bluuebunny/crossref_metadata_2025 huggingface dataset:
Arson: A growing inferno
Authors: JAYARAMAN ANAND , FRAZER JOHN
Published: February 2010

In a series of 34 arsonists, our survey compares the changing trends in arson to an earlier study carried out ten years ago in the same region in the UK by Rix (1994). The survey is based on pre-trial court reports done by the second author only. Fire-setting offending was predominantly seen in the young male (18-32). Fire-setting started as early as age seven and was seen as late as 63 years of age. More than half of the subjects received some form of family support. At least one third had an ICD-10 (WHO, 1992) diagnosable mental disorder and more than half were diagnosed with a psychiatric disorder during the time of reporting. A third of the subjects had a personality disorder diagnosis prior to reporting and another third had disordered personality traits established during the time of reporting. More than half had a psychological motive. Eleven per cent started a fire for excitement with only one for revenge. A third of the subjects were first time arsonists. Sixty-five per cent of arson involved building damage and all the 34 subjects were under the influence of alcohol prior to and during the act of arson. Additionally, there was cannabis use in nearly half of the subjects. Opioids and poly substance abuse were seen in a third of subjects. With the extent of financial and social burden along with risks, attention should be focused on accessing these individuals early to preventing recidivism. More research needs to be undertaken to identify the psychological motives behind fire-setting and to look into the drugs and alcohol problems amongst the younger age groups.
Appealing statistics
Authors: Donnelly Peter
Published: February 2010

In the case of Regina v. Adams [1996], DNA evidence seemed to suggest that there was a 1 in 200 million chance that an innocent person would match the DNA found at the crime scene. Peter Donnelly explains how he subsequently became involved in the case and found himself trying to explain Bayes' theorem to judge and jury. (See p.18 for an explanation).
Reflections on the cot death cases
Authors: Hill Ray
Published: February 2010

Sally Clark, Angela Cannings and Trupti Patel not only suffered the tragic sudden deaths of two or more babies. They were then accused, and in the first two cases convicted, of their murder. The misuse of statistics at Sally Clark's trial had profound consequences, especially for her, but also for the subsequent cases. Ray Hill reflects on the statistical issues involved.
Patient perceptions of medium secure care
Authors: Riordan Sharon , Humphreys Martin
Published: February 2010

Research into patients' experience of medium secure psychiatric services is in its infancy despite growing interest in user involvement in mental health care as a whole. The work reported here aimed to provide an opportunity for patients to reflect upon their understanding of their route into secure psychiatric provision and their time spent in one large unit in the West Midlands. Most (65%) of the patients taking part were admitted to medium security through the criminal justice system. The average length of stay was 18 months (range, two months to two years six months). The experience of being admitted to secure care was generally described as frightening though many patients expressed relief that they were now receiving help. Half of those interviewed thought they had no choice about treatment. Nevertheless, eight said they trusted their doctors to make the right decision about medication. Generally patients thought their relationships with multi-disciplinary team members were positive and felt able to approach them with any concerns. Overall, patients who participated in this study were optimistic about their experience of medium secure care. They felt the advantages of hospital care compensated for the disadvantages, particularly as their mental state stabilised and they gained insight into their illness. Areas of concern for patients were lack of privacy and uncertainty about how long they were likely to remain in hospital.
Medical liabilities of the French physician passenger during a commercial air flight
Authors: Dedouit F. , Tournel G. , Barguin P. , Becart-Robert A. , Hedouin V. , Gosset D.
Published: February 2010

Nearly two billion passengers travel each year on commercial air flights. More elderly people and/or people with a pre-existing condition are taking to the air and with the anticipated growth of air travel, inflight illnesses and injuries are expected to increase as well. Even if in-flight medical events and deaths are still uncommon, physician passengers are occasionally called upon to render assistance. Although no case law exists as yet in France, physicians who often travel on commercial flights should be aware of the risks they run if they do not respond to the well-known call, `Is there a doctor on board?', or if they assist a sick passenger. This paper describes in-flight resources available to a physician who is called upon to treat an ill or injured passenger. Two questions concerning the French physician passenger are discussed: What are the liabilities of the physician who does not respond to the call of a medical event aboard an aircraft? What are the liabilities of the physician providing assistance to a sick passenger? The different liabilities and also the legal status of the French physician passenger are examined.
Claims made by children in Japan for injuries caused before birth
Authors: Sakaihara Mitsuo
Published: February 2010

