Statement of the Independent Forensic Expert Group on Conversion Therapy.

Conversion therapy is a set of practices that aim to change or alter an individual's sexual orientation or gender identity. It is premised on a belief that an individual's sexual orientation or gender identity can be changed and that doing so is a desirable outcome for the individual, family, or community. Other terms used to describe this practice include sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure. Conversion therapy is practiced in every region of the world. We have identified sources confirming or indicating that conversion therapy is performed in over 60 countries. In those countries where it is performed, a wide and variable range of practices are believed to create change in an individual's sexual orientation or gender identity. Some examples of these include: talk therapy or psychotherapy (e.g., exploring life events to identify the cause); group therapy; medication (including anti-psychotics, anti- depressants, anti-anxiety, and psychoactive drugs, and hormone injections); Eye Movement Desensitization and Reprocessing (where an individual focuses on a traumatic memory while simultaneously experiencing bilateral stimulation); electroshock or electroconvulsive therapy (ECT) (where electrodes are attached to the head and electric current is passed between them to induce seizure); aversive treatments (including electric shock to the hands and/or genitals or nausea-inducing medication administered with presentation of homoerotic stimuli); exorcism or ritual cleansing (e.g., beating the individual with a broomstick while reading holy verses or burning the individual's head, back, and palms); force-feeding or food deprivation; forced nudity; behavioural conditioning (e.g., being forced to dress or walk in a particular way); isolation (sometimes for long periods of time, which may include solitary confinement or being kept from interacting with the outside world); verbal abuse; humiliation; hypnosis; hospital confinement; beatings; and "corrective" rape. Conversion therapy appears to be performed widely by health professionals, including medical doctors, psychiatrists, psychologists, sexologists, and therapists. It is also conducted by spiritual leaders, religious practitioners, traditional healers, and community or family members. Conversion therapy is undertaken both in contexts under state control, e.g., hospitals, schools, and juvenile detention facilities, as well as in private settings like homes, religious institutions, or youth camps and retreats. In some countries, conversion therapy is imposed by the order or instructions of public officials, judges, or the police. The practice is undertaken with both adults and minors who may be lesbian, gay, bisexual, trans, or gender diverse. Parents are also known to send their children back to their country of origin to receive it. The practice supports the belief that non-heterosexual orientations are deviations from the norm, reflecting a disease, disorder, or sin. The practitioner conveys the message that heterosexuality is the normal and healthy sexual orientation and gender identity. The purpose of this medico-legal statement is to provide legal experts, adjudicators, health care professionals, and policy makers, among others, with an understanding of: 1) the lack of medical and scientific validity of conversion therapy; 2) the likely physical and psychological consequences of undergoing conversion therapy; and 3) whether, based on these effects, conversion therapy constitutes cruel, inhuman, or degrading treatment or torture when individuals are subjected to it forcibly2 or without their consent. This medico-legal statement also addresses the responsibility of states in regulating this practice, the ethical implications of offering or performing it, and the role that health professionals and medical and mental health organisations should play with regards to this practice. Definitions of conversion therapy vary. Some include any attempt to change, suppress, or divert an individual's sexual orientation, gender identity, or gender expression. This medico-legal statement only addresses those practices that practitioners believe can effect a genuine change in an individual's sexual orientation or gender identity. Acts of physical and psychological violence or discrimination that aim solely to inflict pain and suffering or punish individuals due to their sexual orientation or gender identity, are not addressed, but are wholly condemned. This medico-legal statement follows along the lines of our previous publications on Anal Examinations in Cases of Alleged Homosexuality1 and on Forced Virginity Testing.2 In those statements, we opposed attempts to minimise the severity of physical and psychological pain and suffering caused by these examinations by qualifying them as medical in nature. There is no medical justification for inflicting on individuals torture or other cruel, inhuman, or degrading treatment or punishment. In addition, these statements reaffirmed that health professionals should take no role in attempting to control sexuality and knowingly or unknowingly supporting state-sponsored policing and punishing of individuals based on their sexual orientation or gender identity.

Virtual Autopsy as a Screening Test Before Traditional Autopsy: The Verona Experience on 25 Cases.

