Search results for: forensic audit

Authors: Nidesh Sapkota, Garima Pudasaini, Dikshya Agrawal, Binav Baral, Umesh Bhagat, Dharanidhar Baral

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Background: Medical and Dental students are vulnerable to higher levels of Psychological distress than other age matched peers. Many studies reveals that there is high prevalence of psychoactive substance use and Psychiatric co-morbidities among them. Objectives: -To study the prevalence of substance use among medical and dental students of a Medical University. -To study the prevalence of depression and anxiety in medical and dental students of a Medical University. Materials and Method: A cross-sectional descriptive study in which simple random sampling was done. Semi-structured questionnaire, AUDIT for alcohol use, Fagerstrom test for Nicotine dependence, Cannabis screening test (CAST), Beck’s Depression Inventory (BDI), Beck’s Anxiety Inventory (BAI) were used for the assessment. Results: Total sample size was 588 in which the mean age of participants was 22±2years. Among them the prevalence of alcohol users was 47.75%(281) in which 32%(90) were harmful users. Among 19.55%(115) nicotine users 56.5%(65), 37.4%(43), 6.1%(7) had low, low to moderate and moderate dependence respectively. The prevalence of cannabis users was 9%(53) with 45.3%(24), 18.9%(10) having low and high addiction respectively. Depressive symptoms were recorded in 25.3%(149) out of which 12.6%(74), 6.5%(38), 5.3%(31), 0.5%(3), 0.5%(3) had mild, borderline, moderate, severe and extreme depressive symptoms respectively. Similarly anxiety was recorded among 7.8%(46) students with 42 having moderate and 4 having severe anxiety symptoms. Among them 6.3%(37) had suicidal thoughts and 4(0.7%) of them had suicide attempt in last one year. Statistically significant association was noted with harmful alcohol users, Depression and suicidal attempts. Similar association was noted between Depression and suicide with moderate use of nicotine. Conclusion: There is high prevalence of Psychoactive substance use and psychiatric co-morbidities noted in the studies sample. Statistically significant association was noted with Psychiatric co-morbidities and substance use.

Keywords: alcohol, cannabis, dependence, depression, medical students

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Authors: Emad Al-Abdallat, Faris G. Bakri, Azmi Mahafza, Rayyan Al Ali, Nidaa Ababneh, Ahmed Idhair

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Background: Morgues are high-risk areas for the spread of infection from the cadavers to the staff during the postmortem examination. Infection can spread from corpses to workers by the airborne route, by direct contact, or from needle and sharp object injuries. Objective: Knowledge about the prevalence of these infections among autopsies is prudent to appreciate any risk of transmission and to further enforce safety measures. Method: A total of 242 autopsies were tested. Age ranged from 3 days to 94 years (median 75.5 years, mean 45.3 (21.9 ± SD)). There were 172 (71%) males. Results: The cause of death was considered natural in 137 (56.6%) cases, accidental in 89 (36.8%), homicidal in 9 (3.7%), suicidal in 4 (1.7%), and unknown in 3 (1.2%). Hepatitis B surface antigen was positive in 5 (2.1%) cases. Hepatitis C virus antibody was detected in 5 (2.1%) cases and the hepatitis C virus polymerase chain reaction was positive in 2 of them (0.8%). HIV antibody was not detected in any of the cases. Conclusions: Autopsies can be associated with exposure to blood borne viruses. Autopsies performed during the study period were tested for hepatitis B surface antigen, hepatitis C virus antibody, and human immunodeficiency virus antibody. Positive tests were subsequently confirmed by polymerase chain reaction. There is low prevalence of infections with these viruses in our autopsy cases. However, the risk of transmission remains a threat. Healthcare workers in the forensic departments should adhere to standard precautions.

Keywords: autopsy, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, Jordan

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Authors: Anthony Townsend, Robyn Fasser

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While complete objectivity is a desirable scientific position from which to conduct a care and contact evaluation (CCE), it is precisely the recognition that we are inherently incapable of operating objectively that is the foundation of ethical practice and skilled assessment. Drawing upon recent research from Daniel Kahneman (2021) on the differences between noise and bias, as well as different inherent biases collectively termed “The Elephant in the Brain” by Kevin Simler and Robin Hanson (2019) from Oxford University, this presentation addresses both the various ways in which our judgments, perceptions and even procedures can be distorted and contaminated while conducting a CCE, but also considers the value of second order cybernetics and the psychodynamic concept of ‘ambivalence’ as a conceptual basis to inform our assessment methodologies to limit such errors or at least better identify them. Both a conceptual framework for ambivalence, our higher-order capacity to allow for the convergence and consideration of multiple emotional experiences and cognitive perceptions to inform our reasoning, and a practical methodology for assessment relying on data triangulation, Bayesian inference and hypothesis testing is presented as a means of promoting ethical practice for health care professionals conducting CCEs. An emphasis on widening awareness and perspective, limiting ‘splitting’, is demonstrated both in how this form of emotional processing plays out in alienating dynamics in families as well as the assessment thereof. In addressing this concept, this presentation aims to illuminate the value of ambivalence as foundational to ethical practice for assessors.

