听力测试组合在听觉障碍鉴定中的应用

目的分析不同听力测试方法对听阈评估的作用,探讨组合听力测试在听觉障碍法医学鉴定中的应用。方法对87例外伤后听力损伤者进行听力测试,将纯音听阈测试(PTA)、声导抗、40HzAERP、ABR、ASSR、DPOAEs进行组合。听阈评估采用PTA+ABR+40HzAERP/ASSR,损伤定位采用PTA+声导抗+ABR/40HzAERP+DPOAEs。根据致伤方式的不同,分为头部损伤组和耳损伤组。比较组间DPOAEs阳性率,比较纯音听阈、40HzAERP、ABR及ASSR对听阈评估的作用。结果头部外伤组DPOAEs阳性率明显高于耳损伤组(P<0.05);纯音语频听阈异常耳与40HzAERP语频阈值及ABR比较,纯音语频阈值异常率较40HzAERP及ABR明显高,主、客观听阈明显不符。26耳40HzAERP与ASSR比较,两者在0.5kHz、1kHz、2kHz反应阈均值数相关性较好(r=0.862),ASSR语频均值较40HzAERP低,平均差17dB。结论纯音听阈与ABR、40HzAERP或ASSR组合测试对听阈的评估有互补作用。40HzAERP与ASSR均可以用于语音频率的听阈评估。声导抗、ABR、40HzAERP与DPOAEs多项检查组合,有助于确定损伤部位。     

Cutaneous (tPA) and Skeletal (TnI) mRNA as Markers of Aging in Contused Wound

Wound age estimation is one of the most important forensic aspects. Troponin I (TnI) and many cytokines, for example, tissue plasminogen activator (tPA), are involved in wound inflammation and healing. Skeletal (TnI) and cutaneous (tPA) mRNA was detected using real‐time PCR in 25 female albino rats. They were divided into 5 groups: control and 4 injured groups. Injured groups were sacrificed 1, 6, 24, and 30 h after inflicting contused wound. The expression levels of cutaneous (tPA) were decreased significantly at 1, 6, and 30 h after contusion (71.7%, 30.7 and 16.9%), while the expression levels of skeletal (TnI) were increased significantly at 1 and 6 h post‐traumatic, then they gradually decreased until reaching normal levels at 24 h and assumed significantly lower levels at 30 h postcontusion. These results suggested that the determination of cutaneous (tPA) and skeletal (TnI) mRNA levels was useful for wound age estimation.     

Life Stressors and Posttraumatic Stress Disorder in a Seriously Mentally Ill Jail Population,

Inmates represent a vulnerable population with increased rates of trauma and posttraumatic stress disorder (PTSD). However, little is known about the rates of trauma and PTSD among male inmates with acute psychiatric illness. This prospective, randomized study was conducted to assess the current rates of trauma and PTSD in this population. The sample consisted of 48 patients admitted to a hospital jail psychiatry service in New York City. Subjects were administered the Life Stressor Checklist‐Revised and the Structured Clinical Interview for DSM‐IV‐TR Disorders, PTSD Module (SCID‐I). The rate of PTSD diagnosis via SCID‐I was 46.2% as compared to 2.1% diagnosis via clinical interview. All participants reported a history of at least one stressful and/or traumatic event, and many of these events occurred during incarceration. These results demonstrate that a great deal of trauma and PTSD goes unrecognized and untreated in this population, indicating the need for more effective treatment interventions.     

Occupational exposure to traumatic evidence and posttraumatic stress symptoms in forensic science professionals: Prevalence and patterns

Forensic science professionals are routinely exposed to potentially traumatizing evidence. This study aimed to estimate the prevalence of occupational posttraumatic stress disorder (PTSD) among forensic science professionals, identify job-related correlates of PTSD symptoms, and examine the role of social support in mitigating PTSD symptomology. In response to recruitment through the American Academy of Forensic Sciences, the American Society of Crime Laboratory Directors, and Evidence Technology Magazine, 449 forensic science professionals participated in the current study. Results found that 73.5% (n = 330) of the overall sample experienced at least one work-related traumatic event consistent with meeting Criterion A for PTSD, and these rates were higher for field-based respondents (n = 203, 87.9%). The prevalence of past-month provisional PTSD was 21.6% for the full sample. Disaggregated PTSD rates were 29.0% and 14.5% for field-based and non-field-based respondents, respectively. These rates were 6- to 8-fold higher than the past-year prevalence of PTSD in the general US population, estimated to be 3.5%, and were found to be at least as high as those observed in prior epidemiological research with non-treatment seeking members of the US military deployed to war zones in Iraq and Afghanistan. Results further showed that social support was protective against PTSD symptomology. The high rates of occupational exposure to trauma and consequent PTSD symptomology observed in this large sample of forensic science professionals highlight the under-acknowledged psychological risks of these occupations and the need for enhanced attention to mental health resources for these professionals.     

