bluuebunny/crossref_metadata_2025 huggingface dataset:
Tsunami Disaster Victim Identification in Sri Lanka: Legal aspects
Authors: PERERA CLIFFORD
Published: February 2010

Natural hazards amounting to disasters have almost become an endemic phenomenon during past decades throughout the globe, particularly affecting less resourced countries. The capabilities of the affected nations are stretched to the maximum in most of the disasters, thereby exposing deficiencies at various levels of the disaster mitigation mechanisms. A key factor identified through the human experience of all previous disaster scenarios is the requisite of effective and integrated local, national and regional disaster management mechanisms. The national and regional legal framework in this context can supplement disaster management enormously by drafting and implementing practical legislation which can be activated in disaster situations to co-ordinate the relief missions and minimize the damage.

Thus, the existing legal systems and legislation at national and regional levels should be modified accordingly to yield proper disaster management policies. However, many less resourced countries are still lacking functional disaster management mechanisms in local legislation and are consequently highly vulnerable to heavy casualties in disasters. Sri Lanka is a typical example of a state which had an ineffective disaster management mechanism, not strengthened by legislation, when the Asian tsunami struck the country in December 2004, despite having frequently been affected by natural and man-made hazards during the past three decades. The net effect was total disarray in disaster victim identification, leading to drastic and irreparable consequences.
Paediatric Deaths in Kuala Lumpur
Authors: KUMAR VIRENDRA , JUMALI ISMAIL BIN
Published: February 2010

The main aim of this study was to determine the causes and epidemiological aspects of paediatric death. Data was collected on 143 cases of paediatric death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of paediatric death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.
The Court Medical Expert in France: Changes in status
Authors: BARTOLI C , GIOCANTI D , PIERCECCHI-MARTI D , PELISSIER-ALICOT A L , CIANFARANI F , LEONETTI G
Published: February 2010

In France the status of the court expert has undergone a significant change with the adoption of statute no. 2004-130 of 11 February 2004 and its implementing regulations no. 2004-1463 of 23 December 2004. This article looks at the two most outstanding aspects of this change in status: (i) the conditions for registering on a court of appeal list and, (ii) the practical details of the quality control of the court expert's work as exercised by the judge. The article concludes with a brief comparison with the expert witness situation in England and Wales.
Pattern of Injuries in Fatal Falls from Buildings
Authors: KOHLI ANIL , BANERJEE K.K.
Published: February 2010

When bodies are brought for autopsy it is sometimes unclear whether the injuries are due to a fall from a height or due to blunt trauma from other causes, especially when the bodies are found near buildings with no eyewitnesses available. Studies discussing the injury patterns in adults after falls exclusively from buildings are rare. A five-year retrospective study was carried out on 151 cases of fatal falls from buildings brought for autopsy. The aim was to assess the pattern of these injuries and identify features helpful in discriminating between these and injuries due to blunt trauma from other causes.

The majority of cases comprised subjects who fell from heights of 10-20 feet (3-6 m) with most falls occurring late at night or in the early morning. The pattern that emerged is quite distinct from ground level falls and pedestrian injuries. Abrasions are the commonest injury and bruises very rare. Lacerations are mostly on the head and skull fractures are evenly distributed between the vertex, base and vertex plus base. Subarachnoid haemorrhage is the commonest intracranial lesion. Extradural haemorrhage alone is rare. Fractures of ribs and cervical vertebrae are common and fractures of thoracic vertebrae and long bones are uncommon. Safety measures to prevent such falls have been suggested.
Industrial Accidental Deaths in the Niger Delta Region of Nigeria: A study of 32 autopsies in Port Harcourt
Authors: SELEYE-FUBARA D , BOB-YELLOWE E
Published: February 2010

Accidents in the oil industry in the Niger delta region of Nigera raise concerns about safety measures and the management of industrial sites.

A total of 32 autopsies were performed after coroners' inquest forms were served on the authors by the State, which serve as consent and request. Standard procedures were adopted in all the cases and the reports were appropriately issued.

Death from industrial accidents accounted for 2.5% and 6.1% of total autopsies and accidental death autopsies respectively. The youngest victim was a 19 year old male while the oldest was a 55 year old male. The age group 30-39 years was the most vulnerable. There was a male dominance; (male:female ratio = 9.7:1). The commonest accidents in their order of frequency were: falling from a height, explosion/fire, motor vehicle accidents and falling objects. Multiple injuries, head and neck trauma and drowning were the commonest cause of death at autopsy. Accidental deaths were commoner in the small-scale industries (81%) than in the large-scale industries (19%).