Keywords: ambivalence, forensic, psychology, noise, bias, ethics

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Maad Kamal Al-Anni

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This study is about an algorithmic dependence of Artificial Neural Network on Multilayer Perceptron (MPL) pertaining to the classification and clustering presentations for Mobile Adhoc Network vulnerabilities. Moreover, mobile ad hoc network (MANET) is ubiquitous intelligent internetworking devices in which it has the ability to detect their environment using an autonomous system of mobile nodes that are connected via wireless links. Security affairs are the most important subject in MANET due to the easy penetrative scenarios occurred in such an auto configuration network. One of the powerful techniques used for inspecting the network packets is Intrusion Detection System (IDS); in this article, we are going to show the effectiveness of artificial neural networks used as a machine learning along with stochastic approach (information gain) to classify the malicious behaviors in simulated network with respect to different IDS techniques. The monitoring agent is responsible for detection inference engine, the audit data is collected from collecting agent by simulating the node attack and contrasted outputs with normal behaviors of the framework, whenever. In the event that there is any deviation from the ordinary behaviors then the monitoring agent is considered this event as an attack , in this article we are going to demonstrate the  signature-based IDS approach in a MANET by implementing the back propagation algorithm over ensemble-based Traffic Table (TT), thus the signature of malicious behaviors or undesirable activities are often significantly prognosticated and efficiently figured out, by increasing the parametric set-up of Back propagation algorithm during the experimental results which empirically shown its effectiveness  for the ratio of detection index up to 98.6 percentage. Consequently it is proved in empirical results in this article, the performance matrices are also being included in this article with Xgraph screen show by different through puts like Packet Delivery Ratio (PDR), Through Put(TP), and Average Delay(AD).

Keywords: Intrusion Detection System (IDS), Mobile Adhoc Networks (MANET), Back Propagation Algorithm (BPA), Neural Networks (NN)

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Authors: Nazih Ramadan, Manal Mohy-Eldine, Amani Hanoon, Alaa Shehab

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Background and Aims: The study of fingerprints is widely used in providing a clue regarding identity. Age and gender identification from fingerprints is an important step in forensic anthropology in order to minimize the list of suspects search. The aim of this study was to determine finger ridge density and patterns among Egyptians, and to estimate age and gender using ridge densities. Materials and Methods: This study was conducted on 177 randomly-selected healthy Egyptian subjects (90 males and 87 females). They were divided into three age groups; Group (a): from 6-< 12 years, group (b) from 12-< 18 years and group (c) ≥ 18 years. Bilateral digital prints, from every subject, were obtained by the inking procedure. Ridge count per 25 mm² was determined together with assessment of ridge pattern type. Statistical analysis was done with references to different age and sex groups. Results: There was a statistical significant difference in ridge density between the different age groups; where younger ages had significantly higher ridge density than older ages. Females proved to have significantly higher ridge density than males. Also, there was a statistically significant negative correlation between age and ridge density. Ulnar loops were the most frequent pattern among Egyptians then whorls then arches then radial loops. Finally, different regression models were constructed to estimate age and gender from fingerprints ridge density. Conclusion: fingerprint ridge density can be used to identify both age and sex of subjects. Further studies are recommended on different populations, larger samples or using different methods of fingerprint recording and finger ridge counting.

Keywords: age, sex identification, Egyptian population, fingerprints, ridge density

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Authors: M. Kaya, M. Eris

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Internet use, intelligent communication tools, and social media have all become an integral part of our daily life as a result of rapid developments in information technology. However, this widespread use increases crimes committed in the digital environment. Therefore, digital forensics, dealing with various crimes committed in digital environment, has become an important research topic. It is in the research scope of digital forensics to investigate digital evidences such as computer, cell phone, hard disk, DVD, etc. and to report whether it contains any crime related elements. There are many software and hardware tools developed for use in the digital evidence acquisition process. Today, the most widely used digital evidence investigation tools are based on the principle of finding all the data taken place in digital evidence that is matched with specified criteria and presenting it to the investigator (e.g. text files, files starting with letter A, etc.). Then, digital forensics experts carry out data analysis to figure out whether these data are related to a potential crime. Examination of a 1 TB hard disk may take hours or even days, depending on the expertise and experience of the examiner. In addition, it depends on examiner’s experience, and may change overall result involving in different cases overlooked. In this study, a hash-based matching and digital evidence evaluation method is proposed, and it is aimed to automatically classify the evidence containing criminal elements, thereby shortening the time of the digital evidence examination process and preventing human errors.

Keywords: block matching, digital evidence, hash list, evaluation of digital evidence

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Authors: Ogbonnaya O. Iroanya, Samson T. Fakorede, Osamudiamen J. Edosa, Hadiat A. Azeez

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The human mitochondrial DNA (mtDNA) is about 17 kbp circular DNA fragments found within the mitochondria together with smaller fragments of 1200 bp known as the control region. Knowledge of variation within populations has been employed in forensic and molecular anthropology studies. The study was aimed at investigating the polymorphic nature of the two hypervariable segments (HVS) of the mtDNA, i.e., HVS1 and HVS2, and to determine the haplogroup distribution among individuals resident in Lagos, Southwestern Nigeria. Peripheral blood samples were obtained from sixty individuals who are not related maternally, followed by DNA extraction and amplification of the extracted DNA using primers specific for the regions under investigation. DNA amplicons were sequenced, and sequenced data were aligned and compared to the revised Cambridge Reference Sequence (rCRS) GenBank Accession number: NC_012920.1) using BioEdit software. Results obtained showed 61 and 52 polymorphic nucleotide positions for HVS1 and HVS2, respectively. While a total of three indels mutation were recorded for HVS1, there were seven for HVS2. Also, transition mutations predominate nucleotide change observed in the study. Genetic diversity (GD) values for HVS1 and HVS2 were estimated to be 84.21 and 90.4%, respectively, while random match probability was 0.17% for HVS1 and 0.89% for HVS2. The study also revealed mixed haplogroups specific to the African (L1-L3) and the Eurasians (U and H) lineages. New polymorphic sites obtained from the study are promising for human identification purposes.

