Virtual Trauma Analysis of the Nineteenth-Century Severed Head of the Greek Outlaw Stavrou.

Human remains have been displayed in museums in Europe since many centuries for historical, cultural, and educational reasons. Of particular interest are skeletal remains and body parts that have suffered violent deaths and such remains often feature in Criminology Museums. Despite the well-acknowledged value of human remains in medical education, bioarchaeology, and research, the display of human remains still raises ethical considerations ranging in severity depending on the cultural substrate and legal framework of each country. Recent developments in medical imaging and visualisation are offering an alternative way. Taking into account the emerging issues regarding exhibition and handling of human remains, this research project aims to use virtual methods to reconstruct the circumstances of the death of a nineteenth-century outlaw comprising one of the human exhibits at the Criminology Museum of Athens in Greece.For the purpose of the project, the severed head of the outlaw Stavrou was CT scanned, and the data were used to reconstruct and to evaluate the ballistic trauma sustained at the time of his death. From the scans, it was possible to determine the minimum number of shots, entrance and exit wounds, approximate calibre of the bullets, approximate distance from which they were fired, and general velocity of the round.Shots are fired from the lateral left and backside of the head and bullets exited from the right frontal and temporal area causing extensive damage to the right craniofacial region. The direction of the shots coming from the back and left suggests that Stavrou was more likely ambushed by gendarmerie squads and not shot in a fair fight which would have caused entry wounds in the anterior surface of the body. This is in agreement with historical evidence that placed him in gunfire with his fellow gang member Karapanos against a government squad. On the other hand, the possibility of being captured alive and executed cannot be rejected based only on wound ballistics.This work would be excellent supplementary material to the actual human exhibit for the accurate presentation of Stavrou's history at the Criminology Museum. In addition, it would allow the virtual exhibition of the material for historical and teaching purposes to museums and universities anywhere in Greece and along the globe, thus overcoming the obstacles of moving the actual remains.

Development and validation of a LC/MS method for the determination of Δ(9)-tetrahydrocannabinol and 11-carboxy-Δ(9)-tetrahydrocannabinol in the larvae of the blowfly Lucilia sericata: Forensic applications.

In a number of forensic toxicological cases, Δ(9)-tetrahydrocannabinol (THC) and its metabolite 11-carboxy-delta-9-tetrahydrocannabinol (THCA) are frequently considered as contributor factors to the event. To that, a liquid chromatographic mass spectrometric method is described for the identification and quantitation of THC and its metabolite THCA in the forensically important larvae of L. sericata. Larvae of Lucilia sericata were fortified with varying concentrations of THC and THCA covering the calibration range between 10 and 500pg/mg. For the isolation of the analytes from larvae, several extraction techniques were evaluated and finally liquid-liquid extraction under acidic pH was selected using hexane-ethyl acetate (50:50, v/v) as extraction solvent. For the chromatographic separation, a Waters Symmetry® C18 analytical column was used while the mobile phase was acetonitrile-ammonium acetate (2mM) (30:70, v/v). The detection was performed using electrospray ionization source in negative mode (ESI-) and the selected ions monitored were m/z 313 for THC and m/z 343 for THCA. The proposed method which is simple and sufficiently sensitive for the detection of THC and THCA even in a single larva sampling, assisted the investigation of a forensic case.

Testing the discrepancy between physical and virtual linear measurements.

Virtual calculations of bone morphology are increasingly becoming the golden standard in anthropological sciences, gradually replacing the performance of direct physical measurements. Nevertheless, the potential discrepancy between the two approaches is rarely addressed. Here, we address this question focusing on the second thoracic vertebrae of 24 well-preserved individuals from the skeletal collection of the Forensic Anthropology Unit of Medical School at the National and Kapodistrian University of Athens, Greece. Following traditional osteometric methods, a series of measurements were taken on the vertebral body, both directly (using a digital caliper) as well as on high-resolution 3D surface models. The arithmetic results of the two measuring techniques were then compared through a number of statistical analyses evaluating inter-method precision (Bland-Altman plots, TEM, %TEM and Wilcoxon test). Moreover, the values obtained from each approach were used to develop discriminant function equations for sex determination to evaluate if both approaches provide the same assessment. Both intraobserver and interobserver tests were performed. Although most statistical analyses showed a significant difference between the two measuring techniques, the discriminant function equations for sex determination provided the same assessment. Overall, the results of this experiment support the use of virtual linear measurements, also suggesting that a refinement of digital measuring protocols could improve their level of agreement with traditional direct osteometry.

