Students' physical and psychological reactions to forensic dissection: Are there risk factors?

The reactions of students to forensic dissection encompass psychologico-emotional and physical components. This exploratory study aimed to determine risk factors for students' adverse physical and psychological reactions to forensic dissection. All sixth-year medical students (n = 304) attending the compulsory practical course in forensic medicine in the 2005-2006 academic year were asked to complete a questionnaire at the conclusion of the five-day course. The questionnaire surveyed physical and psychological reactions (outcomes) and 47 student traits, beliefs, and behaviors (risk factors) that might predispose to adverse reactions. Multivariate ordinal logistic regression yielded five independent risk factors for negative psychological reactions: female gender, stereotypic beliefs about forensic pathologists, a less cognitive and more emotional frame of mind relative to forensic dissection, more passive coping strategies, and greater fear of death. The sole independent risk factor for physical symptoms was a less cognitive/more emotional approach to dissection. Students' reactions to forensic dissection integrate a host of inherent and dissection-related risk factors, and future interventions to improve this aspect of medical education will need to take into account the complexities underlying students' experiences with dissection.     

SEBD inclusion research synthesis: a content analysis of research themes and methods in empirical studies published in the journal Emotional and Behavioural Difficulties from 1996–2014

The present paper reports on findings from a systematic journal review study exploring research strategies to investigate inclusive education for pupils with social, emotional, and behavioural difficulties. From a total of 384 articles, published in 19 volumes of the journal Emotional and Behavioural Difficulties between 1996 and 2014, 39 research reports matched inclusion criteria. The sample consists of 22 qualitative, 8 mixed-method, and 9 quantitative studies analysed in terms of research designs, methodological issues, and content-related themes. The findings are discussed with a focus on perspectives for future research strategies.     

Developing a procedure for learning and assessing peer review in a forensic science programme

Peer review of forensic casework is essential for ensuring quality and reducing error rates. However, it is not a common component of forensic science degree courses, and there are no published studies, guidelines or methods for teaching and learning forensic peer review. This study describes a method of learning, teaching and assessing forensic peer review through the use of group work to prepare checklists for reviewing casefiles and expert witness reports, followed by individual peer feedback. Example checklists and assessment criteria are provided. The peer feedback comments on expert reports were categorised revealing that suggestions are the most frequent type of feedback provided, followed by questions. Through a questionnaire, participants strongly agreed that the learning and teaching process described here was relevant to their future professional practice, and that through the use of checklists they understood the criteria for effective forensic peer review. It emerged from a semistructured interview that limited time led some students to surface review expert reports, that peers were seen as legitimate sources of knowledge, and additional feedback from lecturers was required. This study may be relevant to other areas where professional peer review is used, such as open source software development, nursing and community pharmacy.     

What Happens During Language and Literacy Coaching? Coaches’ Reports of Their Interactions With Educators

Research Findings: This study investigated coaches’ interactions with educators in the context of a large-scale, state-implemented literacy professional development (PD). We examined log data and open-comment reports to understand what coaches found salient about their interactions with educators as well as how those reports aligned with the initial design of the PD. Coaches reported spending a large proportion of their interactions with educators completing administrative tasks. Our findings also indicate that coaches disproportionally targeted instructional content from the PD while also adding unrelated instructional content to their coaching. Although coaches reported focusing on relationship building, they reported using less efficacious coaching strategies (e.g., observation and discussion) more frequently than coaching strategies demonstrated to be more efficacious (e.g., modeling and coteaching). Practice or Policy: Our findings suggest an explanation for the mixed evidence around coaching, as coaches in the study seemed to move beyond the specifications of the PD in their coaching interactions. This work has implications for the design of PD for both improving coach training and allowing some flexibility to meet educators’ learning needs that may be secondary to the content of the PD. Findings also support the need for more nuanced mechanisms for investing in coaching and coaching outcomes.     

Which sexual abuse victims receive a forensic medical examination? The impact of Children's Advocacy Centers

OBJECTIVE: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. METHODS: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic medical exams in 1,220 child sexual abuse cases through review of case records. RESULTS: Suspected sexual abuse victims at CACs were two times more likely to have forensic medical examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the medical professional. Receipt of a medical exam was not associated with offenders being charged. CONCLUSIONS: Results of this study suggest that CACs are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims.     