This is the first time such a study has been carried out locally. The proportion of accidental deaths in the small scale industries relative to that of the large ones may be attributed to the poor enforcement of safety measures in the smaller industries
Healthcare law in France: towards healthcare emancipation for minors
Authors: Rougé-Maillart C. , Jousset N. , Penneau M.
Published: February 2010

In France, since 1974 the rights of minors have been gaining ground. The first provisions to this end concerned medical acts in relation to the minor's sexuality (contraceptives and pregnancy termination). The law dated March 4, 2002, relating to patients' rights, gave more scope to this movement, by widening minors' rights so that they could demand confidentiality with regard to their parents. The minor's exercising of these rights can pose a lot of problems. In French law, parental authority is the main representation of the minor. The medical doctor treating a minor must obtain parental authorization. However, the public healthcare code provides that the doctor can override parental wishes during some situations (emergency; parents refuse). But these situations are exceptional. Since 2002, the legislator has gone further, by allowing the doctor to grant requests for care by the minor without parental authorization. However, parental authority remains the normal framework for the protection of a minor. The doctor will have to judge the reasoning and motives of a minor requesting confidentiality regarding their parents in order to decide whether he should grant or refuse care in such conditions.
Elderly suicide rates in the United Kingdom: Trends from 1979 to 2002
Authors: Shah Ajit
Published: February 2010

The proportion of elderly in the population is increasing due to a falling birth rate and increased life expectancy, and suicide rates increase with age. Trends in elderly suicide rates over a 24-year period, 1979 to 2002, were examined. Differences in suicide rates between elderly men and women and between the age-bands 65 to 74 years and 75+ years were examined. Data was ascertained from the WHO website.

Suicide rates for men and women for the age-bands 65 to 74 years and 75+ years declined over the 24-year study period. Suicide rates were higher in men than women for both the age bands. In men, suicide rates were higher in the 75+ age-band than in the 65 to 74 years age-band. Various national initiatives may have contributed to the decline in suicide rates. The challenge will be to sustain the decline, given that the population is ageing and suicide rates generally increase with age.
Sudden death during worker transportation due to massive pulmonary thromboembolism
Authors: Etté Hélèn Yapo , Botti Koffi , Koffi Emmanuel Kouakou , Ebouat Marc
Published: February 2010

This is a report on a 30-year-old black man who suddenly died in the worker transportation vehicle in which he had been quietly sitting for thirty minutes. No information about his medical or surgical history or any family history has been obtained. This case is intended to highlight the fact that forensic autopsy is a valuable tool to recognize the cause of death and that fatal pulmonary thromboembolism still remains a post-mortem diagnosis. In this case report, the autopsy found a fresh saddle pulmonary thromboembolus associated with partially organized thrombi of the inferior vena cava. Can a prolonged seated position encourage thrombus formation? We think that seat-related factors and especially patient-related factors intervene together in the development of thromboembolic events. In our medico-legal unit, having no means to search for these factors, we speculated on the various causes that could be involved in the occurrence of venous thromboembolism in our subject. We emphasize the importance of focusing research on genetic factors and the impact of traditional medicine in African people.
Skeleton used for anatomical study brought for medico-legal autopsy
Authors: Bhardwaj D.N. , Millo T. , Lalwani S.
Published: February 2010

Knowledge of human anatomy is essential for all those practising medicine. The human skeleton is invariably used to study the anatomy of body structures. For this, many human skeletons are obtained from the market by students and teachers and are kept at home or in hostel rooms. However, after use the skeleton has to be disposed off properly. In the present case, a human skeleton used for study purposes was thrown away in garbage and someone informed the police about presence of skeletal remains in the garbage. The case was registered by the police and the skeletal remains were brought for medico-legal autopsy.
Diversity and forensics: diversity in hiring is not enough
Authors: Koppl Roger
Published: February 2010

