Whiplash-Associated Disorders : Clinical and medico-legal guidelines on the methods of ascertainment.

The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.

Statement on access to relevant medical and other health records and relevant legal records for forensic medical evaluations of alleged torture and other cruel, inhuman or degrading treatment or punishment.

In some jurisdictions attempts have been made to limit or deny access to medical records for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medical records may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given.

Assessment of bruise age on dark-skinned individuals using tristimulus colorimetry.

INTRODUCTION: Studies on the ageing of bruises have been reported on Caucasians or individuals of fair ethnicity. This study focuses on bruise changes in dark-skinned individuals using tristimulus colorimetry for forensic analysis in such individuals. METHODS: Eighteen subjects of South Indian or Sri-Lankan ethnicity were recruited. Subjects were bruised using a vacuum pump and then daily colour measurements were taken of the bruise using a tristimulus colorimeter. The L*a*b* readings were recorded of a control area and of the bruise until it disappeared. Two Caucasians were used for comparison. RESULTS: This study showed that, using colorimetry, bruises on dark-skinned individuals can be measured and analysed even if the bruises are unclear visually. As the bruise is beneath the skin, the colour difference ΔL*, Δa* and Δb* were calculated. All values showed a trend, indicating that the L*a*b* measuring technique is a reliable method to analyse bruises on dark-skinned individuals. Comparisons of Asian subjects and Caucasian subjects were performed. The largest difference was seen in the b* value. Statistical analysis showed that ΔL* colour difference was the most consistent (95% CI -4.05 to -2.49) showing a significant difference between days 1-4 and 5-8. CONCLUSION: Objective assessment of bruises on dark-skinned individuals using the L*a*b* method of measuring gave reproducible results. Furthermore, the study showed that the yellowing of a bruise cannot be seen or measured with a tristimulus colorimeter on dark-skinned individuals due to the pigmentation of the skin. With further studies and more subjects, the age of bruises could potentially be assessed for use in forensic analysis.

Can we assess the age of bruises? An attempt to develop an objective technique.

AIMS: The aims of this study were (A) to investigate whether the number of years of forensic experience affected the accuracy with which forensic experts (FEs) were able to age bruises and (B) to identify the properties and colours of a bruise that were utilized by FEs in their assessment of bruise age. The study then investigated the possibility of using a more objective technique. It was decided to use readily available digital photography and software to objectively assess changes in bruise colouration and to investigate if this can be used to age bruises. METHODS: Twenty-three FEs were shown 25 photographs of bruises of varying but known ages and asked to estimate the ages. In part two of the study, bruises were inflicted on volunteers using a vacuum pump and photographs taken of the bruise daily from infliction to resolution. The images were analysed using Adobe Photoshop. Red, green and blue (RGB) values were recorded for each bruise and analyses carried out comparing the values over time between subjects and within subjects. RESULTS: This study both enhanced and supported a previous conclusion that visual assessment of photographs is an unreliable method for ageing bruises. Additionally, it found that the degree of forensic experience had no effect on accuracy. It also identified that colour (particularly yellow, red and purple) and intensity of colour were the most commonly used properties of a bruise in the assessment of its age. The RGB method proved to be a reliable technique with which to measure bruise colour, but its validity in the assessment of bruise age was poor. CONCLUSIONS: Visual assessment of bruises is unreliable and the accuracy of ageing was not improved by the degree of forensic experience. The RGB method gave highly reproducible results, but did not accurately assess bruise age. However, results within subjects suggested that there may be individual variation in haemoglobin metabolism.

Sudden cardiac deaths in young British Army personnel.

Much attention has been paid to sudden cardiac death in young athletes which has led to the implementation of tighter screening controls in many sports at various levels. Less attention has been paid to this subject in young army recruits. We describe three cases of sudden cardiac death in young UK soldiers. The scale of the problem in the UK is unknown. We highlight issues regarding diagnostic testing to identify risk factors for sudden cardiac death and suggest potential additions to the current screening programme for new recruits to help increase the sensitivity of detecting cardiac pathology and reducing the rates of sudden cardiac death in this group.

Visual assessment of the timing of bruising by forensic experts.