In Japan, under Article 721 of the Civil Law 1896, a child who is born disabled is able to file a claim against the person who injured him or her in the mother's womb. On the other hand, there are no legal rights for a stillborn child who died in the mother's womb as it is traditionally considered that a foetus is not a person. Consequently, the parents of a stillborn child are not able to recover damages as administrators for the wrongful death of their child. They are only able to recover damages for pain and suffering related to the stillbirth of their child. This study compares the legal status of a disabled live-birth child and a stillborn child in Japan with those in a similar situation in the UK and USA.
Autopsy study of fatal deliberate self harm
Authors: Arun M. , Palimar Vikram , Menezes Ritesh G. , Babu Y.P. Raghavendra , Bhagavath Prashantha , Mohanty Manoj Kumar
Published: February 2010

A retrospective autopsy study of fatal deliberate self harm (FDSH) was undertaken in the mortuary of Kasturba Hospital, Manipal, Southern India over a period of 12 years (1993-2004). Out of 1917 cases autopsied, 21.2% were deaths due to deliberate self harm (DSH). The male sex (66.1%) and victims in the third decade of life (35.9%) predominated. More than two-thirds of the decedents were married. More fatalities were observed during the winter season (35.8%) and in the day time (62.2%). Dispair with life (61.9%) was the most common motive for FDSH. The majority of fatalities were due to poisoning (73.5%), where organophosphorous compounds topped the list (71.9%). About one-third of the victims survived for 18 to 24 hours after DSH.
Variation in proportion indices and angles between selected facial landmarks with rotation in the Frankfort plane
Authors: Kleinberg Krista F. , Vanezis Peter
Published: February 2010

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° (frontal) to 90° (side view), rotating every 10° 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
Authors: Tarran Sarah L.S. , Craft George E. , Valova Valentina , Robinson Phillip J. , Thomas Graham , Markham Robert , Langlois Neil E.I. , Vanezis Peter
Published: February 2010

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°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.
The effect of aluminium phosphide on the human brain: a histological study
Authors: Tripathi S.K. , Pandey S.K.
Published: February 2010

The study was conducted on 317 cases of poisoning in the Varanasi region, India, between January 2002 and August 2003. Aluminium phosphide (Celphos) was used by 239 victims (75.40% of the total) and was used in 69.03% of male and 30.96% of female cases. It was commoner in males from both rural and urban areas and in the 21-30 year age group. Microscopic investigation of the cerebral and cerebellar cortex showed distinct changes due to the effect of celphos. Findings in the cerebral cortex revealed disorganisation of the different layers, round shaped neurons with a convex border, degenerated Nissl granules in the cytoplasm and a deeply stained degenerated eccentric nucleus. Findings in the cerebellar cortex included degenerated neurons, the infiltration of round cells into the molecular layer and the disappearance of the processes of Purkinje cells. Degenerate nuclei were surrounded by scavenger cells in the granular layer. The subcortical zone of the brain revealed a paucity of glial cells, degeneration of nerve fibres and the appearance of necrotic patches.
Lightning fatalities in the Transkei sub-region of South Africa
Authors: Meel B.L.
Published: February 2010

Lightning is a particularly unsettling product of bad weather. It kills more people than other natural disasters such as floods, hurricanes, and tornadoes, but, because lightning usually kills people one at a time, it tends to be an underrated hazard. High risk groups are uneducated, unsheltered and rural people. This study was carried out to determine the incidence of lightning fatalities in the Transkei sub-region. It is a review of records between 1993 and 2004 from the medico-legal autopsies at Umtata General Hospital (UGH).

During the study period there were 10,860 autopsies performed on those who died of trauma and other unnatural circumstances which included 151(1.4%) lightning fatalities. This represents 0.31 deaths per million per year. The highest (0.5/million) was in 1999, and the lowest (0.13/million) in 1997. The age of the victims ranged from 1 to 82 years, with a mean of 22 years. Males and females were almost equally represented (50%). The highest number of deaths (26.5%) was in the age group of 11 to 20 years, and the lowest number (2.7%) in the age group of 70+ years. There is a high incidence of lightning fatalities in the Transkei sub-region of South Africa. People need to be educated to disregard the myths of lightning strike.
Masking and bondage in suicidal hanging
Authors: Benomran F.A. , Masood S.E. , Hassan A.I. , Mohammad A. A.
Published: February 2010

The body of a 35-year-old man was found hanging in a relatively isolated place outdoors. A vest was wrapped over his head, neck and lower part of the face. The hands were loosely tied in front of the body. The vest was tucked between the neck and the ligature, to act as a pad. Thorough scene examination and post-mortem examination excluded any evidence of foul play. Although bondage is usually associated with autoerotic practices in asphyxiation deaths, it was established that this case was a suicide. DNA was used as a supportive measure to determine that the handkerchief and vest belonged to the deceased.
Applying visible hyperspectral (chemical) imaging to estimate the age of bruises
Authors: Payne Gemma , Langlois Neil , Lennard Chris , Roux Claude
Published: February 2010

