Journal of forensic and legal medicine最新文献

{"title":"Salivary biomarkers in forensic science: Bridging molecular biology and legal medicine","authors":"Arathi Padutholil Ajith Kumar ,&nbsp;Premalatha Bidadi Rajashekaraiah ,&nbsp;Sheethal Chandra Aralaguppe Chandraprakash ,&nbsp;Parvathy Beena Chandran ,&nbsp;Vaishaka Ashok Malali ,&nbsp;Vidyadevi Chandavarkar","doi":"10.1016/j.jflm.2025.103044","DOIUrl":"10.1016/j.jflm.2025.103044","url":null,"abstract":"<div><div>Saliva has emerged as a versatile and non-invasive biological specimen in forensic science. It is a rich source of genomic, transcriptomic, proteomic, metabolic, and microbiomic factors, offering significant potential in forensic investigations. This review explores the multi-dimensional aspects of salivary biomarkers in forensic science, integrating molecular biology with legal medicine.</div><div>It provides a comprehensive overview of the saliva composition, highlighting its biochemical constituents and the methodologies employed for its effective collection in forensic scenarios. From a molecular and analytical perspective, we delve into the diverse classes of salivary biomarkers, including genomic markers that enable individual and kinship profiling; transcriptomic and proteomic biomarkers that reveal gene expression and protein profiles that contribute in post-mortem interval estimation and physiological state evaluation; and metabolomic and microbiomic signatures which offer additional discriminatory power to infer health, lifestyle, and even geographic origins.</div><div>The forensic applications of these biomarkers and their growing acceptance in judicial proceedings, where the admissibility and evidential value of saliva-derived data are critically assessed, are discussed. Supported by relevant case studies, this review highlights the real-world utility and impact of salivary biomarkers in forensic practice. The challenges and limitations of saliva in forensics are addressed. Additionally, insights into future prospects, such as salivaomics, lab-on-a-chip platforms, and AI-driven data interpretation, are provided.</div><div>In conclusion, by mapping the intersection of molecular diagnostics and legal frameworks, this review underscores that saliva can be a revolutionary medium that advances the accuracy and accessibility of forensic identification by bridging its biological complexity with forensic applications.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103044"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age estimation based on Demirjian's method using third molars in individuals from Southeastern Brazil","authors":"Amanda Farias-Gomes ,&nbsp;Maria Luíza dos Anjos Pontual ,&nbsp;Thaísa Pinheiro Silva ,&nbsp;Maria Fernanda Silva Andrade-Bortoletto ,&nbsp;Matheus L. Oliveira ,&nbsp;Francisco Haiter-Neto ,&nbsp;Cleber Zanchettin ,&nbsp;Deborah Queiroz Freitas","doi":"10.1016/j.jflm.2025.103045","DOIUrl":"10.1016/j.jflm.2025.103045","url":null,"abstract":"<div><div>This study assessed the applicability of third molar mineralization stage for estimating chronological age in a Southeastern Brazilian population and tested a previously developed age estimation formula from a Northeastern Brazilian population. Digital panoramic radiographs of 1570 individuals aged 7–22 years were analyzed; 1260 radiographs were used to create the new formula, and 310 to test it. Two independent examiners classified the third molars on the radiographs according to Demirjian's developmental stages. Paired <em>t</em>-test compared chronological and estimated ages; Mann-Whitney test assessed sex differences in mineralization stages (α = 0.05). Multiple linear regression was used to develop a new age estimation formula. Chronological age was similar across all four third molars for different developmental stages, with no sex-related significant differences (p &gt; 0.05). The initial appearance of third molar formation (stage A) and root apex closure (stage H) occurred at mean ages of 8.6 and 19.8 years, respectively. A strong correlation (R = 0.925) was found between chronological age and third molar mineralization stages. The previously developed formula significantly overestimated chronological age by approximately one year (p &lt; 0.05). In contrast, the new formula achieved strong performance, explaining 85 % of the variance in the outcome (R² = 0.85), with low prediction errors (MAE = 1.35; RMSE = 1.71), with no significant differences between estimated and chronological age for most age groups (p &gt; 0.05). This study confirms the strong correlation between third molar mineralization stages and chronological age in a Southeastern Brazilian population. It also underscores the need for population-specific models, as the previously developed formula led to overestimation. The new formula provides a more accurate method for age estimation in this subpopulation, supporting its forensic and clinical applicability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103045"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of clinical toxicology results from 2017 to 2023: exploring the characteristics and prevalence trends of detected drugs and poisons","authors":"Yuxuan Fu ,&nbsp;Sujing Zhang ,&nbsp;Yibo Yan ,&nbsp;Ping Xiang ,&nbsp;Jian Li ,&nbsp;Lei Xin ,&nbsp;Hongxiao Deng ,&nbsp;Hejian Wu ,&nbsp;Xin Wang","doi":"10.1016/j.jflm.2025.103052","DOIUrl":"10.1016/j.jflm.2025.103052","url":null,"abstract":"<div><div>To characterize temporal trends in toxic substance patterns involved in clinical toxicology cases in Shanghai, while considering regulatory changes, and to benchmark these findings against data from other regions. The clinical toxicology results reported by the Academy of Forensic Science (AFS) from January 2017 to December 2023 were collated, summarized, and retrospectively analyzed for the types and blood concentrations of different drugs and poisons. Overall, 4422 clinical toxicology cases were recorded, accounting for an average of approximately 630 cases per year, with 62 % presenting positive results. The positively detected substances were mainly clinical drugs and pesticides. The detected clinical drugs were predominantly sedative-hypnotics, antidepressants, and antipsychotics. Estazolam (n = 347), midazolam (n = 272), bromadiolone (n = 265), clonazepam (n = 228), and quetiapine (n = 199) were the top five most frequently detected substances in clinical toxicological cases. Other cases related to plant poisons, toxic heavy metals, and toxic alcohols were also recorded. The blood concentrations of the various drugs showed significant variability. This study highlights a concerning rise in psychoactive drug use, particularly sedative-hypnotics and antidepressants, reflecting a growing mental health burden in the population. This pattern is further supported by the frequent detection of blood drug concentrations exceeding therapeutic upper limits, indicating widespread non-therapeutic exposure. In response, psychotropic drug prescribing practices must be comprehensively strengthened through stricter regulations and the establishment of prescription surveillance to ensure rational and safe medication use. Additionally, a decline in certain toxicants, such as paraquat, suggests the effectiveness of policy interventions. The findings also emphasize the risks of polypharmacy and the need for enhanced poisoning prevention and emergency response systems.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103052"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual violence and associated factors among female night students in Ethiopia: A systematic review and meta-analysis","authors":"Yeshiwas Ayale Ferede ,&nbsp;Worku Chekol Tassew ,&nbsp;Melese Legesse Mitku ,&nbsp;Abiyie Demelash Gashe ,&nbsp;Girum Meseret Ayenew ,&nbsp;Adane Nigussie ,&nbsp;Agerie Mengistie Zeleke","doi":"10.1016/j.jflm.2025.103053","DOIUrl":"10.1016/j.jflm.2025.103053","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous efforts to prevent and control sexual violence in Ethiopia, the incidence continues to rise. It's crucial to have solid evidence to highlight the severity of the issue. Thus, this study aims to determine the overall prevalence of sexual violence and pinpoint the contributing factors among female night students in Ethiopia.</div></div><div><h3>Method</h3><div>A comprehensive and systematic literature search was conducted across various electronic databases, including PubMed, HINARI, Scopus, EMBASE, Web of Science, African Journal online (AJOL), and Google Scholar. The quality of the studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies, consisting of nine criteria. The heterogeneity of the studies was assessed using the Cochrane Q and I2 test statistics. The pooled prevalence estimate of sexual violence among female night students was calculated using a random-effects model.</div></div><div><h3>Result</h3><div>Out of 6410 studies reviewed, six studies involving 2699 night students were deemed relevant. The pooled estimate of sexual violence among female night students in Ethiopia was found to be 43.58 % (95 % CI: 30.68, 56.48). Factors associated with sexual violence included rural residency (POR = 2.51; 95 % CI: 1.17, 5.41), alcohol use (AOR = 3.30; 95 % CI: 1.68, 6.48), having multiple sexual partners (POR = 2.78; 95 % CI: 1.97, 3.92), and a commute time to school exceeding 20 min (POR = 1.74; 95 % CI: 1.18, 2.58).</div></div><div><h3>Conclusion</h3><div>The research revealed that nearly half of female night students encountered sexual violence, with significant correlations identified between this violence and factors such as having multiple sexual partners, residing in rural areas during childhood, having a commute time to school of over 20 min, and having a history of alcohol use. To effectively address and prevent sexual violence, the Federal Ministry of Health (FMOH), policymakers, and stakeholders must prioritize these findings and take targeted actions.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103053"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How people die inside: Fact patterns in civil litigation for in-custody deaths","authors":"Taleed El-Sabawi ,&nbsp;Shelly Weizman ,&nbsp;Regina LaBelle","doi":"10.1016/j.jflm.2025.103048","DOIUrl":"10.1016/j.jflm.2025.103048","url":null,"abstract":"<div><div>Civil litigation provides a novel and underutilized source of information about deaths in U.S. jails, particularly when official data are incomplete. This study systematically analyzes verdicts, settlements and judgments to explore patterns in practices linked to preventable mortality in U.S jails.</div></div><div><h3>Results</h3><div>Content analysis of facts alleged in 90 cases filed between 2015 and 2020 revealed thematic patterns related to inadequate or delayed medical care. Alleged facts routinely included observable signs of serious medical need—such as incoherence, convulsions, or pleas for help—followed by failures to provide timely or medically appropriate care. In cases of suicide, allegations commonly describe known mental health conditions, discontinued medication, and lapses in monitoring or suicide prevention protocols. Despite repeated warnings—by the individuals themselves, fellow incarcerated persons, or family members—jail staff frequently failed to act. A small subset of cases resulted in judgments for the defense, often where some care was provided or protocols were followed, even if outcomes were still fatal.</div></div><div><h3>Conclusion</h3><div>These findings suggest that in cases resulting in reported settlements, verdicts or judgments in-custody deaths in the U.S. could be prevented through improved intake screening, timely medical monitoring, care coordination, and adherence to established protocols. Litigation records offer important insight into how systemic failures contribute to jail mortality, with implications for policy, public health, and correctional practice.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103048"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of psychoactive substances and attention-related impairments on driving performance: Sex differences and road crash involvement","authors":"Claudio Terranova ,&nbsp;Clara Cestonaro ,&nbsp;Stefano Palumbi ,&nbsp;Laura Marino ,&nbsp;Alessandro Gentili ,&nbsp;Francesco Pozzebon ,&nbsp;Rocco Miazzi ,&nbsp;Anna Aprile","doi":"10.1016/j.jflm.2025.103050","DOIUrl":"10.1016/j.jflm.2025.103050","url":null,"abstract":"<div><h3>Introduction</h3><div>Crashes are a global public health concern, with psychoactive substance use and attention impairments potentially increasing risk and affecting male and female drivers differently. This study aims to identify factors related to psychoactive substance use and attention impairments that predict road crash involvement by sex, offering insights for targeted prevention effort.</div></div><div><h3>Methods</h3><div>This observational study examined individuals assessed for driving license reissuance after driving under the influence of alcohol and/or drugs. Data collected included personal and sociodemographic details, results from a Continuous performance test (CPT-3) (a neuropsychological test assessing inattentiveness, impulsivity, sustained attention, and vigilance), and toxicological analyses of biological samples. Statistical analyses (chi-square, logistic regression, and ROC curve) aimed at identifing sex-specific predictors of road crash involvement.</div></div><div><h3>Results</h3><div>The study included 169 participants (82.8 % males, 17.2 % females). Initial univariate analyses indicated sex differences that were not confirmed after Bonferroni correction for multiple comparisons. Logistic regression found blood alcohol concentration predictive of crashes in males (p = 0.005, OR = 2.52), while inattentiveness was a major factor for females (p = 0.045, OR = 12.0). In the combined model, sex itself was not an independent predictor after adjusting for these factors. The model showed moderate accuracy for males (ROC-AUC = 0.695) and higher accuracy for females (ROC-AUC = 0.816), suggesting that inattentiveness may play a particularly important role in predicting crashes in the female subgroup.</div></div><div><h3>Conclusions</h3><div>Inattentiveness and alcohol use emerged as key predictors of crash involvement, with inattentiveness showing particular relevance in the female subgroup. Prevention should focus on modifiable risk factors rather than sex. The model's higher accuracy in females suggests attentional measures may help identify at-risk drivers, though the small female sample limits generalizability.