[Features of methodology for the formation of standard operational procedure in the practice of bureau of forensic medical expertise]

OBJECTIVE

To analyze and summarize data on formation and implementation in practice of standard operational procedures for developing algorithm to improve the quality management system of bureau of forensic medical expertise.

MATERIAL AND METHODS

Normative legal documents regulating principles of standardization in healthcare were studied. Literature was analyzed in PubMed, Google Scholar, eLIBRARY search engines in English and Russian languages on the issues of development and implementation of standard operational procedures in practice.

RESULTS

Data on using standard operational procedures as a standardization element in medical practice have been analyzed and generalized. Specific proposals for developing system of standard operational procedures, based on general principles for the creation of such documents, in forensic medical expert institutions have been proposed.

CONCLUSION

Suggested recommendations can be used in practice to develop new common standard operational procedures.

Strategies Employed by Forensic Community Mental Health Nurses to Resolve Difficulties in Supporting Offenders With Mental Disorders Under the Medical Treatment and Supervision Act in Japan

OBJECTIVE

This study aimed to identify the strategies used by forensic community mental health nurses to resolve difficulties in supporting offenders with mental disorders under the Medical Treatment and Supervision Act in Japan.

METHOD

Interviews were conducted with 13 nurses, and the data were analyzed using content analysis.

RESULTS

The study identified the strategies for difficulties in (a) assessing and managing risk potential of forensic service patients, (b) addressing offending behavior, (c) managing the transition of patients, (d) supporting patients to understand the impact of justice processes and applying knowledge of legislation to nursing, and (e) promoting the role of forensic community mental health nurses within the multidisciplinary team.

CONCLUSIONS

The findings can benefit and support forensic community mental health nurses' practices. The Japanese forensic community mental health nurses experiencing difficulties and providing home visits to patients can utilize the identified strategies.

Sexual assault and abuse committed against family members: An analysis of 1342 legal outcomes and their motivations

Background

Over the past years medical centres specifically addressed in gender-based violence have developed protocols for the collections of evidence useful in the courtroom, including accurate documentation of physical and psychological states of the victim and collection of samples. Previous studies showed an association between documented physical trauma and conviction but unfortunately, few studies in the recent literature analysed the factors that influence the legal outcome and final judgement. The present study focused on the elements that appeared of significance in the legal outcome, including medico-legal evaluation, source of the crime report and circumstance of the assault.

Methods

It was conducted a retrospective analysis of all the judgments issued by the Public Prosecutor’s Office at a Court of a Metropolitan Italian city regarding sexual and domestic violence, from January 1^st 2011 to 31st December 31^st 2015. Examination regarded the demographic information of the victim and of the defendant, information on the crime, the circumstances of the aggression and medical information retrieved. Sentences were subsequently divided into two categories based on the legal outcome (conviction vs acquittal) and the different characteristics of the two sub-populations were compared to verify if there were variables significantly associated to the judge’s final judgment.

Results

Over the 5 years taken into consideration, there have been 1342 verdicts regarding crimes of sexual violence (374 cases) and regarding abuses against family members or cohabitants (875): other 93 cases regarded both sexual violence and abuse. 66.3% ended in conviction of the offender and 33.7% in acquittal of the accused. Cases of conviction were more frequent when they involved: use of a weapon by the assailant, as well as if the assailant had a criminal record and had a history of drug abuse or other addictions; duration of proceeding less 22 months and a civil party involved; presence of clinical documentation together with other deposition in addition to victim’s deposition; also frequent episodes of violence and application of precautionary measures were associated to conviction.

Conclusions

Many factors seem able to influence the judge’s judgment, although clearly each case must be singularly evaluated. The mere presence of medical documentation, without the support of other sources of evidence, such as the victim’s statement or further declarations, however, is almost always not definitive for the verdict. Despite so, in cases where there are multiple sources of evidence, clinical documentation can provide useful elements and can give clues on the consistency between the history told and injuries observed.