Keywords: hypervariable region, indels, mitochondrial DNA, polymorphism, random match probability

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Authors: Lara Al-Haddad, Mark Whittington

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This paper aims to examine the impact of two influential internal corporate governance mechanisms, namely board characteristics and ownership structure on the use of real activities-based and accrual-based earnings management by Jordanian public firms. Using panel data from Jordanian public firms after the introduction of the Jordanian Corporate Governance Code (JCGC) in 2009, the study finds both institutional ownership and managerial ownership constrain the use of real and accrual earnings manipulations. On the other side, both independent directors and largest shareholders are found to exaggerate the incidence of using real and accrual earnings management. The study also examines the trade-off between real and accrual earnings management and found that Jordanian firms use a combination of real and accrual-based earnings management to obtain the greatest effect on earnings reporting strategies. For the purpose of this study, three types of real earnings management are considered: sales manipulation, overproduction, and the abnormal reduction of discretionary expenditures. The abnormal discretionary accrual is considered for accruals management. While for the internal corporate governance mechanisms; board characteristics are examined by using board independence, board size, and CEO-duality; and ownership structure is examined by using managerial ownership, institutional ownership, foreign ownership and largest shareholder ownership. To the best knowledge of the researchers, this study is the first to examine the relationship between board characteristics and real earnings management in Jordan. Further, it is the first to examine the relationship between corporate governance mechanisms and discretionary accruals after the introduction of the Jordanian Corporate Governance Code in 2009. Thus, the findings of this study have important policy implications for policymakers, regulators, standard setters, audit professional, and investors in their attempts to constrain the practice of earnings management, whether real or accrual, and to improve the financial reporting quality in Jordan.

Keywords: board characteristics, Jordan, ownership structure, real earnings management

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Authors: Taufik Hidayat, Yudha Nurhantari, Bambang U. D. Rianto

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Introduction: The examination of the Short Tandem Repeats (STR) locus on nuclear DNA is very useful in solving the paternity cases. The purpose of this study is to know the description of paternity cases and paternity index/probability of paternity analysis based on Indonesian allele frequency at Sardjito Hospital Yogyakarta. Method: This was an observational study with cross-sectional analytic method. Population and sample were all cases of disputed paternity from January 2011 to June 2015 that fulfill the inclusion and exclusion criteria and were examined at Forensic Medicine Unit of Sardjito Hospital, Medical Faculty of Gadjah Mada University. The paternity index was calculated with EasyDNA Program by Fung (2013). Analysis of the study was conducted by comparing the results through unpaired categorical test using Kolmogorov-Smirnov test. This study was designed with 95% confidence interval (CI) with α = 5% and significance level is p < 0,05. Results: From 42 disputed paternity cases we obtained trio paternity cases were 32 cases (76.2%) and duo without a mother was 10 cases (23.8%). The majority of the fathers' estimated ages were 21-30 years (33.3%) and the mother's age was 31-40 years (38.1%). The majority of the ages of children examined for paternity were under 12 months (47.6%). The majority of ethnic clients are Javanese. Conclusion of inclusion was 57.1%, and exclusion was 42.9%. The Kolmogorov-Smirnov test obtained p-value = 0.673. Conclusion: There is no significant difference between paternity index/probability of paternity based on Indonesian allele frequency between trio and duo of paternity.

Keywords: disputed paternity, paternity index, probability of paternity, short tandem

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Authors: Seham El Kareh, Miramar Etman

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Recently, detecting liars and extracting features which distinguish them from truth-tellers have been the focus of a wide range of disciplines. To the author’s best knowledge, most of the work has been done on facial expressions and body gestures but only few works have been done on the language used by both liars and truth-tellers. This paper sheds light on four axes. The first axis copes with building an audio corpus for deceptive and truthful speech for Egyptian Arabic speakers. The second axis focuses on examining the human perception of lies and proving our need for computational linguistic-based methods to extract features which characterize truthful and deceptive speech. The third axis is concerned with building a linguistic analysis program that could extract from the corpus the inter- and intra-linguistic cues for deceptive and truthful speech. The program built here is based on selected categories from the Linguistic Inquiry and Word Count program. Our results demonstrated that Egyptian Arabic speakers on one hand preferred to use first-person pronouns and present tense compared to the past tense when lying and their lies lacked of second-person pronouns, and on the other hand, when telling the truth, they preferred to use the verbs related to motion and the nouns related to time. The results also showed that there is a need for bigger data to prove the significance of words related to emotions and numbers.

