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10 pages, 1592 KiB

Open AccessArticle

Three-Dimensional Dental Analysis for Sex Estimation in the Italian Population: A Pilot Study Based on a Geometric Morphometric and Artificial Neural Network Approach

by Giorgio Oliva, Vilma Pinchi, Ilenia Bianchi, Martina Focardi, Corrado Paganelli, Rinaldo Zotti and Domenico Dalessandri

Healthcare 2022, 10(1), 9; https://doi.org/10.3390/healthcare10010009 - 22 Dec 2021

Cited by 11 | Viewed by 3318

Abstract

Dental dimorphism can be used for discriminating sex in forensic contexts. Geometric morphometric analysis (GMA) allows the evaluation of the shape and size, separately, of uneven 3D objects. This study presents experiments using a novel combination of GMA and an artificial neural network [...] Read more.

Dental dimorphism can be used for discriminating sex in forensic contexts. Geometric morphometric analysis (GMA) allows the evaluation of the shape and size, separately, of uneven 3D objects. This study presents experiments using a novel combination of GMA and an artificial neural network (ANN) for sex classification, applied to premolars of Caucasian Italian adults (50 females and 50 males). General Procrustes superimposition (GPS) and the partial least square (PLS) method were performed, respectively, to study the shape variance between sexes and to eliminate landmark variations. The “set-aside” approach was used to assess the accuracy of the proposed neural networks. As the main findings of the pilot study, the proposed method applied to the first upper premolar correctly classified 90% of females and 73% of males of the test sample. The accuracy was 0.84 and 0.80 for the training and test samples, respectively. The sexual dimorphism resulting from GMA was low, although statistically significant. GMA combined with the ANN demonstrated better sex classification ability than previous odontometric or dental morphometric methods. Future research could overcome some limitations by considering a larger sample of subjects and other kinds of teeth and experimenting with the use of computer vision for automatic landmark positioning. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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25 pages, 7092 KiB

Open AccessArticle

Use of Advanced Artificial Intelligence in Forensic Medicine, Forensic Anthropology and Clinical Anatomy

by Andrej Thurzo, Helena Svobodová Kosnáčová, Veronika Kurilová, Silvester Kosmeľ, Radoslav Beňuš, Norbert Moravanský, Peter Kováč, Kristína Mikuš Kuracinová, Michal Palkovič and Ivan Varga

Healthcare 2021, 9(11), 1545; https://doi.org/10.3390/healthcare9111545 - 12 Nov 2021

Cited by 50 | Viewed by 12348

Abstract

Three-dimensional convolutional neural networks (3D CNN) of artificial intelligence (AI) are potent in image processing and recognition using deep learning to perform generative and descriptive tasks. Compared to its predecessor, the advantage of CNN is that it automatically detects the important features without [...] Read more.

Three-dimensional convolutional neural networks (3D CNN) of artificial intelligence (AI) are potent in image processing and recognition using deep learning to perform generative and descriptive tasks. Compared to its predecessor, the advantage of CNN is that it automatically detects the important features without any human supervision. 3D CNN is used to extract features in three dimensions where input is a 3D volume or a sequence of 2D pictures, e.g., slices in a cone-beam computer tomography scan (CBCT). The main aim was to bridge interdisciplinary cooperation between forensic medical experts and deep learning engineers, emphasizing activating clinical forensic experts in the field with possibly basic knowledge of advanced artificial intelligence techniques with interest in its implementation in their efforts to advance forensic research further. This paper introduces a novel workflow of 3D CNN analysis of full-head CBCT scans. Authors explore the current and design customized 3D CNN application methods for particular forensic research in five perspectives: (1) sex determination, (2) biological age estimation, (3) 3D cephalometric landmark annotation, (4) growth vectors prediction, (5) facial soft-tissue estimation from the skull and vice versa. In conclusion, 3D CNN application can be a watershed moment in forensic medicine, leading to unprecedented improvement of forensic analysis workflows based on 3D neural networks. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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10 pages, 380 KiB

Open AccessArticle

Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians

by Vittorio Fineschi, Mauro Arcangeli, Nicola Di Fazio, Zoe Del Fante, Benedetta Fineschi, Paola Santoro, Paola Frati and Associazione Consulcesi Health and ONLUS Futura Ricerca

Healthcare 2021, 9(9), 1097; https://doi.org/10.3390/healthcare9091097 - 25 Aug 2021

Cited by 22 | Viewed by 2548

Abstract

Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was [...] Read more.

Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was administered through a mail-list including 600 gynecological specialists (of these 168 doctors completed the test), both in public and private settings. It was made of twenty multiple choice questions, concerning their awareness about the practice of defensive medicine and the planning and execution of CS. All doctors involved received clear and complete information about the purpose of this study and about the organizations that received their answers. Analyses of variance and regression were performed to describe differences between groups and to estimate the relationships between variables. The value of p < 0.5 was considered statistically relevant. Results: our analysis revealed that most respondents are confident with the defensive medicine definition and characteristics. This survey confirmed that gynecologists fear legal actions promoted by their patients and therefore modulate their choices by implementing professional behaviors of so-called “defensive medicine”. This relates to a greater number of medical liability judgements, which more often concern omission or delayed execution of cesarean section, rather than unskillful surgical procedures. Conclusions: there are few data to support a relation between the high rate of CS and defensive medicine. Numerous scientific studies associated this CS rate with the phenomenon of defensive medicine. This practice is constantly growing in all medical areas, especially in high-risk specialties such as obstetrics and gynecology. Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice, affecting the choice of the type of delivery to be performed. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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9 pages, 1265 KiB

Open AccessArticle

Litigation in Anesthesia and Intensive Care Units: An Italian Retrospective Study

by Emiliano Petrucci, Alessandro Vittori, Marco Cascella, Alessandro Vergallo, Gilberto Fiore, Antonio Luciani, Barbara Pizzi, Giulia Degan, Vittorio Fineschi and Franco Marinangeli

Healthcare 2021, 9(8), 1012; https://doi.org/10.3390/healthcare9081012 - 7 Aug 2021

Cited by 21 | Viewed by 2799

Abstract

Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This [...] Read more.

Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This is a retrospective observational study on an insurance complaints database for anesthetic accidents that result in injuries to patients. The analyzed period runs from 1 January 2014 to 31 December 2016. A total of 1309 complaints related to 873 insurance claims were analyzed. Criminal complaints comprised 805 (64.4%) of the total, and civil complaints were 445 (35.6%). The iatrogenic damage claimed included: death (58% of the cases); peripheral nerve damage (8%); spinal cord injuries (5%); unspecified injuries (7%); dental damage (4%); infections (3%); needing second surgical procedure (2%); and other injuries (13%). There is a statistical significance between the size of the hospital and the number of the claims: small hospital complaints comprised 40.1% of the cases, while complaints against medium-sized and large hospitals constituted 20.6% of the cases (χ²GL = 8 = 39.87, p = 0.00). In Italy, anesthesiologists and intensivists are often involved in litigation even when they are not directly responsible for iatrogenic injuries, and the most frequent claims in ICU are related post-operative complications. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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9 pages, 597 KiB

Open AccessArticle

Hair Analysis to Evaluate Polydrug Use

by Giovanna Tassoni, Marta Cippitelli, Gianmario Mietti, Alice Cerioni, Erika Buratti, Emanuele Bury and Mariano Cingolani

Healthcare 2021, 9(8), 972; https://doi.org/10.3390/healthcare9080972 - 31 Jul 2021

Cited by 6 | Viewed by 1988

Abstract

Polydrug use is a frequent pattern of consumption in Europe. This behavior has mainly been analyzed within restricted groups; more rarely in large populations. Current polydrug use is less studied than simultaneous use. This study focused on the concurrent assumption of polydrug among [...] Read more.

