The main results of expert activities in the forensic biological departments of the bureau of forensic medical expertise of the Russian Federation for 2009

This paper reports the main results of expert activities in the forensic biological departments of the Bureau of Forensic Medical Expertise of the Russian Federation for 2009. Analysis of expert data is supplemented by the comparison of the efficacy of the methods applied for the purpose of forensic medical studies. The information about the staff composition, material and technical support of the forensic biological departments is presented. A number of drawbacks have been revealed in the work of the forensic biological departments; recommendations are proposed for the improvement of their activities.     

Characteristic of mortality in the Russian Federation

The objective of the present work was to estimate the overall mortality in the Russian Federation and to elucidate the structure and characteristics of violent and non-violent mortality in this country. The study is largely based on the materials of reports on the activities of local bureaus of forensic medical expertise for the period from 2003 to 2008; in addition, the data from the official demographic and statistical yearbooks issued by the Russian State Statistical Committee (Goskomstat) in 2008-2009 were used. It is shown that cardiovascular pathology appears to be currently the leading cause of general mortality in the Russian Federation. A substantial fraction in the structure of general mortality is constituted by mechanical injuries most of which are inflicted in car accidents. More than half of the fatal cases caused by external factors and around one third of the deaths from cardiovascular diseases are associated with alcohol intoxication. Statistical treatment of the results of analysis conducted in the present study provided materials for the development of recommendations designed to improve the demographic situation in the Russian Federation.     

Analysis of violent deaths of mountaineers and tourists at high altitudes

The principal causes of violent death of mountaineers and tourists at high altitudes are described with special reference to the character of injuries to the skin, soft tissues, bones, and internal organs inflicted by mechanical impacts. The cases of violent death from other factors are described, such as general hypothermia, atmospheric electricity, compression and obturation asphyxia of mountaineers and tourists who died in the epicenter of an avalanche. The additional criteria for forensic medical diagnostics of violent death of montaineers and tourists at high altitudes are considered.     

Problems in organization of medical criminological registration and personality identification for subjects occupationally exposed to life risk

The paper discusses problems in organization of identification studies under conditions of mass deaths as exemplified by forensic medical records of medical criminological identification studies of subjects killed during war conflict in Chechnya. The evolution of the organization model of identification studies is shown transformation of organization philosophy, formation of expert algorithms, formalization and technologic realization of expert solutions.     

法医学鉴定强制性标准的现状、问题和对策——以《强制性国家标准管理办法》为视角

法医学鉴定意见是重要的诉讼证据,鉴定标准尤其是强制性标准直接影响鉴定意见的科学性、公正性和权威性。当前我国法医学鉴定的强制性国家标准仅有3项,推荐性国家标准及行业标准489项。法医学标准数量有限,尤其强制性标准奇缺,已经影响到我国法医学鉴定实践和学科发展。《强制性国家标准管理办法》旨在加强和推进我国强制性国家标准的管理和发展。笔者建议,以该办法的实施为契机,相关行政管理部门应当发挥更多作用,采取有力措施推进法医学鉴定强制性国家标准的制定,进一步补充、修改、完善法医学鉴定行业标准,强化法医学鉴定强制性国家标准的执行。     

Violence. Roots and remedies: the perspective of the forensic psychiatrist

The role of the forensic psychiatrist is described in this paper. This role is unique in that it applies the research findings of the neurologist, the neuropsychologist, the criminologist, and other behavioral specialists to courtroom proceedings. The possibility that medical malfunction such as brain damage, endocrinological problems, toxicity, infection, or neurological disorder may be associated with violent behavior is discussed. The forensic psychiatrist has several functions to perform in the courtroom. He or she must be able to assess the likelihood that any type of malfunctioning such as those mentioned may have had a part in the defendant's violent behavior, assess the defendant's state of mind at the time of commission of the crime, and determine whether the individual is competent to stand trial. The five phases of the criminal justice system are reviewed as they bear on the work of the forensic psychiatrist.     