INTRODUCTION: Forensic experts are frequently asked to comment on the age of injuries and interpretation may have significant medico-legal consequences. The purpose of this study is to determine the accuracy with which forensic experts can visually age a bruise from photographs produced under standard conditions. METHODS: Bruises were produced on the upper arms of 11 subjects by a suction pump. Sequential photographs were taken daily until they were no longer visible to the naked eye. Fifteen forensic experts who did not know the age of the bruises were asked to estimate their ages and also to place them in chronological order. RESULTS: Hundred and thirty-two images of 25 bruises were produced, ranging from 0 to 209h in age. There was considerable inter- and intra-observer variability in accuracy (median difference between the estimated age and the real age=26.0h (95% C.I. 24.0-31.0h). There was greatest accuracy for bruises photographed between 0 and 12h. No significant differences were seen between male and female observers (p=0.553) and performance was also unaffected by the age of the observer (p=0.160). Of the bruise images placed in chronological order >80% of the observers made between 0 and 2 errors. CONCLUSION: Bruise age estimates by forensic experts, from photographs, are unreliable. However, it appears that the vast majority of observers are better able to place bruises from the same subjects in their chronological order.

Inter- and intra-individual variation in applied force when listening at a surface, and resulting variation in earprints.

We aimed to explore the level of inter- and intra-individual variation in applied force when listening at a surface, and assess the resulting variation in earprints. We further intended to identify possible sources of this variation. Forty subjects each listened twenty-four times at a surface while applied force was recorded. In between efforts the level and frequency of the target sound, and the level of ambient noise were varied. Each listening effort was characterized by two values: the mean of a series of force recordings ('functional force') and the highest force reading of the effort ('peak value'). A mixed model analysis of variance revealed that repetition during multiple efforts of listening and the level of the target sound significantly affected both values for applied force. The frequency of the target sound affected the peak value, but we assume this was due to confounding effects. The level of ambient noise did not affect applied force. To explore the correlation between values for applied force of various efforts by single ear, the intra-class correlation coefficient was calculated. For functional force it was 0.80; for the peak value it was 0.79. To study intra-individual variation in earprints, five prints from each ear were lifted and studied. Variation in prints is discussed.

STR data for the GenePrint PowerPlex 1.2 system loci from three United Arab Emirates populations.

Allele frequencies for the eight STRs included in the GenePrint PowerPlex 1.2 kit were obtained from three population groups that are resident in the United Arab Emirates (UAE); 228 unrelated UAE individuals, 194 unrelated Indian individuals and 197 unrelated Pakistani individuals were analysed.

Interpreting bruises at necropsy.

The accurate interpretation of bruising at necropsy is essential to understanding how a victim has been injured and assists the pathologist in a reliable reconstruction of the events leading to death. It is essential not only to assess the mechanism of production of a bruise, taking into account the type of impacting surface and the magnitude of force used, but also to estimate when the injury was caused. An account is given of the various methods used in the examination of bruises, particularly with respect to aging, as well as the factors that may affect their appearance. Differentiation from artefacts resulting from postmortem changes is also discussed in some detail.

STR population data for 10 STR loci including the GenePrint PowerPlex 1.2 kit from El-Minia (Central Egypt).

Allele frequencies for 10 STRs including the GenePrint PowerPlex 1.2 loci and also D3S1358, HumvWA and HumFGA were obtained from a sample of unrelated individuals from El-Minia City.

Cranio-facial reconstruction in forensic identification--historical development and a review of current practice.

Cranio-facial reconstruction has its origins in the 19th century, initially to recreate and 'bring back to life' the faces of the rich and the famous. Since then, over the last 100 years, there have been various methods used to produce reconstructions for forensic identification as well as for historical or archaeological purposes. These range from the traditional sculpting methods to those based on up-to-date computer technology. When no other method of identification is available in skeletalized, badly mutilated or decomposing remains, forensic cranio-facial reconstruction may be employed to produce a face which it is hoped will trigger recognition and thus lead to a positive identification. This paper discusses the role that cranio-facial reconstruction may play in identification and its limitations.

The use of mitochondrial DNA and short tandem repeat typing in the identification of air crash victims.