Hyperspectral (chemical) imaging collects spectroscopic data in a two-dimensional spatial format. The potential application for the determination of the age of bruises is demonstrated and compared to reflectance probe spectrophotometry as well as photography. Blood was deposited on white cotton cloth or injected subcutaneously into pig skin to simulate a ‘fresh bruise’. A mixture of blood and bile was used to simulate ‘old’ bruises. On the cloth background all the photographic methods clearly separated the two groups of samples (i.e. ‘blood only’ from ‘blood plus bile’). However, on the pig skin the two groups could be separated by one of the photographic methods only. Separation of blood from blood and bile mixtures was obtained on the cloth and skin backgrounds using spectrophotometry and hyperspectral imaging. In a test using serial dilutions of blood and bile mixtures, the hyperspectral system performed slightly better than the spectrophotometer. The former also had the advantage of imaging a wider area and providing spatial data. Hyperspectral (chemical) imaging and spectrophotometry are superior to photography for the detection of bilirubin on a background of skin (due to the presence of yellow chromophores); this technology combined with mathematical analysis of the spectral data warrants further investigation.
A study of wound fatalities in the north of Jordan
Authors: Shotar Ali M. , Jaradat Sa'eed
Published: February 2010

The aim of the present study is to analyze the epidemiological and demographic features of sharp wound fatalities. A retrospective study was carried out of 58 fatalities from injuries induced by the use of sharp objects which were sent to the Forensic Medicine Teaching Centre of North Jordan — affiliated to Jordan University of Science and Technology — for the period January 1989 to December 2000. Results showed that the majority of cases (46 - 79.31%) were young people, below 30 years of age. Forty-six cases were male (79.31%) and 12 (20.69%) were female. The 58 cases sustained 182 injuries. The trunk sustained the maximum number of injuries 145 (79.63%). Sharp wound fatalities showed a slight variation over the 12-year study period and rose twice, in 1991 and 2000. Forty four cases (75.86%) were urban residents. Thirty-seven (63.79%) cases occurred during the warmer months of the year. Most cases were murder 47 (81.03%) and 51 (88%) victims died from acute haemorrhagic shock. Forty-three (74.14%) cases died before receiving any treatment. None of the 58 victims had used alcohol or drugs. One victim was a Syrian labourer. Cases of sharp wound fatality were more or less stable with two peaks in 1991 and 2000. As in other parts of the world, most victims were young males living in urban areas under stressful conditions. Socio-cultural factors have reduced the frequency of fatalities.
Elderly suicide rates: cross-national comparisons and association with sex and elderly age-bands
Authors: Shah Ajit , Bhat Ravi , McKenzie Sheena , Koen Chris
Published: February 2010

Suicide rates generally increase with age. Examination of cross-national variations in elderly suicide rates may allow the generation of aetiological hypotheses.

Suicide rates for males and females in the age-bands 65-74 years and 75+ years were ascertained from the World Health Organisation website for all the listed countries. Cross-national variations were examined by segregating different countries into four quartiles of elderly suicide rates. Suicide rates between males and females and between the two age-bands were compared across different countries.

The main findings were: (i) there is wide cross-national variation in elderly suicide rates; (ii) elderly suicide rates were the lowest in Caribbean, central American and Arabic countries, and the highest in central and eastern European, some oriental and some west European countries; (iii) suicide rates were higher in men compared to women for both the age-bands; and, (iv) suicide rates were higher in the age-band 75+ years compared to the age-band 65-74 years for males and females.

Potential explanations for regional and cross-national variations in elderly suicide rates include cross-national differences in genetic and environmental factors, prevalence of mental illness in the elderly, life expectancy, socio-economic deprivation, social fragmentation, cultural factors, the availability of appropriate healthcare services, and public health initiatives to improve the detection and treatment of mental illness, mental health and suicide prevention.
Predicting driver from front passenger using only the post-mortem pattern of injury following a motor vehicle collision
Authors: Curtin Eleanor , Langlois Neil E.I.
Published: February 2010

This study aimed to establish whether post-mortem injury patterns can assist in distinguishing drivers from front seat passengers among victims of motor vehicle collisions without regard to collision type, vehicle type or if safety equipment had been used. Injuries sustained by 206 drivers and 91 front seat passengers were catalogued from post-mortem reports. Injuries were coded for the body region, depth and location of the injury. Statistical analysis was used to detect injuries capable of discriminating between driver and passenger. Drivers were more likely to sustain the following injuries: brain injury; fractures to the right femur, right posterior ribs, base of skull, right humerus and right shoulder; and superficial wounds at the right lateral and posterior thigh, right face, right and left anterior knee, right anterior shoulder, lateral right arm and forearm and left anterior thigh. Front passengers were more vulnerable to splenic injury; fractures to the left posterior and anterior ribs, left shoulder and left femur; and superficial wounds at the left anterior shoulder region and left lateral neck. Linear discriminant analysis generated a model for predicting seating position based on the presence of injury to certain regions of the body; the overall predictive accuracy of the model was 69.3%. It was found that driver and front passenger fatalities receive different injury patterns from motor vehicle collisions, regardless of collision type. A larger study is required to improve the predictive accuracy of this model and to ascertain its value to forensic medicine.
Are Asians at greater risk of compulsory psychiatric admission than Caucasians in the acute general adult setting?
Authors: Ali S. , Dearman S.P. , McWilliam C.
Published: February 2010

Patients of African-Caribbean origin appear to be at greater risk of compulsory admission to psychiatric hospitals in the United Kingdom but it is not clear whether this is the case for patients of Asian origin. Case notes and original sections papers were retrospectively reviewed over a one-year period in a psychiatric unit serving a large city in the UK. Caucasian and Asian patients were compared in terms of their representation in the population at risk and rates of detention under mental health legislation. Asian patients were significantly over-represented as in-patients, were more likely to be detained at admission and more likely to be detained under longer term powers during their stay. Asian patients may be similarly over-represented in the psychiatric in-patient population and more likely to be detained under mental health legislation than African-Caribbean patients in the UK. Future studies and service providers may need to consider patients of Asian origin as having different mental health needs.
Pattern of skeletal injuries in cases of falls from a height
Authors: Venkatesh V.T. , Kumar M.V. Pradeep , Jagannatha S.R. , Radhika R.H. , Pushpalatha K.
Published: February 2010

Differentiating the injuries exclusively due to falls from a height is difficult if no proper history is provided. Some clinical studies and case reports have been published on the subject, but an autopsy-based approach to the subject is missing in the literature of recent decades. A retrospective study was carried out on 80 cases of fatal falls from a height brought for autopsy. In selected instances police reports, suicide notes, medical records and scene photographs were reviewed. The principal aim was to look for a pattern of skeletal injuries formed as a result of falls from a height.

The majority of the victims were male, aged between 20-30 years and labourers by occupation. Most of them fell from a height of 0-10 feet. The head is the most vulnerable structure with fractures of the vertex being common. As the height of falls increases, fractures of the ribs and sternum are also found. Finally, it is concluded that falls on the head are more likely and the most fatal of all. However, it cannot be taken as a sole indicator of the manner of death. Risk assessment should be carried out before any work at a height is undertaken.
A comparative analysis of suicide and parasuicide
Authors: Arun M. , Yoganarasimha K. , Kar Nilamadhab , Palimar Vikram , Mohanty Manoj Kumar
Published: February 2010

A prospective study was conducted to analyse the spectrum of suicide attempters and completers at Kasturba Hospital, Manipal, India, over a period of three years (January 2001 to December 2004). The present study comprised a total sample population of 246 cases, of whom 90 died and 156 survived the attempt (1:1.73). Men outnumbered women in the deceased group and women surpassed men in the survivor group. The mean age for the deceased group was 42 years compared with 30 years for the survivor group. Prior attempted suicide in the deceased group was 6.6%. Eighty-three percent of the total population studied opted for ‘chemical methods’, where insecticides topped the list (64.6%) in both the deceased and the survivor group. Among those who preferred ‘physical methods’, 50% died and 50% survived. In the current study, 17% of the subjects had received a psychiatric consultation, of whom 91.3% were diagnosed in the spectrum of ‘depressive disorders.’ Knowledge about the legalities of suicide was lacking in 65% of victims and their kin.
A tale of two cities: a review of homicide in Melbourne and Glasgow in 2005
Authors: Lynch Matthew , Black Marjorie
Published: February 2010

The Departments of Forensic Medicine and Science at the University of Glasgow and the Victorian Institute of Forensic Medicine in Melbourne are academic university-based forensic medicine units providing a medico-legal death investigation service to the Strathclyde region of Scotland and the State of Victoria, Australia, respectively. We reviewed and compared homicides in the two jurisdictions for the year 2005. Whilst gross numbers were comparable, the homicide rate per capita was significantly higher in Glasgow. Death due to stabbing comprised a greater proportion of homicides in Glasgow, reflective of a well recognised social epidemic of knife-related trauma amongst young males. Blunt force trauma was the most prevalent cause of homicidal injury in the Australian cases. The cities shared a low incidence of firearm- related homicide, reflective of strict legislative initiatives.
Sudden death while driving a four-wheeled vehicle: an autopsy analysis
Authors: Motozawa Yasuki , Hitosugi Masahito , Kido Masahito , Kurosu Akira , Nagai Toshiaki , Tokudome Shogo
Published: February 2010

We retrospectively analysed forensic autopsies to resolve various issues associated with sudden natural death while driving. We collected information about the medical history, drug treatment, anthropometry and body mass index (BMI) of 34 individuals who suddenly died of natural causes while driving four-wheeled vehicles. The reasons for driving, details of the vehicle, type of collision, perspective of vehicle behaviour and types of avoidance manoeuvres were also examined. The injury severity score (ISS), the Abbreviated Injury Scale (AIS) and the degree of cardiomegaly of the driver were determined from autopsy findings. The dominant cause of death was ischemic heart disease, which closely agreed with previous findings. However, forensic signs indicated that only 20.6% of deceased drivers had attempted avoidance manoeuvres such as braking or steering before the fatal accident, which contradicts previous findings.
Proceedings of the fifth Northern Region Paediatric Colloquium
Authors: Bartlett S. , Bent J. , Kaplan C.A.
Published: February 2010

The disciplines of medicine, law and ethics frequently impinge upon each other in clinical practice but are seldom given the opportunity to come together in dialogue. It was with this aim that senior professionals from law and medicine met at the fifth Northern Region Paediatric Colloquium. An added dimension to the ethical viewpoint was brought to the meeting by the attendance of local religious leaders for the first time. We report the proceedings of the Colloquium, which adopted the usual format of clinical case presentation followed by discussion.
Sleep-related automatism and the law
Authors: Ebrahim Irshaad Osman , Fenwick Peter
Published: February 2010

Crimes carried out during or arising from sleep highlight many difficulties with our current law and forensic sleep medicine clinical practice. There is a need for clarity in the law and agreement between experts on a standardised form of assessment and diagnosis in these challenging cases. We suggest that the time has come for a standardised, internationally recognised diagnostic protocol to be set as a minimum standard in all cases of suspected sleep-related forensic cases. The protocol of a full medical history, sleep history, psychiatric history, neuropsychiatric and psychometric examination and electroencephalography (EEG), should be routine. It should now be mandatory to carry out routine polysomnography (PSG) to establish the presence of precipitating and modulating factors.

Sleepwalking is classified as insane automatism in England and Wales and sudden arousal from sleep in a non-sleepwalker as sane automatism. The recent case in England of R v. Lowe (2005) highlights these anomalies. Moreover, the word insanity stigmatises sleepwalkers and should be dropped. The simplest solution to these problems would be for the law to be changed so that there is only one category of defence for all sleep-related offences – not guilty by reason of sleep disorder. This was rejected by the House of Lords for cases of automatism due to epilepsy, and is likely to be rejected for sleepwalkers. Removing the categories of automatism (sane or insane) would be the best solution. Risk assessment is already standard practice in the UK and follow up, subsequent to disposal, by approved specialists should become part of the sentencing process. This will provide support for the defendant and protection of the public.
Sudden death during restraint: do some positions affect lung function?
Authors: Parkes John , Carson Ray
Published: February 2010

Small but significant numbers of people die during restraint following violent incidents. Current guidance within the NHS states that all restraint positions should be considered to present equal risk. We used a repeated measures design to compare lung function in four restraint positions with a standing control position. Participants restrained flat on the floor, prone or supine, showed non-significant reductions in forced vital capacity (FVC) and forced expiratory volume FEV1 compared with the standing control position. Participants restrained face down with the body weight of the restraining persons pressed on their upper torso and/or in a flexed restraint position showed a significant reduction in lung function (mean reductions in FVC of 23.8% and 27.4% respectively). Recommendations that all restraint positions pose equal risk, or that all prone restraint is dangerous, are not supported by these findings. Some, but not all, prone restraint positions show significant restriction of lung function.
Sexual assault statistics from the Republic of Ireland for 2004-2005
Authors: McDermott Seán D. , McBride Bríd Martina , Lee-Gorman Marce
Published: February 2010

The Republic of Ireland, like all other countries, has strict laws governing the crimes of rape and sexual assault. Victims of such assaults are treated in sexual assault treatment units where evidential material is gathered and forwarded to the forensic science laboratory (FSL). This paper represents the first published study from the Republic of Ireland of the time, day and month most frequently encountered in sexual assault cases presented to the FSL. In addition, the study examines the location and nature of the assault, together with such factors as the age of the victim, relationship to the suspect and degree to which the victim has a clear recollection of the events.