Analysis of scientific and pedagogical activities of Forensic Medicine Departments (courses) at higher medical schools in Russia

Pedagogical staff of departments (courses) of forensic medicine at higher medical schools of the Russian Federation, topics of research and pedagogical work at various faculties of higher school are analyzed. Forensic dentistry curriculum is suggested for students of dentistry faculties. New forms of forensic medical training are presented.     

创伤科病历书写相关缺陷及其对司法鉴定的影响

病历是创伤病人进行司法鉴定的重要客观资料，病历书写中相关缺陷直接或间接影响着司法鉴定活动的正常进行。分析创伤科病历书写中的一些常见缺陷对司法鉴定带来影响，强调提高创伤科医务人员的法律意识及病历书写质量是保证司法鉴定结论客观公正的重要因素之一。     

Origin and development of forensic medicine in the Kingdom of Saudi Arabia

The medicolegal death investigation system in the Kingdom of Saudi Arabia (KSA) is unique in the world. It is exclusively derived from Islamic judiciary based on Shari'ah law, which is the definitive Islamic law or doctrine. This law is applied on Saudi citizens as well as foreigners. This is different from other Islamic countries, which have a combination of Islamic and other judiciary systems.The forensic medicine centers in KSA are related administratively to the Ministry of Health (MOH) and its subdivisions in the different governorates. They are concerned with forensic medical examination and autopsy, as well as the clinical forensic medical examination of sexual assault cases, and those injured in civil and criminal cases. The assisting laboratories (forensic histopathology, microbiology, serology, forensic chemistry) are working independently under the funding of MOH, whereas the DNA laboratory and other departments of forensic sciences, for example, counterfeiting and forgery unit are related administratively to the Ministry of Interior represented by the Administration of Criminal Evidences. Efforts concerning crime scene investigations are shared with Administration of Criminal Evidences' crime scene investigators.Forensic medicine education in KSA developed in the past few years after the foundation of Saudi specialty certificate in forensic medicine. The certificate is a postgraduation qualification equivalent to a doctorate degree in forensic medicine and requires completion of a 4-year training program in both MOH- and Ministry of Interior-related departments, as well as passing annual evaluation and examination.This review is aimed at providing in the next decade the medicolegal centers with national forensic specialists throughout the kingdom and granting skillful headships for the next generations. Moreover, this review suggests more scientific associations with the academic universities in the various fields of forensic sciences through academic cooperation.     

Forensic medicine and criminalistics

The supplementary designation "criminalistics" in the title of certain forensic medical institutes in the first half of this century is to be regarded as a reaction to faulty developments in our specialty, which almost led to the elimination of forensic medicine as an independent scientific discipline in the 1960s. The ability to think in terms of criminalistics and the corresponding working procedures has always been a crucial precondition for the forensic physician, since forensic medicine is the application of medical knowledge for juridical purposes. Forensic medicine originated with the appraisal of cases of violent death by doctors, i.e., reconstruction of the facts in the case. To use the term "criminalistics" in the form of a supplementary designation is thus not required. An attempt is nevertheless made to define "medical criminalistics" as a small but important component of criminalistics. They are subdivided into two phases: the first part begins at the scene of the crime or the place of discovery (local evidence). Here, the trained eye of the forensic physician is indispensable to the criminal investigation department and the prosecutor. Medical criminalistic thinking and working procedures continue at the autopsy. Here, forensic autopsy differs from that practiced by the pathologist. Without knowledge of the situation at the discovery location, the forensic physician runs the risk of not recognizing facts that are important for reconstruction and thus becoming a "destroyer of clues". The second part of medical criminalistics is the actual detection of medical clues, i.e., the investigation of medical clues with special methods, including histological and toxicological investigations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Predictors of length of stay in forensic psychiatry: The influence of perceived risk of violence

This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n = 125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.     