Arsenic, Familicide, and Female Physiology in Nineteenth-Century America

Sarah Jane Whiteling was accused of fatally poisoning her husband and two children in Philadelphia in 1888. The case prompted public outrage over the appearance that Ms. Whiteling's motive was to collect life insurance. It was evident, however, that she was disturbed, raising a question of culpability. Dr. Alice Bennett, the first female physician in charge of an asylum, provided the defense with expert testimony on the defendant's mental state. Dr. Bennett, who had little forensic but much clinical experience, proposed a physiological theory of insanity among women with reproduction-related derangements. At that time, cultural ideas about "female poisoners" colored popular and journalistic perceptions of Ms. Whiteling. Familicide was considered unconscionable because a mother's duty was to nurture and protect her family. When Ms. Whiteling was convicted and sentenced to death, Dr. Bennett undertook a campaign for commutation. Her unsuccessful efforts to reduce culpability were followed by Ms. Whiteling's hanging in 1889, the first execution of a woman in Philadelphia since colonial times. This article recounts the Whiteling case, Dr. Bennett's involvement in it, and how it relates to what is known about familicide. It is argued here that Dr. Bennett was a pioneer in applying medical expert testimony to effect individualized mitigation.

Reform of the death investigation system in Japan

The autopsy rate in Japan is lower than that in other countries, and most death investigations have historically been conducted by police officers through external inspection. Although medicolegal autopsy was not performed during the samurai administration, the European death investigation system was adopted in the second half of the 19th century and judicial autopsy began in universities' forensic medicine departments. After World War II, the medical examiner system was introduced under US influence, but it was only adopted in certain areas. Further reforms were introduced in the 21st century-in 2012, two laws relating to death investigation were enacted: The Act on Promotion of Death Investigation (Promotion Act), which provided foundational principles and included measures for investigating the causes of death and identification of bodies, and the Act on the Investigation of Cause of Death and on Identification of Bodies Handled by the Police, which recommended a procedure for death investigation, including a new autopsy system.The Death Investigation Promotion Program was to meant to be decided by the government in 2014. However, the relevant Act expired after it ran out of time. Later, in 2019, the Basic Act for Promotion of Death Investigation, the successor to the Promotion Act, was passed. This Act is significant because it sets the basic foundational principle and imposes plans created by the government. However, it remains unclear how these measures can be implemented, so further discussion and financial investment are now required.

[Deaths that seem natural]

Every dead body is examined by a doctor to establish the manner of death. In the Netherlands, however, both the quality of post-mortem examinations and the number of autopsies carried out in a clinical or forensic setting are low. Not all causes of death can be determined by post mortem examination alone; the law should, therefore, be changed to allow a forensic physician to legally request additional investigations, such as a toxicological or radiological report, to ensure the detection of crimes such as murder. Additional investigation could increase the quality of post-mortem examinations, and might bridge the quality gap between full autopsy and a simple post mortem. The information obtained could, for instance, be informative for relatives in the context of hereditary research. Finally, to improve the quality of post-mortem examination and identify all cases of murder, it is of the utmost importance that there is sufficient focus on post mortem examination of the cadaver during medical specialist training.

Psychiatry and Fitness to Fly After Germanwings

In March 2015, a co-pilot flying Germanwings Flight 9525 deliberately pointed his airplane into a descent, killing himself, five other crew members, and 144 passengers. Subsequent investigation and review teams examined the incident and considered potential lessons to maximize air safety. In this article, aviation industry clinical leaders, including the U.S. Federal Air Surgeon and Chief Psychiatrist from the Federal Aviation Administration (FAA), along with a professional pilot and collaborating forensic psychiatrists, discuss suicide-by-plane, evolving themes related to public safety responsibilities for psychiatrists treating pilots, and forensic trends in pilot evaluation for medical certification from an aerospace psychiatric perspective. We explore how psychiatric aspects of pilot fitness and aviation safety are examined across perspectives, including unsafe acts, preconditions, organizational factors, and unsafe supervision. We explore practices for civilian pilots and offer information related to military pilot fitness. Lessons from Germanwings are presented, as is the need for increased support for pilots who might be concerned about revealing mental health challenges for fear of loss of medical certification and pilot employment. The Air Line Pilots Association Pilot Assistance Network is highlighted as one example of pilots supporting pilots to increase airway safety.

Current legal issues of conducting a forensic medical examination of newborns' corpses

OBJECTIVE

Introduction: Forensic medical examination is a mandatory investigative action in determining the causes of death of newborns. It is especially significant and occupies a key place in proving the corpus deliciti. The aim is to study the current legal issues of a forensic medical examination of newborns' corpses.

PATIENTS AND METHODS

Materials and methods: The study of legal and literary sources was carried out. The library-semantic and the content analysis methods were applied.