Fatal gunshot trauma of a child: A case from colonial Cyprus.

Forensic science has made some significant contributions to the investigation of human rights abuses related to armed conflicts, especially in the last 40 years. Some investigations are aimed at the collection of evidence in order to prosecute those responsible, while others are humanitarian in nature. This paper presents the multidisciplinary effort to recover and identify the remains of a 7-year-old child who was shot by British colonial forces in Cyprus in 1956. An investigation led to the discovery of the burial site, and archaeological methods were used to recover the remains. The anthropological examination provided information about the age of the child, as well as the nature of the skeletal trauma present. DNA results confirmed the identity of the victim, and the remains were released to the surviving family members for burial.

Evaluation of the accuracy of different molar teeth measurements in assessing sex.

Teeth are considered to be a very useful tissue for sex determination and molars are among the most dimorphic teeth. Even though mesiodistal (MD) and buccolingual (BL) crown diameters are usually employed for sex assessment, alternative measurements like MD and BL cervical diameters as well as crown and cervical diagonal diameters have been developed. This study explores the utility of crown and cervical MD, BL and diagonal measurements of molars in sex assessment when used separately. A total of 254 permanent molars (excluded third molars) from 101 individuals (51 males, 50 females) from the Athens Collection were examined. Stepwise discriminant analysis was used to evaluate the accuracy of each diameter group in assessing sex. It was found that the accuracy ranges from 65.5 to 88.4 %. Cervical diagonal diameters are the most accurate followed by crown diagonal diameters, and crown and cervical MD and BL diameters. Therefore the high classification accuracy of diagonal diameters show that these measurements are more reliable for sex determination than the traditional MD and BL and can be considered a promising method for sex assessment from human teeth.

Root dentin translucency and age at death estimation in adults using single rooted teeth: Update of the Forensic International Dental Database.

Since the publication of Lamendin's age estimation technique, the root dentin translucency has received increasing attention as an important indicator of age. Recently, Parra and colleagues presented the Forensic International Dental Database (FIDB), a proposal to estimate age at death in adults based on Bayes theorem by applying the criteria of Lamendin's technique. The present study aims to update the procedure and to evaluate a new version of the method (named FIDBv2) using two control samples from Colombia and Greece. The performance of this new version was acceptable and suggests that the method is suitable for age at death estimation in adult individuals from different forensic contexts. The best approximations to chronological age were obtained for individuals between 30 and 60 years old, with errors less than 10 years. The age estimations calculated on control samples suggest the adequate performance of FIDBv2 on individuals from varied populations. It can be stated that the FIDBv2 constitutes a solid alternative to be used in contexts where no additional data are available. Here we reinforce the initial idea that this model for estimating age at death in adults may be generalizable to any forensic context in the world.

Is shock wave lithotripsy efficient for the elderly stone formers? Results of a matched-pair analysis.