The study covers information from 890 cases submitted to the FSL in the time period January 2004 to December 2005. The most common age category of victim was 16-30, the most likely time of occurrence was Saturday night/Sunday morning during the summer months of June, July or August. The assailant will most likely be known to the victim even if only recently met. Loss of memory mainly associated with the consumption of alcohol was a significant factor in many of the cases. The figures were compared to international studies with no significant differences between our findings and other studies. We also compared our results to a similar study in 1995-1996 and found little difference except for the number of the victims who were non-Irish nationals: 3% in the 1995-1996 study but by 2004-2005 that figure had risen to 11%.
The use of section 5(2) of the Mental Health Act 1983: an audit
Authors: Gangaram Poornima , Kumar Palanivelu S.
Published: February 2010

Section 5(2) of the Mental Health Act 1983 (MHA) deals with the compulsory detainment of a mentally unwell inpatient in hospital for a period of 72 hours. During this time the Responsible Medical Officer (RMO) must review the patient and either increase the duration of compulsory stay by converting it to a section 2/section 3, or discharge the patient if appropriate or make the patient's stay informal. Section 5(2) can be implemented by either the RMO or his deputy (duty doctor).

An audit of the use of section 5(2) MHA within a psychiatric hospital was carried out between October 2000 and September 2001. The medical case notes of those patients identified were used to obtain data on patient demographics, date of implementation of section 5(2), date of reassessment after section 5(2) and outcome of the assessment. We also looked at reasons for the use of section 5(2), and the documentation standards.

Section 5(2) was implemented 55 times during this period. Nearly 83% of cases were in the age group 21 to 60 years. Most were implemented out of working hours. Seventy-five per cent of the patients were assessed within the next 48 hours by the RMO. Forty-one per cent of the patients who were placed under 5(2) were re-graded to informal, 32% were put under section 3 of MHA and 27% placed under section 2 of MHA. When compared with similar studies, this study showed a higher conversion rate from section 5(2) to section 2/3 suggesting that section 5(2) may have been used appropriately (Table I).

Many current areas of practice do not meet with standards recommended by the Code of Practice as suggested in a cross sectional survey on the use of section 5(2) (Jacob and Freer, 2005). Higher conversion rates of section 5(2) to a further section may indicate appropriate use of Section 5(2), and also increasing psychiatric inpatient morbidity.
An audit of basic record keeping standards: lessons learnt from the Royal College of Physicians
Authors: Galappathie Nuwan , Jethwa Krishma , Andonovska Biljana
Published: February 2010

This paper describes an audit of the basic standard of record keeping for inpatient clinical records. Following an initial audit, the Royal College of Physicians' inpatient record keeping standards 6 and 7 were adopted. The standard was then reassessed in a second audit.

During the first audit, 189 medical entries were assessed and 274 were assessed on repeat audit. A significant improvement was achieved in many areas including recording of time (19-82%), name of author (60-89%), location of patient (58-94%) and identity of the most senior doctor present (68-89%), (p<0.001).

The Royal College of Physicians' record keeping standards through the use of audit can lead to considerable improvement in the standard of record keeping within psychiatric practice.
Relatives' attitudes towards medico-legal investigation and forensic autopsy: a study from South Delhi
Authors: Behera C. , Rautji R. , Dogra T.D.
Published: February 2010

Relatives of deceased persons on whose bodies a medico-legal autopsy had been performed at the All India Institute of Medical Sciences, New Delhi, India were personally asked to complete a questionnaire. The aim of study was to determine surviving family members' attitudes towards medico-legal investigation and forensic autopsy. The majority of the relatives showed a positive attitude towards forensic autopsy but were not aware of the detailed procedure of the autopsy. They wanted sufficient information to be provided before the autopsy. They showed a great interest in autopsy results i.e. the cause of death. It was concluded that sufficient relevant explanations given before the autopsy improves the relatives' acceptance and helps alleviate the suffering of the bereaved. The experience and opinions of relatives may help an autopsy surgeon in more effective management of medico-legal cases.
The vulnerable adult in police custody: lessons learned from the case of R v Paul James Aspinall
Authors: Olubokun Jibowu
Published: February 2010

This case review highlights some of the problems that vulnerable adults, especially those with a mental disorder as defined in section 1(2) of the Mental Health Act 1983, face in police custody. These service users already experience some form of discrimination within the wider society in terms of access to community services. The role of the appropriate adult in providing support to the person in custody is fundamental, as enshrined in the Police and Criminal Evidence Act 1984 Code of Practice. It is one of the important safeguards of the legislation often referred to as a “gateway safeguard” because it leads to other safeguards. The roles and functions of the custody officer are reviewed.
An audit of the quality of reports to Mental Health Review Tribunals
Authors: O'Muirithe Barry , Shankar Rohit
Published: February 2010

The Mental Health Review Tribunal (MHRT) Rules 1983 place a statutory responsibility on the Responsible Authority to provide the tribunal with a formal medical report. Such reports are valuable records providing a systemic and evidence-based viewpoint for detaining an individual under the Mental Health Act 1983 (MHA). The reports allow the treating team to present its concerns and subsequent care package to the tribunal, whose members could be from a non-mental health background. There is evidence that the majority of the MHRT reports do not satisfactorily meet the tribunal's requirements. Recent literature has indicated that the circulation of structured guidelines has resulted in improved quality of the reports.

