General practice trainees' understanding of post-sexual assault care: the impact of a specialist educational intervention

BACKGROUND

Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees' knowledge of and comfort with post-SA care.

METHODS

Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants' knowledge and comfort levels with subject material. Significance was set at p-value below 0.05.

RESULTS

Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees' comfort levels in explaining a forensic examination (p < 0.0001), referral pathways to a SATU (p < 0.0001) and offering advice in relation to emergency contraception (p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) (p < 0.001) and forensic examination (FE) time-lines (p < 0.001).

CONCLUSION

This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review

BACKGROUND

Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies.

AIMS AND OBJECTIVES

We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed.

METHODS

Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms.

RESULTS

Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized.

CONCLUSIONS

This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.

Female perpetrated sexual assault: a review of attendances to the national sexual assault treatment units in the Republic of Ireland

BACKGROUND

Female perpetrated sexual assault is under-represented in sexual assault research, and indeed possibly an underreported crime. The aim of this study is to address the lack of comprehensive data in relation to female perpetrated sexual assault attendances to the national sexual assault treatment unit network in the Republic of Ireland.

METHODS

This is a cross-sectional study analysing the attendances of female perpetrated sexual assault attendances at the six sexual assault treatment units in the Republic of Ireland between 1 January 2017 and 31 December 2022.

RESULTS

There were 95 attendances where the assailant (or one of the assailants) was identified as female. 62% (n=59) of these attendances involved a solo female assailant, 3.2% (n=3) where it was a multiple assailant assault with only female assailants and 34.7% (n=33) cases with male and female assailants. 74.7% (n=71) of victims identified as female, 24.2% (n=23) as male and 1.1% (n=1) as 'other'. The average age of attenders was 27.0 ± 10.7 years old. 54.7% (n=52) of attendances were within 72 hours of the assault. 52.6% (n=50) of these underwent a forensic examination. 30.5% (n=29) of incidents occurred in the assailant's home. 23% of assailants were described as a friend of the victim/survivor. 34.7% (n=33) sustained bodily injuries (genital and/or extra-genital).

CONCLUSION

Female perpetrated sexual assault is a distinct entity when analysing attendances to the national sexual assault treatment unit network, representing just under 2% of all attendances. We have shown that those who experience these assaults are likely to be female, be assaulted by a single female perpetrator who is known to them and attend a sexual assault treatment unit within 72 hours of the assault. Awareness of the characteristics of these attendances will ultimately allow us to develop appropriate supports for these victims/survivors and to raise awareness of this type of crime.

Male patient attendances at Sexual Assault Treatment Units in Ireland: An analysis of 381 cases and a comparison with female patients

BACKGROUND

Sexual violence is a crime that affects people of all genders. While focus is frequently on female survivors, it is crucial to acknowledge that males also experience sexual violence and to ensure that gender-sensitive services are available to all survivors. Understanding the prevalence of, and factors associated with, sexual violence against males is a critical first step in addressing this issue. We aim to address the lack of data in relation to sexual violence against males.

METHODS

A cross-sectional study of all male attendances at 6 Sexual Assault Treatment Units (SATU) in the Republic of Ireland over a 6-year period and, where applicable, comparison with corresponding female attendances.

RESULTS

There were 381 male attendances with an average age of 28.5 years over the study period, representing 7 % of all SATU patients. There was a 24 % increase in male attendances during the study period. 39.1 % presented within 24 h of the assault. 61.9 % reported the crime to the police. Employment status included 37.3 % employed, 24.9 % unemployed, and 26.2 % students, with 86.7 % being Irish nationals. Most incidents occurred on weekdays (53.3 %) and at night (56.7 %). Referrals were primarily from police (55.9 %), and psychological support was provided in 62.3 % of cases. Alcohol (60.4 %) and illicit drugs (20.5 %) were reported before assaults. 18.6 % suspected drug-facilitated assaults. Male assailants constituted 90.1 %, with 13.9 % involving multiple assailants. Male attenders were significantly more likely than females to be assaulted in their assailant's home and to be assaulted by more than one assailant. They were significantly less likely than females to report the crime to the police or to have consumed alcohol.

CONCLUSION

To our knowledge, this is one of the largest case series of male patients attending a sexual assault treatment service to be published in the international literature. Male patients are a distinct group that are increasingly accessing SATU services. Significant differences exist between male and female patients' reported experiences of sexual violence. Knowledge of these factors will support appropriate tailoring of treatment & service provision, prevention and awareness strategies to help modify the impact and reduce the incidence of sexual violence in this cohort.

The impact of COVID19 pandemic and government enforced lockdowns on levels of attendance and context of sexual assaults reported at Saint Marys Sexual Assault Referral Centre

Globally, government enforced lockdowns were one measure introduced to reduce the transmission of COVID-19. The impact of these social movement restrictions on victims of sexual assault and their access of sexual assault services needed clarity. This study aimed to understand the impact of COVID-19 pandemic lockdowns on: Sexual Assault Referral Centres (SARC) attendance; characteristics of clients; characteristics of alleged perpetrators and nature of sexual assaults. Routinely collected data from the Saint Mary's SARC in the North West of England over two financial years, April 2019-March 2020 (pre-COVID-19) and April 2020-March 2021 (during COVID-19), were analysed. Compared to the pre COVID-19 year, monthly SARC attendance for children and adults decreased during national lockdowns and increased as restrictions lifted. Ethnicity of clients was significantly different during COVID-19 with more South Asian adults and more bi-racial children attending. Attendance of adults aged over 57 years also significantly increased during COVID-19. A significant increase in adults meeting alleged perpetrators online and a significant decrease in alleged perpetrators being a sex worker client were also identified. Finally, a significant increase in not-recorded data for health characteristics of adult and child clients was noted. While this study has illuminated some changes in the vulnerability profile of clients attending SARC during COVID-19 and its associated lockdowns, it has also highlighted shortcomings in changes to usual care introduced in the challenging and changing context of a global pandemic. These findings in parallel usefully recommend areas in need of service improvement.

Density estimations and comparisons of a fragmented single fiber using X-ray computed tomography

A commercial X-ray computed tomography (CT) apparatus using a quasi-monochromatic beam was utilized for density estimations and comparisons of a fragmented single fiber. The validation of quasi-monochromaticity of the X-ray source was investigated by radiograph measurements. For the case of a transmittance higher than 50%, the contribution of Cu Kα characteristic X-rays was dominant. To realize a sufficient statistical quality, an attempt to increase the number of averaged voxels was demonstrated using the neighboring slices of the 3D-CT image. A minimum value of the coefficient of variation (CV) was achieved using multiple images rather than using a single image. The observed values of the inverse of the transmitted X-ray intensity (CT value) of the polymers showed a fairly good relationship with their density. An analytical curve derived from measurements of reference samples of known densities could provide the relative density of an unknown fragmented fiber down to the size of 30 μm in diameter and 35 μm in length. The CV of the estimated density was from 1.5 to 2%, which was estimated from the CV of CT values. Moreover, the correlation of CT values was improved with the linear absorption coefficient than the density. A better performance of discrimination of polymers including fibers might be realized with the difference of linear absorption coefficients for X-rays.

The value of the defence postmortem examination in England and Wales

The defence or second postmortem examination is instructed by the defence legal team, per defendant, following an initial postmortem examination performed by a Home Office registered forensic pathologist. The obscure origin of this practice has allowed it to proceed as a matter of routine in English and Welsh culture, in stark contrast to international jurisdictions. The Chief Coroner's Guidance (2019) describes a change in perspective from the Home Office Circular 30 (1999) in which a presumed right to request a second postmortem examination is replaced by a process of heavy scrutiny, favouring a paper-based desktop review of the evidence. The reasons for supporting this seismic change in practice are numerous, from the limited evidential value attained to undue distress experienced by the decedent's family. Whilst it remains imperative for accused persons to examine and test the evidence, this can often be objectively and robustly enacted without a second invasive examination. Any paradigm shift takes time, and may be met with resistance, particularly when the culture is established at all levels of the legal system in which it exists. We discuss the reasons why this shift in practice is necessary to best serve both the defendant and the decedent.

Patho-mechanical comparative morpho-characterization of contre-coup injuries of liver by cadaveric experimental simulation for medico-legal and forensic implications

BACKGROUND

Liver is the most common organ to get injured in cases of blunt force trauma to the abdomen (BFTA). It is the 2nd commonest organ after brain to sustain injuries out of all the trauma related fatalities. However, the literature about contre-coup injuries to the liver due to BFTA is scarce in-spite of the high mortality rates seen out of injury to this particular organ.

PURPOSE

The authors intended to systematize the characteristic morphogenesis of the contre-coup injuries of the liver on the basis of the patho-mechanics involved in various types of BFTA.

METHODOLOGY

One hundred and sixty three cases of BFTA were identified, and interpretation was attempted for the contre-coup rupture of the liver seen in twenty out of all the trauma related fatalities that presented for post-mortem examination during the study period. However, the mechanics of the pattern of the rupture injuries to the liver were indiscernible. This motivated the authors to conduct the comparative characterization of injuries to the liver by experimental simulation of BFTA after necessary permission via inflicting pre-calculated forces on unclaimed cadavers.

RESULTS

The patterns of contre-coup rupture/s of liver were established in all the twenty-eight out of one sixty-three cases of BFTA. The rupture depicted patterns of injury in the situations of - 1) strong hits with a limited surface trauma, 2) very strong hits with a generalized surface trauma, 3) and collision with a solid surface resulting due to fall onto the side of the abdomen. The causative mechanism discerned was deformation of the liver, followed by its parenchymal rupture due to the shear and strain types of force/s consequent upon tissue compression. The minimum force and energy of impact required for the liver to rupture was estimated to be 2000 N and 141.5 J.

CONCLUSION

This series of the simulation experiments revealed two variants of liver rupture in the contre-coup impact zone. The pattern of injury was maintained in cases, those studied at post-mortem examinations, but the relief ruptures were found to vary depending upon the overall mechanics of the traumatic forces involved in the simulation experiments performed on the cadavers. The anti-shock ruptures were formed during shock trauma, and shockproof ruptures were not seen in cases of underlying compressive forces. The morphogenetic characterization of the relief rupture surface of the liver was also delineated in relation to its surface orientation to the spine on the basis of the terms "large" and "very large" depicting the quantum of force/s delivered out of an impact or blow.

Sexual Assault of Women in the region of Kairouan, Tunisia: an 8-year retrospective study on epidemiological and medicolegal characteristics

BACKGROUND

Despite the abundance of studies reporting the prevalence of women's sexual abuse all over the world, there is a real lack of such reports in developing countries in general and Arab-Muslim societies in particular. However, due to the little number of published studies in Tunisia, and the absence of a national database, data on female sexual assaults are still underestimated, which is a gap that needs to be filled in order to make specific preventive actions. We aim to identify the pattern of female victims of sexual abuse in the governorate of Kairouan (Tunisia) in order to provide recommendations for prevention.

METHODS

Retrospective data were collected on all-female sexual assault victims, particularly rape, presented to the Department of Forensic Medicine of the University Hospital Ibn El Jazzar of Kairouan (Tunisia), during an 8-year period, from 2009 to 2016.

RESULTS

Two hundred and sixteen victims were included. Age ranged from 3 to 82 years with a mean age of 20.4 years. Victims were single in 84.3%, unmarried in 90.7% and they lived in rural areas in the majority of cases. Rape was committed by a single individual in 94.9% of cases, and the assailant was a stranger in only 26.8%. The assault occurred most frequently in the assailant's home (73.6%) or the public places (11.6%). Evidence of recent acute general body trauma was found in 41.2% of the victims, and the most common injuries were located on the thigh, upper arm, and chest. In 28.1% of the cases, injuries were seen in the face and the neck. Genital examination showed that 188 victims (87%) had a tear in the hymenal membrane and only 13% of victims had intact hymenal membrane. A complacent hymen was noted in 2.3%. A recent anal lesion was seen in 8.3% of the cases. Cytology was performed on 78 victims. In 22 cases (28.2%), sperm could be detected in vaginal swabs up to 3 days post-assault, and pregnancy was seen in 7.4% of assault victims.

CONCLUSION

Sexual abuse represents a human rights and public health problem that is thriving in a culture of silence, particularly in the Arab region. There is a particular need to create a Tunisian national database on female sexual assaults, in order to centralize data and provide holistic follow-up for specific preventive measures. Finally, efficient management of such cases will need, in addition to legislation, a partnership between the various actors involved in taking care of the victims (health care professionals, the police, social specialists, and psychologists). In addition, civil societies are key partners to break the silence, support this issue, and raise awareness.

Forensics in motion - Historic vehicles, genuine or fake?

In-depth forensic investigation and analysis of historic vehicles is a relatively new field of research. However, such examinations are becoming an important tool in the face of rising market values and the associated increase of manipulations and forgeries. We review various forensic approaches used in our interdisciplinary work in this field, including vehicle specialists, metallurgists, restorers, and archaeometry laboratories. The related investigations cover a general examination of the vehicle including detailed analysis of its materials and construction techniques, which are cross-referenced with the techniques and materials used in period. We illustrate our theoretical and analytical approach with practical examples from our work on collector vehicles. Finally, we consider methods and approaches currently under development.

A retrospective observational study of genital findings in adult women presenting to a New Zealand Adult Sexual Abuse Assessment and Treatment Service following an allegation of recent sexual assault

OBJECTIVE

The aim of this study was to report on the prevalence of genital findings documented in women attending a forensic examination following an allegation of recent sexual assault. A secondary aim was to investigate for any associations between genital findings and variables related to population demographics and clinical factors.

STUDY DESIGN

A retrospective review of clinical records was undertaken for 593 women, aged between 17 and 45 years of age, who underwent a forensic examination within 72 h following an alleged sexual assault at the Pohutukawa clinic, adult Sexual Abuse Assessment and Treatment Service (SAATS) in Auckland, New Zealand over a four-year period. Statistical analysis to examine for any associations between any documented genital findings and subject variables was performed.

RESULTS

The key finding was that 66.4% (394/593) of the women had a normal genital examination. Of the 182 women with genital findings the presence of skin disruption and/or bruising was noted in 21.1% (125/593) and non-specific findings in 9.6% (57/593). 17 women were not included as the genital examination was incomplete. For 9.5% (56/593) of women the presence of abnormal genital skin was documented. From the adjusted odds ratios obtained by multivariate analysis there was a statistically significant association between the presence of genital findings and abnormal skin condition (OR 3.13, p = 0.0004).

CONCLUSION

The study demonstrated that the majority of women seen within 72 h of an alleged sexual assault had a normal genital examination. Given the strength of the association between the presence of genital findings and skin condition, we recommend that documentation of the genital skin condition should become a routine part of a forensic examination following sexual assault. This is particularly important if genital findings are present, in order to present the full complexity of clinical examination findings to the court and provide an expert opinion regarding the limitations of attributing causation.

Rapid detection of 17β-estradiol based on shaddock peel derived fluorescent aptasensor for forensic examination

17β-estradiol (E2) detection technique had been shown to a potent method for identification of female blood in forensic practice since it was abundant in the healthy female body. Herein, we developed a fluorescent aptasensor based on carbon quatum dots (CQDs) derived from shaddock peel green synthesis for rapid detection of E2 as a useful auxiliary tool of forensic examination. The CQDs conjugated to the aptamer achieved fluorometric detection of E2 in blood and the blood of healthy female from 12 to 60 years old could be sensitive detected with the limit of detection of 0.025 ng/ml, and the analytical process could be completed within 10 min. The aptasensor was also used to assay E2 in forensic samples including blood and blood stain. In all instances, the results were positive when mixed samples involving female sample. This fluorescent aptasensor was proved to be a green, rapid and sensitive detection method of E2, and it exhibited great potential in discrimination of female samples in forensic practice.

Feasibility Studies of X-Ray Computed Tomography for Forensic Examination of Single Fibers

Non-destructive observations of cross-sectional shapes of acrylic single fibers using X-ray computed tomography (CT) were performed. A commercial X-ray CT apparatus (Rigaku nano3DX) was employed because of its micrometer-scale spatial resolution and remarkable image contrast for soft matter. We assessed two types of sample support, a paraffin strip and a nylon string, for single fiber samples in terms of easy handling and sample recovery. Fixed individual single fibers were loaded into a narrow polyimide tube in both cases, and the tube ensured that the sample remained in the field of view during the CT measurements. In both cases, the cross-sectional shapes of individual single fibers could be distinguished, with a circular shape for one sample and a triangular shape for the other. However, the support using a nylon string was found to be more suitable for further analysis. The cross-sectional profile of the obtained tomographic image showed a clear difference between polyimide and nylon. The intensity ratio or the image contrast corresponded to that of the local densities. It was also found that the effect of the artifact appeared at around the boundaries of the objects, but the local density could still be utilized for examining individual single fibers.

Police reporting in cases of sexual assault - a 10-year study of reported cases, unreported cases, and cases with delayed reporting

The aim of this study was to identify characteristics of reported, later-reported and unreported cases of sexual assault. All cases with female complainants (> 15 years) of sexual assault, who had been examined at the Centre for Victims of Sexual Assault (CVSA) in the Region of Southern Denmark in a 10-year period, were included. Retrospective data were collected from medico-legal examination reports and police reports. Descriptive bivariate analysis and logistic analysis were performed. Forensic pathologists examined 850 complainants of sexual assault in 2009-2018, of which 753 cases were included in this study. Of these, 191 cases (25%) were initially not reported to the police, but 53 women (7%) filed a police report, days, weeks or months later. There was a higher relative risk (RR) of not-reporting for young adults, for single women, if the accused was well known to the complainant, if the complainant experienced amnesia, or if there had been some degree of consensual physical interaction at time of the incident but before the assault. The non-reporters also showed a higher degree of delayed examination. The later-reporters only differed from the non-reporters in one parameter - they had a higher degree of partial amnesia. Interestingly, injuries (ano-genital or other) or verbal/physical resistance was not associated with reporting tendency, reflecting the modus of the local judicial system. The opportunity of a reflection period after a high-quality forensic examination, which is not dependent of police involvement, is essential for sexual assault complainants. Furthermore, education and guidance of victims and of the police and judicial system on the unique nature of sexual assault cases is important.

Sleep, waking and sleep inertia in sexual assault: A retrospective descriptive study

Women who wake from sleep during sexual assault commonly report confusion and disorientation. Confusion and disorientation, with impaired decision making after waking, are symptoms of 'sleep inertia', and part of the normal transition from sleep to full wakefulness which is maximal in the minutes after wakening and can be prolonged. In this study of 305 adult females (median age 26, range 18-68), who presented for a sexual assault forensic medical examination, 38 (12%) (median age 27, range 18-51) woke to find sexual acts already in progress. For 25 of these women (25/38 for 66%), an act of penile-vaginal penetration was already occurring when the woman woke. Of the 38 women (12%) who woke during the sexual assault, several had factors known to enhance the impairment of sleep inertia including forced arousal (38/38, 100%) and age under 25 (15/38, 39%). 17 (17/38 for 45%) of these women who woke had consumed varying amounts of alcohol prior to sleep and these 17 woke fully during the assault and then stayed awake. A further 16 women, (16/38 for 42%) woke during the sexual assault but returned to sleep during or after the assault, and all these 16 gave a history of intoxication by drugs or alcohol prior to sleep. Importantly 5, (5/38 for 13%) of the women who woke during the assault had consumed no intoxicating substances. A further 68 (23%) of the 305 women, (median age 26, range 18-58) had no memory on waking of the alleged sexual assault despite having other reasons to believe that a sexual assault had occurred. Forensic medical examiners can assist both the justice process, and patient care, by considering the possibility of sleep inertia among victims who report disorientation and slow or confused decision making on waking during a sexual assault.

Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females

BACKGROUND

Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases.

OBJECTIVES

To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables.

METHODS

We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted.

RESULTS

We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears.

CONCLUSION

External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.

Collection and storage of forensic evidence to enable subsequent reporting of a sexual crime to the police "Option 3"-an Irish experience

BACKGROUND

Sexual Assault Treatment Units (SATUs) provide holistic care, frequently including forensic examination, for people who disclose sexual violence. Storage of forensic evidence without reporting to An Garda Síochána (AGS), the Irish national police service (Option 3), was introduced in August 2016. This allowed attendees time to decide whether they wanted to report to AGS, without the loss of all forensic evidence.

AIMS

This paper presents a retrospective analysis of all "Option 3" cases including their subsequent disclosures to AGS, at the Dublin SATU, between 1 Aug. 2016 and 30 Jul 2020.

METHODS

The contemporaneous medical charts of Option 3 cases were reviewed and anonymised data extracted from them.

RESULTS

During the study period, there were 1258 attendances to the Dublin SATU. Of these, 10% (n = 127/1258) were Option 3. Ninety-three percent (n = 118/127) were female and 7% (n = 9/127) were male. The mean age was 26. Seventy percent (89/127) indicated a sexual assault occurred and 30% (38/127) were unsure. Twenty percent (n = 25/127) subsequently reported the incident to AGS, 60% (n = 15/25) within 7 days, and 80% (n = 20/25) within 1 month. Eighty percent (n = 20/25) of these reported cases had their evidence retrieved by AGS for analysis. Three percent (n = 4/127) requested that their evidence kits be kept for an additional year. None of these patients reported over that following year, and their evidence was subsequently destroyed.

CONCLUSION

In conclusion, the availability of Option 3 has afforded people the opportunity to access responsive SATU care including storage of forensic evidence which may have significant evidential value. This potentially provides further opportunities for comprehensive detection of a crime, even if reporting to AGS is delayed.

The forensic investigation of vehicle-pedestrian collisions: A review

Rapid urbanisation, a steady increase in the number of vehicles, speeding, negligence in road safety, and other factors have led to the inevitable worldwide growth of road traffic accidents involving pedestrians. According to the 'Global Status Report on Road Safety' released by the World Health Organization, road traffic collisions are one of the leading causes of death for people of all ages, with approximately 1.35 million road fatality deaths occurring globally each year. Figures from the report also highlight that a large part of road deaths involves pedestrians as the most vulnerable road users. Therefore, forensic examination of vehicle-pedestrian collisions has become increasingly important in the detection, investigation and reduction of road casualties and permanent development of this discipline is urgently needed. Thus, this article aims to review the capability and effectiveness of forensic examination in tackling road fatalities and explores the most important aspects of this discipline, such as nature of a vehicle-pedestrian collision, common issues resolved by this type of examination and typical physical evidence used in the reconstruction of vehicle-pedestrian collisions. Moreover, the paper outlines the latest advances and approaches in the field.

Mongolian spots as a finding in forensic examinations of possible child abuse-implications for case work

Mongolian spots (MS) are congenital dermal conditions resulting from neural crest-derived melanocytes migration to the skin during embryogenesis. MS incidences are highly variable in different populations. Morphologically, MS present as hyperpigmented maculae of varying size and form, ranging from round spots of 1 cm in diameter to extensive discolorations covering predominantly the lower back and buttocks. Due to their coloring, which is also dependent on the skin type, MS may mimic hematoma thus posing a challenge on the physician conducting examinations of children in cases of suspected child abuse. In the present study, MS incidences and distribution, as well as skin types, were documented in a collective of 253 children examined on the basis of suspected child abuse. From these data, a classification scheme was derived to document MS and to help identify cases with a need for recurrent examination for unambiguous interpretation of initial findings alongside the main decisive factors for re-examination such as general circumstances of the initial examination (e. g., experience of the examiner, lighting conditions) and given dermatological conditions of the patient (e. g., diaper rash).

Swipe right: the emergence of dating-app facilitated sexual assault. A descriptive retrospective audit of forensic examination caseload in an Australian metropolitan service

The use of dating 'apps' to facilitate real-word social encounters between strangers is culturally mainstream. Sexual assaults facilitated following dating-app meetings have been reported in the media, and anecdotally noted at increasing frequency by clinical forensic physicians. Limited empirical data suggests there has been a marked increase in real life sexual offences facilitated in this manner. There is little additional information known about the circumstances of these alleged incidents. This retrospective audit of a small forensic examination caseload from an Australian metropolitan clinical forensic medicine service identified that 14% (11 of 76) of alleged sexual assaults where complainants underwent a forensic examination were facilitated following a dating-app meeting. Further analysis of these cases identified that all complainants were female, most under 30 years of age. All alleged a single male perpetrator and in over half of the cases the complainant was impaired. In all cases where it was asked (n = 9), the alleged incident occurred at the first face-to-face meeting. More than half of the incidents occurred at the alleged perpetrator's private residence. Anogenital injuries were observed at the time of forensic examination in 60% of cases, and 70% had visible body injuries. There was no reported condom use. Only one complainant had no observable injury. This small case series quantified a high proportion of forensic sexual assault examination caseload as being facilitated by dating-app meetings, and identified some common features that may be characteristic of alleged sexual assaults occurring in this manner. The authors propose a larger prospective period of data collection at the time of forensic medical examination, to characterize the features of sexual assaults allegedly occurring following app-based meetings.

Understanding rates of genital-anal injury: Role of skin color and skin biomechanics

PURPOSE

A series of studies suggest that non-Hispanic White women have significantly more injuries than non-Hispanic Black women after sexual assault and consensual sexual intercourse. One explanation for this difference is that the degree of skin protection may vary as skin mechanics and skin pigmentation vary. The aim of the study was to determine the association among genital-anal injury, skin color, skin viscoelasticity and skin hydration in women following consensual sexual intercourse when controlling for age, smoking history, body mass index (BMI), sun exposure, and health status.

PROCEDURES

We employed a prospective cohort study design to enroll women 21 years of age or older at two study sites. They underwent two data collection sessions, baseline and follow-up after consensual sexual intercourse. Baseline genital-anal injury identification occurred with a standard forensic examination (direct visualization, nuclear staining with toluidine blue contrast, and colposcopy examination) and measurements of other variables (skin color, skin viscoelasticity, skin hydration, age, smoking history, body mass index [BMI], sun exposure, and health status). Participants were then asked to have consensual sexual intercourse with a male partner of their choice and to return for a second forensic examination for injury detection. Genital-anal injury was regressed on skin color, skin viscoelasticity, skin hydration, age, smoking history, BMI, sun exposure, and health status.

FINDINGS

We enrolled 341 participants, 88 non-Hispanic White (25.8%), 54 non-Hispanic Black (15.8%), 190 Hispanic/Latina (55.7), and 9 Other Identities (2.6%). At baseline the genital-anal injury prevalence was 57.77% and at follow-up after consensual sexual intercourse, injury prevalence was 72.73%. External genital injury prevalence was associated with increased L* (lightness) values (Adjusted Odds Ratio [AOR] = 1.98, 95% Confidence Interval [CI] = 1.03, 4.04) and decreased skin elasticity (AOR = 0.96, 95% CI = 0.93, 0.99) at baseline. Increased skin hydration was associated with a significantly higher frequency of external, internal, anal, and total genital-anal injuries (Adjusted Rate Ratio [ARR] > 1.27) at follow-up. Also at the follow-up examination, Hispanic/Latina participants had significantly lower external genital and total genital-anal injury prevalence and frequency as compared to non-Hispanic White participants (AOR < 0.40).

CONCLUSIONS

Our findings provide qualified support for the importance of skin color during the forensic examination. Women with lighter skin tones may have skin that is more easily injured than women with darker tones. In contrast, external genital injuries may be more easily identified in women with light as compared to dark skin, a situation that is important in both the health care and criminal justice systems. Additionally, women with decreased viscoelasticity and increased hydration may be more easily injured. These findings support the need to develop forensic procedures that are effective in people across the range of skin colors and to interpret forensic findings considering the innate properties of the skin.

Inclusion of a specific prompt within the standard clinical pro forma used in assessment of patients referred to a child and adolescent sexual assault treatment service: A suggested safety-net to facilitate detection of other children at risk of child sexual abuse

BACKGROUND

Evaluation of an index case of child abuse necessitates risk assessment of other children who could be vulnerable to abuse from the same perpetrator/s.

OBJECTIVE

To determine the effectiveness of the addition of a prompt to the standard clinical pro forma used for the assessment of new referrals to a child and adolescent sexual assault treatment service in terms of impact upon detection of other at risk children.

PARTICIPANTS AND SETTING

All referrals to a Child and Adolescent Sexual Assault Treatment Service, Galway, West Ireland.

METHODS

Retrospective chart review of all children assessed between September 2016 and March 2017. Intervention initiated on September 1st^, 2017. Prospective chart review of all children assessed between September 2017 and March 2018. Chart reviews established whether potential risk to siblings, and other close child contacts, of the index case had been adequately considered.

RESULTS

Comparing pre and post intervention groups, documentation of children at risk significantly increased from 70% to 96% (p = 0.0124). Cases in which a letter was sent to social services regarding other "at risk" children also significantly increased from 50% to 92% (p = 0.0005). There was a change in the percentage of "at risk" children examined or planned for examination, from 66% to 84%, however that was not statistically significant (p = 0.80).

CONCLUSIONS

Introduction of a simple prompt within the standard clinical pro forma had a significant positive impact upon clinicians' consideration of other "at risk" children. We suggest that other services consider including a similar section in their own pro forma documents.

Sexual Assault: Forensic Examination in the Living and Deceased

The forensic examination of a person suspected of having been sexually assaulted encapsulates the breadth of forensic medicine possibly more completely than any other situation in forensic practice. Whether in the living or deceased, detection of injury and biological material to support or exclude sexual activity requires a careful, methodical approach to ensure robust evidentiary value and an understanding of genito-anal anatomy and sexual physiology to interpret its significance for the courts. This paper is not intended as an exhaustive guideline but aims to provide a general overview of the key components of forensic sexual assault examination highlighting the common and different aspects in living and deceased persons.

The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends

OBJECTIVE

The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape.

METHODS

All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included.

RESULTS

The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015.

CONCLUSION

The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

Rapid and sensitive detection of ketamine in blood using novel fluorescence genosensor

In recent years, drug abuse has been considered as a most challenging social problem that aroused public attention. Ketamine has increased in unregulated use as a 'recreational drug' in teenagers. However, there is no suitable and maneuverable detection method for ketamine in situ at the moment. Fluorescence sensor technique, with predominant recognition and simple operation, is a good potential application in drug detection. Here, we first reported a highly sensitive and selective fluorescence genosensor for rapid detection of ketamine based on DNA-templated silver nanoclusters (DNA-AgNCs) probes, in which the DNA sequence could specially recognize ketamine with high affinity. Parameters affecting detection efficiency were investigated and optimized. Under optimum conditions, the as-prepared genosensor can allow for the determination of ketamine in the concentration range of 0.0001-20 μg/mL with two linear equations: one is y = 2.84x-7.139 (R² = 0.987) for 0.0001-0.1 μg/mL, and the other is y = 1.87x-0.091 (R² = 0.962) for 0.1-20 μg/mL, and the estimated detection limit of ketamine is 0.06 ng/mL. Moreover, the feasibility of this proposed method was also demonstrated by analyzing forensic blood samples. Compared with official gas chromatography/mass spectrometry (GC/MS), this fluorescence genosensor is simple, rapid, and accurate for quantitative determination of ketamine in blood for pharmaceutical and forensic analysis. Overall, it is the first report on a fluorescence genosensor for detecting ketamine directly in blood. This research may provide a new insight for the analyst to band fluorescence genosensor technology together with drug monitoring in the battle against drug abuse and forensic examination. Graphical abstract High selectively detection of ketamine using a novel fluorescence genosensor based on DNA-AgNCs probe.

[Forensic examination of sexual assault victims: Medical aspects and associations with the legal outcomes]

OBJECTIVES

To describe the medical and legal characteristics of sexual assault victims and to highlight which aspects of the medical examination may be associated with a conviction of the alleged offender.

METHODS

This study included all women who consulted to the center for the victims of sexual assault in Nancy between 2008 and 2012 and who filed a complaint. Associations were evaluated with a logistic regression trying to explain the presence of a conviction at the end of the legal proceeding.

RESULTS

Three hundred seventy-six victims were included. Following aspects were associated with a reduced probability of conviction: the use of psychoactive substances, the prescription of an antiretroviral therapy and the presence of more than one assailant. The prescription of pain killers were contrarily related to the conviction of an assailant.

CONCLUSION

A detailed description, an interpretation of the physical injuries and the prescription of toxicological tests if needed are decisive in the outcome of the legal proceedings of victims of sexual assault. The education of populations at risk and the accompanying of the victims can reduce the delay of care and optimize the collection of evidence.

Child sexual assault reported to an acute sexual assault referral centre in London

OBJECTIVE

To describe demographic and assault-related characteristics of children attending an acute sexual assault referral centre in London within a week of alleged sexual assault.

DESIGN

Retrospective case note review of all children aged 12 years and under who reported between 1 January 2008 and 31 December 2013.

MAIN OUTCOME MEASURES

Age, sex, ethnicity, drugs and alcohol around the time of assault, nature of offence, relationship with perpetrator, additional violence, verbal threats, presence of injury.

RESULTS

176 children attended; 80% were female. Perpetrators were known casually to the victim in almost half of cases (49%) and familial assault was reported in 55 cases (31%). 43% of boys and 28% of girls reported that the perpetrator was under the age of 16 years. Familial domestic violence was reported by 17%, and more boys (26%) than girls (14%) were reported to have a learning difficulty. Extragenital injury was found in 14% and anogenital injury in 17%.

CONCLUSIONS

This study provides an important overview of young children referred for forensic medical examination in the week following an allegation of sexual assault. Rates of learning difficulty and domestic violence were relatively high, and alcohol and drug use was rare. A large number of alleged perpetrators were young themselves. Additional violence was not common, and rates of injury were low. There may be important differences in sexual offences against boys and girls. Further research is necessary, as is greater case identification and referral for services.

Acute Sexual Assault in the Pediatric and Adolescent Population

Children and adolescents are at high risk for sexual assault. Early medical and mental health evaluation by professionals with advanced training in sexual victimization is imperative to assure appropriate assessment, forensic evidence collection, and follow-up. Moreover, continued research and outreach programs are needed for the development of preventative strategies that focus on this vulnerable population. In this review we highlight key concepts for assessment and include a discussion of risk factors, disclosure, sequelae, follow-up, and prevention.

Forensic examination of the mentally disabled sexual abuse complainant

Individuals who have mental disabilities are more vulnerable to sexual abuse than the general population and even less likely to report the offence. Furthermore they face greater barriers if they wish to seek help, support or prosecution. Where abuse is alleged or suspected, a complainant with a mental disability will often have the capacity to decide whether they wish to undergo intimate forensic examination. However, in cases where the individual truly lacks capacity it must be decided on an case to case basis without assumption or preconception whether such an examination is truly in their best interests. This aim of this review is to discuss sexual offences against adults with mental disabilities and the identification and management of these individuals.

Factors influencing the prosecution of child physical abuse cases in a Swedish metropolitan area

AIM

To examine whether case characteristics of alleged child physical abuse, such as severity, influence criminal investigation procedures and judicial outcomes.

METHOD

We identified all police-reported cases of nonfatal child physical abuse during 2006 in a Swedish metropolitan area (n = 158). Case characteristics were abstracted from police records.

RESULTS

Over half (56%) of the victims were boys, and the median age group was 9-12 years. The severity of the alleged violence was low in 8% of cases, moderate in 51% and high in 41%. Suspects were interviewed in 53% of cases, with fathers more likely to be interviewed than mothers. Children were forensically interviewed in 52% of cases, with 9% physically examined by a clinician and 2.5% by a forensic specialist. Seven per cent of the cases were prosecuted and 1.3% resulted in summary punishment. We found no association between severity of alleged abuse and whether the suspect was interviewed, the child was forensically interviewed or physically examined or whether the perpetrator was prosecuted.

CONCLUSION

Despite the high severity of alleged violence, physical examination rates were low, suggesting a need for criminal investigative procedures on child physical abuse to be reviewed in Sweden.