CONCLUSION

Conclusions: Forensic medical examination should also include questions regarding the mother of the newborn: whether she was healthy at the time of delivery; if the medical staff caused any harm to her or her child; if she had the necessary help before and during the childbirth, etc. Examination should be appointed if one of the parents has the desire, which must be expressed in writing in the form of a motion.

Medical evidence and proof of cause of death in Nigerian courts

Medical evidence has continued to be given and evaluated in Nigerian courts since Nigeria's independence from Britain. The attitudes of the courts have been largely varied against a background of the individual judge's appreciation of forensic science and who should be considered an expert witness. The prosecution and defence lawyers equally display limited knowledge of forensic science. This paper reviews some of the decided cases, the reasons for the verdicts, forensic concerns and recommendations for the improvement of the criminal justice system. There is need to improve the knowledge base of the bar and the bench.

[Autopsy legal under the law]

Only a physician specialized in forensic medicine is allowed to process a autopsy legal. The 2011 reform of forensic medicine aimed to homogenize and enhance thanatological practices over French state territory. According to the law, biological samples withdrawn during an autopsy can't be given back to the families after analysis(art. 230-30 CPP). Respecting the human body and restoring their physical aspect are mandatory by law (art. 230-29 CPP). After a autopsy legal, dead bodies must be given back to their relatives as soon as possible.

Judges' delivery of ground rules to child witnesses in Australian courts

Ground rules directions are given to children in forensic interviews to explain what is expected of them, and to reduce their tendency to acquiesce to erroneous or incomprehensible questions. Ground rules may also be necessary when children provide testimony in court. Drawing on research conducted for the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, the present study examined the use of ground rules directions delivered in court in 52 trials by 24 presiding judges in three jurisdictions to 57 child complainants (aged 7-17.5 years). Eleven categories of rules were identified. The number of words spoken to deliver each rule was counted, and grade-level readability scores were calculated as a proxy for the complexity of the ground rules. When judges asked comprehension or practice questions, the question types were coded. More than one third of the children (35%) received no ground rules directions from the judge; the remaining 65% received directions on an average of 3.5 types of ground rules out of a maximum of 11 types. While comprehension questions were common, practice questions were rare. Comprehension questions were most often presented in a yes/no format that implied the expected response, although this form of question is unlikely to provide an effective assessment of a child's comprehension. Neither the number of rules delivered nor the number of words used was related to children's age. Implications for children's court testimony are discussed.

Setting a minimum age for juvenile justice jurisdiction in California

Purpose Despite the existence of minimum age laws for juvenile justice jurisdiction in 18 US states, California has no explicit law that protects children (i.e. youth less than 12 years old) from being processed in the juvenile justice system. In the absence of a minimum age law, California lags behind other states and international practice and standards. The paper aims to discuss these issues. Design/methodology/approach In this policy brief, academics across the University of California campuses examine current evidence, theory, and policy related to the minimum age of juvenile justice jurisdiction. Findings Existing evidence suggests that children lack the cognitive maturity to comprehend or benefit from formal juvenile justice processing, and diverting children from the system altogether is likely to be more beneficial for the child and for public safety. Research limitations/implications Based on current evidence and theory, the authors argue that minimum age legislation that protects children from contact with the juvenile justice system and treats them as children in need of services and support, rather than as delinquents or criminals, is an important policy goal for California and for other national and international jurisdictions lacking a minimum age law. Originality/value California has no law specifying a minimum age for juvenile justice jurisdiction, meaning that young children of any age can be processed in the juvenile justice system. This policy brief provides a rationale for a minimum age law in California and other states and jurisdictions without one.

Conforming STOP Violence Against Women Formula Grant Program Regulations to Statutory Change; Definitions and Confidentiality Requirements Applicable to All OVW Grant Programs. Final rule

This rule amends the regulations for the STOP (ServicesTrainingOfficersProsecutors) Violence Against Women Formula Grant Program (STOP Program) and the general provisions governing Office on Violence Against Women (OVW) programs to comply with statutory changes and reduce repetition of statutory language. Also, this rule implements statutory requirements for nondisclosure of confidential or private information relating to all OVW grant programs.

The Clinical-Forensic Network of Styria as a pilot project: findings of the accompanying socio-scientific study

The clinical-forensic documentation of domestic violence and sexual offences should preferably be done shortly after the incident both under standardized and professional conditions in order to secure items of evidence for any legal proceedings in the best possible way. For this purpose, Austria's first low-threshold clinical forensic care unit was founded in 2008 in Graz. The resulting model project "Clinical-Forensic Network of Styria" (,,Klinisch-forensisches Netzwerk Steiermark") was developed to offer Styria-wide low-threshold facilities for forensic examinations, legally admissible documentation and securing of evidence. The need to pursue and extend this interdisciplinary network is obvious; this project may have a role model effect on the establishment of clinical-forensic networks in other federal states of Austria. In this regard, a high potential and an integrative effect on inter- and transdisciplinary network building are attributed to forensic medicine.