The authors undertook an audit cycle to test the above hypothesis. A preliminary audit ascertained the current practice of MHRT report-making in Cornwall. The reports were objectively assessed against “gold standards” of a comparative framework of eighteen criteria laid out by the Royal College of Psychiatrists. The guidelines were circulated in the form of a template and a re-audit carried out to ascertain any change in practice. The subsequent re-audit demonstrated significant improvements in the quality of reports.
Medical response time to section 5(4) (nurses' holding power) of the Mental Health Act 1983 over a 24-year period
Authors: Ashmore Russell
Published: February 2010

This study examines the trends associated with medical response time (MRT) for all section 5(4)s of the Mental Health Act 1983 applied in one mental health trust over a 24-year period. Eight hundred and three section 5(4)s were applied during the study period of which 786 had a recorded medical response time. The mean MRT was 140 minutes and 647 (82.3%) patients were seen by a doctor within the four-hour period specified in the Mental Health Act Code of Practice (DoH, 1999). Analysis of MRT showed no significant difference with the day of the week or when the weekday mean MRT was compared to that for the weekend. A significant difference was observed for the mean MRT prior to, and following, the introduction of the four-hour period noted in the MHA Code of Practice. Significant differences were also observed for the MRT over the 24-hour period. The mean MRT for the “working hours” period was significantly higher than that for the combined period Monday-Friday, 5pm-9am, and Saturday and Sunday. The findings suggest the need for mental health trusts to review their practices to ensure that patients receive a medical assessment in the shortest period of time following the application of section 5(4).
Firearm fatalities in Dammam, Saudi Arabia
Authors: Al Madni Osama , Kharosha Magdy Abdel Azim , Shotar Ali M.
Published: February 2010

This paper provides a database representing injury mortality in Dammam, Saudi Arabia, with the aim of establishing a system which will record information about the incidence of such deaths, identify new trends and give priority to violence prevention. The retrospective study was carried out on 64 fatalities from gunfire injuries at the Forensic Medicine Centre in Dammam, Saudi Arabia during the period from January 2002 — December 2006. The deaths included 55 cases of homicide, seven cases of suicide and two accidental shootings. Twenty-six victims were aged between 16-30 years and 24 victims were between 31-45 years. Fifty-nine of the cases were male.

A handgun was the weapon used in 49 cases. The most common sites for the firearm entrance wounds were the head (45 cases) and the chest (35 cases). In the majority of cases (56.3%) a single shot was fired while in 15.6% of cases there were two shots. In 51.5% of cases no bullet was recovered from the body while a single bullet was recovered in 31.5% and two bullets in 6.2% of the cases.

Distant range fire was observed in 65.6% of cases. Exit wounds were found on the head in 36.7% and on the chest in 28.7% of cases.

The majority of victims were young males living in urban areas. This result should help in forming a strategy to improve the livelihoods of this group. The low incidence of alcohol abuse (one case, 1.56%) and only three cases (4.68%) of amphetamine abuse is significant.
Retrograde amnesia following carbon monoxide poisoning
Authors: Acland Peter R. , Heaver Catriona
Published: February 2010

Retrograde amnesia is a recognised neurological complication of carbon monoxide poisoning. This article describes the case of a female found dead in her bath where initial post-mortem findings and the surrounding circumstances raised strong suspicions of homicide, especially when there was contradictory evidence from her husband who was the only other person present. He was later diagnosed as having retrograde amnesia between his two visits to the bathroom to attend to his wife which caused him to merge them into one event, thus arousing suspicions of foul play. The discussion explores the current clinical views on non-fatal carbon monoxide poisoning as well as problems of interpretation of information derived from case work.
Fatal cerebral infarction complicating therapeutic embolisation of a facial cavernous haemangioma
Authors: Lau Gilbert
Published: February 2010

An eight-year-old female developed cerebral infarction, with eventual brain death, as a consequence of therapeutic embolisation of a large facial haemangioma. Post-mortem histological examination revealed the presence of identical foreign body emboli, consistent with at least one of the embolic agents used in the procedure, within the haemangioma and both cerebral hemispheres. It is possible that some of these particles might have entered the cerebral circulation through anastomoses between the right external and internal carotid arteries, and subsequently crossed over from the ipsilateral to the contralateral cerebral vasculature via the Arterial Circle of Willis.
Should doctors who make clinical errors be charged with manslaughter? A survey of medical professionals and members of the public
Authors: Kay Natasha , Green Alexis , McDowell Sarah E. , Ferner R.E.
Published: February 2010

If a doctor is grossly negligent and the patient dies as a result, the doctor can be charged with manslaughter. We have investigated the difference in opinion between medical professionals and the public on whether doctors should face criminal charges following different fatal medical errors.