In February 1998, a civilian air plane crashed into a remote mountainside in the Philippines, killing all 104 passengers and crew. The victims were subjected to severe environmental insult, preventing conventional identification methods in most cases. As part of the identification process, samples were subjected to a combination of mitochondrial DNA (mtDNA) and short tandem repeat (STR) DNA profiling. The DNA extracted from the victims' remains was in all cases highly degraded. However, profiling using mtDNA was still successful with 95% of the victims' samples; this compared to a 50% success rate using three STR loci. The use of mtDNA and STR profiling enabled 187 human fragments from the crash site to be placed into 80 distinct groups; when combined with postmortem data, the samples could be further separated into 95 distinct groups, thereby assisting in the identification process.

Puncture resistance and tensile strength of skin simulants.

This study aims ultimately to quantify the force needed to penetrate human tissue. The results will reduce the subjectivity of expert opinion in stabbing incidents. They will also aid clinicians in assessing the severity of injury and help prevent the unnecessary deaths which can occur when this is not fully appreciated. Tensile tests were performed to identify suitable skin simulants with synthetic chamois and pigskin as candidate materials. Quasi-static penetration experiments were also performed in which a knife blade penetrated a skin simulant target. Pigskin was found to be much stronger than chamois under tensile load yet the puncture resistance was almost identical for the two materials.

Investigation of clandestine graves resulting from human rights abuses.

The role of the forensic scientist in the investigation of clandestine graves resulting from human rights abuses is discussed. Individuals buried in such circumstances have perished following abuse by persons in authority or by other political factions. Such persons have been classed by the abusers as dissidents or political opponents, or have been killed simply for belonging to a particular racial or religious grouping. Guidelines for investigation and the general approach by the scientist are suggested and examples of exhumations are cited in which the author has had personal involvement. These include exhumations carried out in the former Yugoslavia, Rwanda and Chile.

Medicolegal aspects of the Thai Airbus crash near Kathmandu, Nepal: findings of the investigating pathologists.

A Thai Airbus, carrying 99 passengers and 14 crew members, traveling from Bangkok to Kathmandu, hit a mountain and crashed several minutes before landing. There were no survivors. Recovered human remains, none of which was easily identifiable, varied in size from a small piece of muscle to mutilated bodies. Of the 97 fragments, only 15 were sufficiently intact (albeit, only partially) to be designated as "bodies." Of the fragments and "bodies," only 11 were positively identified. Causes of death, although all traumatic, could not be stated accurately due to the degree of disintegration. Identification of human remains in these circumstances is a major problem for the pathologist.

Morphological classification of facial features in adult Caucasian males based on an assessment of photographs of 50 subjects.

Fifty sets of photographs showing facial features of Caucasian males aged 18 to 60 years were examined to establish a morphological classification of the face. It is suggested that such a classification could assist facial identification by photocomparison. The selection criteria stress the importance of interassessor agreement and discrimination among feature subset units in formulating the proposed classification.

Photometric assessment of skin colour and lightness using a tristimulus colorimeter: reliability of inter and intra-investigator observations in healthy adult volunteers.

The ageing of injuries is an important aspect of forensic medicine, and one which can have significant medico-legal consequences. The sequence and timing of color changes associated with the appearance and disappearance of bruises, as well as the factors which govern this process, have long been a source of controversy. Whilst visual assessment currently remains the easiest and most practical method available to date bruises, it appears unlikely that it can be relied upon to provide an accurate and consistent measure of the age of a bruise. In an ongoing pilot study designed to assess the applicability of colorimetry to the dating of bruises, the Dr. Lange MICRO COLOR tristimulus colorimeter will be used to assess how the color and colour density (lightness) of bruises change over time. The results of a preliminary study are presented, in which the variability of skin colour measurements obtained by different investigators was assessed. Measurements were taken of the same area on the volar surface of the forearm of five volunteers, after having them remain with their arm motionless for a predetermined period of time (2, 5, and 10 min). Four sets of measurements were taken by each investigator over a total period of 3 h. No significant statistical difference was found after the resting time interval of 5 min between the values obtained by the two investigators (P > 0.05). While studies on a much larger population remain to be completed, our initial findings would seem to suggest that the colorimeter is able to provide an objective, quantitative, and relatively consistent measure of skin colour when used by different individuals.