Keywords: Egyptian Arabic corpus, computational analysis, deceptive features, forensic linguistics, human perception, truthful features

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Authors: Saker Lilia, Youcef Mellouki, Lakhdar Sellami, Yacine Zerairia, Abdelhaid Zetili, Fatma Guahria, Fateh Kaious, Nesrine Belkhodja, Abdelhamid Mira

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Background: Sudden death is regarded as a suspicious demise necessitating autopsy, as stipulated by legal authorities. Chronic disseminated intravascular coagulation (DIC) is an acquired clinical and biological syndrome characterized by a severe and fatal prognosis, stemming from systemic, uncontrolled, diffuse coagulation activation. Irrespective of their origins, DIC is associated with a diverse spectrum of manifestations, encompassing minor biological coagulation alterations to profoundly severe conditions wherein hemorrhagic complications may take precedence. Simultaneously, microthrombi contribute to the development of multi-organ failures. Objective This study seeks to evaluate the role of autopsy in determining the causes of death. Materials and Methods: We present two instances of sudden death involving females who underwent autopsy at the Forensic Medicine Department of the University Hospital of Annaba, Algeria. These autopsies were performed at the request of the prosecutor, aiming to determine the causes of death and illuminate the exact circumstances surrounding it. Methods Utilized: Analysis of the initial information report; Findings from postmortem examinations; Histological assessments and toxicological analyses. Results: The presence of DIC was noted, affecting nearly all veins with distinct etiologies. Conclusion: For the establishment of a meaningful diagnosis: • Thorough understanding of the subject matter is imperative; • Precise alignment with medicolegal data is essential.

Keywords: chronic disseminated intravascular coagulation, sudden death, autopsy, causes of death

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Authors: Mst Shapna Akter, Hossain Shahriar

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One of the most important challenges in the field of software code audit is the presence of vulnerabilities in software source code. Every year, more and more software flaws are found, either internally in proprietary code or revealed publicly. These flaws are highly likely exploited and lead to system compromise, data leakage, or denial of service. C and C++ open-source code are now available in order to create a largescale, machine-learning system for function-level vulnerability identification. We assembled a sizable dataset of millions of opensource functions that point to potential exploits. We developed an efficient and scalable vulnerability detection method based on deep neural network models that learn features extracted from the source codes. The source code is first converted into a minimal intermediate representation to remove the pointless components and shorten the dependency. Moreover, we keep the semantic and syntactic information using state-of-the-art word embedding algorithms such as glove and fastText. The embedded vectors are subsequently fed into deep learning networks such as LSTM, BilSTM, LSTM-Autoencoder, word2vec, BERT, and GPT-2 to classify the possible vulnerabilities. Furthermore, we proposed a neural network model which can overcome issues associated with traditional neural networks. Evaluation metrics such as f1 score, precision, recall, accuracy, and total execution time have been used to measure the performance. We made a comparative analysis between results derived from features containing a minimal text representation and semantic and syntactic information. We found that all of the deep learning models provide comparatively higher accuracy when we use semantic and syntactic information as the features but require higher execution time as the word embedding the algorithm puts on a bit of complexity to the overall system.

Keywords: cyber security, vulnerability detection, neural networks, feature extraction

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Authors: Peter Collett, Mike Pynn, Haseeb Ur Rahman

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For the last few years across the UK there has been a push towards implementing treatment escalation plans (TEP) for every patient admitted to hospital. This is a paper form which is completed by a junior doctor then countersigned by the consultant responsible for the patient's care. It is designed to address what level of care is appropriate for the patient in question at point of entry to hospital. It helps decide whether the patient would benefit for ward based, high dependency or intensive care. They are completed to ensure the patient's best interests are maintained and aim to facilitate difficult decisions which may be required at a later date. For example, a frail patient with significant co-morbidities, unlikely to survive a pathology requiring an intensive care admission is admitted to hospital the decision can be made early to state the patient would not benefit from an ICU admission. This decision can be reversed depending on the clinical course of the patient's admission. It promotes discussions with the patient regarding their wishes to receive certain levels of healthcare. This poster describes the steps taken in the Aneurin Bevan University Health Board (ABUHB) when implementing the TEP form. The team implementing the TEP form campaigned for it's use to the board of directors. The directors were eager to hear of experiences of other health boards who had implemented the TEP form. The team presented the data produced in a number of health boards and demonstrated the proposed form. Concern was raised regarding the legalities of the form and that it could upset patients and relatives if the form was not explained properly. This delayed the effectuation of the TEP form and further research and discussion would be required. When COVID 19 reached the UK the National Institute for Health and Clinical Excellence issued guidance stating every patient admitted to hospital should be issued a TEP form. The TEP form was accelerated through the vetting process and was approved with immediate effect. The TEP form in ABUHB has now been in circulation for a month. An audit investigating it's uptake and a survey gathering opinions have been conducted.