We conducted a survey of 40 medical professionals and 40 members of public, using a set of questions about negligence and manslaughter relating to four real-life cases of doctors charged with manslaughter where eventual outcomes were known.

Medical professionals and the public agreed that lessons could be learnt from all four cases and that an independent review of each case should be carried out. However, across all cases, the public were more likely to respond that the doctor should be charged with manslaughter (OR=2.1; 95% CI=1.3-3.2).

The public and, to a lesser extent, medical professionals still hold individuals responsible following a death due to medical error. This has implications for those who advocate a systems-based approach for assessing the root causes of medical errors, where there is a limited focus on individual accountability.
Sudden infant death syndrome/unexplained infant deaths in Sri Lanka
Authors: Fernando Ravindra , Abeyasinghe Nilukshi
Published: February 2010

Sudden Infant Death Syndrome (SIDS), also known as ‘unexplained deaths under one year’, is rarely reported in Sri Lanka as a cause of post-neonatal mortality. The aim of this study was to assess the opinion of paediatricians and pathologists regarding the reasons for this rarity. Members of the Colleges of Paediatricians, Pathologists and Forensic Pathologists who met the inclusion criteria were selected as the study population. A brief self-administered questionnaire was used for data collection.

Results were analysed using standard statistical methods. The sample consisted of 50 paediatricians, 15 histopathologists and seven forensic pathologists with a mean career span of 26.3 years. SIDS was reportedly diagnosed by only nine (12.5%) of the respondents while the other 63 (87.5%) have never encountered SIDS during their careers. Of the nine doctors, three (33.3%) based their diagnosis on autopsy findings but histological and toxicological studies had not been performed. The other six doctors (66.6%) relied on clinical history alone.

Twenty-five doctors (34.7 %) believed that keeping babies under close adult supervision was the reason SIDS is so rare in Sri Lanka. Twenty paediatricians (40%) and four histopathologists (26.7%) agreed with this view while five forensic pathologists (71.4%), believed the reason was under-diagnosis.

In conclusion, the majority of doctors believe the most likely reason for the rarity of SIDS in Sri Lanka is that babies are kept under close adult supervision, in comparison with developed countries. By contrast, most forensic pathologists are of the opinion that SIDS is under-diagnosed.
Drowning deaths in Mthatha area of South Africa
Authors: Meel B.L.
Published: February 2010

Deaths by drowning are a serious public health problem worldwide. They are under-investigated and hence under-estimated. Drowning is an important and preventable cause of death.

This paper aims to estimate the deaths by drowning in Mthatha area of South Africa.

Records of the medico-legal autopsies in Umtata General Hospital (UGH) were reviewed from 1993 to 2004. All cases of unnatural death are brought by the police to UGH mortuary.

Three hundred and forty-three cases of death as a result of drowning were recorded over a period of 12 years (1993-2004). There was an increased trend of drowning from 2.7 per 100, 000 in 1993 to 12 per 100, 000 in 2004. Males outnumbered females by 2.6:1. The incidence of drowning declines as age advances. The highest number (96) of victims was under ten years of age. Deaths due to drowning are increasing especially among male children and young adults.
Who are sexual offenders? A survey of pre-trial psychiatric reports
Authors: Balasundaram Bharathi , Frazer John B. , Wood Peter J. W.
Published: February 2010

Sexual offending is a serious and growing problem in our society. The aim of the study was to investigate the main characteristics of people charged with sexual offences who presented before the criminal courts.

The survey was conducted retrospectively between August 2001 and August 2006 on pre-trial court reports stored in a computer database shared by forensic psychiatrists using The Grange consulting rooms in West Yorkshire. A data collection form was used to gather the characteristics of sexual offenders. The data collected was analysed using descriptive statistics. Our survey revealed the following results.

Out of 78 cases evaluated, the commonest sexual offence was against children (68.8%). Thirty-two per cent of those with paedophilic behaviour had a history of childhood sexual abuse. Rape was alleged as the main sexual offence in 27.27% cases. Substance abuse (30.76%) and sexual motivation (42.30%) were the predominant motives for offending behaviour. Low rates of sexual fantasy and sadistic behaviour (8.97%) in our sample could be due to the nondisclosure by sexual offenders. Mental disorder was observed in 7.69 % cases. Significant personality factors were observed in 14.10% of the sample.

A sexual offending treatment programme was recommended in 57.69% cases. A very high risk of re-offending was recorded in 32.25% cases. Of the total sample, 93.50% were deemed fit to plead.