Polydrug use is a frequent pattern of consumption in Europe. This behavior has mainly been analyzed within restricted groups; more rarely in large populations. Current polydrug use is less studied than simultaneous use. This study focused on the concurrent assumption of polydrug among drivers using hair matrix. Hair matrix, for its biological characteristics, allows to identify illicit drug use more often than other matrices, i.e., urine, and it provides information on the long-term use of them. Hair samples of subjects positive for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ⁹-THC) collected by the forensic toxicology laboratory of the University of Macerata in the period 2010–2020, were analyzed using a gas chromatography-mass spectrometry method. Our results evidenced that a significant part of the examined population (12.15%) used polydrug. A strong predominance of males over females was evident. Polydrug users were more frequently young people. The abuse of two substances was predominant. Cocaine and Δ⁹-THC was the most common combination, followed by cocaine and morphine, and morphine and Δ⁹-THC. The timeframe of polydrug use was also analyzed. Our study shows that polydrug use is a very frequent behavior, and that hair analysis may be a powerful tool to obtain objective biological information of this complex phenomenon. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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9 pages, 872 KiB

Open AccessArticle

Aggressions on Social Networks: What Are the Implications for Healthcare Providers? An Exploratory Research

by Micaela La Regina, Arianna Mancini, Francesco Falli, Vittorio Fineschi, Nicola Ramacciati, Paola Frati and Riccardo Tartaglia

Healthcare 2021, 9(7), 811; https://doi.org/10.3390/healthcare9070811 - 28 Jun 2021

Cited by 10 | Viewed by 3412

Abstract

Incidents of violence by healthcare users against staff have been considered as sentinel events. New forms of aggression, i.e., cyberbullying, have emerged with the advent of social networks. Medical literature includes some reports about workplace cyberbullying on nurses and young doctors by colleagues/supervisors, [...] Read more.

Incidents of violence by healthcare users against staff have been considered as sentinel events. New forms of aggression, i.e., cyberbullying, have emerged with the advent of social networks. Medical literature includes some reports about workplace cyberbullying on nurses and young doctors by colleagues/supervisors, but not by users. To investigate cyberbullying on healthcare providers via social networks, we carried out an exploratory quali-quantitative study, researching and analyzing posts and comments relating to a local Health Trust (ASL5) in Italy, published from 2013 until May 2020 on healthcare worker aggressions on social networks on every local community’s Facebook page. We developed a thematic matrix through an analysis of the most recurring meaning categories (framework method). We collected 217 texts (25 posts and 192 comments): 26% positive and 74% negative. Positive posts were shared about ten times more than negative ones. Negative comments received about double the “Likes” than the positive ones. Analysis highlighted three main meaning categories: 1. lack of adequate and functional structures; 2. negative point of view (POV) towards some departments; 3. positive POV towards others. No significant differences were observed between the various categories of healthcare workers (HCW). Geriatric, medical wards and emergency department were the most frequent targets of negative comments. All the texts referred to first-line operators except for one. Online violence against HCW is a real, largely unknown, problem that needs immediate and concrete attention for its potentially disastrous consequences. Compared to traditional face-to-face bullying, it can be more dangerous as it is contagious and diffusive, without spatial, temporal or personal boundaries. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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11 pages, 23492 KiB

Open AccessArticle

A Case of Nosocomial Outbreak of Pantoea agglomerans Related to Parenteral Nutrition Procedures

by Dora Mirtella, Piergiorgio Fedeli, Roberto Scendoni, Nunzia Cannovo and Mariano Cingolani

Healthcare 2021, 9(6), 684; https://doi.org/10.3390/healthcare9060684 - 7 Jun 2021

Cited by 8 | Viewed by 3637

Abstract

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamination from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found [...] Read more.

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamination from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found as an opportunistic pathogen in immunocompromised patients. It is not rare to find reports of bacteremia and sepsis from contamination of intravenous fluid, parenteral nutrition, blood products and anesthetic agents—that is, through contamination of medical devices and products. We reported a bacterial infection epidemic occurred in 2011 in a hospital in middle Italy which involved different hospital wards; Pantoea agglomerans was isolated from blood cultures of all infected patients and the source of infection was identified in contaminated parenteral nutrition prepared from the local pharmacy. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

14 pages, 2291 KiB

Open AccessArticle

Age Estimation Using the Cameriere Methods of Open Apices: A Meta-Analysis

by Sorin Hostiuc, Ioana Diaconescu, Mugurel Constantin Rusu and Ionut Negoi

Healthcare 2021, 9(2), 237; https://doi.org/10.3390/healthcare9020237 - 23 Feb 2021

Cited by 18 | Viewed by 3423

Abstract

Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, [...] Read more.