The current organization of forensic work may induce biases in forensic analysis (Risinger et al., 2002). Such biases may have a differential impact across groups, creating differential bias. We should reorganize forensic work to reduce this bias. The obvious strategy of hiring ethnically diverse forensic workers will not work. `Us vs. Them' thinking is an important source of differential bias. The definitions of `Us' and `Them' are socially conditioned. The current organization of forensic work induces forensic workers to see the police as `Us' and suspects of any ethnicity as `Them'. Thus, differential biases in arrests become differential biases in forensic analysis. I argue that my prior proposal for `competitive self regulation' (Koppl, 2005) would reduce or eliminate differential bias. Competitive self regulation divides forensic work among several, unrelated parties, and hides extraneous, bias-inducing information from forensic analysts. These measures separate forensic workers from the police, reduce their sense of identification with the police, and hide from them the knowledge of what result the police are looking for. My argument builds on a literature on biases, Us vs. Them thinking, and the role of `coalitional alliances' (Kurzban et al., 2001) in bias formation.
Death due to traumatic railway injury
Authors: Mohanty Manoj Kumar , Panigrahi Manoj Kumar , Mohanty Sachidananda , Patnaik Kiran Kumar
Published: February 2010

This study was carried out on 88 railway related deaths in order to determine the specific pattern and distribution of wounds. Of the 88 victims, 79.5% were males and 20.5% were females. The majority were in the age group of 21-40 years. Most of the victims died as the result of an accident (80.7%). Of the 17 suicide cases, ten deaths occurred during the night. In 71 railway accident deaths, 64.8% of victims were pedestrians; thirty-five victims were illiterate and two had consumed alcohol. Decapitation wounds were more common in suicidal deaths and the head was the body region most commonly involved in railway accidents. Our results indicate that railway related deaths could be prevented by surveillance, education and public awareness.
Asphyxia in a confined space
Authors: De Giorgio Fabio , Abbate Antonio , Arena Vincenzo , De Mercurio Domenico , Fucci Nadia , Vetrugno Giuseppe
Published: February 2010

We describe a death in a hospital wardrobe of a 40-year-old male suffering from HIV infection and lobar pneumonia. On the basis of circumstantial evidence and autopsy findings we conclude that the cause of death was asphyxia in a confined space as a result of several pathomechanical factors. As well as establishing the cause and manner of death, the interpretation of the case involves the evaluation of the professional responsibility of the medical personnel. This report discusses different aspects concerning the cause, mechanism, and manner of death and illustrates various problems encountered in forensic pathology.
Insomnia in places of detention: a review of the most recent research findings
Authors: Elger Bernice S.
Published: February 2010

Up to 40% of prisoner patients in a general medicine outpatient service seek medical consultation for sleep problems. This paper provides a brief overview of what is known about insomnia and its treatment from studies on non-detained patients and discusses the relevance of the findings from studies in liberty for prison health care. The clinical and ethical issues of insomnia in prison are described, followed by a summary of the existing studies on insomnia in prison.

The results of the reported studies show that insomnia in places of detention should not be reduced to a secondary problem related to substance abuse and mental illness, as it appears to be an independent situational problem. Correctional health care physicians' evaluation of insomnia is insufficient. Drug prescription works well in some patients, but has a limited effect on insomnia relief in others.

A clear need exists for the education of prison health care professionals on insomnia evaluation and management. Additional non-pharmacological treatment in the prison health care setting should be used more frequently. Prison health care services should develop clear guidelines based on research evidence about insomnia and which contain treatment recommendations based on the principle of equivalence of health care outside and inside places of detention.
Rib fractures in infancy: establishing the mechanisms of cause from the injuries — a literature review
Authors: Worn M.J. , Jones M.D.
Published: February 2010

In the absence of a history of a significant accidental event, the most likely diagnosis in an infant with rib fractures is non-accidental injury. Medical opinion is essential when deciding if child abuse has taken place or not and this requires a consideration of whether a proposed causal explanation fits with the observed injuries. To assist in the interpretation of injuries and inform medical practitioners, it is essential to develop a clear understanding of their biomechanical mechanism of causation. The types and ‘likely’ mechanisms of rib fracture are well-documented, however, what forces, deflections and loading rates are required to produce particular fractures are relatively unknown. This paper presents a review of the literature, from a biomechanical engineering perspective, to assess information regarding the various types of rib fracture and their likely mechanisms, paying particular attention to the likely forces, deflections and loading rates involved.

