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Authors: Mohammed Mustafa, Fatima Abusin, Mariam Abufatema

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Objective: This audit aims to evaluate the practices and outcomes of operative vaginal deliveries (OPVD) at Mayo University Hospital, focusing on identifying trends, complications, and adherence to clinical guidelines. Methods: A retrospective review was conducted on all cases of operative vaginal deliveries at Mayo University Hospital over one year. Data was collected from patient records, including demographics, OPVD indications, types of instruments used (forceps or vacuum), maternal and neonatal outcomes, and any associated complications. Statistical analyses were performed to assess the rates of successful and unsuccessful OPVDs and identify factors influencing outcomes. Results: The study included 159 [out of 174 total OPVD in 1 year] cases of operative vaginal deliveries. The indications predominantly consisted of the prolonged second stage of labor, fetal distress and suspicious CTG. The success rate of OVD was [97.5%]; maternal perineal tears [10 cases], hemorrhage[43 cases] and neonatal outcomes needed for SCBU admission[12 cases] were also assessed. Conclusion: This audit provides insights into the current practices and outcomes of operative vaginal deliveries at Mayo University Hospital. The findings underline the importance of adherence to clinical guidelines and highlight areas for potential improvement in practice

Keywords: OPVD operative vaginal delivery, GTG green top guidelines, PPH postpartum hemorrhage, SCBU special care baby unit

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Islam Khalil, Amr El-Kadi

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With the increased use of web technologies, microservices, and Application Programming Interface (API) for integration between systems, and with the development of containerization of services on the operating system level as a method of isolating system execution and for easing the deployment and scaling of systems, there is a growing need as well as opportunities for providing platforms that improve the security of such services. In our work, we propose an architecture for a containerization platform that utilizes various concepts derived from the human immune system. The goal of the proposed containerization platform is to introduce the concept of slowing down or throttling suspected malicious digital pathogens (intrusions) to reduce their damage footprint while providing more opportunities for forensic inspection of suspected pathogens in addition to the ability to snapshot, rollback, and recover from possible damage. The proposed platform also leverages existing intrusion detection algorithms by integrating and orchestrating their cooperative operation for more effective intrusion detection. We show how this model reduces the damage footprint of intrusions and gives a greater time window for forensic investigation. Moreover, during our experiments, our proposed platform was able to uncover unintentional system design flaws that resulted in internal DDoS-like attacks by submodules of the system itself rather than external intrusions.

Keywords: containers, human immunity, intrusion detection, security, web services

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Authors: Ajitesh Pal, Arpan Datta Roy, H. K. Pratihari

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The different illegal firearms crudely made by skilled gunsmith from scrap materials are popularly known as country made firearms. Such firearms along with improvised ammunition are clandestinely marketed at the cheaper price without any license to the extremist group, criminal, poachers and firearm lovers. As per National Crime Records Bureau (NCRB), MHA, Govt of India about 80% firearm cases are committed by country made/improvised firearms. The ballistic division of the laboratory has examined a good number of cases. The analysis of firearm cases received for forensic examination revealed that 7.65mm calibre pistols mostly improvised firearm are commonly used in firearm related crime cases. In the present communication, physical parameters and other characteristics features of some 7.65mm calibre pistols have been discussed in detail. The detailed study on country made (CM) firearm will help to prepare a database related to type of material used, origin of the raw material and tools used for inscription. The study also includes to establish the chemistry of propellants & head stamp pattern. The database will be helpful to the firearm examiners, researchers, students pursuing study on forensic science as reference material.

Keywords: improvised pistol, stringent gun law, working mechanism, parameters, database

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Authors: Olivia Rybak-Karkosz

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This paper aims to present the results of scientific research on family resemblance in the handwriting of painters. Such a problem is known in handwriting analysis, but it was never a research subject in the scope of painters' signatures on works of art. For this research, the author chose Jacek, and Rafał Malczewski (father and son) as many of their paintings are in museums, and most of them are signed. The aim was to create a catalogue of traits similar to the handwriting of both artists. Such data could be helpful for the expert’s opinion in the decision-making process to establish whether the signature is authentic and, if so, whether it is the artist whose signature is analysed, not the other family member. There are known examples of relatives of the artists who signed their works. Many of them were artists themselves. For instance Andrzej Wróblewski’s mother, Krystyna was a printmaker. To save his legacy, she signed many of her son’s works after his death using his name. This research methodology consisted of completing representative samples of signatures of both artists, which were collected in selected Polish museums. Then a catalogue of traits was created using a forensic handwriting graphic-comparative method (graphic method). The paper contains a concluding statement that it could be one of the elements of research in an expert’s analysis of the authenticity of the signature on paintings.