Keywords: acute medicine, clinical governance, intensive care, patient centered decision making

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Authors: Othman Salim Hussein Al-Fleesy

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Background: Studies showed that sudden infant death syndrome (SIDS) has association with sleeping positions. Up-to-date no study explained how could they prevent it? Objectives: 1-To determine which sleeping position is certainly safe one to prevent SIDS. 2-To establish criteria for suggesting definition and making diagnosis for SIDS. 3-To discuss the controversy surrounding SUND, ALTE, NM, as compared to SIDS. Method: This literature review was built on a previous literature. Articles were obtained randomly according to their availability to the author. For the purpose of this work an easy approach was built by modeling an overview on SIDS topic after clarifying the misconception and misinterpretation of a number of controversial issues in regard to SIDS such as: asphyxia, sudden unexpected death among adults (Bangungut or Pokkuri), apparent life threatening event (ALTE), Nightmare, and comparing the findings with the literature review results..By this unique method we got a clue for prevention of Sudden Infant Death Syndrome. Results: The revision revealed with no doubt that no study before have studied right-side sleeping position at all. The author determined right side as the only safe position to preventing SIDS. A new definition for SIDS is suggested. The author postulated a Right side position hypothesis (Alfleesy hypothesis) which is a testable hypothesis in front of all researchers for further study . Conclusion: Our results contradict totally all previous studies and recommendations. We recommended strongly the right side position only for sleeping to prevent SIDS. New definition is suggested and a new hypothesis is postulated.

Keywords: SIDS, ALTE, nightmare, forensic sciences

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Authors: Christian Perrin, Nicholas Blagden, Louise Allen, Sarah Impey

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Social workers in the UK and professionals globally are faced with a particular challenge when dealing with allegations of child sexual abuse (CSA) in the community. In the absence of a conviction or incontestable evidence, staff can often find themselves unable to take decisive action to remove a child from harm, even though there may be a credible threat to their welfare. Conversely, practitioners may over-calculate risk through fear of being accountable for harm. This is, in part, due to the absence of a structured and evidence-based risk assessment tool which can predict the likelihood of a person committing child sexual abuse. Such assessments are often conducted by forensic professionals who utilise offence-specific data and personal history information to calculate risk. In situations where only allegations underpin a case, this mode of assessment is not viable. There are further ethical issues surrounding the assessment of risk in this area which require expert consideration and sensitive planning. This paper explores this entangled problem extant in the wider call to prevent sexual and child sexual abuse in the community. To this end, 32 qualitative interviews were undertaken with social workers dealing with CSA cases. Results were analysed using thematic analysis and operationalised to formulate a risk and protection protocol for use in case management. This paper reports on the early findings associated with the initial indications of protocol reliability. Implications for further research and practice are discussed.

Keywords: sexual offending, child sexual offence, offender rehabilitation, risk assessment, offence prevention

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Authors: Mangala Kohli, P. A. Athira, Reeha Mahajan

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The subthalamic nucleus (STN) is a biconvex nucleus situated in the diencephalon. The knowledge of the morphometry of the subthalamic nucleus is essential for accurate targeting of the nucleus during Deep Brain Stimulation. The present study aims to note the morphometry of the subthalamic nucleus in both the cerebral hemispheres which will prove to be of great value to radiologists and neurosurgeons. A cross‐sectional observational study was conducted in the Departments of Anatomy and Forensic Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi on thirty adult cadaveric brain specimens of unclaimed and donated corpses. The specimens were categorized into 3 age groups: 20-35, 35-50 and above 50 years. All samples were collected after following the standard protocol for ethical clearance. The morphometric study of 60 subthalamic nucleus was thus conducted. Transverse section of the brain was made at a plane 4mm ventral to the plane containing mid commissural point. The dimensions of the subthalamic nucleus were measured bilaterally with the aid of digital Vernier caliper and magnifying glass. In the present study, the mean length and width and AC-PC length of the subthalamic nucleus was recorded on the right and left side in Group A, B and C. On comparison of mean of subthalamic nucleus dimensions between the right and left side in Group C, no statistically significant difference was observed. The length and width of subthalamic nucleus measured in the 3 age groups were compared with each other and the p value calculated. There was no statistically significant difference between the dimensions of Group A and B, Group B and C as well as Group A and C. The present study reveals that there is no significant reduction in the size of the nucleus was noted with increasing age. Thus, the values obtained in the present study can be used as a reference for various invasive and non-invasive procedures on subthalamic nucleus.

Keywords: cerebral hemisphere, deep brain stimulation, morphometry, subthalamic nucleus

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Authors: Daniel Mueller, Melanie Breitbach, Stefan Cornelius, Sarah Pakulla-Dickel, Margaretha Koenig, Anke Prochnow, Mario Scherer

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The European STR standard set (ESS) of loci as well as the new expanded CODIS core loci set as recommended by the CODIS Core Loci Working Group, has led to a higher standardization and harmonization in STR analysis across borders. Various multiplex PCRs assays have since been developed for the analysis of these 17 ESS or 23 CODIS expansion STR markers that all meet high technical demands. However, forensic analysts are often faced with difficult STR results and the questions thereupon. What is the reason that no peaks are visible in the electropherogram? Did the PCR fail? Was the DNA concentration too low? QIAGEN’s newest Investigator STR kits contain a novel Quality Sensor (QS) that acts as internal performance control and gives useful information for evaluating the amplification efficiency of the PCR. QS indicates if the reaction has worked in general and furthermore allows discriminating between the presence of inhibitors or DNA degradation as a cause for the typical ski slope effect observed in STR profiles of such challenging samples. This information can be used to choose the most appropriate rework strategy.Based on the latest PCR chemistry called FRM 2.0, QIAGEN now provides the next technological generation for STR analysis, the Investigator ESSplex SE QS and Investigator 24plex QS Kits. The new PCR chemistry ensures robust and fast PCR amplification with improved inhibitor resistance and easy handling for a manual or automated setup. The short cycling time of 60 min reduces the duration of the total PCR analysis to make a whole workflow analysis in one day more likely. To facilitate the interpretation of STR results a smart primer design was applied for best possible marker distribution, highest concordance rates and a robust gender typing.