Natural death in the forensic setting: a study and approach to the autopsy

Although unexpected natural deaths comprise a large proportion of the cases seen in the forensic setting, the investigation of these cases remains a unique challenge. Some cases are straightforward; however, others require special examination and dissections, as well as the use of special dissections and ancillary studies. For the forensic investigator to accurately assign a cause and manner of death, one must be aware of the differential diagnoses, common scenarios, and typical victim. The authors reviewed all forensic cases referred to the Forensic Section of the Medical University of South Carolina over a 15-year period from January 1989-December 2003. The number of natural deaths occurring in adults (age 18 years and older) was 6932, compared with the overall number of 13,227 cases. The natural deaths were then analyzed as to autopsy findings, cause of death, cardiac versus noncardiac, age, race, and gender. Current techniques, special dissections, and ancillary studies that can assist in the classification of these deaths in the forensic setting are reviewed.     

Cocaine and homicide in Memphis and Shelby county: an epidemic of violence

In Memphis and the surrounding county, there were a record number of homicides (179) in 1986. During the same year, there was a marked increase in medical examiner cases where tests were positive for cocaine or its metabolites. Review of medical examiner and toxicology records from 1980 to 1986 found 87 cocaine related deaths; 46 of these were homicides. In 1986 alone, there were 53 cocaine related deaths, all manners, and 31 cocaine related homicides. In this year, 17.3% of the homicides were positive for cocaine or metabolite. The cocaine related homicides were similar to other homicides in terms of age, race, sex, blood ethanol concentration, and cause of death being due most often to firearms. In homicide cases in which an abuse drug was detected, cocaine accounted for the entire increase in 1986. Police records indicated that cocaine directly contributed to the homicide in 39% of the cases in which the drug was found. In other cases, we speculate that cocaine altered behavior may have contributed to the victim's being murdered either during the drug "high" or during the posteuphoric depression or withdrawal phase.     

Level of agreement between opinions of medical examiner investigators and forensic pathologist medical examiners regarding the manner of death

To evaluate the level of agreement between medical examiner investigators' opinion of the manner of death and what the manner of death was as certified by forensic pathologist medical examiners (MEs), we reviewed the case records stored in a database of all deaths reported to the office of the medical examiner in Fulton County, Georgia. Of 15,771 deaths reported to the office during a 10-year period, a difference exists in 1908 cases. In 900 natural deaths, the investigators recorded 135 accident, 10 homicide, 10 suicide, and 745 undetermined manners of death. In 755 accidental deaths, the investigators recorded 16 natural, 8 homicide, 13 suicide, and 718 undetermined manners of death. In 107 homicides, the investigators recorded 12 natural, 8 accident, 0 suicide, and 87 undetermined manners of death. In 70 suicides, the investigators recorded 9 natural, 9 accident, 3 homicide, and 49 undetermined manners of death. In 61 deaths classified as undetermined, the investigators recorded 25 natural, 13 accident, 17 homicide, and 6 suicide manners of death. In 15 deaths, the discrepancy exists due to an apparent error in the database information. This study confirms a high concordance between investigator and ME opinion regarding manner of death but also documents the need for case review and autopsies by forensic pathologists to confirm the investigators' opinion of the manner of death, determine the manner of death when the investigator selects undetermined, and on occasion, refute the investigators' opinion regarding the manner of death.     

The characteristics of gunshot and blast trauma in Moscow in 1997

Forensic medical, social, and criminological characteristics of 417 cases with gunshot and explosion injuries investigated at Bureau of Forensic Medical Expert Evaluations of Moscow in 1997 are presented. Public and social groups of victims and types of violent deaths are discussed.     