The Origin and Development of Medical Jurisprudence in Xiangya

The origin of medical jurisprudence in China can be traced back to as early as 1920s, and since then, the discipline has undergone a great development. This paper, based on the disciplinary development of medical jurisprudence at Xiangya School of Medicine, illustrates its evolution in three aspects covering the scientific and theoretic foundation, legal system and policy support. The current investigation reflected a glimpse of the modern forensic science in China, providing useful historical reference for the development of Chinese forensic science.

[About the role of subjective factors in forensic expertise]

The article examines the influence of subjective factors on the activities of a forensic expert. It is noted that to improve the objectivity and reliability of the findings of forensic experts is necessary to strictly observe the presumption of innocence, to develop guidelines for certain types of expertise, production of which is not carried out in the state forensic institutions, as well as carry out some other organizational and methodical activities.

[The new federal law in the light of forensic medical and legal proceedings]

The objective of the present study was the article by article analysis of the Code of administrative legal proceedings of the Russian Federation with special reference to the judicial-expert procedures with a view to enhancing the awareness of the readers with the new directions of activities of forensic medical experts in the law-courts. It is emphasized that a number of provisions of the Code have not been properly elaborated, nor have they been adequately coordinated with the standard regulatory acts concerning the analogous or related issues. It is concluded that the provisions of the Code pertaining to the activities of the forensic medical experts remain to be widely discussed in the public domain to provide a basis for the development of recommendations for the legislative correction of the selected articles of the Code.

[A critical review of applied criminology]

By reporting on a recent decision of the Regional Court (LG) of Marburg (Germany) calling attention to applied criminology, a concept still insufficiently considered in the administration of criminal justice, the paper argues that professional action in the execution of the sentence represents nothing else but applied criminology. Based on this assumption, the paper discusses practical diagnosis and correctional planning. Beyond that, the paper deals with the future of criminology. In the opinion of the author an important aspect for the future of criminology will be if it will be able to remain in touch with the world in which we live, as an independent empirical science. Applied criminology and its methodology constitute the link between science and practice.

Forensic Age Estimation

BACKGROUND

Forensic age estimation is requested by courts and other government authorities so that immigrants whose real age is unknown should not suffer unfair disadvantages because of their supposed age, and so that all legal procedures to which an individual's age is relevant can be properly followed. 157 age estimations were requested in Berlin in 2014, more than twice as many as in 2004.

METHODS

This review is based on pertinent articles retrieved by a selective search in the PubMed and MEDPILOT databases, supplemented by relevant recommendations and by the findings of the authors' own research.

RESULTS

The essential components of age estimation are the history, physical examination, X-rays of the hands, panorama films of the jaws, and, if indicated, a thin-slice CT of the medial clavicular epiphyses, provided that there is a legal basis for X-ray examinations without a medical indication. Multiple methods are always used in combination, for optimal accuracy. Depending on the legal issues at hand, the examiner may be asked to estimate the individual's minimum age and/or his or her most probable age. The minimum-age concept can be used in determinations whether an individual has reached the age of legal majority. It is designed to ensure that practically all persons classified as adults have, in fact, attained legal majority, even though some other persons will be incorrectly classified as minors.

CONCLUSION

Forensic age estimation lets courts and other government authorities determine the official age of persons whose actual age is unknown-in most cases, unaccompanied refugees who may be minors. The goal is to carry out age-dependent legal procedures appropriately in accordance with the rule of law. The minimum-age concept is designed to prevent the erroneous classification of minors as legal adults.

On manual laterality (handedness) in humans and its forensic significance - a literature review

Manual laterality (handedness) in humans has some significance for forensic practice where it is primarily employed in the form of handedness preference, based on a simplified three-stage classification (right-handed, left-handed and ambidextrous). In cases of homicide or suicide, the pattern of injuries, particularly cutting or stab injuries and gunshot wounds, may provide clues as to the perpetrator's handedness. In injuries inflicted by another person, the pattern of findings can in isolated cases allow to draw conclusions as to the handedness of the perpetrator. In self-inflicted injuries and suicide, the dominant hand is usually used either alone or as the lead hand. If it is found that fatal injuries were inflicted by the non-dominant hand, this gives rise to doubt that the manner of death is suicide. Evidence of handedness is of little value in distinguishing between suicide and homicide. Due to new developments in dentistry, imaging procedures and especially genetics, the utility of handedness in the identification of unknown persons or cadavers has significantly diminished. In living subjects, useful evidence of handedness can be obtained by observing the performance of specific gestures or activities. The subject should be asked to perform tasks involving one and two hands in a specific sequence. Standardised measurements of the morphology of the shoulders and upper extremities are able to make a statistical distinction between right and left. Since the accuracy of this process is, however, only,around 75 %, morphological determination of handedness should not be used in living subjects, but should be restricted to the identification of unknown cadavers or other post-mortem examinations.

Necessity of including medico-legal autopsy data in epidemiological surveys of individuals with major trauma

BACKGROUND

It is rare that epidemiological surveys of patients with major trauma include both those admitted to the emergency department and those sent for medico-legal autopsy. The main aim of the present population-based study of major trauma was to examine the importance of medico-legal autopsy data.

METHODS

A new injury severity score (NISS)>15 or lethal outcome was used as criteria for major trauma and to identify patients at the emergency, anaesthesiology and forensic departments and/or being within the jurisdiction of the Malmö police authority and subjected to a medico-legal autopsy between 2011 and 2013. According to Swedish legislation all trauma related deaths should be reported to the police who refer these cases for medico-legal autopsy.

RESULTS

Among the 174 individuals included, 92 (53%) died and 81 (47%) underwent medico-legal autopsy. One hundred twenty-six patients were primarily admitted to hospital and 48 died before admission to hospital and were sent directly for medico-legal autopsy. Forty-four in-hospital deaths occurred, of whom 33 (75%) were sent to medico-legal autopsy. In those sent directly to the department of forensic medicine the proportion of accidents was lower (p<0.001), self-inflicted injuries higher (p<0.001) and gunshot wounds higher (p=0.002) in comparison with those sent to hospital. The most prevalent drugs detected by forensic toxicology screening in the 81 fatalities were ethanol (20%), sedatives (16%), anti-depressives (15%) and illicit narcotics (9%). Forty-four cases (54%) were positive for at least one drug, and twenty-eight cases (35%) were positive for two or more drugs. Factors associated with a lower rate of medico-legal autopsies among trauma-related deaths at hospital were high age (p<0.001), lower NISS (p<0.001), a longer duration between trauma and death (p<0.001), falls (p=0.030) and trauma-related infections (p<0.001).

CONCLUSION

This population based study covering clinical and forensic data shows that more than half of the individuals sustaining major trauma died. An additional 25% of the in-hospital fatalities should have undergone medico-legal autopsy according to legislation, but did not. The high proportion of positive toxicological findings among fatalities examined at medico-legal autopsy implies that toxicology screening should be routine in major trauma patients, in order to improve treatment and prevention.

Mimics of child abuse: Can choking explain abusive head trauma?

Choking is one of the alternative explanations of abusive head trauma in children that have been offered in courtroom testimony and in the media. Most of these explanations - including choking - are not scientifically supported. This article highlights four points. (1) The origins of choking as an explanation for intracranial and retinal hemorrhages are speculative. (2) Choking has been used in high profile court testimony as an explanation for the death of a child thought to have been abused. (3) A case report that proposes choking as an alternative explanation for the death of a child diagnosed with abusive head trauma includes omissions and misrepresentations of facts. (4) There was a decision by the editor of the journal that published the case report that it was not necessary to include all the facts of the case; moreover, the editor indicated that facts are not required when presenting an alternative explanation. The use of scientifically unsupported alternative explanations for abusive head trauma based on inaccurate and biased information constitutes further victimization of the abused child and represents a travesty of justice.

The General Approach and Management of the Patient Who Discloses a Sexual Assault

The effects a sexual assault on a survivor can be profound and multifaceted. Some of the aftermath may include bodily and/or anal/genital injury, sexually transmitted infection (STI) or disease (STD), post-traumatic stress disorder (PTSD), depression, suicidal ideation, and pregnancy. There is no typical experience or survivor response. So, if a survivor presents to the Emergency Departments for care, it is imperative for healing that the response is stabilizing, coordinated, and compassionate. Immediate needs of a survivor of sexual assault include: medical and/or psychiatric evaluation and stabilization, activation of community advocacy to the bedside, mandated reporting as directed by state statutes, offering and conducting (if desired by the survivor) the Sexual Assault Forensic Exam (SAFE), collaboration with law enforcement (if desired by the survivor), prophylactic medications for STI and STD, pregnancy risk evaluation and care and safe discharge planning.

Acceptance of forensic imaging in Israel

BACKGROUND

Forensic imaging was officially introduced in Israel in 2011. Religious and cultural opposition to autopsies prevails in most of the population of Israel.

OBJECTIVES

To examine the extent to which forensic imaging has been accepted as an adjuvant or partial replacement of forensic autopsy, particularly among those opposed to forensic autopsy.

METHODS

The study was conducted in the pediatric population. Data were collected from the National Center of Forensic Medicine and Assaf Harofeh Medical Center during the 18 month period following the introduction of forensic imaging (group A). The data were compared to those of the previous 18 months (group B). The examined parameters were cases submitted, examined, autopsied or imaged depending on family consent.

RESULTS

Consent to autopsy was similar in both groups (A = 56% vs. B = 54%). In group A, consent for imaging was 24% of all cases, and of those imaged 77% underwent autopsy. Of those examined externally only, 16% consented to imaging. For 7% of the total cases in group A, estimation of cause of death was based on virtopsy alone.

CONCLUSIONS

In a country with a high level of religious and cultural opposition to autopsy, it is a challenge to add forensic imaging to the pediatric forensic investigation. Those consenting to forensic imaging are more likely to be those consenting to autopsy. Consent for forensic imaging only was given in 7% of cases. Greater efforts should be invested to educate and inform the public regarding the benefits of virtual autopsy and the importance of data acquired from forensic images.

[On the classification of the failure to render medical assistance to the patient]

The authors propose the classification of the failure to render medical assistance to the patient. At present, much attention is given to the analysis of drawbacks in the provision of medical care to the victims of various human activities. A variety of classifications of these disadvantageous practices have been proposed. However, they either only casually deal the problem of failure to render medical assistance to the patient or totally disregard it. The necessity to develop the new classification of the failure to render medical assistance to the patient arises from the formulation of article 124 of the Criminal Code of the Russian Federation that requires to evaluate the severity of harm to the health of the patient resulting from the inaction of the person(s) obliged to provide the necessary medical aid.

[The criteria for appointing experts in forensic medicine]

In the Czech Republic, forensic medicine is an independent medical field, in which physicians with the appropriate attestation perform expert activities, especially in criminal proceedings, after being formally appointed by a regional court. In order to improve the quality of the activities provided by these experts, the Ministry of Justice is endeavouring to tighten up the general conditions for the appointment of new forensic experts. The individual criteria do not, however, take into account the special nature of forensic medicine as a medical field, the very essence of which involves the specialist qualifications which are necessary for the provision of expert opinions, most frequently to the police. In particular, the introduction of a strict requirement for ten-years of work experience after leaving medical school has hindered and stalled the entrance of young physicians with completed post-graduate studies into the area of forensic medicine. An inquiry sent to the regional courts has discovered that the average length of work experience for newly appointed experts in the period from 2004 to 2013 was 8.2 years, that half of them had work experience of seven years or less and that 75 percent of the newly appointed experts did not meet any set requirements for the length of their work experience at the time of their appointment. The new conditions may have a negative impact on attracting qualified graduates to forensic medicine after the completion of their medical studies and in the long term it may endanger the ability of the field of forensic medicine to provide expert opinions in criminal proceedings. In conclusion, it is the authors opinion that the appointment conditions should be set in cooperation with the professional medical associations and that they should take into account the specific characteristics of the individual medical fields, especially if they are to be set directly by means of a legal regulation within the framework of the recodification of the standing of forensic experts in the Czech Republic.

KEYWORDS

forensic medicine - expertises - criminal procedure.

[TO CURE THE APPARENTLY DEAD. NOSOLOGY AND MEDICAL RESUSCITATION IN ITALY(XVIII CENT.)]

The first specific techniques and triages for medical resuscitation developed in the XVIII century, specifically to rescue the drowned persons. The topic of resuscitation in strictly connected to the theme of the apparent death, to the dread of the "buried alive", to the progress of forensic medicine and to the administrative and legislative policies. The contribute aims to focus on the contribution of the medical and pathologic nosology about the conception of the apparent death, read as asphyxia.