Forensic medical results and law enforcement actions following sexual assault: A comparison of child,adolescent and adult cases

BackgroundIn sexual assault cases, little research has examined differences in forensic medical findings and law enforcement response by victim age across the entire age range.ObjectiveThis study addressed this gap by comparing four victim age groups: adults, adolescents over the age of consent, adolescents under the age of consent, and children under 12.Participants and settingCases were randomly sampled from a statewide database of medical reports on sexual assault examinations conducted in hospital emergency departments, including only cases reported to law enforcement (N = 563).MethodsData were combined from a medical report database, from coding of medical documentation and crime laboratory reports, and from case data provided by law enforcement.ResultsRates for both younger and older adolescent victims and adult victims were comparable, with no statistically significant differences on most variables: penetration, perpetrator use of force, non-genital and genital injuries, presence of biological evidence, generating assailant DNA profiles, DNA match to suspect, hits in the FBI’s DNA database, and law enforcement unfounding (i.e., determining allegations to be false or baseless). Child victims were significantly less likely to have a non-genital injury, and their cases were significantly more likely to be founded by law enforcement. Arrests were significantly more likely when victims were under the age of consent.ConclusionsDespite significant differences by victim age, similarity between adolescent and adult cases was substantial. Both younger and older adolescents may be at higher risk of physical violence during sexual assault than previously recognized, and need greater attention in response systems.     

Forensic child sexual abuse evaluations: assessing subjectivity and bias in professional judgements

Objectives

Evaluators examining the same evidence often arrive at substantially different conclusions in forensic assessments of child sexual abuse (CSA). This study attempts to identify and quantify subjective factors that contribute to such disagreements so that interventions can be devised to improve the reliability of case decisions.

Methods

Participants included 1106 professionals in the field of child maltreatment representing a range of professional positions or job titles and years of experience. Each completed the Child Forensic Attitude Scale (CFAS), a 28-item survey assessing 3 forensic attitudes believed to influence professional judgments about CSA allegations: emphasis-on-sensitivity (i.e., a focus on minimizing false negatives or errors of undercalling abuse); emphasis-on-specificity (i.e., a focus on minimizing false positives or errors of overcalling abuse); and skepticism toward child and adolescent reports of CSA. A subset of 605 professionals also participated in 1 of 3 diverse decision exercises to assess the influence of the 3 forensic attitudes on ratings of case credibility.

Results

Exploratory factor analysis identified 4 factors or attitude subscales that corresponded closely with the original CFAS scales: 2 subscales for emphasis-on-sensitivity and 1 each for emphasis-on-specificity and skepticism. Attitude subscale scores differed significantly by sample source (in-state trainings vs. national conferences), gender, years of experience, and professional position, with Child Protective Service workers unexpectedly more concerned about overcalling abuse and more skeptical of child disclosures than other professionals—a pattern of scores associated with an increased probability of disbelieving CSA allegations. The 3 decision exercises offered validation of the attitude subscales as predictors of professional ratings of case credibility, with adjusted R²s for the three exercises ranging from .06 to .24, suggesting highly variable effect sizes.

Conclusions

Evaluator disagreements about CSA allegations can be explained, in part, by individual differences in 3 attitudes related to forensic decision-making: emphasis-on-sensitivity, emphasis-on-specificity, and skepticism toward child reports of abuse. These attitudes operate as predispositions or biases toward viewing CSA allegations as likely true or likely false. Several strategies for curbing the influence of subjective factors are highlighted including self-awareness of personal biases and team approaches to assessment.     