Keywords: artist’s signatures, authenticity of an artwork, forensic handwriting analysis, graphic-comparative method

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Authors: Adesoji Sodeinde

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Analytical derivatives has recently undergone an explosive growth in areas of separation techniques, likewise in detectability of certain compound/concentrated ions. The gloomy and depressing scenario which charaterized the application of analytical derivatives in areas of water analysis, water cycle and the environment should not be allowed to continue unabated. Due to technological advancement in various chemical/biochemical analysis separation techniques is widely used in areas of medical, forensic and to measure and assesses environment and social-economic impact of alternative control strategies. This technological improvement was dully established in the area of comparison between certain separation/detection techniques to bring about vital result in forensic[as Gas liquid chromatography reveals the evidence given in court of law during prosecution of drunk drivers]. The water quality analysis,pH and water temperature analysis can be performed in the field, the concentration of dissolved free amino-acid [DFAA] can also be detected through separation techniques. Some important derivatives/ions used in separation technique. Water analysis : Total water hardness [EDTA to determine ca and mg ions]. Gas liquid chromatography : innovative gas such as helium [He] or nitrogen [N] Water cycle : Animal bone charcoal,activated carbon and ultraviolet light [U.V light].

Keywords: analytical derivative, environment, water analysis, chemical/biochemical analysis

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Authors: Tomas Barnak, Libor Matejka

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The aim of this study is to create a standard application using multi-criteria evaluation in the field of forensic engineering. This situation can occur in the professional assessment in several cases such as when it is necessary to consider more criteria variant of the structural subsystems, more variants according to several criteria based on a court claim, which requires expert advice. A problematic situation arises when it is necessary to clearly determine the ranking of the options according to established criteria, and reduce subjective evaluation. For the procurement in the field of construction which is based on the prepared text of the law not only economic criteria but also technical, technological and environmental criteria will be determined. This fact substantially changes the style of evaluation of individual bids. For the above-mentioned needs of procurement, the unification of expert’s decisions and the use of multi-criteria assessment seem to be a reasonable option. In the case of experimental verification when using multi-criteria evaluation of alternatives construction subsystem the economic, technical, technological and environmental criteria will be compared. The core of the solution is to compare a selected number of set criteria, application methods and evaluation weighting based on the weighted values assigned to each of the criteria to use multi-criteria evaluation methods. The sequence of individual variations is determined by the evaluation of the importance of the values of corresponding criteria concerning expertise in the problematic of outside wall constructional subsystems.

Keywords: criteria, expertise, multi-criteria evaluation, outside wall subsystems