RELIGION AND DISASTER VICTIM IDENTIFICATION

Disaster Victim Identification (DVI) is a triangle, the components of which are secular law, religious law and custom and professional methods. In cases of single non-criminal deaths, identification often rests with a hospital or a medical authority. When dealing with criminal or mass death incidents, the law, in many jurisdictions, assigns identification to the coroner/medical examiner, who typically uses professional methods and only answers the religious requirements of the deceased's next-of-kin according to his personal judgment. This article discusses religious considerations regarding scientific methods and their limitations, as well as the ethical issues involved in the government coroner/medical examiner's becoming involved in clarifying and answering the next-of-kin's religious requirements.

[The validity of proofs in demonstrating risk and in research into the causal connection of occupational diseases]

The verification of the occupational origin of a disease is a forensic medical activity requiring: the confirmation of the existence and of the exact nosographic identification of the disease, as well as the type of work really performed, and the actual exposure to an effective occupational hazard during an adequate time, and finally a reconstruction of the causal relationship based on objective data. Checking the disease is essentially documentary, corroborated by direct survey by medical examination. The assessment of exposure to the occupational hazard must be scrupulous also, not being acceptable the medical history alone: that is, it does require documentary evidence. Finally, the logical process of recognition of causation requires the application of rigorous forensic medical methodology, with references to current scientific knowledge, and the application of legal criteriology from the legal field of law in which you are moving. Indeed, forensic medical methodology is not the same of epidemiological one: probability of occurrence of an event is not a proof, but only a circumstantial element. A forensic medical doctor organizes every evidence and circumstantial evidence in a unique decision-making process, as a result of a logical process, and probabilistic data can be among circumstantial evidence, but they must suit the case in details, in order to reach the so called "logic probability". But this doesn't mean that you have "proven" the occupational origin of a disease. In the "demonstration" of a fact you use the same forensic medical methodology (thus referring to classic criteria: temporality, biological gradient and plausibility, topographical, exclusion, and phenomenal continuity if suitable, too), and also the same general scientific references, nevertheless the law can be different in causality principles admitted (the principles governing the causal link are the same in Criminal Code and Civil law both, but they differ in private insurance), and besides there is a different rule of evidence, that is the "quantum of evidence" required (the amount of evidence needed) and, secondarily, also a different quality of proof required (how reliable such evidence should be considered, and which types of evidence admitted). Therefore in Civil law you can reach a "procedural truth" different from the one in Criminal law, and various from the one needed to prevail in litigation with social security insurance or with private insurance.

Autopsy findings in bodies repatriated to the UK

Following the death of a British National on foreign soil, a primary investigation is conducted by the authorities of that country; HM Coroner and the United Kingdom police have no jurisdiction to conduct investigations abroad. Upon repatriation of a body, the legal investigation in the UK remains largely unchanged since the publication of the "harmonisation of medico-legal autopsy rules" (1999) and the passing of the Coroners and Justice Act (2009). We identified 44 cases within a 10-year period. An invasive autopsy had been performed abroad in 25 cases; an autopsy report was received prior to UK autopsy in one case. Seven cases showed incomplete evisceration; the absence of part or whole organs was recorded in 11 cases. Toxicology was performed abroad in five cases. Recurring technical difficulties related chiefly to embalming, including difficulty with dissection and noxious fumes. When an autopsy had been performed abroad, the time to UK inquest was prolonged by an average of seven months. A verdict of unlawful killing was returned in nine cases. The discussion expands on these issues, and attempts to offer reasoned explanation where possible. Two cases are used as exemplars to highlight difficulties to both the pathologist and Coroner. This casework remains rare but the potential problems include: absence of tissue; lack of information; technical difficulties; and a disproportionately high number of unlawful killings, making clear the need for experience and caution when making the post mortem examination.

[Application of microperimeter in the visual function evaluation]

In condition of direct vision on hindus of eye, microperimeter can quantitatively detect the retinal light sensitivity of macular area, and record real time tracking of the eye, automatically analyze the location and stability of fixation. Microperimeter matches hindus image with micro cyclogram point-to-point, thus it achieves the combination of visual function and structure. The characteristics of microperimeter have good relations with subjective vision, so it can be a new method for the accurate vision evaluation and has application potential to assess the visual function in legal medicine. In this article, we summarize the principle, method and parameters of microperimeter. Also, the applications of microperimeter in vision assessment are focused in order to provide a reference for the assessment of visual function in the legal medicine.