The aim of the study was to evaluate the impact of age on the efficacy of extracorporeal shock wave lithotripsy (SWL), in a comparative study based on the principles of matched-pair analysis. Over a period of 4 years, 2,311 patients were treated with SWL in a tertiary referral center. Patient and stone data were recorded in a prospective electronic database. Among these patients, 115 (4.97%) were older than 70 years of age and fulfilled the criteria for inclusion in the study (Group A). For the purposes of the comparative analysis, Group A patients were matched for gender and stone parameters (side, location of stone, and diameter ±2 mm) with a control group of patients under the age of 70 (Group B). Following matching, the patients' electronic medical records were reviewed, to identify SWL success rates at 3 months and McNemar's test was used to compare the efficacy of SWL between the two groups. Matching was possible in all cases. The results indicate that there were no statistically significant differences in the mean number of SWL sessions or in the mean number of impulses per session between the two groups. The overall stone clearance rate achieved by SWL alone was 71.3% for Group A and 73.9% for group B. Discordant pairs were found in 37 cases (in 17 pairs only patients in Group A became stone-free, while in 20 pairs only patients in Group B became stone-free). By using McNemar's test, the difference in stone clearance rates between the two groups was not found to be statistically significant (p = 0.742). A total of 22 patients (19.1%) in Group A and 17 patients (14.7%) in Group B underwent an adjuvant procedure to achieve stone clearance. McNemar's test also revealed the absence of any statistically significant difference in SWL success rates between older and younger patients in the subgroups of patients presenting with either ureteric or renal stones (p = 0.727 and p = 0.571, respectively). In conclusion, SWL is still considered one of the first-line tools for geriatric patients suffering from urolithiasis, as increased age alone does not seem to adversely affect the efficacy of SWL.

Osteometric reassociation of commingled human remains from a modern Greek sample using bone elements of the craniovertebral junction.

There is a high demand of osteometric methods to address the issue of commingled remains, however, the research in reassociating the crania with C1, and C1 with C2, as part of the craniovertebral junction, is limited. Reassociating crania with the postcranial skeleton can offer beneficial information for personal identification, as the cranium is broadly utilized for sex and age estimation. Moreover, cranium contributes to the facial reconstruction, a useful supplementary method for forensic identification. For this study, measurements were collected from 159 crania and 182 C1 and C2 vertebrae from the Athens Collection, representing adult males and females between 18 and 99 years. A reassociation method was produced utilizing osteometrics of articular surfaces. A supplementary sample of ten individuals was utilized as a test sample, originating from Athens Medical School. Seven equations were generated by simple linear regression analysis for the reassociation of the cranium to C1, and C1 to C2. The blind test results demonstrated that this method can be applied with 80-100% success. Overall, the results indicated that the produced regression models are a useful addition to the existing sorting methodologies, as they can be applied in mixed-sex and/or fragmented commingled osteological assemblages.

Ballistic Simulation of a Head Wound Inflicted by a Homemade Gun Used in a Suicide Case.

Homemade guns may inflict serious injuries mainly depending on the shooting distance. A case of a male victim discovered dead with a head wound thought to be inflicted by a homemade gun firing modified ammunition is presented. Upon completion of the postmortem examination, the question of whether the homemade gun recovered on site was able to inflict such a wound arose. An experimental approach was employed to evaluate the ballistic characteristics and wounding pattern of the homemade gun and then compare it with the actual case. Ballistic gelatin with an incorporated bone simulant was used to model and approximate the behavior of the projectile when striking and penetrating the victim's head. The retention of the bullets' path in gelatin was verified through experimental shootings using the same homemade gun and similar type of projectiles. Analysis of the experimental shootings allowed for improved observation and documentation of the wounding pattern, thus confirming the initial hypothesis that the recovered homemade gun did in fact inflict the wound observed during the autopsy of the victim.

Sexing the sternal rib end in modern Greeks: A virtual osteometric approach using high-resolution 3D surface models.

Sex determination is one of the first biological attribute to be assessed when unidentified remains surface. In material of forensic interest, being able to use every skeletal element available for identification purposes is of paramount importance. The osteometric method from the sternal rib end has been found to generate accurate sex estimates, but as various studies have proved, all osteometric methods should be population-specific, as one equation does not fit all. The aim of this study is to assess sexual dimorphism in a contemporary Greek population sample of 68 males and 43 females, with the use of discriminant function analysis. The superior-inferior height (SIH) and anterior-posterior breadth (APB) from the third to fifth sternal rib ends of both sides were taken from 3D models created with the use of a hand-held 3D scanner. The results demonstrated that SIH is more sexually dimorphic than APB (alpha value of .05) while the application of Iscan's (1985) formula on the contemporary Greek sample, provided results of low accuracy, ranging from 48.6-52.4%. The cross-validated discriminant functions equations for the current sample, produced results ranging between 74.0-82.9% indicating that population-specific formulas produce results of higher accuracy, that are vital in cases of forensic interest.

