IPMICALC: an Integrated Post-mortem Interval Calculator.

Correctly estimating the post-mortem interval (PMI) is essential in forensic practice. In recent decades, the measurement of vitreous humor analyte concentrations - especially of hypoxanthine and potassium - and their correlation with the PMI have returned good results. However, calculating the PMI from the data collected can be quite complex. The present paper describes a web resource ( http://modestya.usc.es:3838/Forensic/ ) that simplifies the procedure. The PMI is determined (with its 95% confidence interval) in a rapid, easy, and reliable manner based on the use of mathematical models, the biochemistry of the vitreous humor, and physical variables such as the ambient temperature, the rectal temperature, and bodyweight. The application is entirely free to use.

A Timeframe for SARS-CoV-2 Genomes: A Proof of Concept for Postmortem Interval Estimations.

Establishing the timeframe when a particular virus was circulating in a population could be useful in several areas of biomedical research, including microbiology and legal medicine. Using simulations, we demonstrate that the circulation timeframe of an unknown SARS-CoV-2 genome in a population (hereafter, estimated time of a queried genome [QG]; tE-QG) can be easily predicted using a phylogenetic model based on a robust reference genome database of the virus, and information on their sampling dates. We evaluate several phylogeny-based approaches, including modeling evolutionary (substitution) rates of the SARS-CoV-2 genome (~10-3 substitutions/nucleotide/year) and the mutational (substitutions) differences separating the QGs from the reference genomes (RGs) in the database. Owing to the mutational characteristics of the virus, the present Viral Molecular Clock Dating (VMCD) method covers timeframes going backwards from about a month in the past. The method has very low errors associated to the tE-QG estimates and narrow intervals of tE-QG, both ranging from a few days to a few weeks regardless of the mathematical model used. The SARS-CoV-2 model represents a proof of concept that can be extrapolated to any other microorganism, provided that a robust genome sequence database is available. Besides obvious applications in epidemiology and microbiology investigations, there are several contexts in forensic casework where estimating tE-QG could be useful, including estimation of the postmortem intervals (PMI) and the dating of samples stored in hospital settings.

Prosecutorial decision-making regarding offenders' social reintegration programs in intimate partner violence cases. A Portuguese study.

Intimate partner violence is one of the most challenging and demanding problems that the criminal justice system has to face. Given the severe consequences of intimate partner violence, it is imperative that intervention from the criminal justice system, regarding perpetrators, be effective to prevent further victimization and recurrences. In Portugal, it is up to the state prosecutor to decide which cases will be subject to a social reintegration program as a pretrial diversion program. This study aims to explore the variables that might influence the state prosecutor's decision-making process. We have examined 283 intimate partner violence cases in which provisional suspension of criminal proceedings was applied. The decision as to whether defendants should be referred for social reintegration program attendance (G1) or not (G2) was made by the state prosecutor. Differences between G1 and G2 were identified: the victim's age, couple living in a current relationship, drug-addicted defendant, intimate partner violence child exposure. However, defendants' unemployment and drug abuse were the only two variables identified as a determinant for state prosecutor decisions. We believe that the effectiveness of state prosecution decision-making would benefit from: (a) systematically taking into account all intimate partner violence risk factors; (b) an index or checklist detailing what science reveals useful in intimate partner violence offenders' social reintegration; (c) rehabilitation solutions based on the needs of each offender instead of a "one-size-fits-all" approach.

Intimate partner violence against women. Does violence decrease after the entry of the alleged offender into the criminal justice system?

Intimate partner violence (IPV) is simultaneously assumed as a serious crime and a major public health issue, having recurrences as one of its main characteristics and, consequently, re-entries of some alleged offenders in the criminal justice system (CJS). The main goal of this study is to assess if in cases of female victims of IPV, violence decreases after the first entry of the alleged offender in the CJS. A retrospective study was performed based on the analysis of police reports of alleged cases of IPV during a 4-year period. The final sample (n = 1 488) was divided into two groups according to the number of entries in the CJS (single or multiple) followed by a comparative approach. Results suggest that violence decreases after the first entry of alleged offenders in the CJS. Re-entries were found in only 15.5% of the cases but they were accountable for 3.3 times more crimes on average. Besides, victims of recidivism presented more injuries and required more medical care. Thus, a small group of alleged offenders seems to be more violent and accountable for most of the IPV crimes registered in the CJS suggesting that regardless of legal sanctions aiming to deter violence, these measures may not be enough for a certain group of offenders. This study sustains the need for a predictive model to quantify the risk of repeated IPV cases within the Portuguese population.