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Authors: Saule Mussabekova

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A number of chemical elements widely presented in the nature is seldom met in people and vice versa. This is a peculiarity of accumulation of elements in the body, and their selective use regardless of widely changed parameters of external environment. Microelemental identification of human hair and particularly dead body is a new step in the development of modern forensic medicine which needs reliable criteria while identifying the person. In the condition of technology-related pressing of large industrial cities for many years and specific for each region multiple-factor toxic effect from many industrial enterprises it’s important to assess actuality and the role of researches of human hair while assessing degree of deposition with specific pollution. Hair is highly sensitive biological indicator and allows to assess ecological situation, to perform regionalism of large territories of geological and chemical methods. Besides, monitoring of concentrations of chemical elements in the regions of Kazakhstan gives opportunity to use these data while performing forensic medical identification of dead bodies of unknown persons. Methods based on identification of chemical composition of hair with further computer processing allowed to compare received data with average values for the sex, age, and to reveal causally significant deviations. It gives an opportunity preliminary to suppose the region of residence of the person, having concentrated actions of policy for search of people who are unaccounted for. It also allows to perform purposeful legal actions for its further identification having created more optimal and strictly individual scheme of personal identity. Hair is the most suitable material for forensic researches as it has such advances as long term storage properties with no time limitations and specific equipment. Besides, quantitative analysis of micro elements is well correlated with level of pollution of the environment, reflects professional diseases and with pinpoint accuracy helps not only to diagnose region of temporary residence of the person but to establish regions of his migration as well. Peculiarities of elemental composition of human hair have been established regardless of age and sex of persons residing on definite territories of Kazakhstan. Data regarding average content of 29 chemical elements in hair of population in different regions of Kazakhstan have been systemized. Coefficients of concentration of studies elements in hair relative to average values around the region have been calculated for each region. Groups of regions with specific spectrum of elements have been emphasized; these elements are accumulated in hair in quantities exceeding average indexes. Our results have showed significant differences in concentrations of chemical elements for studies groups and showed that population of Kazakhstan is exposed to different toxic substances. It depends on emissions to atmosphere from industrial enterprises dominating in each separate region. Performed researches have showed that obtained elemental composition of human hair residing in different regions of Kazakhstan reflects technogenic spectrum of elements.

Keywords: analysis of elemental composition of hair, forensic medical research of hair, identification of unknown dead bodies, microelements

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Authors: B. Kenny, M. Dixon, A. Boshell

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The use of alcoholic surgical prep was recently introduced into the Royal Newcastle Center for elective procedures. In the past 3 months there have been a significant number of burns believed to be related to ‘pooling’ of this surgical prep in patients undergoing procedures where they are placed in the lateral position with hip bolsters. The aim of the audit was to determine the reason for the burns, analyze what pre-existing factors may contribute to the development of the burns and what can be changed to prevent further burns occurring. All patients undergoing a procedure performed on the hip who were placed in the lateral position with sacral and anterior, superior iliac spine (ASIS) support with ‘bolsters’ were included in the audit. Patients who developed a ‘burn’ were recorded, details of the surgery, demographics, surgical prep used and length of surgery were obtained as well as photographs taken to document the burn. Measures were then taken to prevent further burns and the efficacy was documented. Overall 14 patients developed burns over the ipsilateral ASIS. Of these, 13 were Total Hip Arthroplasty (THA) and 1 was a removal of femoral nail. All patients had Chlorhexidine 0.5% in Alcohol 70% Tinted Red surgical preparation or Betadine Alcoholic Skin Prep (70% etoh). Patients were set up in the standard lateral decubitus position with sacral and bilateral ASIS bolsters with a valband covering. 86% of patients were found to have pre-existing hypersensitivities to various substances. There is very little literature besides a few case reports on surgical prep-related burns. The case reports that do exist are related to the use of tourniquet-related burns and there is no mention in the literature examining ‘bolster’ related burns. The burns are hypothesized to be caused by pooling of the alcoholic solution which is amplified by the use of Valband.

Keywords: arthroplasty, chemical burns, wounds, rehabilitation

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Authors: Adeyinka Adesanya, Isaac Bamgboye

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There is a growing need to develop the processes to produce renewable fuels and chemicals due to the economic, political, and environmental concerns associated with fossil fuels. Lignocellulosic biomass is an excellent renewable feedstock because it is both abundant and inexpensive. This project aims at producing bioethanol from lignocellulosic plants (Sorghum Arundinacieum and Heteropogon Contortus) by biochemical means, computing the energy audit of the process and determining the fuel properties of the produced ethanol. Acid pretreatment (0.5% H2SO4 solution) and enzymatic hydrolysis (using malted barley as enzyme source) were employed. The ethanol yield of wild sorghum was found to be 20% while that of spear grass was 15%. The fuel properties of the bioethanol from wild sorghum are 1.227 centipoise for viscosity, 1.10 g/cm3 for density, 0.90 for specific gravity, 78 °C for boiling point and the cloud point was found to be below -30 °C. That of spear grass was 1.206 centipoise for viscosity, 0.93 g/cm3 for density 1.08 specific gravity, 78 °C for boiling point and the cloud point was also found to be below -30 °C. The energy audit shows that about 64 % of the total energy was used up during pretreatment, while product recovery which was done manually demanded about 31 % of the total energy. Enzymatic hydrolysis, fermentation, and distillation total energy input were 1.95 %, 1.49 % and 1.04 % respectively, the alcoholometric strength of bioethanol from wild sorghum was found to be 47 % and the alcoholometric strength of bioethanol from spear grass was 72 %. Also, the energy efficiency of the bioethanol production for both grasses was 3.85 %.

Keywords: lignocellulosic biomass, wild sorghum, spear grass, biochemical conversion

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Authors: Raja Ezman Raja Shariff

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Acute kidney injury (AKI) is commonly seen in inpatients, and places a great cost on the NHS and patients. Timely and appropriate management is both nephron sparing and potentially life-saving. Ultrasound scanning (USS) is a well-recognised method for stratifying patients. Subsequently, the NICE AKI guidance has defined groups in whom scanning is recommended within 6 hours of request (pyonephrosis), within 24 hours (obstruction/cause unknown), and in whom routine scanning isn't recommended (cause for AKI identified). The audit looks into whether Stockport NHS Trust USS practice was in line with such recommendations. The audit evaluated 92 patients with AKI who had USS, between 01/01/14 to 30/04/14. Data collection was divided into 2 parts. Firstly, radiology request cards and the online imaging software (PACS) were evaluated. Then, the electronic case notes (ADVANTIS) was evaluated further. Based on request cards, 10% of requests were for pyonephrosis. Only 33% were scanned within 6hours and a further 33% within 24hours. 75% were requested for possible obstructions and unknown cause collectively. Of those due to possible obstruction, 71% of patients were scanned within 24 hours. Of those with unknown cause, 50% were scanned within 24 hours. 15% of requests had a cause declared and so potentially did not require scanning. Evaluation of the patients’ notes suggested further interesting findings. Firstly, potentially 39% of patients had a known cause for AKI, therefore, did not need USS. Subsequently, the cohort of unknown cause and possible obstruction was collectively reduced to 45%. Alarmingly the patient cohort with possible pyonephrosis went up to 16%, suggesting an under-recognition of this life-threatening condition. We plan to highlight these findings within our institution and make changes to encourage more appropriate requesting and timely scanning. Time will tell if we manage to save or increase our costs in this cost-conscious NHS. Patient benefits, though, seem to be guaranteed.

Keywords: AKI, ARF, kidney, renal

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Authors: Emma Carr, Bilal Aslam-Pervez, David Laraway

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Litigation against surgeons and hospitals continues to increase in Western countries. While verbal consent is all that is required legally, it has for a long time been considered that written consent offers proof of discussion and interaction between the surgeon and the patient. Inadequate consenting of patients continues in the United Kingdom leaving surgeons and Health Trusts open to litigation. We present a standardised consent form which improves patient autonomy and engagement. The General Medical Council recommends that all material risks relevant to the patient are discussed and recorded prior to undergoing surgery, regardless of how likely they are to occur. Current literature was reviewed to evaluate complications associated with surgical management of mandible fractures. Analysis of risks on 52 consent forms were analysed within the Glasgow OMFS department, leading to a procedure-specific form being designed and implemented. This audit showed that the documentation of risks on consent forms was extremely variable- with uncommon risks not being recorded. Interestingly, not a single consent form was found which highlighted all the risks associated with mandible fractures. Our re-audit data confirms 100% of risks being discussed when a procedure specific form is utilised. Our hope, is to introduce further forms for inclusion on the BAOMS website and peripheral distribution. The forms are quick and easy to print and leave more time for consultation with the patient. Whilst we are under no illusion that the forms may not decrease the incidence of intended litigation, we feel confident that they will decrease the chances of it being successful.