Purpose: To evaluate the actual variability of the mean difference between chronological and dental age using the Cameriere method of open apices and to test its accuracy in variable age groups. Method: We selected studies that contained data about the mean, standard deviation, and number of cases for chronological age, dental age and gender. We used a random-effects model. Statistical significance was estimated, at a p < 0.05, using prediction intervals. For the analysis of publication bias we used the funnel plot and Egger’s regression test for plot asymmetry. I² was used to test the presence of heterogeneity between studies. The Z test was used to test for statistical differences between subgroups, with p < 0.05 being considered statistically significant. We also used 95% for confidence intervals and prediction intervals. Results: In boys, the average difference between chronological and dental age was 0.44 (0.26–0.63) years, while in girls the average difference between chronological and dental age was 0.34 (0.19–0.49) years. In the 6–7 years age group and in the 14–15 years age group, there was a statistically significant difference between dental and chronological age. Our study shows that the Cameriere method is useful for estimating the chronological age, with errors of less than one year. Conclusions: The Cameriere method of evaluating dental age using open apices is sufficiently accurate for forensic practice, at least in the 7–14 age-interval. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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Review

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7 pages, 225 KiB

Open AccessReview

Informed Consent and Protection of Personal Data in Genetic Research on COVID-19

by Piergiorgio Fedeli, Roberto Scendoni, Mariano Cingolani, Marcelo Corrales Compagnucci, Roberto Cirocchi and Nunzia Cannovo

Healthcare 2022, 10(2), 349; https://doi.org/10.3390/healthcare10020349 - 11 Feb 2022

Cited by 2 | Viewed by 2276

Abstract

The particular characteristics of COVID-19 demand the careful biomedical study of samples from patients who have shown different symptomatology, in order to understand the genetic foundations of its phenotypic expression. Research on genetic material from COVID-19 patients is indispensable for understanding the biological [...] Read more.

The particular characteristics of COVID-19 demand the careful biomedical study of samples from patients who have shown different symptomatology, in order to understand the genetic foundations of its phenotypic expression. Research on genetic material from COVID-19 patients is indispensable for understanding the biological bases for its varied clinical manifestations. The issue of “informed consent” constitutes the crux of the problem in regulating research biobanks, because it concerns the relationship between the person and the parts separated from the body. There are several consensus models that can be adopted, varying from quite restricted models of specific informed consent to forms that allow very broad authorization (open consent). Our current understanding of COVID-19 is incomplete. Thus, we cannot plan, with precision, the research to be conducted on biological samples that have been, or will be, collected from patients infected by the novel coronavirus. Therefore, we suggest utilizing the “participation pact” between researchers and donors, based on a new form of participation in research, which offers a choice based on the principles of solidarity and reciprocity, which represent the communication of “values”. In the last part of this paper, the general data protection regulation concerning the matter is discussed. The treatment of personal data must be performed with explicit goals, and donors must be provided with a clear, transparent explanation of the methods, goals and time of storage. The data must not be provided to unauthorized subjects. In conclusion, open informed consent forms will be necessary for research on individual patients and on populations. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

13 pages, 416 KiB

Open AccessReview

Take-Home Messages from the COVID-19 Pandemic: Strengths and Pitfalls of the Italian National Health Service from a Medico-Legal Point of View

by Matteo Bolcato, Marco Trabucco Aurilio, Anna Aprile, Giulio Di Mizio, Bruno Della Pietra and Alessandro Feola

Healthcare 2021, 9(1), 17; https://doi.org/10.3390/healthcare9010017 - 25 Dec 2020

Cited by 34 | Viewed by 4546

Abstract

The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 [...] Read more.