Keywords: PCR, QIAGEN, quality sensor, STR

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Authors: Daniel Faraj, Arabella Raupach, Charlotte Hespe, Helen Wilcox, Kristie-Lee Anning

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Aim: International child sponsorship programs comprise a considerable proportion of global aid accessible to the general population. Team Philippines (TP), a healthcare and welfare initiative run in association with the University of Notre Dame Sydney since 2013, leads a holistic sponsorship program for thirty children from Calauan, Philippines. To date, empirical research has not been performed on the overall success and impact of the TP child sponsorship program. As such, this study aims to evaluate its effectiveness in improving pediatric outcomes. Methods: Study cohorts comprised thirty sponsored and twenty-nine age- and gender-matched non-sponsored children. Data were extracted from the TP Medical Director database and lifestyle questionnaires for July-November 2019. Outcome measures included anthropometry, markers of medical health, dental health, exercise, and diet. Statistical analyses were performed in SPSS. Results: Sponsorship resulted in fewer medical diagnoses and prescription medications, superior dental health, and improved diet. Further, sponsored children may show a clinically significant trend toward improved physical health. Sponsorship did not affect growth and development metrics or levels of physical activity. Conclusions: The TP child sponsorship program significantly impacts positive pediatric health outcomes in the Calauan community. The strength of the program lies in its holistic, sustainable, and community-based model, which is enabled by effective international child sponsorship. This study further supports the relationship between supporting early livelihood and improved health in the pediatric population.

Keywords: child health, public health, health status disparities, healthcare disparities, social determinants of health, morbidity, community health services, culturally competent care, medically underserved areas, population health management, Philippines

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Authors: Feng-Ming Fan, Xiu-Hui Wen, Po-Feng Chen, Yi-Ching Tu

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Because of inborn natural conditions and man-made sabotage, the water resources insufficient phenomenon in Taiwan is a very important issue needed to face immediately. The regulations and law of water resources protection and recycling are gradually completed now but still lack of specific water recycling effectiveness checking method. The research focused on the industrial parks that already had been certificated with EIA to establish a professional checking system, carry through and forge ahead to contribute one’s bit in water resources sustainable usage. Taiwan Government Policies of Environmental Impact Assessment established in 1994, some development projects were requested to set certain water recycling ratio for water resources effective usage. The water covers and contains everything because all-inclusive companies enter and be stationed. For control the execution status of industrial park water and waste water recycling ratio about EIA commitment effectively, we invited experts and scholars in this filed to discuss with related organs to formulate the policy and audit plan. Besides, call a meeting to set public version water equilibrium diagrams and recycles parameter. We selected nine industrial parks that were requested set certain water recycling ratio in EIA examination stage and then according to the water usage quantity, we audited 340 factories in these industrial parks with spot and documents examination and got fruitful results – the average water usage of unit area per year of all these examined industrial parks is 31,000 tons/hectare/year, the value is just half of Taiwan industries average. It is obvious that the industrial parks with EIA commitment can decrease the water resources consumption effectively. Taiwan government policies of Environmental Impact Assessment took follow though tracking function into consideration at the beginning. The results of this research verify the importance of the implementing with water recycling to save water resources in EIA commitment. Inducing development units to follow EIA commitment to get the balance between environmental protection and economic development is one of the important EIA value.

Keywords: Taiwan government policies of environmental impact assessment, water recycling ratio of EIA commitment, water resources sustainable usage, water recycling

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Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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Authors: Yunfan Jiang

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In response to an identified gap in available treatment programmes for high-risk offenders with multiple criminogenic needs and guided by emerging literature in the field of correctional rehabilitation, Singapore Prison Service (SPS) developed the Integrated Criminogenic Programme (ICP) in 2012. This evidence-informed psychological programme was designed to address all seven dynamic criminogenic needs (from the Central 8) of high-risk offenders by applying concepts from rehabilitation and psychological theories such as Risk-Need-Responsivity, Good Lives Model, narrative identity, and motivational interviewing. This programme also encompasses a 6-month community maintenance component for the purpose of providing structured step-down support in the aftercare setting. These sessions provide participants the opportunity for knowledge reinforcement and application of skills attained in-care. A quantitative evaluation of the ICP showed that the intervention group had statistically significant improvements across time in most self-report measures of criminal attitudes, substance use attitudes, and psychosocial functioning. This was congruent with qualitative data from participants saying that the ICP had the most impact on their criminal thinking patterns and management of behaviours in high-risk situations. Results from the comparison group showed no difference in their criminal attitudes, even though they reported statistically significant improvements across time in their substance use attitudes and some self-report measures of psychosocial functioning. The programme’s efficacy was also apparent in the lower rates of recidivism and relapse within 12 months for the intervention group. The management of staff issues arising from the development and implementation of an innovative high-intensity psychological programme such as the ICP will also be discussed.

Keywords: evaluation, forensic psychology, intervention programme, offender rehabilitation

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Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng

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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.

Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work

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Authors: Sandhra M. Pillai

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This article examines the relevance, difficulties, and potential applications of DNA analysis in the criminal justice system. A potent tool for connecting suspects to crime sites, clearing the innocent of wrongdoing, and resolving cold cases, DNA analysis has transformed forensic investigations. The scientific foundations of DNA analysis, including DNA extraction, sequencing, and statistical analysis, are covered in the article. To guarantee accurate and trustworthy findings, it also discusses the significance of quality assurance procedures, chain of custody, and DNA sample storage. DNA analysis has significantly advanced science, but it also brings up substantial moral and legal issues. To safeguard individual rights and uphold public confidence, privacy concerns, possible discrimination, and abuse of DNA information must be properly addressed. The paper also emphasises the effects of the criminal justice system on people and communities while highlighting the necessity of equity, openness, and fair access to DNA testing. The essay describes the obstacles and future directions for DNA analysis. It looks at cutting-edge technology like next-generation sequencing, which promises to make DNA analysis quicker and more affordable. To secure the appropriate and informed use of DNA evidence, it also emphasises the significance of multidisciplinary collaboration among scientists, law enforcement organisations, legal experts, and policymakers. In conclusion, DNA analysis has enormous potential for improving the course of criminal justice. We can exploit the potential of DNA technology while respecting the ideals of justice, fairness, and individual rights by navigating the ethical, legal, and societal issues and encouraging discussion and collaboration.

Keywords: DNA analysis, DNA evidence, reliability, validity, legal frame, admissibility, ethical considerations, impact, future direction, challenges

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Authors: Carolyn J. Ortega, Stephen E. Berger

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The role of the custody evaluator is perhaps one of the most controversial and risky endeavors in clinical practice. Complaints filed with licensing boards regarding a child-custody evaluation constitute the second most common reason for such an event. Although the evaluator is expected to answer for the family-law court what is in the “best interest of the child,” there is a lack of clarity on how to establish this in any empirically validated manner. Hence, practitioners must contend with a nebulous framework in formulating their methodological procedures that inherently places them at risk in an already litigious context. This study sought to qualitatively investigate patterns of practice among doctoral practitioners conducting child custody evaluations in the area of Southern California. Ten psychologists were interviewed who devoted between 25 and 100% of their California private practice to custody work. All held Ph.D. degrees with a range of eight to 36 years of experience in custody work. Semi-structured interviews were used to investigate assessment practices, ensure adherence to guidelines, risk management, and qualities of evaluators. Forty-three Specific Themes were identified using Interpretive Phenomenological Analysis (IPA). Seven Higher Order Themes clustered on salient factors such as use of Ethics, Law, Guidelines; Parent Variables; Child Variables; Psychologist Variables; Testing; Literature; and Trends. Evaluators were aware of the ever-present reality of a licensure complaint and thus presented idiosyncratic descriptions of risk management considerations. Ambiguity about quantifying and validly tapping parenting abilities was also reviewed. Findings from this study suggested a high reliance on unstructured and observational methods in child custody practices.

Keywords: forensic psychology, psychological testing, assessment methodology, child custody

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Authors: Nikolett Deutsch, Éva Pintér, Péter Bagó, Miklós Hetényi

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Strategic technology management has emerged and evolved parallelly with strategic management paradigms. It focuses on the opportunity for organizations operating mainly in technology-intensive industries to explore and exploit technological capabilities upon which competitive advantage can be obtained. As strategic technology management involves multifunction within an organization, requires broad and diversified knowledge, and must be developed and implemented with business objectives to enable a firm’s profitability and growth, excellence in strategic technology management provides unique opportunities for organizations in terms of building a successful future. Accordingly, a framework supporting the evaluation of the technological readiness level of management can significantly contribute to developing organizational competitiveness through a better understanding of strategic-level capabilities and deficiencies in operations. In the last decade, several innovation maturity assessment models have appeared and become designated management tools that can serve as references for future practical approaches expected to be used by corporate leaders, strategists, and technology managers to understand and manage technological capabilities and capacities. The aim of this paper is to provide a comprehensive review of the state-of-the-art innovation maturity frameworks, to investigate the critical lessons learned from their application, to identify the similarities and differences among the models, and identify the main aspects and elements valid for the field and critical functions of technology management. To this end, a systematic literature review was carried out considering the relevant papers and articles published in highly ranked international journals around the 27 most widely known innovation maturity models from four relevant digital sources. Key findings suggest that despite the diversity of the given models, there is still room for improvement regarding the common understanding of innovation typologies, the full coverage of innovation capabilities, and the generalist approach to the validation and practical applicability of the structure and content of the models. Furthermore, the paper proposes an initial structure by considering the maturity assessment of the technological capacities and capabilities - i.e., technology identification, technology selection, technology acquisition, technology exploitation, and technology protection - covered by strategic technology management.