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103050"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrinsic factors influencing the post-mortem mechanical excitability of human skeletal muscle","authors":"H. Stigter,&nbsp;J. Kloosterman,&nbsp;T. Krap,&nbsp;W.L.J.M. Duijst","doi":"10.1016/j.jflm.2025.103055","DOIUrl":"10.1016/j.jflm.2025.103055","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Post-mortem, supravital muscle reaction (SMR) of human skeletal muscle is dependent on energy supply. Intrinsic variables, like peri-mortem body temperature and underlying diseases, influence the rate of cell metabolism in skeletal muscle cells post-mortem, and thus the available energy for SMR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;A field study was conducted, comprising deceased found under differing conditions. We investigated the influence of the body temperature of the deceased on the outcome of post-mortem mechanical stimulation of skeletal muscle in the first hours post-mortem. In addition, we investigated the influence of sex, age, state of rigor mortis and the length of the dying process on SMR. Furthermore, we hypothesized that the outcome of post-mortem muscle stimulation could differ between musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on the same body examined at the same time, due to a higher cooling velocity of more peripheral located skeletal muscles (MBR).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;In the period of January 2017 to August 2023 four forensic physicians from two different regions in the Netherlands performed mechanical stimulation of both upper and forearms of deceased with a known or an estimated PMI of &lt;14 h, by using a reflex hammer. The research population concerned in-hospital-deaths, out-of-hospital deaths that were transferred to the morgue of a hospital, and out-of-hospital deaths that were examined at the place where the body was found. The sex and age of the deceased, body temperature, and state of rigor mortis were registered in the Dutch national register of forensic medicine, which was used as a data resource. The length of the dying process was registered separately using SPSS 27.0 which also served as a data resource. The Welch Two Sample &lt;em&gt;t&lt;/em&gt;-test, chi-squared test, logistic regression and multiple logistic regression were performed to investigate the influence of the PMI, body temperature, sex, age, state of rigor mortis and the length of the dying process on the outcome of SMR. Statistical analyses were performed by using R 4.4.1. Significance was accepted at P &lt; 0.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In total, 142 cases were included, in which musculus biceps brachii (MBB) and the musculus brachioradialis (MBR) on both arms were mechanically stimulated with a reflex hammer. The population consisted out of 65 males (mean age: 73.4 ± 16.8 years) and 77 females (mean age: 82.1 ± 13.0 years). SMR was present in 74 out of 142 cases (52.1 %). The mean PMI did not differ significantly between cases with a positive SMR (157.3 min) and cases showing no SMR (168.4 min). The number of male cases that showed SMR (63.1 %) was significantly higher than the number of female cases (42.9 %) that showed SMR. No relationship was detected between age, body temperature, rigor mortis and the length of the dying process, and the outcome of post-mortem musc","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103055"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crossing Borders: A look at migrant deaths in the Caribbean","authors":"Ken Obenson","doi":"10.1016/j.jflm.2025.103042","DOIUrl":"10.1016/j.jflm.2025.103042","url":null,"abstract":"","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103042"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical liability related legislation and insurance policies around the world: A narrative literature review","authors":"Ioannis Ketsekioulafis ,&nbsp;Konstantinos Katsos ,&nbsp;Dimitrios Kouzos ,&nbsp;Chara Spiliopoulou ,&nbsp;Theodoros Lytras ,&nbsp;Emmanouil I. Sakelliadis","doi":"10.1016/j.jflm.2025.103040","DOIUrl":"10.1016/j.jflm.2025.103040","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Medical law defines the rules of healthcare by specifying the rights of healthcare consumers while at the same time defining the obligations of healthcare providers. When clinicians fail to provide the standard of care, medical malpractice claims arise, leading to medical liability. While many malpractice claims allege deviation from the &lt;em&gt;lex artis&lt;/em&gt;, a substantial proportion do not ultimately establish negligence and are dismissed or settled without a finding of fault. Due to the significant impact of medical negligence on the quality of medical care, as well as on the domestic and global economy, different countries adopt