The World Health Organization (WHO) declared the outbreak of the Coronavirus disease-2019 (COVID-19) infection a pandemic on 11 March 2020. As of the end of October 2020, there were 50 million cases of infection and over one million deaths recorded worldwide, over 45,000 of which occurred in Italy. In Italy, the demand for intensive care over the course of this pandemic crisis has been exceptionally high, resulting in a severe imbalance between the demand for and availability of the necessary resources. This paper focuses on elements of preventive medicine and medical treatments in emergency and non-emergency situations which, based on the international scientific literature, may prove to be useful to physicians on a behavioral level and avert professional liability problems. In order to achieve this objective, we have performed a search on MEDLINE to find published articles related to the risks associated with the pandemic that contain useful suggestions and strategies for mitigating risks and protecting the safety of the population. The results have been collocated in line with these specific study areas. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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6 pages, 220 KiB

Open AccessEditor’s ChoiceOpinion

Environment, Environmental Crimes, Environmental Forensic Medicine, Environmental Risk Management and Environmental Criminology

by Michelangelo Bruno Casali, Guido Vittorio Travaini, Carlotta Virginia Di Francesco and Umberto Rosario Genovese

Healthcare 2022, 10(2), 263; https://doi.org/10.3390/healthcare10020263 - 29 Jan 2022

Cited by 1 | Viewed by 3281

Abstract

Forensic medicine has always held the human environment, either seen as a source for pathological agents or the background of judicial events, in great consideration. The concept of the environment has evolved through time, expanding itself to include all the physical and virtual [...] Read more.

Forensic medicine has always held the human environment, either seen as a source for pathological agents or the background of judicial events, in great consideration. The concept of the environment has evolved through time, expanding itself to include all the physical and virtual sub-spaces in which we exist. We can nowadays talk of technoenvironmental reality; virtual spaces exploded because of the COVID-19 pandemic making us come to terms with the fact that those are the places where we work, where we socialize and, even, where we meet our doctors and can be cured. Artificial Intelligence (AI) has contributed to shaping new virtual realities that have got their own rules yet to be discovered, carved and respected. We already fight a daily battle to save our natural environment: along with the danger of green crimes, comes the need for environmental justice and environmental forensic medicine that will probably develop a forensic branch and an experimental branch, to implement our technical culture leading to definition of the real dimension of the risk itself to improve the role of legal medicine in the Environmental Risk Management. While green criminology addresses widespread green crimes, a virtual environment criminology will also develop, maybe with a contribution of AI in the justice field. For a sustainable life, the environmental revolution must rapidly take place, and there is the need for a new justice, a new forensic medicine and a new criminology too. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

8 pages, 229 KiB

Open AccessCommentary

Organizational Strategies for the Management of Intravenous Iron Therapy in Non-Hospitalized Settings: A Safe Opportunity to Implement Patient Blood Management in Italy

by Matteo Bolcato, Ivo Beverina, Daniele Rodriguez, Anna Aprile and Marco Trabucco Aurilio

Healthcare 2021, 9(9), 1222; https://doi.org/10.3390/healthcare9091222 - 16 Sep 2021

Cited by 3 | Viewed by 2308

Abstract

This article analyzes the recommendations issued by the Emilia Romagna region in July 2020 on “Organizational strategies for the safe management of intravenous iron therapy in patients in non-hospitalized settings”. The objective of these recommendations is to set up safe intravenous iron administration [...] Read more.

This article analyzes the recommendations issued by the Emilia Romagna region in July 2020 on “Organizational strategies for the safe management of intravenous iron therapy in patients in non-hospitalized settings”. The objective of these recommendations is to set up safe intravenous iron administration sites outside the hospital environment across the national territory. The document facilitates the organization of methods for intravenous iron infusion that are safe for the patient and correct from a medico-legal perspective. In addition, it opens the way for the widespread use of iron infusion in the field, providing benefits to patient quality of life. This program prevents unnecessary transfusions, reduces costs, prevents overcrowding in hospitals in the event of a pandemic, and enables patient treatment in the field, thus, saving on the use of personnel. Full article

(This article belongs to the Special Issue New Trends in Forensic and Legal Medicine)

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