BACKGROUND: Interest has grown into the use of multidetector computed tomography (CT) and magnetic resonance imaging as an adjunct or alternative to the invasive autopsy. We sought to investigate these possibilities in postmortem CT scan using an innovative virtual autopsy approach. METHODS: Twenty-five postmortem cases were scanned with the Philips Brilliance CT-64 and then underwent traditional autopsy. The images were interpreted by two blinded forensic pathologists assisted by a radiologist with the INFOPSY® Digital Autopsy Software System which provides three-dimensional images in Digital Imaging and Communications in Medicine format. Diagnostic validity of virtual autopsy (accuracy rate, sensitivity, specificity, and predictive values) and concordance between the two forensic pathologists (kappa intraobserver coefficients) were determined. RESULTS: The causes of death at traditional autopsies were hemorrhage due to traumatic injuries (n = 8), respiratory failure (5), asphyxia due to drowning (4), asphyxia due to hanging or strangulation (2), heart failure (2), nontraumatic hemorrhage (1), and severe burns (1). In two cases, the cause of death could not be ascertained. In 15/23 (65%) cases, the cause of death diagnosed after virtual autopsy matched the diagnosis reported after traditional autopsy. In 8/23 cases (35%), traditional autopsy was necessary to establish the cause of death. Digital data provided relevant information for inferring both cause and manner of death in nine traumatic cases. The validity of virtual autopsy as a diagnostic tool was higher for traumatic deaths than other causes of death (accuracy 84%, sensitivity 82%, and specificity 86%). The concordance between the two forensic pathologists was almost perfect (>0.80). CONCLUSIONS: Our experience supports the use of virtual autopsy in postmortem investigations as an alternative diagnostic practice and does suggest a potential role as a screening test among traumatic deaths.

The Reliability of Facial Recognition of Deceased Persons on Photographs.

In humanitarian emergencies, such as the current deceased migrants in the Mediterranean, antemortem documentation needed for identification may be limited. The use of visual identification has been previously reported in cases of mass disasters such as Thai tsunami. This pilot study explores the ability of observers to match unfamiliar faces of living and dead persons and whether facial morphology can be used for identification. A questionnaire was given to 41 students and five professionals in the field of forensic identification with the task to choose whether a facial photograph corresponds to one of the five photographs in a lineup and to identify the most useful features used for recognition. Although the overall recognition score did not significantly differ between professionals and students, the median scores of 78.1% and 80.0%, respectively, were too low to consider this method as a reliable identification method and thus needs to be supported by other means.

Underwater DVI: Simple fingerprint technique for positive identification.

An underwater disaster can be declared when a maritime accident occurred or when an aircraft is plunged into water area, be it ocean, sea or river. Nevertheless, handling of human remains in an underwater recovery operation is often a difficult and demanding task as working conditions may be challenging with poor to no visibility, location of remains at considerable depths and associated hazards from surrounding water. A case of the recent helicopter crash, into a famous river in Sarawak, domiciled by huge crocodiles, is discussed in this paper. Search and recovery team as well as the combat divers from the Special Elite Troop Commando, known as VAT 69, were deployed to the scene to perform the underwater recovery to search for all the victims on board involving five Malaysians with a pilot of Philippines nationality. This paper highlights the limitations and challenges faced during the underwater search and recovery. All the bodies recovered were in moderate decomposition stage with crushed injuries and mutilated face and body. A simple and conventional fingerprint technique were used to record the fingerprint. The prints impressions were later photographed using a smartphone and transferred back to the RMP headquarters in Kuala Lumpur for fingerprint match by using WhatsApp Messenger, a phone application. All the first five victims were identified within an average of 10min. The last victim recovered was the pilot. For foreign nationals, the Immigration Department of Malaysia will record the prints of both index fingers only. The lifting of the fingerprint of the last victim was the most challenging in which only one index finger left that can be used for comparison. A few techniques were attempted using the black printer's ink, glass and tape techniques for the last victim. Subsequently, images of the prints impression were taken using the same smartphone with additional macro lens attached to it to enhance the resolution. The images were transferred to the RMP headquarters through WhatsApp Messenger. The prints were confirmed to be the pilot 20min later.

Death by electrocution: Histological technique for copper detection on the electric mark.

The current observation of deaths by electrocution, both for domestic and work-related accidents as well as those in other contexts, has deepened the scope of investigation into electric marks, especially from the histological point of view. This is one of the few investigation tools that may lead to the diagnosis of death by electrocution in this distinct area, bearing in mind the diagnostic difficulties that this type of fatality presents. Our attention has been placed on the phenomenon of metallization. In particular, we focused on using the Timm's method [1] to locate the copper deposits. The phenomenon of metallization, usually could be caused by the copper deposit, this happens due to the copper debris released onto the skin by the live conductor. To date, this technique has only been used in the pathological field. Nevertheless, we tried to assess its application in seven selected cases, after partially modifying the technique, comparing it with the most common staining detection techniques and analysing the specificity, sensitivity as well as the potential for its application in the routine.

Guidelines for photography of cutaneous marks and injuries: a multi-professional perspective.

Investigators assessing the likelihood of physical abuse, must make a decision as to whether the injury seen matches the explanation given. In some instances the pattern of these injuries can give the investigator a possible link to the cause of the injury. Thus, matching an injury pattern to an implement or weapon used has forensic implications. The current method of capturing patterned injuries together with poor scale placement often result in some form of distortion that causes a change to the shape of the patterned injury. The aim of this guideline is to assist individuals dealing with the capture of photographic evidence for the investigation of suspected non-accidental patterned cutaneous injuries (PCI), and to ensure high standards of image quality are met for both evidential records and for forensic analysis. The technical equipment specified within these guidelines are recommended by the authors as a basic requirement for imaging best practice, due to their ability to capture detailed and critical data. For precise pattern matching analysis, it is vital that both the injury and the suspected implement are photographed in accordance with this guidance.

Focussing on the future: survey results on the image capture of patterned cutaneous injuries.

An investigator who is involved in assessing the likelihood of physical abuse must make a decision as to whether the injury seen matches the explanation given. In some instances the pattern of these injuries can give the investigator a possible link to the cause of the injury. Photographic imaging is used to record the patterned cutaneous injuries (PCI) and to facilitate forensic interpretation. The current method of capturing PCI often results in some form of distortion that causes a change to the shape of the patterned injury. The Dermatological Patterned Injury Capture and Analysis (DePICA) research group was formed to assess current image capture methods and practices. An online survey was set up to assess the value of localised imaging protocols and training specific to imaging PCI and was made available to law enforcement professionals, forensic investigators and hospital staff. 80 participants responded to the survey. The majority of the survey participants have had training in medical or forensic photography, however 66 (83%) have not had specific training in how to photograph PCI. 41 (51%) of the participants responded that they always use a rigid scale and 34 (43%) position the camera so that it is perpendicular to the scale and injury. Comments made about the quality of images obtained and produced raises concerns about how much knowledge those initiating such images have about image relevance in criminal cases. It is evident that a clear and comprehensive guide to photographing PCIs is required to improve the quality of the photographic evidence that is collected.

Malpractice and medical liability. European Guidelines on Methods of Ascertainment and Criteria of Evaluation.

The manuscript presents the European Guidelines on medico-legal Methods of Ascertainment and Criteria of Evaluation in cases of suspected subjective "Medical Responsibility and/or Liability" developed by an international working group under the patronage of the European Academy of Legal Medicine. It includes a step-by-step illustrated explanation of approved Flow Charts, articulated in 18 sequential steps and comprehensive of both Methods of Ascertainment and Evaluation Criteria.

Failure of anthropometry as a facial identification technique using high-quality photographs.

Anthropometry can be used in certain circumstances to facilitate comparison of a photograph of a suspect with that of the potential offender from surveillance footage. Experimental research was conducted to determine whether anthropometry has a place in forensic practice in confirming the identity of a suspect from a surveillance video. We examined an existing database of photographic lineups, where one video image was compared against 10 photographs, which has previously been used in psychological research. Target (1) and test (10) photos were of high quality, although taken with a different camera. The anthropometric landmarks of right and left ectocanthions, nasion, and stomion were chosen, and proportions and angle values between these landmarks were measured to compare target with test photos. Results indicate that these measurements failed to accurately identify targets. There was also no indication that any of the landmarks made a better comparison than another. It was concluded that, for these landmarks, this method does not generate the consistent results necessary for use as evidence in a court of law.

Variation in proportion indices and angles between selected facial landmarks with rotation in the Frankfort plane.

A number of different techniques are employed in facial image comparison of living persons. In this study, the effect of rotation on angles and proportion indices between selected facial landmarks is evaluated as a first step to assess whether facial anthropometry could be usefully applied to facial image comparison. The faces of five volunteers were photographed in the Frankfort plane at different angles of rotation from 0 degree (frontal) to 90 degrees (side view), rotating every 10 degrees both clockwise and counter-clockwise. Four landmarks were used: right and left ectocanthions, nasion, and stomion. The proportion indices of the measurements between these landmarks were calculated as well as the angles created by the lines connecting the same landmarks. The results show a consistent and predictable variation between the five subjects. With rotation, the greatest variation is seen where horizontal landmark connecting lines are combined with the ectocanthion/ stomion lines or nasion/stomion. There is less variation in the proportion indices for vertical and diagonally orientated landmark connecting lines.

The use of proteomics to study wound healing: a preliminary study for forensic estimation of wound age.

Proteomics is the analysis of the protein complement of the genome. The technique involves extracting proteins from the tissue being examined; separating the proteins using methods such as two-dimensional gel electrophoresis and then identifying the proteins by mass spectrometry. This paper describes the application of proteomics to incised wounds of the rat to determine if this technology could be applied to the important forensic issue of determining the age of wounds. Experimental incised skin wounds were inflicted on rats 5, 15, 30 and 60 minutes, 3, 6, 12 and 24 hours and 2, 5, 7 and 12 days before euthanasia. Each wound was excised and frozen at 80 degrees C; protein extracts were prepared and subjected to two-dimensional polyacrylamide gel electrophoresis over the range pH 3 to pH 10. Protein spots were identified using Matrix-assisted Laser Desorption/Ionisation Time-of-Flight (MALDI-TOF) mass spectrometry. A number of proteins were identified in skin wounds. After wounding the most prominent change was in the level of haemoglobin, which was elevated in wounds five minutes old and remained elevated for three hours, falling to near control levels after 12 hours. This pilot study has illustrated the feasibility for proteomics to be applied to determining wound age.

Exploratory study on classification and individualisation of earprints.

The FearID research project is aimed at the individualisation of earprints for the purpose of forensic research. The study presented here was carried out within the framework of this project. It intends to combine a review of what is known from literature on the classification and individualisation of earprints with results from a preliminary study of earprints. Possibilities for, and limitations to, the use of earprints in forensic investigation are addressed. Differences between eliminating a suspect, placing a suspect at a crime scene, and linking crimes by prints left at different scenes are considered.

The creation of inter-ethnic images for studies in applied psychology.

The facial transformation programme, is an integral part of the computerised three-dimensional facial reconstruction system, employed at the University of Glasgow for forensic and historical cases. It was applied to the creation of inter-ethnic images for use in studies to assess the response of various groups to facial appearance in the assessment of racial stereotyping. We initially acquired a three-dimensional facial image from a young black (Negroid) male volunteer, using our optical laser scanning system. This image was then used as a template over a Caucasian skull to produce a reconstruction using facial criteria applicable to white (Caucasian) males. The other image used was that of the facial template of the black male. A commercially available electronic identikit system, E-FIT was then used to add appropriate hair styles and open eyes to both images. In addition, on the 'Caucasian reconstruction' we were able to reduce the contrast and lighting on the face. This was relatively straightforward as we were using greyscale images rather than colour. The shape of the nose and lips on the white male were also altered to be more in keeping with Caucasoid average measurements. The resulting images were shown to a group of second-year clinical psychology students and their responses are discussed. Similar images may also be used in studies of racial stereotyping in different categories of professionals such as police, prison personnel, probation officers, social workers, potential employers, doctors, and others, in order to assess the response to individuals by facial appearance.