A new algorithm for use in computer identification

On 9 May 1987, a Soviet-made IL-62M Polish airliner, LOT Flight 5055, crashed, exploded, and burned, killing the crew and 183 passengers. A forensic science team from the Armed Forces Institute of Pathology, comprised of 6 dental officers, 3 forensic pathologists, and 3 medical photographers, worked in concert with the Polish forensic science team. The small number of antemortem records and the extreme fragmentation of the remains presented a new scenario for computer use. Typically, the Computer-Assisted Postmortem Identification (CAPMI) software is used to compare remains against an antemortem database. Results are listed by the number of tooth-to-tooth matches based on restorative or other characteristics or both. The Polish disaster confounded this approach to some degree, however, and suggested a reconsideration of the theory on which the sort is made, that is, that the cases with maximum number of matches to preexisting dental records would be the most likely identification (ID) match. A hypothesis was constructed that, if searches were accomplished for fragments with a minimum number of mismatches, the correct matches would appear higher in the rank order. Six antemortem records (that had all dental information) were sorted against one hundred and twelve postmortem fragmented records. The resulting report was reordered so that records were listed by minimum number of mismatches. There was significant improvement in rank placement for all of the records. Thus it was accepted that in the situation of highly fragmented remains a different sorting based on the number of mismatches is indicated. Programming changes to make this option available have been implemented in the new version of CAPMI.     

Deaths in preschool and school age--a retrospective analysis from a medicolegal point of view

At the Department of Legal Medicine in Giessen all forensic autopsies from the years 1990 until 2001 were investigated under the aspect of "death in preschool and school age between 3 and 16 years of age." Out of 69 deaths 19% were due to a natural and 81% to an unnatural cause of death. Both groups (3 to 6 and 7 to 16 years of age) were analyzed retrospectively with regard to age and circumstances of death and compared with the literature. The purpose of the differentiating evaluation is to furnish ideas how to prevent violent deaths of children.     

Discrimination between functions of an expert bureau and a burial firm (topic for discussion)

The authors suggest measures aimed at discrimination of the functions performed by forensic medical experts and the services rendered by burial firms. The responsibilities of pathology departments of hospitals and bureaus of forensic medical expert evaluations, which should be reflected in official documents, should be confined to manipulations needed to solve the professional problems and removal of sections. Cases when utilization of certain chemicals or manipulations aimed at restoration of the body are prohibited should be listed in detail. The order of transfer of the body from pathology department or forensic medical bureau to the burial firm and to relatives should be regulated with consideration for the results of autopsy. The moment of the end of autopsy studies is to be determined.     

Adolescent death: a 15-year retrospective review

Adolescents comprise an eclectic mix of people vitally important to society yet long-term comprehensive studies on the circumstances of their deaths are lacking in the pediatric forensic literature. The authors reviewed all forensic cases referred to the Medical University of South Carolina Forensic Pathology section over the fifteen years between January 1989 and December 2003. In accordance with the World Health Organization (WHO) definition of adolescents, only decedents 10-19 years of age were included. The authors examined the cause and manner of death, age, gender, and race of the victims in all cases. The toxicology results, perpetrator, death scenario and location, and victim traits were analyzed when available. For all adolescents, the most common manner of death was accident followed by homicide, suicide, natural, and undetermined. Within the adolescent population two distinct groups, 10-14 years old and 15-19 years old, were identified. Though both groups were similar in that they experienced a high number of accidental deaths, decedents of older age group suffered a higher percentage of violent deaths while decedents of the younger group were more likely to die of natural causes. Many of the accidental deaths in this review were preventable, including deaths due to motor vehicle collisions and drowning. In deaths due to homicide, the perpetrator was often known to the victim, whether as an acquaintance or family member. Toxicology testing was often positive in decedents of the older age group, while only rarely positive in decedents of the younger age group. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of adolescent death. The authors present their findings in this 15-year retrospective study to better aid forensic pathologists, death investigators, law enforcement, and epidemiologists.     

The Influence of Actuarial Risk Assessment in Clinical Judgments and Tribunal Decisions about Mentally Disordered Offenders in Maximum Security

Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report at the time of decision making, patient characteristics and history, and clinical presentation over the previous year. Detained and transferred patients did not differ in their actuarial risk of violent recidivism. The best predictor of tribunal decision was the senior clinician's testimony. There was also no significant association between the actuarial risk score and clinicians' opinions. Whether the actuarial report was available at the time of decision making did not alter the statistical model of either clinical judgments or tribunal decisions. Implications for the use of actuarial risk assessment in forensic decision making are discussed.