Estimation of Age-at-Death Using Cortical Bone Histomorphometry of the Rib and Femur: A Validation Study on a British Population.

Histomorphometry constitutes a valuable tool for age estimation. Histological interpopulation variability has been shown to affect the accuracy of age estimation techniques and therefore validation studies are required to test the accuracy of the pre-existing methodologies. The present research constitutes a validation study of widely known histological methods on the sixth rib and the femoral midshaft of a 19th century British population originating from Blackburn, England. An evaluation of the histomorphometric features of eleven ribs and five femora was performed and used to test the accuracy of selected methods. Results indicated that osteon area and circularity were the only histomorphometric variables that presented significant interpopulation variability. Cho et al.'s method for the ribs and the average value produced using Kerley and Ubelaker's method for intact osteon and percentage of lamellar bone equations for femur were considered the only reliable markers for estimating the age on the Blackburn sample. In the case of old individuals, Goliath et al.'s method provided more satisfactory results. Overall, the present study provides evidence on the applicability of the aging histomorphometric methods on a British sample and highlights the limitations of applying histomorphometric methods developed on different reference populations than the one under investigation.

Non-Fatal Attacks by Dogs: Characteristics of Victims and Attacking Dogs, From the Forensic Perspective: A Series of 106 Cases From Athens, Greece, and Brief Review of the Literature.

INTRODUCTION: The close association of dogs with humans may explain the fact that dog bites are possibly the most common animal bites recorded. The relevant data concerning Greece is scarce. We aimed to study this phenomenon by describing its characteristics. METHODS: We performed a retrospective analysis of cases concerning dog attack victims, examined our Department, between 2011 and 2019. Recorded variables included sex, age, nationality, occupation, marital status, medical history, ownership status of the dog, injury anatomic location, incident time, the timing of clinical forensic examination, incapacitation time, and medical care provided. Statistical analysis was performed using Stata/MP 13 (Stata Corp., College Station, TX) and IBM SPSS Statistics Version 20 (IBM, Armonk, NY). Statistical significance was defined as a two-sided p value of <0.05. RESULTS: Most incidents involved male victims (54.2%). The victim's mean age was 44.9 years. The dog involved was unowned in 19.8% of cases. The most frequent anatomical site of injury was the legs (48.1%). Older victims suffered injuries in more sensitive areas of the body (head and neck), when compared to younger adults. Only 1.9% of victims required hospitalization. The mean incapacitation time was estimated at 5.39 days. CONCLUSIONS: Per our results, males tend more often to be victims of dog attacks. Typically, victims are of increased age and are attacked by a dog already known to them. Most incidents take place during late winter and spring, more specifically during February and during May. The most frequently affected anatomical sites were the legs. Older people suffered injuries in more sensitive areas of the body.

Guidelines for the recognition of cemetery remains in Greece.

Forensic pathologists frequently consult anthropologists for the identification of skeletonized human remains. These remains may be the result of criminal activity or remains that were unearthed because of erosion, or during construction projects. In some cases, human remains that had been previously buried in a cemetery may be the subject of a forensic investigation. Early recognition of cemetery remains prevents unnecessary efforts and conserves precious resources. One of the key characteristics of cemetery remains is the presence of embalmed tissue. However, there are countries where embalming is not a common practice, and other clues must be sought for identifying previously buried remains. Current funerary customs in Greece and, in particular, the tradition of exhumations result in a large number of misplaced human remains. The present study presents examples of cemetery remains from Greece and offers guidelines for recognizing changes on skeletal remains that may be indicative of a cemetery origin. Location of discovery, condition of the remains, and the types of associated artifacts are all factors that aid forensic anthropologists in identifying cemetery remains.

Macroscopic determination of the pre-burning condition of human remains recovered from an unusual forensic context: A case report.

Understanding the taphonomic process of burning allows forensic practitioners to better interpret remains and reconstruct the burning incident in a medicolegal investigation. This can yield critical information, especially when other details, such as the biological profile, are obscured by fire. A forensic case involving human remains recovered within a Greek Orthodox cemetery that exhibited a distinctive pattern of differential burning is reported. The bones exhibited a range of differential burning in a pattern inconsistent with the anatomical position of the remains during heat exposure. No macroscopic signs of skeletal trauma or evidence of dismemberment were present on the remains. The pre-burning condition of the bones was inferred based on the presence of the differential burning and its localization identified through analysis of a suite of macroscopic heat-induced traits, as well as consideration of the forensic context. The anthropologists concluded that the bones were skeletonized prior to burning and that the remains were once interred or stored in an ossuary and were likely burned in a ritualistic manner, given the artifacts present and the conspicuous location of the burn area. This case highlights the practical experience required of forensic practitioners encountering burned remains and the necessity of understanding fire as a taphonomic agent that can be analyzed to determine pre-burning condition and the scenario of the burning event in a medicolegal investigation. Furthermore, this case underscores the achievability of pre-burning condition determination using macroscopic traits alone, even when there is a paucity of skeletal elements in the inventory. Due to knowledge of the funerary customs of modern-day Greece, the practitioners were able to interpret the origin of the remains, thereby this paper provides insight into a geographically specific forensic context.

Trepanations in the ancient Greek colony of Akanthos: Skull surgery in the light of Hippocratic medicine.

OBJECTIVE: The study presents seven new cases of trepanations on four individuals from the ancient Greek colony of Akanthos (5th - 1st c. BC) and juxtaposes the paleopathological observations with the Hippocratic treatises. MATERIALS: A meta-analysis of 42 published trepanations on 27 individuals from Greece. METHODS: Trepanations from Akanthos were observed macroscopically, stereoscopically and by computer tomography. The meta-analysis considers the demographic, geographical and temporal distribution, the techniques, associated pathology, and survival rate. RESULTS: Trepanations were observed on four females in Akanthos. Three trepanations were performed with scraping and four with drilling. Two individuals exhibited significant signs of healing, and two survived shortly after the operation. In two cases, trepanation was practiced for treating cranial injuries. In Greek antiquity trepanation was performed predominantly in males, principally as a surgical treatment of cranial injuries. The survival rate was 62.9 %. Scraping was the oldest, most frequent and successful technique. CONCLUSIONS: Trepanation performed systematically in Greece since the Bronze Age (ca. 2,000 BC). Hippocrates who rationally conceived medicine, codified the pre-existing empirical knowledge. The trepanations from Akanthos show technical similarities but also discrepancies from the Hippocratic recommendations, confirming the mental and technical readiness of the ancient surgeon. SIGNIFICANCE: The synchronous to Hippocrates trepanations from Akanthos, provide the opportunity to compare physical evidence with the written sources. LIMITATIONS: The frequency of trepanations is affected by the representativeness and the state of the skeletal preservation. SUGGESTIONS FOR FUTURE RESEARCH: Trepanations published in previous decades, need to be reassessed with new imaging modalities. A standard recording methodology is fundamental for data comparison.

Accurate and semi-automated reassociation of intermixed human skeletal remains recovered from bioarchaeological and forensic contexts.

Commingled remains describes the situation of intermixed skeletal elements, an extremely common occurrence in contemporary forensic cases, archaeological mass graves, as well as fossil hominin assemblages. Given that reliable identification is typically impossible for commingled contexts, a plethora of previous studies has focused on the development of refined methods for reassociating the bones of each individual skeleton. Here, a novel virtual approach for quantifying the degree of three-dimensional shape compatibility between two adjoining bone articular surfaces is put forth. Additionally, the integrability of this method with traditional osteometric techniques is evaluated. We focus on the paradigm of the hip joint, whose articulating bone elements (the femur and the innominate bone) are crucial for reconstructing the biological profile of unidentified human remains. The results demonstrate that this new semi-automated methodology is highly accurate both for large commingled assemblages (such as those resulting from mass disasters or burials) as well as smaller-scale contexts (such as those resulting from secondary burials).

Biomechanics of the human thumb and the evolution of dexterity.

Systematic tool production and use is one of humanity's defining characteristics, possibly originating as early as >3 million years ago.1-3 Although heightened manual dexterity is considered to be intrinsically intertwined with tool use and manufacture, and critical for human evolution, its role in the emergence of early culture remains unclear. Most previous research on this question exclusively relied on direct morphological comparisons between early hominin and modern human skeletal elements, assuming that the degree of a species' dexterity depends on its similarity with the modern human form. Here, we develop a new approach to investigate the efficiency of thumb opposition, a fundamental component of manual dexterity, in several species of fossil hominins. Our work for the first time takes into account soft tissue as well as bone anatomy, integrating virtual modeling of musculus opponens pollicis and its interaction with three-dimensional bone shape form. Results indicate that a fundamental aspect of efficient thumb opposition appeared approximately 2 million years ago, possibly associated with our own genus Homo, and did not characterize Australopithecus, the earliest proposed stone tool maker. This was true also of the late Australopithecus species, Australopithecus sediba, previously found to exhibit human-like thumb proportions. In contrast, later Homo species, including the small-brained Homo naledi, show high levels of thumb opposition dexterity, highlighting the increasing importance of cultural processes and manual dexterity in later human evolution.

Technical note: Development of regression equations to reassociate upper limb bones from commingled contexts.

The major upper limb skeletal elements (scapulae, humeri, ulnae and radii) are frequently utilized for sex determination and stature estimation. Consequently, in forensic cases that involve commingled remains, it is crucial to reassociate the aforementioned bones and attribute them to the right individual. The aim of the present study is to develop simple and multiple regression equations for sorting commingled human skeletal elements of the upper limb. In that context, ten common anthropological linear measurements of the articular surfaces of scapulae, humeri, ulnae, and radii were performed on 222 adult skeletons from the Athens Collection. The functions developed for sorting adjoining bones presented a strong positive linear relationship (r=0.69-0.93, p<0.05). The values of the determination coefficient statistics (r2=0.47-0.86) were found to be high and those of the standard errors of the estimate were found to be low (SEE=0.88-1.61). Blind tests indicated that when metric and morphoscopic sorting techniques are combined, a reliable sorting of the skeletal elements of the upper limbs is possible.

Unusual Elevator-Related Deaths: A Report of Two Cases.

We present two cases of elevator-related deaths that occurred in two different elevators, and deaths were caused by a similar, but unusual, mechanism. An elevator is a platform or compartment housed in a shaft for raising and lowering people or things to different levels. Elevator-related deaths and injuries are rarely reported in the literature. In most of these cases, cause of death was attributed to falls. It seems that most of the elevator accidents may be attributed to factors related to device maintenance inadequacies or even to device malfunctioning. In our cases, both elevator cars were not equipped with full-length inner doors, thus allowing both accidents to occur. Since 2014, the European Union adopted a relative directive, which imposes the need to equip all elevators with such full-length doors. The enforcement of the above-mentioned EU Directive is crucial, in order to prevent similar accidents in the future.

A Reliable Regression-Based Approach for Reassociating Human Skeletal Elements of the Lower Limbs from Commingled Assemblages.

Accurate sorting of commingled human remains comprises a fundamental requirement for all further anthropological analyses. The lower limb bones are particularly important for reconstructing biological profiles. This study introduces a metric technique for sorting these elements using eight standard anthropological measurements and 222 adult individuals from Greece. The bones utilized were the os coxae, the femora, the tibiae and the tali. Simple regression analyses were used to develop functions for reassociating articulating bones, providing strong correlations (r = 0.74-0.95, p-value <0.05) and high coefficients of determination (r2 =0.54-0.91). Blind tests demonstrated that combining metric and morphoscopic techniques provides an excellent sorting accuracy for the hip and knee joints (ten of ten individuals), allowing for a reliable reassociation between a sex and age indicator (os coxae) and a body size indicator (femur). Overall, these results indicate the high value of metric methods in sorting commingled human remains.