A meta-analytic review of the frequency and patterning of laryngohyoid and cervical fractures in cases of suicide by hanging

The frequency and distribution of fractures are commonly utilized to assist in interpreting the manner of death. In cases of alleged suicide by hanging, however, the evidence base for the frequency and patterning of laryngohyoid and cervical vertebrae fractures resulting from such blunt force traumatic events is limited and so fractures cannot be reliably used to assist in interpreting the manner. Using meta-analytic techniques, this study aimed to estimate frequency and distribution of fractures in the context of relevant intrinsic and extrinsic variables. A systematic review of the literature identified 20 studies with relevant data (8523 cases of suicide by hanging). Meta-analyses identified the frequency and distribution of fractures present and how fracture frequency was affected by the subgroups of age, sex, completeness of suspension, ligature knot position and study design. Results indicated that fracture frequency was variable, there was no unique patterning, and high levels of heterogeneity were present in all variable sub-groups. Age was the only subgroup to show differences. Findings suggest that neck fracture frequency is inconsistent and cannot be predicted by the chosen variables. Subsequently, neck fractures in isolation should not be given weight in medico-legal interpretations of a hanging death as suicidal.     

The utility of trauma evaluations in judicial decision-making in child sex trafficking cases: A qualitative analysis

Youth coerced into trafficking experience multiple forms of abuse, and are deprived of basic human rights associated with liberty and self-determination, all of which can adversely affect mental and psychological well-being (Ottisova et al., Behavioral Medicine, 44(3), 234-241.). This study uses a qualitative approach to exploring how judges use trauma-related information to make decisions about how to adjudicate cases involving minors who have been sexually trafficked. Additionally, the study identifies barriers to receiving data, the court resources needed to effectively respond, and potential remedies to address gaps in effective case management. The study uses data from 82 juvenile and family court judges from around the USA 27-item structured interview was used to determine the availability and utility of trauma services, needed resources, and solutions to overcome gaps in effective case adjudication. Themes emerged related to lack of access to and timing issues that limited the utility of reports, lack of congruency between recommendations and available resources and child and family resistance to disclosures. Solutions to overcome barriers are related to increased cross-disciplinary collaboration, awareness and responsiveness. Legal remedies such as Safe Harbor laws can only be realized if the systemic context is aligned and appropriately resourced toward responsiveness.     

Offenders as victims: post-traumatic stress disorder and substance use disorder among male prisoners

Background: Comorbid substance use disorder(s) and post-traumatic stress disorder (SUD-PTSD) is common among prisoners and linked to an increased risk of criminal recidivism; however, little is known about the characteristics of prisoners with this comorbidity. Aim: This study provides a preliminary examination of the clinical and criminal profile of male inmates with symptoms of SUD-PTSD, and examines whether this profile differs according to whether a person has experienced a trauma while in prison. Methods: Thirty male inmates from two correctional centres in Sydney, Australia, were recruited and assessed using a structured interview. Results: The sample reported extensive criminal, substance use and trauma histories. A history of substance dependence was almost universal (90%) and 56.7% met diagnostic criteria for PTSD with the remainder experiencing sub-threshold symptoms. Forty-three per cent reported a traumatic event while in prison. Those who had experienced trauma in prison, compared to those who had not, were more likely to nominate heroin as their main drug of concern and to be receiving drug treatment in prison. There was also a trend toward inmates who had experienced a trauma in prison being more likely than inmates who had no prison trauma to have experienced a physical assault. Conclusion: Male prisoners with SUD-PTSD are a high-needs group yet treatment responses are poor. Further research examining treatment options for this comorbidity may improve prisoner well-being and reduce recidivism.     

THE DEFEAT THAT CHANGED CHINA'S HISTORY

正This year marks the 120th anniversary of the outbreak of the First Sino-Japanese War of 1894-95,commonly known in China as the Jiawu War.Time has passed,but the trauma of the conflict is still felt by the Chinese people even today.The war,during which China’s then-ruling Qing Dynasty(1644-1911)was defeated,changed the fate of the country.It exposed the     

Blast Injury and the Human Skeleton: An Important Emerging Aspect of Conflict‐Related Trauma

Recent decades have seen an accelerating trend in warfare whereby a growing proportion of conflict‐related deaths have been caused by explosions. Analysis of blast injury features little in anthropological literature. We present a review of clinical literature that includes prevalence of injury to anatomical regions and potential indicators of blast injury which can be used by forensic anthropologists. This includes high prevalence of extremity (22.8–91.2%) and facial (19.6–40%) injury in combat contexts, lower limb fractures (19–74.3%) in suicide bombing, traumatic amputation (3–43%) and diffuse fracture patterns in terrorist bombings. Potential indicators of blast trauma include blowout fractures in sinus cavities from blast overpressure, transverse mandibular fractures, and visceral surface rib fractures. Ability to recognize blast trauma and distinguish it in the skeleton is of importance in investigations and judicial proceedings relating to war crimes, terrorism, and human rights violations and likely to become increasingly crucial to forensic anthropology knowledge.     

The Effect of Previous Traumatic Injury on Homicide Risk

Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case–control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09–2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24–5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs.