Emergency Department Management of the Sexual Assault Victim in the COVID Era: A Model SAFET-I Guideline From San Diego County.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19. OBJECTIVE: Investigators sought to update the San Diego County sexual assault guidelines, created in collaboration with health care professionals, forensic specialists, and law enforcement, through a consensus iterative review process. An additional objective was to create a SAFET-I Tool for use by frontline providers during the COVID-19 pandemic. DISCUSSION: The authors present a novel SAFET-I Tool that outlines the following five components of effective sexual assault patient care: stabilization, alert system activation, forensic evidence consideration, expedited post-assault treatment, and trauma-informed care. This framework can be used as an educational tool and template for agencies interested in developing or adapting existing sexual assault policies. CONCLUSIONS: There is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV.

A quarter century of decline of autopsies in the Netherlands.

OBJECTIVE: Autopsy rates have been declining worldwide. The present study reports the outcome of a retrospective analysis of all non-forensic autopsies in the Netherlands over a course of 25 years, and compares these with the most recent Dutch study. METHOD: Retrospectively, 25 years of data on clinical autopsies from the Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands (PALGA) was paired with the mortality registry (Statistics Netherlands). RESULTS: The crude prevalence of autopsies declined from 7.07% in 1991 to 2.73% in 2015. After adjusting for age at death, there was no difference in autopsy rate between males and females. An increasing age significantly decreased the autopsy rate. CONCLUSION: In the Netherlands, clinical autopsies have been declining over the last quarter century. Age at death, but not sex, was associated with the autopsy rate. These different results stress the importance of correct collection and analysis methods of data.

Research Progress on Forensic Molecular Phenotyping in the Age of Precision Medicine.

ABSTRACT: With the development of new technologies, such as whole genome sequencing and big data, many countries have constructed large cohorts as strategic resources for precision medicine study. Related studies have significantly promoted research progress in many fields, such as medicine and biology, creating the genetic testing industry. In the forensic field, characterization technologies for features, such as biogeographic ancestry, genetic genealogy and physical appearance have emerged and developed rapidly. Compared with traditional forensic DNA technology, the new technology can search for characteristics and provide clues, quickly becoming an important means to solve difficult cases such as cold cases and accumulated cases. This paper briefly reviews the current status of the construction of large cohorts at home and abroad, and the research progress of forensic molecular phenotyping in the context of precision medicine in the context of precision medicine.

Exploitation of microbial forensics and nanotechnology for the monitoring of emerging pathogens.

Emerging infectious diseases remain among the leading causes of global mortality. Traditional laboratory diagnostic approaches designed to detect and track infectious disease agents provide a framework for surveillance of bio threats. However, surveillance and outbreak investigations using such time-consuming approaches for early detection of pathogens remain the major pitfall. Hence, reasonable real-time surveillance systems to anticipate threats to public health and environment are critical for identifying specific aetiologies and preventing the global spread of infectious disease. The current review discusses the growing need for monitoring and surveillance of pathogens with the same zeal and approach as adopted by microbial forensics laboratories, and further strengthening it by integrating with the innovative nanotechnology for rapid detection of microbial pathogens. Such innovative diagnostics platforms will help to track pathogens from high risk areas and environment by pre-emptive approach that will minimize damages. The various scenarios with the examples are discussed where the high risk associated human pathogens in particular were successfully detected using various nanotechnology approaches with potential future prospects in the field of microbial forensics.

[Research Progress of CircRNA and Its Application Prospect in Forensic Medicine].

Circular RNA （circRNA） is a type of noncoding RNA with tissue specificity and high stability, which forms a closed continuous loop and is abundantly expressed in tissue cells. According to recent research, the regulatory function of circRNA elucidating in the occurrence and development of disease shows a potential for diagnosing clinical disease and revealing disease mechanism. This paper reviews the biological characteristics, analysis methods of circRNA and its research progress in clinical application as biomarker, and outlooks its application in the field of forensic medicine.

[Forensic medical expertises and the studies of material evidence of biological origin in Russia (based on the materials collected during the period from 2003 till 2017)]. / Sudebno-meditsinskie ékspertizy i issledovaniia veshchestvennykh dokazatel'stv biologicheskogo proiskhozhdeniia v Rossii (po materialam 2003-2017 gg.).

The objective of the present study was the analysis of expert activities of the forensic biological, forensic cytological, and molecular genetic divisions and laboratories of the state agencies carrying out forensic medical expertise in the Russian Federation during the past 15 year period (2003-2017). We scrutinized the data on the organizational structure and the personnel scheduling chart of the aforementioned units. The study has demonstrated the progressive decrease in the number of forensic biological and forensic cytological investigations versus enhanced activities of the molecular genetic laboratories. The volume of work done by the forensic biological department was reduced by 42% during 2017 in comparison with 2003 whereas that of molecular genetic expertises and investigations increased by 6.9 times within the same period. Simultaneously, the structure of the molecular genetic expertises and investigations underwent appreciable changes. The relative amount of blood studies decreased while that of hair, teeth, bones, and other biological tissues increased. The time spent for the performance of expertises and investigations in the respective departments and laboratories decreased in comparison with 2003.

[The synopsis of results of the 20 year activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University)]. / Itogi 20-letnei raboty kafedry sudebnoi meditsiny Sechenovskogo universiteta.

The present article was designed to summarize the results of the 20 year scientific, practical, and educational activities of the Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenovsky University). The main directions of the research work and achievements of the Department's staff are described, and the prospects for its further development are highlighted. The new approaches to and technologies for the teaching and training specialists in forensic medicine are introduced to meet the novel requirements imposed in the framework of the ongoing reform of higher medical education in accordance with the main principles of the Bologna declaration.

[The forensic medical aspects of the inappropriate medical care in the modern-day Ukraine]. / Sudebno-meditsinskie osobennosti nenadlezhashchei meditsinskoi pomoshchi v sovremennoi Ukraine.

Despite the fact that the ever growing relevance of the problem of the inappropriate medical care was long ago brought to the worldwide attention, it has not been practically addressed in the Ukraine since the country gained independence in 1991. The objective of the present study was to consider the specific features of expert examination of the cases of inappropriate medical care as exemplified by the materials of the legal actions and lawsuits instituted against healthcare specialists violating their occupational duties. The results of forensic medical examination by the local Bureaux of forensic medical expertise concerning the 350 so-called malpractice suits instituted in the Ternopol, Zhitomir, and Chernovtsy regions during the period from 207 to 2016 were available for the analysis. The facts of inadequate and inappropriate medical care were documented in 245 (72.0%) cases. The frequency of diagnostic and therapeutic errors amounted to 29.7% and 26.9% respectively while the improper formulation of the medical documentation was recorded in 21.3% of the cases. The cases of poor organization of the diagnostic and treatment process accounted for 14.6% of the total whereas the improper behaviour of the medical personnel was reported in 7.5% of all the known cases of provision of the healthcare services. It is concluded that in the majority of the cases, the citizens of the modern-day Ukraine receive the inappropriate (insufficient and untimely) medical care. Over 80% of the cases of the inappropriate medical care currently provided in the country can be accounted for by the objective reasons, with each fifths case being due to the violation of professional responsibilities by the healthcare providers.

[The efficiency of the application of the modern computed technologies in the clinical practice and the prospects for the further use of the biomechanical 3D-models in forensic medicine]. / Éffektivnost' ispol'zovaniia sovremennykh komp'iuternykh tekhnologii v klinicheskoi praktike i perspektivy primeneniia biomekhanicheskikh 3D-modelei v sudebnoi meditsine.

To-day, the computer-assisted 3D-technologies for the mathematical simulation of the engineering facilities are extensively used for the purpose of technical calculations in all branches of industry and building. The positive experience gained with the application of the 3D-models finds wide application in the joined investigations on the topical problems of the prosthetic and surgical treatment of bones, teeth, joints, cardiac valves, blood vessels, etc. The objective of the present study was the analysis of the positive experience with the involvement of the specialists in the design and practical application of 3D-models for the solution of problems facing the medical prosthetics and the management of various pathological conditions. Another objective was to discuss the possible prospects for the interdisciplinary collaboration in these fields with a view to improving the quality of expert conclusions in the framework of forensic medical and criminalistics examinations. The data readily available from the official domestic and foreign Internet resources were used for the purpose of the study. The analysis of the published data has demonstrated the obvious advantages of the application of the mathematical 3D-models and the biomechanical studies for the solution of the concrete medico-biological problems. The currently available positive experience gained due to the participation of domestic specialists in biomechanics in the solution of the specific clinical problems gives hope that their collaboration between themselves and with the forensic medical experts will open up the promising prospects for the further investigations of the issues of common interest.

Improving human forensics through advances in genetics, genomics and molecular biology.

Forensic DNA profiling currently allows the identification of persons already known to investigating authorities. Recent advances have produced new types of genetic markers with the potential to overcome some important limitations of current DNA profiling methods. Moreover, other developments are enabling completely new kinds of forensically relevant information to be extracted from biological samples. These include new molecular approaches for finding individuals previously unknown to investigators, and new molecular methods to support links between forensic sample donors and criminal acts. Such advances in genetics, genomics and molecular biology are likely to improve human forensic case work in the near future.

[Current macro-diagnostic trends of forensic medicine in the Czech Republic]. / Makrodiagnostické trendy soucasné soudnelékarské praxe v Ceské republice.

Over the last few years, advanced diagnostic methods have penetrated in the realm of forensic medicine in addition to standard autopsy techniques supported by traditional X-ray examination and macro-diagnostic laboratory tests. Despite the progress of imaging methods, the conventional autopsy has remained basic and essential diagnostic tool in forensic medicine. Postmortem computed tomography and magnetic resonance imaging are far the most progressive modern radio diagnostic methods setting the current trend of virtual autopsies all over the world. Up to now, only two institutes of forensic medicine have available postmortem computed tomography for routine diagnostic purposes in the Czech Republic. Postmortem magnetic resonance is currently unattainable for routine diagnostic use and was employed only for experimental purposes. Photogrammetry is digital method focused primarily on body surface imaging. Recently, the most fruitful results have been yielded from the interdisciplinary cooperation between forensic medicine and forensic anthropology with the implementation of body scanning techniques and 3D printing. Non-invasive and mini-invasive investigative methods such as postmortem sonography and postmortem endoscopy was unsystematically tested for diagnostic performance with good outcomes despite of limitations of these methods in postmortem application. Other futuristic methods, such as the use of a drone to inspect the crime scene are still experimental tools. The authors of the article present a basic overview of the both routinely and experimentally used investigative methods and current macro-diagnostic trends of the forensic medicine in the Czech Republic.

[Research Progress of Sudden Cardiac Death in Forensic Medicine].

Sudden death （SD） is a special kind of death owing to disease, which severely threatening the lives of community population. As the most common type of SD, sudden cardiac death （SCD） has always been a crucial content of identification and research in forensic pathology. This article reviews the research progress from the aspects of epidemiology, morphology, molecular pathology and virtual anatomy of SCD in forensic medicine, so as to provide a reference for the morphological identification, determination of cause of death, and integrated control of this kind of SD.

[The problems of professional competence in the complementary professional forensic medical expertise programs of advanced training and professional requalification]. / Professional'nye kompetentsii v dopolnitel'nykh professional'nykh programmakh po spetsial'nosti «Sudebno-meditsinskaia ékspertiza¼ (povyshenie kvalifikatsii i professional'naia perepodgotovka).

This article reports the results of the analysis of the new tendencies and normatives of the working legislation in the field of additional professional education in the speciality of «forensic medical expertise¼ and the application of the competency-based approach to the training of specialists in the framework of professional requalification and advanced training programs. Special attention is given to the problems of organization of the educational process and the elaboration of additional training programs based on the competency approach to the training of specialists at the Department of Forensic Medicine and Law with the professor V.N. Kryukov Course of Advanced Professional Training and Professional Requalification of Specialists at the state budgetary educational Institution of higher professional education «Altai State Medical University¼, Russian Ministry of Health. The study revealed the problems pertaining to the development of professional competencies in the framework of educational programs for the professional requalification and advanced training in the speciality «forensic medical expertise¼. The authors propose the legally substantiated approaches to the solution of these problems.

Expansion of Microbial Forensics.

Microbial forensics has been defined as the discipline of applying scientific methods to the analysis of evidence related to bioterrorism, biocrimes, hoaxes, or the accidental release of a biological agent or toxin for attribution purposes. Over the past 15 years, technology, particularly massively parallel sequencing, and bioinformatics advances now allow the characterization of microorganisms for a variety of human forensic applications, such as human identification, body fluid characterization, postmortem interval estimation, and biocrimes involving tracking of infectious agents. Thus, microbial forensics should be more broadly described as the discipline of applying scientific methods to the analysis of microbial evidence in criminal and civil cases for investigative purposes.

[A critical review of applied criminology]. / Angewandte Kriminologie auf dem Prüfstand.

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.

[The analysis of the articles concerning toxicological (forensic) chemistry published in the journal "Sudebno-meditsinskaya ekspertiza (Forensic Medical Expertise)" during the period from 2004 to 2013. Part 2. The analysis and assessment of the publications, peculiarities of the development of investigations].

The author presents the results of the analysis of the publications concerning toxicological (forensic) chemistry issues published in the journal "Sudebno-meditsinskaya ekspertiza" during the period from 2004 to 2013 with their assessment making use of scientometrical methods. Special emphasis is laid on the publications devoted to the development and improvement of the approaches to the investigation into narcotic and psychotropic drugs as well as other toxic substances. Specific features of such investigations are described.

Child protection: a 50-year perspective.

It has been 50 years since Kempe et al. published 'The Battered Child Syndrome', describing harm from inflicted injury mechanisms derived from parents and care givers. Since then, there has emerged a rapidly expanding literature on paediatric forensic medicine and child protection, which has offered new insights into injury mechanisms, informed us of the sequelae of abuse and neglect, aided diagnosis and guided clinical practice in the treatment and management of children who become involved in the child protection system. Through the scrutiny of government inquiries and at times uncomfortable media exposure, there have been improvements in child protection and forensic practices resulting in recognition of need for specialised forensic training, improved funding, development of resources and development of professional standards that support accountable, objective, safe and robust practice. From the perspective of an Australian child protection paediatrician, this paper chronicles some of the most significant and at times controversial research in the last 50 years in child protection that have played a key role in shaping our current understanding of child abuse and neglect.

[Advances in Event-related Potential and Its Forensic Application Value].

The event-related potential (ERP) is considered as one of the most effective methods to study and analyze objectively human mental activity based on nerve electrophysiology. At present, ERP is not only used in the study of lie detection, but also in the clinical medicine for the cognitive assessment on patients with cerebrovascular disease, dementia or traumatic brain injury and auxiliary diagnosis of mental illness. With the further development of ERP detection technology, it would have a wider application prospect in the field of forensic medicine.

[Research Progress on Forensic Toxicology of Z-drugs].

The Z-drugs (zolpidem, zopiclone, and zaleplon), as the innovative hypnotics, have an improvement over the traditional benzodiazepines in the management of insomnia. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. As benzodiazepines, Z-drugs exert their effects through increasing the transmission of γ-aminobutyric acid. Z-drugs overdose are less likely to be fatal, more likely would result in poisoning. Z-drugs can be detected in blood, urine, saliva, and other postmortem specimens through liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Z-drugs have improved pharmacokinetic profiles, but incidence of neuropsychiatric sequelae, poisoning, and death may prove to be similar to the other hypnotics. This review focuses on the pharmacology and toxicology of Z-drugs with respect to their adverse effect profile and toxicity and toxicology data in the field of forensic medicine.

[The current problems of investigations into thanatogenesis and the causes of death considered in the articles published in the journal "Sudebno-meditsinskaya ekspertiza (Forensic Medical Expertise)" during the period from 2000 to 2014].

The objective of the present work was the analysis of the scientometrical characteristics of the publication activity of the authors of the articles concerning the problems of investigations into thanatogenesis and the causes of death that were submitted for the publication in the journal "Sudebno-meditsinskaya ekspertiza" during the period from 2000 to 2014. The analysis was aimed at detecting the priority fields of research of interest not only for domestic but especially for foreign specialists. The study has revealed the most popular Russian-language and foreign journals that were most frequently cited by the authors of "Sudebno-meditsinskaya ekspertiza". It was shown that the largest number of publications were submitted by the research groups affiliated with the departments and other subdivisions of the practical expert institutions of Moscow, Sankt-Petersburg, Astrakhan, Krasnodar, Baku, and Krasnoyarsk. It is concluded that the further analysis and assessment of the research activities of specialist in forensic medical expertise with the use of scientometrical methods constitute the indispensable condition for the development and improvement of the quality of forensic medical expertise in the Russian Federation.