different systems for managing these disputes. Finally, the mandatory or non-mandatory medical malpractice insurance makes doctors carry out their medical work without the fear of medical liability. In fact, in most countries today, doctors are given the opportunity to choose between claims-made and occurrence-based policies of medical malpractice insurance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;The study is a narrative review of scientific and legal works from different countries. For the comparison of medical liability systems and insurance policies a comprehensive review of databases and legal texts was conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This study compares medical liability and malpractice insurance systems across countries, examining variations in the handling of malpractice claims and their implications. The system is adversarial in many countries, especially in the United States, to allow for a substantial compensation, while other countries, such as the United Kingdom and Germany, focus on mediation and structured compensation processes. Notably, France, Japan and other countries follow a no-fault system, of reasoning that the system is more efficient in the sense that it reduces the patient's burden of proving negligence and thus expedites the compensation. These findings reveal how each country negotiates the balance between patient rights and healthcare provider protections, and, in turn, how these negotiations affect malpractice insurance costs and legal reforms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The analysis contrasts fault-based systems which offer large compensation awards with no-fault systems which focus on quick compensation but may lack accountability. Countries with high litigation rates like the US and Brazil have higher insurance costs, while countries like Canada and Australia have stabilized their systems through reforms. Medical liability insurance options, claims-made versus occurrence-based, raise different economic and legal concerns. Occurrence-based policies are more expensive for younger professionals, but they provide longer-term coverage than claims-made policies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Global medical liability frameworks vary considerably, reflecting cultural, economic and legal contexts. However, the compari","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103040"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145577826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An investigation of shored gunshot exit wound morphologies using a range of forensically relevant surfaces","authors":"Bandula Nishshanka ,&nbsp;Chris Shepherd ,&nbsp;Randika Ariyarathna ,&nbsp;Paranitharan Paranirubasingam ,&nbsp;Amila Rathnayaka","doi":"10.1016/j.jflm.2025.103035","DOIUrl":"10.1016/j.jflm.2025.103035","url":null,"abstract":"<div><div>Shored exit wounds are produced when the skin at the point of the bullet exit is supported or buttressed by some object or surface, causing an abraded ring around the shored exit wound. This work looks to add critical understanding of shored wound processes on a range of surface types, expanding on the currently limited literature that focuses only on soft shoring materials. This large empirical study was conducted to develop a deeper understanding of shored exit wounds for a range of common surface types available in contemporary urban environments. To facilitate this, two ammunition types (5.56 mm and 7.62 mm) were fired into a porcine model designed to simulate the downward force of a human body pressing into various modern building materials. The exit wounds produced by shoring the porcine model on wall tiles, concrete, and two engineered wood types (MDF and Melamine) significantly contrast with the existing, more generalised explanation of shored exit wounds. This highlights the necessity for a more valid, target-type-specific approach to interpreting shored exit wound characteristics. The study highlights that hard-shoring surfaces produce comparatively larger exit wounds, while irregular surfaces give rise to increased shoring and soft surfaces under pressure, produce less shoring. It also reports novel shored exit wound features and wounding mechanisms not documented previously that have potential forensic investigative value in helping determine if a gunshot wound has resulted from a shored scenario or not. While significantly adding to the understanding of shored exit wounds for forensic pathology practice, the study's findings suggest that the shored exit wound characteristics can be interpreted according to different target types, such as yielding and non-yielding surfaces.</div></div>","PeriodicalId":16098,"journal":{"name":"Journal of forensic and legal medicine","volume":"117 ","pages":"Article 103035"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}