Child sexual abuse--Medical statement conclusions in criminal legal process

OBJECTIVES

To evaluate medical statement conclusions in the criminal-legal process in suspected cases of child sexual abuse (CSA).

STUDY DESIGN

An observational study of a random sample of 130 medically examined, police reported CSA suspected cases during 2001-2009. Medical statements were evaluated and their conclusions were analyzed with an end-point in the legal process. The data consists of official investigation documents from the University Hospital records, the Police, crime laboratories, the State Prosecutor, and the Courts of Law.

RESULTS

The median age of the children was 5.3 years (range 11 months-17.3 years) at the time of the suspected sexual abuse. In most cases (76.2%, 99/130) medical statement conclusions neither supported nor excluded the suspicion of CSA. Twenty-one (16.2%) medical statements supported and in 10 cases (7.7%) the conclusion did not support the suspected CSA. Of the suspected CSA cases a hundred (76.9%) proceeded to the Prosecutor. The charge filing rate was 41.5% (54/130). The final conviction rate was 30.8% (40/130) and 74% in the charged cases. Medical statements were mentioned as evidence in the Prosecutor's decision to file charges in 18 (33.3%) of suspected CSA cases and in 15 (36%) of verdicts. A child's clear disclosure of CSA (p<0.001) and medical statements (p=0.037) had a significant role in decision making on convictions.

CONCLUSION

In medical statement conclusions, physical findings with proper documentation and interpretation are needed to avoid misunderstandings in the legal process. The present study supports a routine medical statement peer review to minimize the risk of neglect caused by lack of knowledge among authorities working with sexually abused children.

[The topical issues of road traffic injury emerging from the publications in the journal "Forensic Medical Expertise" for the period from 1958 to 2012]

The results of the sientometric analysis of the publications in the journal Sudebno-meditsinskaya ekspertiza (Forensic Medical Expertise) for the 55 year period (from 1958 to 2012) was used to evaluate the information support of scientific research and practical observations of forensic medical experts concerning the topical issues of road traffic injury in this country. The authors performed the search for the relevant publications which revealed 165 articles that were classified and grouped with a view to their systematic assessment for the enhancement of the effectiveness of research work and practical activities of specialists concerned with forensic medical traumatology with special reference to road traffic injury. The present paper is a preliminary communication to be followed by a series of further publications containing the results of in-depth sientometric analysis of the articles published by specialists in injury cases involving cars, trains, and airplanes in the journal Sudebno-meditsinskaya ekspertiza.

Brain trauma, PET scans and forensic complexity

Positron Emission Tomography (PET) is a medical imaging technique that can be used to show brain function. Courts have admitted PET scan evidence in cases involving brain damage, injury, toxic exposure, or illness ("brain trauma") and to support claims of diminished cognitive abilities and impulse control. Despite the limited data on the relationships between PET, brain trauma and behavior, many courts admit PET scan evidence without much critical analysis. This article examines the use of PET as proof of functional impairment and justification of abnormal behavior by explaining its diagnostic use and limitations, the limited support for claims of its relationship to behavior, and evidentiary considerations that should govern its admission into court as evidence. The authors urge courts to consider PET evidence, claims of experts, and the scope of the proposed testimony with greater deference to the clinical scope of PET, as outlined by the American College of Radiology's appropriateness criteria and the Working Group Report of the American Psychiatric Association.

[The inexpediency of using the term "iatrogenicity" in expert and legal practices]

Various contradictory definitions of "iatrogenicity" are considered. Bearing in mind the absence of the universally recognized interpretation of this concept, the authors believe it nappropriate to use the term "iatrogenic" in expert and juridical practice.

[The state of forensic medical expertise of civil cases concerning medical disputes]

It is concluded that the current state of forensic medical expertise of civil cases concerning disputable issues, such as causing harm to health in medical practice, does not meet the requirements of the relevant legal procedures.

[Trial helplessness of defendant healthcare facilities in cases concerning nosocomial infections]

The number of pecuniary cases involving patient claims due to nosocomial infections has been increasing for many years, and with it, the amount of adjudged compensations has also been increasing. In this situation, it is important for defendant healthcare facilities to implement a proper policy, both before the trial and during the court proceedings. Unfortunately, as a rule, defendant facilities commit a variety of errors, such as: wrong strategy, inability to cooperate on the part of those involved in the matter and improper preparation and usage of evidence. The result is that the risk of unfavorable assessment of the case increases significantly.