Keywords: innovation capabilities, innovation maturity models, technology audit, technology management, technology management maturity models

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Authors: N. Haj Salem, M. Belhadj, S. Ben Jomâa, S. Saadi, R. Dhouieb, A. Chadly

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Introduction: Sudden death in young is seen as a dramatic phenomenon requiring knowledge of its impact and determining their causes. Aim: We aim to study the epidemiological characteristics of sudden death in young, and to discuss the mechanism and the importance of autopsy in these situations. Material and methods: We performed a retrospective cohort study using autopsy data from the department of forensic medicine at the University Hospital of Fattouma Bourguiba, Monastir-Tunisia. A review of all autopsies performed during 23 years was done. In each case, clinical information and circumstances of death were obtained. We have included all sudden death in persons aged between 1 year and 35 years for the male and from one year to 45 years for female. We collected 312 cases of sudden death during the studied period. The collected data were processed using SPSS 20. The significance level was set at 0.05. Results: Thirty-two cases of cardiac ischemic sudden death have been collected. Myocardial infarction was the second cause of sudden death in young patients. There was a male predominance. The most affected subjects were aged between 25-45 years. The death occurred more frequently at rest. Coronary artery disease has been discovered in twenty-four cases (75%). A severe coronary artery disease was observed in two children with medical history of familial hypercholesterolemia. The myocardial infarction occurred in healthy coronary arteries in eight cases. An anomalous course of coronary arteries, in particular, myocardial bridging, was found in eight cases (25%). Toxicological screening was negative in all cases. Second cause of death was hypertrophic cardiomyopathy. Neurological and respiratory causes of death were implicated respectively in 10% and 15%. Conclusion: Identifying epidemiological characteristics of sudden death in this population is important for guiding approaches to prevention that must be based on dietary hygienic measures and the control of cardiovascular risk factors.

Keywords: autopsy, cardiac death, sudden death, young

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Authors: Elisavet Arsenaki

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Paracetamol overdose is associated with significant and possibly permanent consequences including hepatotoxicity, acute and chronic liver failure, and death. This quality improvement project explores the prevalence of accidental iatrogenic paracetamol overdose in hospital patients with a low body weight, defined as <50kg and assesses the impact of educational posters in trying to reduce it. The study included all adult inpatients on the admissions ward, a short stay ward for patients requiring 12-72 hour treatment, and consisted of three cycles. Each cycle consisted of 3 days of data collection in a given month (data collection for cycle 1 occurred in January 2022, February 2022 for cycle 2 and March 2022 for cycle 3). All patients given paracetamol had their prescribed dose checked against their charted weight to identify the percentage of adult inpatients <50kg who were prescribed 1g of paracetamol instead of 500mg. In the first cycle of the audit, data were collected from 83 patients who were prescribed paracetamol on the admissions ward. Subsequently, four A4 educational posters were displayed across the ward, on two separate occasions and with a one-month interval in between each poster display. The aim of this was to remind prescribing doctors of their responsibility to check patient body weight prior to prescribing paracetamol. Data were collected again one week after each round of poster display, from 72 and 70 patients respectively. Over the 3 cycles with a cumulative 225 patients, 15 weighed <50kg (6.67%) and of those, 5 were incorrectly prescribed 1g of paracetamol, yielding a 33.3% prevalence of accidental iatrogenic paracetamol overdose in adult inpatients. In cycle 1 of the project, 3 out of 6 adult patients weighing <50kg were overdosed on paracetamol, meaning that 50% of low weight patients were prescribed the wrong dose of paracetamol for their weight. In the second data collection cycle, 1 out of 5 <50kg patients were overdosed (20%) and in the third cycle, 1 out of 4 (25%). The use of educational posters resulted in a lower prevalence of accidental iatrogenic paracetamol overdose in low body weight adult inpatients. However, the differences observed were statistically insignificant (p value 0.993 and 0.995 respectively). Educational posters did not induce a significant decrease in the prevalence of accidental iatrogenic paracetamol overdose. More robust strategies need to be employed to further decrease paracetamol overdose in patients weighing <50kg.

Keywords: iatrogenic, overdose, paracetamol, patient, safety

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Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan

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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.

Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda

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Authors: Edeaghe Ehikhamenor, Jennifer Nnamdi

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Introduction: Gender-based violence (GBV) was a well-known global crisis before the COVID-19 pandemic. The pandemic burden only intensified the crisis. With prevailing lockdowns, increased poverty due to high unemployment, especially affecting females, and other mobility restrictions that have left many women trapped with their abusers, plus isolation from social contact and support networks, GBV cases spiraled out of control. Prevalence of economic with cultural disparity, which is greatly manifested in Nigeria, is a major contributory factor to GBV. This is made worst by religious adherents where the females are virtually relegated to the background. Our societal approaches to investigations and sanctions to culprits have not sufficiently applied forensic/DNA tools in combating these major vices. Violence against women or some rare cases against men can prevent them from carrying out their duties regardless of the position they hold. Objective: The main objective of this research is to highlight the origin of GBV, the victims, types, contributing factors, and the applications of forensics/DNA tools and remedies so as to minimize GBV in our society. Methods: Descriptive information was obtained through the search on our daily newspapers, electronic media, google scholar websites, other authors' observations and personal experiences, plus anecdotal reports. Results: Findings from our exploratory searches revealed a high incidence of GBV with very limited or no applications of Forensics/DNA tools as an intervening mechanism to reduce GBV in Nigeria. Conclusion: Nigeria needs to develop clear-cut policies on forensics/DNA tools in terms of institutional framework to develop a curriculum for the training of all stakeholders to fast-track justice for victims of GBV so as to serve as a deterrent to other culprits.

Keywords: gender-based violence, forensics, DNA, justice

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