Suspension of Criminal Proceedings for Perpetrators of Intimate Partner Violence Against Women: Impact on Re-Entries.

Intimate partner violence (IPV) is one of the most prevalent crimes in our society, but the legal mechanisms to oppose it are recent. The Portuguese Provisional Suspension of Criminal Proceedings (PSCP) as a criminal justice system (CJS) response proposes an integrated consensual solution with the involved parties, to reduce offenders' recidivism. This article analyses the effect of PSCP on re-entries into the CJS. We examined 1,662 IPV police reports, exploring cases that underwent PSCP and re-entries of the same offender in the CJS. Results show that PSCP is applied in 17% of the cases. From all analyzed determinants, with a possible relation to the PSCP implementation, it was found that social violence and the age of both victims and defendants emerge as significantly associated with the request or acceptance of this legal mechanism. No variables tested moderated the relationship between PSCP and re-entry over 96months following the first police report. The article also examined variables that might moderate the decision to request this legal mechanism among victims and defendants.

Heavy metal contamination in Peru: implications on children's health.

Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.

Estimation of the post-mortem interval: Effect of storage conditions on the determination of vitreous humour [K+].

Obtaining a reliable estimate of the post-mortem interval (PMI) has been a long-running challenge in forensic medicine. Several more or less successful techniques for making such estimates have been developed, but in recent years important advances have been made thanks to the detailed study of the relationship between the PMI and the analytes - in particular K+ - of the vitreous humour (VH). The extraction and pre-treatment of VH samples has been standardized, the influence of certain environmental factors on analytical results has been quantified, and some of the circumstances under which techniques become unreliable have been identified. The present work examines how the conditions to which VH samples are subject in routine practice may alter the results of their analysis. Exposure to light and ambient temperature was found to alter the values returned in determinations of VH [K+], [Na+] and [Cl-], while exposure to several freezing/thawing cycles (even with final heating) led to no significant modifications in determinations of VH [K+] and [Na+]. It is recommended that if analysis has to be delayed, VH should be frozen for storage in a refrigerator before bringing to room temperature for processing. It is also recommended that samples not be exposed to ambient light and temperature.

Attitudes towards physician-assisted suicide and euthanasia in Spanish university students / Actitudes hacia la eutanasia y el suicidio medicamente asistido en estudiantes universitarios españoles / Atitudes em relação a eutanásia e suicídio medicamente assistido em estudantes universitários espanhóis

Abstract Attitudes toward physician-assisted death among medical students differ between populations. The aim of this study was to explore attitudes towards euthanasia and physician-assisted suicide among Spanish university students. A cross-sectional survey was conducted by asking undergraduate students (Medicine, Nursing and Law) of the University of Santiago de Compostela to complete an anonymous 17-item questionnaire. Most participants exhibited a positive attitude towards physician-assisted suicide (54%) and euthanasia (75%), as well as towards their legalization. Attitudes were consistent with the underlying ethical reasoning, with no differences in terms of age, gender or academic degree. In addition, consistency was found between attitudes and willingness to participate in physician-assisted suicide and euthanasia, should they be legal. The results showed that the attitudes of medical students towards euthanasia and physician-assisted suicide were positive and similar to non-medical students.

Resumen La actitud de los estudiantes de Medicina ante a la muerte médicamente asistida difiere entre poblaciones. El objetivo de este estudio ha sido explorar las actitudes hacia la eutanasia y el suicidio médicamente asistido en estudiantes universitarios españoles. Se realizó una encuesta transversal en estudiantes de grado (Medicina, Enfermería y Derecho) de la Universidad de Santiago de Compostela que completaron un cuestionario anónimo de 17 preguntas. La mayoría de los participantes mostraron una actitud positiva hacia el suicidio médicamente asistido (54%) y la eutanasia (75%), así como hacia su legalización. Las actitudes fueron coherentes con los argumentos éticos, no encontrando diferencias en relación con la edad, el sexo o la titulación. Asimismo, las actitudes estaban de acuerdo con la intención de participar en estos procedimientos, si fueran legales. Los resultados muestran que la actitud de los estudiantes de medicina hacia la eutanasia y el suicidio asistido es positiva y similar a la de estudiantes de enfermería y derecho.

Resumo A atitude dos estudantes de medicina ante a morte medicamente assistida difere entre populações. O objetivo deste estudo foi explorar as atitudes para a eutanásia e o suicídio medicamente assistido em estudantes universitários espanhóis. Foi realizada uma pesquisa transversal em estudantes de graduação (medicina, enfermagem e direito) da Universidade de Santiago de Compostela que completaram um questionário anônimo de 17 perguntas. A maioria dos participantes mostrou atitude positiva para o suicídio medicamente assistido (54%) e a eutanásia (75%), bem como para a sua legalização. As atitudes foram coerentes com os argumentos éticos, não encontrando diferenças em relação a idade, sexo ou titulação. Assim mesmo, as atitudes estavam de acordo com a intenção de participar nestes procedimentos, se fossem legais. Os resultados mostram que a atitude dos estudantes de medicina para a eutanásia e o suicídio assistido é positiva e similar à de estudantes de enfermagem e direito.

A reliable method for estimating the postmortem interval from the biochemistry of the vitreous humor, temperature and body weight.

The estimation of the time elapsed since death is of paramount importance in the field of forensic sciences and criminal investigation, owing, among other factors, to the possible legal repercussions. Over the past few years various formulae have been developed to calculate this interval using a combination of different statistical methods and the concentrations of substances found in the vitreous humor. Corrective factors, such as ambient temperature, cause of death or age, which can modify the concentration of these substances and therefore the estimation of the postmortem interval, have been incorporated into models. In this paper five simple and reliable models to estimate PMI based the on the analysis of potassium, hypoxanthine and urea in the vitreous humor are presented. Corrective factors, such as body weight, rectal temperature and ambient temperature, which can influence the estimation of this interval have been incorporated into the formulae. Finally, the R2 and the mean squared error have been calculated for each model in order to select the best of the five. A free software program which calculates the PMI from the model and parameters used is available from the authors. It provides quick and reliable results as well as the error committed and R2 for each case.

Predictive models for the assessment of bodily harm.

The Spanish scale to quantify or qualify bodily harm resulting from any unintentional traffic accident prior to 1 January 2016 is established by Royal Legislative Decree (RDL) 8/2004. This scale assigns points to the sequelae, which are converted into Euros using a table that is updated annually. The objective of this study is to develop a predictive model of sequelae points that will enable the estimation of compensation a short time after the accident. This will facilitate the calculation of the money reserve and rapid access to compensation for the injured party. To conduct this study, we developed a database with information from 999 individuals who had suffered car crash injuries which were evaluated according to the scale contained in RDL 8/2004 for medical experts. Predictive models based on logistic regression models were designed on this database. To choose the best model, we calculated Mallow's Cp. The use of hurdle models made it possible to predict the points received by an injured party within a relatively short period of time after the accident. Once these points are known, it is a simple matter to calculate the corresponding compensation. The prediction models developed provide an easy way to predict the compensation to be awarded to the injured party. These models use days of hospitalization, sex, age and the results of international scales based on the Abbreviated Injury Scale. These variables can be used soon after the occurrence of the crash.

Intimate partner violence against women in Spain: A medico-legal and criminological study.

Intimate partner violence (IPV) is a significant worldwide problem whose magnitude and risk factors vary across different settings and cultures. Nowadays, it is a priority to improve the knowledge on this issue in order to formulate better evidence-based policy responses. This study aims to contribute to a better understanding of non-fatal IPV against women in Spain. A retrospective analysis of IPV cases with a final judicial decision was carried out. The period under study extended from January 2005 to December 2012, with a total of 582 files included in the investigation. Most IPV victims were young adult women of Spanish origin, either married or single, with children, unemployed and with a low family income level. The majority of alleged perpetrators were young adults, employed, with a middle-low income level, a history of alcohol consumption/abuse, but no criminal records. Most victims had previous history of IPV, were engaged in a long-term relationship with their abuser and lived with him at the time of assault. The combination of psychological and physical abuse was the most frequent form of violence. The most common mechanisms of assault consisted in minor acts of physical violence, which resulted in mild injuries, most of them in the upper limbs and face. Nearly half of women sought medical care, but physician's injury report was only made in about a quarter of these cases, even though it is mandatory for health professionals. The majority of criminal proceedings were initiated by the victim's report and ended in conviction, most of them being considered occasional mistreatment. This study confirms the heterogeneity of the phenomenon of intimate partner violence. The importance of adopting standard IPV concepts and promoting the recognition and assessment of this form of violence amongst health care professionals, criminal investigators and forensic personnel is emphasized.

How reliable is the Spanish bodily harm assessment scale?

The use of scales to quantify or qualify bodily harm resulting from an unintentional car accident has been mandatory in Spain since 1995 and compensation for personal injuries resulting from a traffic accident is calculated according to a legal ruling established by Royal Decree 8/2004 (RDL). This present study assesses the reliability of the scale. Agreement between the evaluations for the same patient by 24 qualified observers following the Royal Decree 8/2004 was measured using the Kappa index. The variables assessed were the days of hospitalization, impeditive days, non impeditive days and the functional and aesthetic sequelae. The application of the Fleiss Kappa index obtained a result of 0.37, indicating a "fair agreement" according to the rating scale proposed by Landis and Koch. This study demonstrates the unreliability of the Spanish medical scale for the assessment of injury as described in the RDL 8/2004. The scale should adopt the measurement systems and clinical classifications of outcomes such as the ASIA, SCI scale or the Daniels scale of neurological injury and allow scientific discussion of the findings of the report. The resulting quantitative value should operate as a reliable indicator of a specific quality of the damage.

Unusual Forms of Adrenal and Extra-Adrenal Myelolipomas.

Myelolipomas are rare benign tumors of poorly understood tumorigenesis composed of mature hematopoietic tissue and fat. They mostly occur in the adrenal glands, but extra-adrenal myelolipomas have been reported in other locations such as the presacral region or retroperitoneum. It is not unusual that they are incidental findings revealed in the study of different diseases. We report 3 unusual examples of myelolipomas. The first is a multiple, unusually large, extra-adrenal myelolipoma, presented as an autopsy finding in an individual who had died suddenly from a central nervous system hemorrhage. The remaining 2 were incidental findings in patients studied for different reasons. Both were located within another neoplasm, namely an adrenal adenoma and a liver focal nodular hyperplasia. Moreover, the first showed infiltration by a non-Hodgkin lymphoma.

Cardiac inhibitory reflex as a cause/mechanism of death.

The role of cardiac inhibitory reflex as a potential cause of death is still a matter of debate. This study reports two cases of death under unusual circumstances. Case 1 corresponds to a man found hanging where the role of ligature compression of the carotid sinus became relevant as a possible explanation of death. In Case 2, the participation of a vasovagal syncope was clearly triggered by the laryngoscopic procedure. It is proposed that cardiac inhibitory reflex should be taken into account in those cases of unexpected death, which fulfills the following three criteria: (i) The investigation of the circumstances of the death is consistent with a hypothesis of cardiac arrest. (ii) A typical triggering peripheral stimulus is present. (iii) The performance of a complete autopsy cannot rule out the participation of a cardiac inhibitory reflex in the cause of death.

University students' attitudes towards Voluntary Interruption of Pregnancy.

An evaluation of the future professional trends was performed by analyzing the attitudes of university students to the Voluntary Interruption of Pregnancy (VIP). An anonymous questionnaire was distributed to 300 students (Medicine, Nursing and Law) of the University of Santiago de Compostela, with questions on their personal beliefs, opinion on the law and intention to participate in VIP. Of the 245 respondents (response rate 82%), 66.5% were pro-abortion and their attitudes towards VIP were consistent with their opinion on the beginning of life and with the ethical arguments related to the fetus and the mother. No differences were found with age, sex or degree. The students showed to be well informed on the VIP law, and the majority of them considered unsuitable termination of pregnancy in minors without parental consent. Students' intentions to take part in abortion provision were influenced by their views on abortion, level of participation and circumstances of pregnancy. Although the majority of participants would be willing to perform VIP in situations that affect fetus and mother's life or health (87-66%), their intentions clearly diminished in other situations, such as abortion on demand (17%). These data suggest that conscientious objection of health professionals can even increase with the new policy, a fact that might affect VIP availability. It is important to stress the need of ethical training to help in the solution of conflicts between patient and health professional values.

Flexible regression models for estimating postmortem interval (PMI) in forensic medicine.

Correct determination of time of death is an important goal in forensic medicine. Numerous methods have been described for estimating postmortem interval (PMI), but most are imprecise, poorly reproducible and/or have not been validated with real data. In recent years, however, some progress in PMI estimation has been made, notably through the use of new biochemical methods for quantifying relevant indicator compounds in the vitreous humour. The best, but unverified, results have been obtained with [K+] and hypoxanthine [Hx], using simple linear regression (LR) models. The main aim of this paper is to offer more flexible alternatives to LR, such as generalized additive models (GAMs) and support vector machines (SVMs) in order to obtain improved PMI estimates. The present study, based on detailed analysis of [K+] and [Hx] in more than 200 vitreous humour samples from subjects with known PMI, compared classical LR methodology with GAM and SVM methodologies. Both proved better than LR for estimation of PMI. SVM showed somewhat greater precision than GAM, but GAM offers a readily interpretable graphical output, facilitating understanding of findings by legal professionals; there are thus arguments for using both types of models. R code for these methods is available from the authors, permitting accurate prediction of PMI from vitreous humour [K+], [Hx] and [U], with confidence intervals and graphical output provided.