Keywords: consent, litigation, mandible fracture, surgery

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Authors: jihen ayadi sellami

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The rapid evolution of the global financial landscape has led to increased attention to corporate tax policies and the need to understand the factors that influence their tax behavior. In order to mitigate any residual loss for shareholders resulting from tax aggressiveness and resolve the agency problem, appropriate systems that separate the function of management from that of controlling are needed. In this context of growing concerns to limit aggressive corporate taxation practices through governance, this study discusses. Its aims is to examine the influence of six key characteristics of the board of directors (board size, diligence, CEO duality, presence of audit committees, gender diversity and independence of directors), given a governance mechanism, on the tax decisions of non-financial corporations in the United State. In fact, using a sample of 90 non-financial US firms from S&P 500 over a period of 4 years going from 2014 to 2017, the results based on a multivariate linear regression highlight significant associations between these characteristics and corporate tax policy. Notably, larger board, gender diversity, diligence and increased director independence appear to play an important role in reducing aggressive taxation. While duality has a positive and significant correlation with tax aggressiveness, that can be explained by the fact that the manager did properly exploit his specific position within the company. These findings contribute to a deeper understanding of how board characteristics can influence corporate tax management, providing avenues for more effective corporate governance and more responsible tax decision-making

Keywords: tax aggressiveness, board of directors, board size, CEO duality, audit committees, gender diversity, director independence, diligence, corporate governance, united states

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Authors: Aarati Susan Mathew, Radhika Narendra Patel, Jiji Mathew

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A retrospective study conducted at Christian Medical College (CMC) Teaching Hospital, Vellore, India on 14th August 2014 to assess the accuracy of clinically estimated foetal weight upon labour admission. Estimating foetal weight is a crucial factor in assessing maternal and foetal complications during and after labour. Medical notes of ninety-eight postnatal women who fulfilled the inclusion criteria were studied to evaluate the correlation between their recorded Estimated Foetal Weight (EFW) on admission and actual birth weight (ABW) of the newborn after delivery. Data concerning maternal and foetal demographics was also noted. Accuracy was determined by absolute percentage error and proportion of estimates within 10% of ABW. Actual birth weights ranged from 950-4080g. A strong positive correlation between EFW and ABW (r=0.904) was noted. Term deliveries (≥40 weeks) in the normal weight range (2500-4000g) had a 59.5% estimation accuracy (n=74) compared to pre-term (<40 weeks) with an estimation accuracy of 0% (n=2). Out of the term deliveries, macrosomic babies (>4000g) were underestimated by 25% (n=3) and low birthweight (LBW) babies were overestimated by 12.7% (n=9). Registrars who estimated foetal weight were accurate in babies within normal weight ranges. However, there needs to be an improvement in predicting weight of macrosomic and LBW foetuses. We have suggested the use of an amended version of the Johnson’s formula for the Indian population for improvement and a need to re-audit once implemented.

Keywords: clinical palpation, estimated foetal weight, pregnancy, India, Johnson’s formula

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Authors: Adnan Lanjawi

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This paper is carried out to investigate the management of hazardous waste in the chemistry section which belongs to Dubai Police forensic laboratory. The chemicals are the main contributor toward the accumulation of hazardous waste in the section. This is due to the requirement to use it in analysis, such as of explosives, drugs, inorganic and fire debris cases. This leads to negative effects on the environment and to the employees’ health and safety. The research investigates the quantity of chemicals there, the labels, the storage room and equipment used. The target is to reduce the need for disposal by looking at alternative options, such as elimination, substitution and recycling. The data was collected by interviewing the top managers there who have been working in the lab more than 20 years. Also, data was collected by observing employees and how they carry out experiments. Therefore, a survey was made to assess their knowledge about the hazardous waste. The management of hazardous chemicals in the chemistry section needs to be improved. The main findings illustrate that about 110 bottles of reference substances were going to be disposed of in 2014. These bottles were bought for about 100,000 UAE Dirhams (£17,600). This means that the management of substances purchase is not organised. There is no categorisation programme in place, which makes the waste control very difficult. In addition, the findings show that chemical are segregated according to alphabetical order, whereas the efficient way is to separate them according to their nature and property. In addition, the research suggested technology and experiments to follow to reduce the need for using solvents and chemicals in the sample preparation.

Keywords: control, hazard, laboratories, waste,

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Authors: Lianyan Zhou

Abstract:

According to the National Conference of State Legislatures, a person experiencing a mental health crisis is more likely to encounter law enforcement than crisis intervention or treatment. People with mental illness are overrepresented in incarceration, often resulting in exacerbation of the symptoms and increasing the likelihood of recidivism and rearrest. To address the issue of the large number of people with mental illness cycling through the criminal justice system, mental health courts and diversion programs were established. Mental health diversion programs are considered as more appropriate options for offenders whose mental illness is significantly contributing to their criminal offenses. However, these programs are controversial, with criticism that offenders may view the programs as the only to get treatment or to avoid jail time. This paper provides a comprehensive review of the effectiveness of mental health diversion programs. More specifically, it examines how these programs may reduce recidivism compared to incarceration. Materials presented in this review were selected from forensic and general psychology journals. Additional policy documents, government reports, and court records are also included for discussion. The results suggest that mental health diversion programs are overall more successful in intervening compared to incarcerations. The recidivism rates for program participants are lower. However, individual factors do contribute to the outcome of the programs.

Keywords: diversion programs, forensic psychology, justice system, mental health courts, mental illness, rearrest, recidivism

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Authors: Rizwan Iqbal

Abstract:

Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

Procedia PDF Downloads 62

Authors: Ranjitkumar Patil

Abstract:

Age estimation has its importance in forensic dentistry. Dental age estimation has emerged as an alternative to skeletal age determination. The methods based on stages of tooth formation, as appreciated on radiographs, seems to be more appropriate in the assessment of age than those based on skeletal development. The study was done to evaluate dental age in north Indian population using Cameriere’s method. Aims/Objectives: The study was conducted to assess the dental age of North Indian children using Cameriere’smethodand to compare the chronological age and dental age for validation of the Cameriere’smethod in the north Indian population. A comparative study of 02 year duration on the OPG (using PLANMECA Promax 3D) data of 497 individuals with age ranging from 5 to 15 years was done based on simple random technique ethical approval obtained from the institutional ethical committee. The data was obtained based on inclusion and exclusion criteria was analyzed by a software for dental age estimation. Statistical analysis: Student’s t test was used to compare the morphological variables of males with those of females and to compare observed age with estimated age. Regression formula was also calculated. Results: Present study was a comparative study of 497 subjects with a distribution between male and female, with their dental age assessed by using Panoramic radiograph, following the method described by Cameriere, which is widely accepted. Statistical analysis in our study indicated that gender does not have a significant influence on age estimation. (R2= 0.787). Conclusion: This infers that cameriere’s method can be effectively applied in north Indianpopulation.

Keywords: Forensic, Chronological Age, Dental Age, Skeletal Age

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Authors: Hatice Boyacioglu, Nursel Akkaya, Humeyra Ozge Yilanci, Hilmi Kansu, Nihal Avcu

Abstract:

The strong relationship between the reduction in the size of the pulp cavity and increasing age has been reported in the literature. This relationship can be utilized to estimate the age of an individual by measuring the pulp cavity size using dental radiographs as a non-destructive method. The purpose of this study is to develop a population specific regression model for age estimation in a sample of Turkish adults by applying Cameriere’s method on panoramic radiographs. The sample consisted of 100 panoramic radiographs of Turkish patients (40 men, 60 women) aged between 20 and 70 years. Pulp and tooth area ratios (AR) of the maxilla¬¬ry canines were measured by two maxillofacial radiologists and then the results were subjected to regression analysis. There were no statistically significant intra-observer and inter-observer differences. The correlation coefficient between age and the AR of the maxillary canines was -0.71 and the following regression equation was derived: Estimated Age = 77,365 – ( 351,193 × AR ). The mean prediction error was 4 years which is within acceptable errors limits for age estimation. This shows that the pulp/tooth area ratio is a useful variable for assessing age with reasonable accuracy. Based on the results of this research, it was concluded that Cameriere’s method is suitable for dental age estimation and it can be used for forensic procedures in Turkish adults. These instructions give you guidelines for preparing papers for conferences or journals.

Keywords: age estimation by teeth, forensic dentistry, panoramic radiograph, Cameriere's method

Procedia PDF Downloads 450

Authors: Morteza Rahbar Taramsari, Arya Mahdavi Baramchi, Mercedeh Enshaei, Ghazaleh Keshavarzi Baramchi

Abstract:

Introduction: Malingering is one of the most challenging issues in the forensic psychology and imposes a heavy financial burden on health care and legal systems. It seems that some mental and personality abnormalities might have a crucial role in developing this condition. Materials and Methods: In this cross-sectional study, we aimed to assess 100 malingering clients of Gilan province general office of forensic medicine, all filled the related questionnaires. The data about some psychometric characteristics were collected through the 71-items version- short form- of Minnesota Multiphasic Personality Inventory (MMPI) questionnaire and the personality traits were assessed by NEO Personality Inventory-Revised (NEO PI-R) - including 240 items- as a reliable and accurate measure of the five domains of personality. Results: The 100 malingering clients (55 males and 45 females) ranged from 23 to 45 (32+/- 5.6) years old. Regarding marital status, 36% were single, 57% were married and 7% were divorced. Almost two-thirds of the participants (64%) were unemployed, 21% were self-employed and the rest of them were employed. The data of MMPI clinical scales revealed that the mean (SD) T score of Hypochondrias (Hs) was 67(9.2), Depression (D) was 87(7.9), Hysteria (Hy) was 74(5.8), Psychopathic Deviate (Pd) was 62(8.5), Masculinity-Feminity (MF) was 76(8.4), Paranoia (Pa) was 62(4.5), Psychasthenia (Pt) was 80(7.9), Schizophrenia (Sc) was 69(6.8), Hypomania (Ma) was 64(5.9)and Social Introversion (Si) was 58(4.3). NEO PI-R test showed five domains of personality. The mean (SD) T score of Neuroticism was 65(9.2), Extraversion was 51(7.9), Openness was 43(5.8), Agreeableness was 35(3.4) and Conscientiousness was 42(4.9). Conclusion: According to MMPI test in our malingering clients, Hypochondriasis (Hs), depression (D), Hysteria (Hy), Muscularity-Feminity (MF), Psychasthenia (Pt) and Schizophrenia (Sc) had high scores (T >= 65) which means pathological range and psychological significance. Based on NEO PI-R test Neuroticism was in high range, on the other hand, Openness, Agreeableness, and Conscientiousness were in low range. Extroversion was in average range. So it seems that malingerers require basic evaluations of different psychological fields. Additional research in this area is needed to provide stronger evidence of the possible positive effects of the mentioned factors on malingering.

Keywords: malingerers, mental profile, MMPI, NEO PI-R, personality profile

Procedia PDF Downloads 266

Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

Abstract:

Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

Procedia PDF Downloads 121

Authors: Michael Josef Schwerer

Abstract:

Background: The identification of unknown victims from mass disasters, violent crimes, or terrorist attacks is frequently facilitated through information from missing persons lists, portrait photos, old or recent pictures showing unique characteristics of a person such as scars or tattoos, or simply reference samples from blood relatives for DNA analysis. In contrast, the identification or at least the characterization of an unknown perpetrator from criminal or terrorist actions remains challenging, particularly in the absence of material or data for comparison, such as fingerprints, which had been previously stored in criminal records. In scenarios that result in high levels of destruction of the perpetrator’s corpse, for instance, blast or fire events, the chance for a positive identification using standard techniques is further impaired. Objectives: This study shows the forensic genetic procedures in the Legal Medicine Service of the German Air Force for the identification of unknown individuals, including such cases in which reference samples are not available. Scenarios requiring such efforts predominantly involve aircraft crash investigations, which are routinely carried out by the German Air Force Centre of Aerospace Medicine as one of the Institution’s essential missions. Further, casework by military police or military intelligence is supported based on administrative cooperation. In the talk, data from study projects, as well as examples from real casework, will be demonstrated and discussed with the audience. Methods: Forensic genetic identification in our laboratories involves the analysis of Short Tandem Repeats and Single Nucleotide Polymorphisms in nuclear DNA along with mitochondrial DNA haplotyping. Extended DNA analysis involves phenotypic markers for skin, hair, and eye color together with the investigation of a person’s biogeographic ancestry. Assessment of the biological age of an individual employs CpG-island methylation analysis using bisulfite-converted DNA. Forensic Investigative Genealogy assessment allows the detection of an unknown person’s blood relatives in reference databases. Technically, end-point-PCR, real-time PCR, capillary electrophoresis, pyrosequencing as well as next generation sequencing using flow-cell-based and chip-based systems are used. Results and Discussion: Optimization of DNA extraction from various sources, including difficult matrixes like formalin-fixed, paraffin-embedded tissues, degraded specimens from decomposed bodies or from decedents exposed to blast or fire events, provides soil for successful PCR amplification and subsequent genetic profiling. For cases with extremely low yields of extracted DNA, whole genome preamplification protocols are successfully used, particularly regarding genetic phenotyping. Improved primer design for CpG-methylation analysis, together with validated sampling strategies for the analyzed substrates from, e.g., lymphocyte-rich organs, allows successful biological age estimation even in bodies with highly degraded tissue material. Conclusions: Successful identification of unknown individuals or at least their phenotypic characterization using pigmentation markers together with age-informative methylation profiles, possibly supplemented by family tree search employing Forensic Investigative Genealogy, can be provided in specialized laboratories. However, standard laboratory procedures must be adapted to work with difficult and highly degraded sample materials.

Keywords: identification, forensic genetics, phenotypic markers, CPG methylation, biological age estimation, forensic investigative genealogy

Procedia PDF Downloads 51

Authors: Ranjitkumar Patil

Abstract:

Age estimation has importance in forensic dentistry. Dental age estimation has emerged as an alternative to skeletal age determination. The methods based on stages of tooth formation, as appreciated on radiographs, seem to be more appropriate in the assessment of age than those based on skeletal development. The study was done to evaluate dental age in the north Indian population using Cameriere’s method. Aims/Objectives: The study was conducted to assess the dental age of North Indian children using Cameriere’s method and to compare the chronological age and dental age for validation of the Cameriere’s method in the north Indian population. A comparative study of 02-year duration on the OPG (using PLANMECA Promax 3D) data of 497 individuals with ages ranging from 5 to 15 years was done based on simple random technique ethical approval obtained from institutional ethical committee. The data was obtained based on inclusion and exclusion criteria and was analyzed by software for dental age estimation. Statistical analysis: The student’s t-test was used to compare the morphological variables of males with those of females and to compare observed age with estimated age. The regression formula was also calculated. Results: Present study was a comparative study of 497 subjects with a distribution between males and females, with their dental age assessed by using a Panoramic radiograph, following the method described by Cameriere, which is widely accepted. Statistical analysis in our study indicated that gender does not have a significant influence on age estimation. (R2= 0.787). Conclusion: This infers that Cameriere’s method can be effectively applied to the north Indian population.

Keywords: forensic, dental age, skeletal age, chronological age, Cameriere’s method

Procedia PDF Downloads 116

Authors: Anurag Tripathi, Sanad Khandelwal

Abstract:

Age and gender determination are required in forensic for victim identification. There is secondary dentine deposition throughout life, resulting in decreased pulp volume and size. Evaluation of pulp volume using Cone Beam Computed Tomography (CBCT)is a noninvasive method to evaluate the age and gender of an individual. The study was done to evaluate the efficacy of pulp volume method in the determination of age and gender.Aims/Objectives: The study was conducted to estimate age and determine sex by measuring tooth pulp volume with the help of CBCT. An observational study of one year duration on CBCT data of individuals was conducted in Lucknow. Maxillary central incisors (CI) and maxillary canine (C) of the randomly selected samples were assessed for measurement of pulp volume using a software. Statistical analysis: Chi Square Test, Arithmetic Mean, Standard deviation, Pearson’s Correlation, Linear & Logistic regression analysis. Results: The CBCT data of Ninety individuals with age range between 18-70 years was evaluated for pulp volume of central incisor and canine (CI & C). The Pearson correlation coefficient between the tooth pulp volume (CI & C) and chronological age suggested that pulp volume decreased with age. The validation of the equations for sex determination showed higher prediction accuracy for CI (56.70%) and lower for C (53.30%).Conclusion: Pulp volume obtained from CBCT is a reliable indicator for age estimation and gender prediction.

Keywords: forensic, dental age, pulp volume, cone beam computed tomography

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