Three models of child abuse consultations: A qualitative study of inpatient child abuse consultation notes

Child abuse pediatricians have multiple roles in caring for abused children, including prevention, diagnosis, treatment, and, when needed, expert legal opinion. The child physical abuse consultation differs from the traditional medical consultation in that it has medical, investigative and legal audiences, all of whom have different information needs. How child abuse pediatricians approach their cases and how they document their initial inpatient consultations that will be used by such a diverse audience is currently unexplored. We used content analysis to examine 37 child physical abuse consultation notes from a national sample of child abuse pediatricians in order to understand physicians’ approaches to these consultations. Three commonly used models of child physical abuse consultation were identified in the data that we named the base model, the investigative model, and the family-dynamic model. While model types overlap, each is distinguished by key features including the approach used to gather information, the information recorded, and the language used in documentation. The base model most closely mirrors the traditional medical approach; the investigative model concentrates on triangulation of sources of information; and, the family-dynamic model concentrates on physician perceptions of family relationships. The three models of consultations for child physical abuse mirror the areas of child abuse pediatrics: diagnostic, forensic and therapeutic. These models are considered in relationship to best practice from other medical specialties with forensic components.     

Urgent medical assessment after child sexual abuse

BACKGROUND: Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or examination findings as compared to those seen non-urgently or whether forensic findings would be affected by child characteristics, type of reported contact, or later events. DESIGN/SETTING: We evaluated 190 consecutive cases of children under 13 years of age urgently referred during a 5-year period in 1998-2003 to a community child advocacy center and compared them to those non-urgently referred with regard to their physical examination findings, any sexually transmitted infections or forensic evidence, gender, pubertal development, type of contact, reported ejaculation, later bathing or changing clothes, time to examination, and gender, age and relationship of alleged perpetrator. RESULTS: Children seen urgently were younger and had less frequent CPS involvement, more disclosures, and more positive physical examinations, and had more contact with older perpetrators than those seen non-urgently. Overall, most children were female and had normal or non-specific physical examinations. Certain case characteristics were predictive of evidence isolation in the 9% who had positive forensic evidence identified. Semen or sperm was identified from body swabs only from non-bathed, female children older than 10 years of age or on clothing or objects. CONCLUSIONS: Female children over 10 years old who report ejaculation or genital contact without bathing have the highest likelihood of positive examinations or forensic evidence. While there are other potential benefits of early examination, physicians seeking to identify forensic evidence should consider the needs of the child and other factors when determining the timing of medical assessment after sexual abuse.     

An examination of the conflict resolution strategies and goals of children with depressive symptoms

The purpose of this study was to examine (a) the reports of conflict strategies and goals in response to hypothetical conflict situations, (b) generation of solutions to hypothetical conflicts, and (c) conflict in observed dyadic exchanges in children with high and low depressive symptoms. Children from Grades 4, 5, and 6 were divided into high (n = 57) and low (n = 57) depressive symptoms groups. Results indicated that the two groups differed on the types of conflict strategies but not conflict goals chosen in hypothetical social problem‐solving tasks. Also, children reporting depressive symptoms typically chose less effective strategies to solving social problems. In observed dyadic exchanges, the high depressive symptoms group employed more negative strategies than the low depressive symptoms group, but no significant differences were noted for the prosocial conflict resolution strategies exhibited. Findings and implications for children with depressive symptoms are highlighted.     

论医疗损害赔偿案件代理中的几个问题

本文从代理人的角度,论述医疗损害赔偿案件的三个基本问题:一是医疗损害赔偿案件既包括医疗事故,又包括非事故性医疗损害;二是案件中鉴定的效力和种类;三是举证责任倒置原则的理解和运用.     

Beyond synthesis: augmenting systematic review procedures with practical principles to optimise impact and uptake in educational policy and practice

ABSTRACT

Whilst systematic reviews, meta-analyses and other forms of synthesis are considered amongst the most valuable forms of research evidence, their limited impact on educational policy and practice has been criticised. In this article, we analyse why systematic reviews do not benefit users of evidence more consistently and suggest how review teams can optimise the impact of their work. We introduce the Beyond Synthesis Impact Chain (BSIC), an integrated framework of practical strategies for enhancing the impact of systematic reviews. Using examples from health professions education, we propose that review teams can optimise the impact of their work by employing strategies that (1) focus on practical problems and mindful planning in collaboration with users; (2) ensure reviews are relevant and syntheses reflexively account for users’ needs; and (3) couch reports in terms that resonate with users’ needs and increase access through targeted and strategic dissemination. We argue that combining practical principles with robust and transparent procedures can purposefully account for impact, and foster the uptake of review evidence in educational policy and practice. For systematic review teams, this paper offers strategies for enhancing the practical utility and potential impact of systematic reviews and other forms of synthesis.     

华东地区汉族人群D8S1477和D8S592基因座的遗传多态性研究

建立了D8S1477和D8S592基因座的分型方法,获得了华东汉族群体D8S1477和D8S592基因座的遗传学数据,并对华东汉族群体数据与华西及印度四个群体的群体遗传学数据做了构成比较．结果表明：D8S1477基因座等位基因频率分布较好,对我国华东地区汉族人群具有较高的非父排除率和个人识别能力,D8S592基因座属非高度多态性STR基因座,不适于法医学应用．     

‘Teaching Is Still a Good Job for a Woman’: the influence of gender on career and life choices

This article reports on an investigation of primary and early‐childhood teacher‐education students’ understandings and beliefs about the influence of gender on their careers and life choices. The research was undertaken by a collaborative team from three Victorian universities. We took as our premiss that if teacher‐education students are to be effective in promoting gender inclusiveness throughout the schooling culture, they must first reflect on the operation of the sex/gender system in their own lives. A range of viewpoints are included about the gendered understandings commonly held by the tertiary students surveyed. The resulting insights enabled us to suggest more effective strategies for fostering gender awareness in teacher education.     

Curricular strategies for reducing examination anxiety

Considerable stress is associated with undergraduate examinations. Traditional medical schools appear to regard such stress as inevitable and expect students to cope with their anxieties. The Newcastle medical school decided to develop curricular strategies for preventing (or at least reducing) such anxieties, rather than adopt medical or psychological treatment methods for students who subsequently appear unable to cope. Students and staff recommended changes to the original assessment programme after it had operated for four terms. This article reviews the changes and reports on students' greater satisfaction with them and the Newcastle medical school's attitude towards programme improvement. Suggestions are made for a more open, educational approach to student assessment by other learning institutions.     

案例教学法在卫生法学专业法医学教学中的应用

法医学是一门应用医学,卫生法学是医学与法学交叉性专业,伴随着涉及法医学专业领域的诉讼案件的日益增多,对于将来从事法律工作的法学专业学生来说必须要具备一定的法医学知识。案例教学法是以学生为中心、理论联系实践、提高学生专业水平的好方法,是教学法改革的突破。建立以案例为基础的教学法,应用于法医学教学实践中,利用案例式考试和问卷对该教学法加以评估。案例教学法比传统的教学法在司法实践中有更突出的优势,不仅使学生能系统学习法医学的基本知识,更重要的是培养了学生运用所学知识解决实际问题的能力,真正实现了学以致用。     

Best Practices for Interviewing Children with Intellectual Disabilities in Maltreatment Cases

Globally, children with intellectual disabilities are at an increased risk of being victims of maltreatment compared to those without disabilities. Among the children who do disclose the abuse, limitations with communication and working memory can result in their allegation being perceived as not credible. There are several evidence-based interviewing methods available to interviewers for improving the accuracy and amount of detail in children’s testimonies, such as free-recall and cognitive load questioning. In general, these interviewing methods have been developed and tested with typically developing populations, and do not take into consideration the needs of children with intellectual disabilities. Further, there is very little empirical work to guide forensic interviews with intellectually disabled populations, despite there being a great need for such strategies. To address this notable gap in the literature, the current article reviews the contemporary literature on forensic interviewing to identify the best methods for questioning children with intellectual disabilities in maltreatment cases. Adaptations to the commonly used forensic interviewing techniques, including verbal, nonverbal, and repeated questioning strategies, are proposed that address the unique developmental, social, and emotional needs of this population. Furthermore, a series of recommendations are provided to enhance the limited forensic interviewing research with this population.     

The reality of living with AD/HD: children's concern about educational and medical support

A diagnosis of AD/HD may tell us that the child has the core characteristics of inattentiveness, impulsivity and or hyperactivity, but it fails to convey the extent to which the social context of the child's environment manipulates these characteristics. This article reports on how children with a diagnosis of AD/HD view the impact their social environment has on their behaviour; providing us with insight into how educational and medical intervention strategies are failing to achieve their potential. The findings suggest that if children with AD/HD and their families are to benefit from educational and medical intervention then stakeholders need to work together to provide coordinated and consistent support.     

Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score (p < 0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score (p < 0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support.