The biomechanical parameters, applied during ‘two finger’ infant cardiopulmonary resuscitation (CPR), are identified and discussed, and are currently believed to be below the limit at which rib fracture may occur. However, a new ‘two thumb’ CPR technique is identified which involves a holding/gripping mechanism of the infant thorax, similar to that which is believed to occur in inflicted injury scenarios, such as shaking. The two thumb method may provide a greater magnitude of force and deflection, a greater rate of loading and may perhaps pose a greater risk of fracture, compared with the ‘two finger’ supine, anterior-posterior chest compression approach. It is proposed to introduce a force/deflection boundary condition into mechanical and computer/numeric infant models. Subject to the future inclusion of loading rate/response data, a three-dimensional (force/deflection/loading rate) boundary condition will be used to provide a minimum injury threshold for potentially injurious scenarios. A number of further studies are suggested, since this paper is intended to provide a first step to developing a more sophisticated understanding of the causes of infant rib fracture. Areas of further study include specific rib fracture mechanisms, as well as the effects of age dependent characteristics, positioning and area of force application. Such additional information would allow the proposed initial boundary condition to be further refined to provide an indication of the likelihood, type and number of fractures that might be expected.
Characteristics of mentally disordered offenders referred for low secure forensic rehabilitation
Authors: Neillie Darren , Saini Mandeep Singh , Humphreys Martin
Published: February 2010

In the light of recognition of an increased need for secure mental health provision both at a local and national level, a 12-bed low secure forensic rehabilitation unit, Hillis Lodge, was opened in Birmingham in 2001. The aim of this study was to investigate characteristics of patients referred to this service. A retrospective case note survey was undertaken of all referrals to Hillis Lodge between August 2000 and April 2004. A comparison was then made between the accepted group and those not accepted for admission to identify characteristics that may be associated with admission to a low secure forensic unit. For the referred sample, mean age was 38 years (range 23-65 years, SD=9.17) and in 86.4% of cases the primary diagnosis was schizophrenia. Those accepted were more likely to be detained under Part III sections of the Mental Health Act 1983 and have a greater number of previous convictions. By identifying need in this particular patient sample, this study has helped to inform the assessment process and treatment programmes in a low secure forensic rehabilitation service.
Attitudes of psychiatrists towards forensic psychiatry: a survey
Authors: Hill Simon A. , Mather Gregory , Laugharne Richard
Published: February 2010

Forensic psychiatry has been rapidly expanding in recent years and more NHS forensic beds are planned. This study aimed to examine the attitudes of psychiatrists towards forensic psychiatry. A questionnaire was given to psychiatrists attending a regional Royal College of Psychiatrists conference. In addition forensic psychiatrists were surveyed in the two local regional secure units. Ninety-eight psychiatrists, including twenty-four forensic psychiatrists, completed the questionnaire. Forensic and non-forensic psychiatrists tended to agree with the expansion in forensic beds. Non-forensic psychiatrists wanted a lower threshold for admission to secure units. Forensic psychiatrists disagreed. Non-forensic psychiatrists tended to feel that forensic psychiatry has been over-funded compared with other psychiatric services. They also commented that forensic services should integrate more closely with other non-secure psychiatric services and should offer more community forensic services rather than concentrating care on in-patients. Forensic services should consider what services they provide and try to meet the desires of secondary services, such as more community forensic services and greater integration with other psychiatric services.
Mentally disordered offenders in Zimbabwe and in England and Wales: a socio-demographic study
Authors: Menezes S.B. , Oyebode F. , Haque M.S.
Published: February 2010

Our aim was to compare socio-demographic, clinical and criminal characteristics of mentally disordered offender patients in a special institution in a developing and a developed country.

Zimbabwe data from 1980-1990 was obtained from a hospital patient survey, in a written semi-structured format. The English special (high security) hospital patients' data for the same period was obtained from the case register.

The sample size for Zimbabwe was 367 patients (337 males, 30 females) and for England and Wales it was 1,966 patients (1,643 males, 323 females). The average age for Zimbabwean patients was 36 years, with standard deviation of 9.7; for England and Wales the average age was 29.7 with standard deviation of 9.6. There was significant difference in marital status in the two countries. Seventy-eight per cent of patients were single in England and Wales, compared with 49% in Zimbabwe. There were 20% illiterate patients in Zimbabwe, compared with 4% in England and Wales. Thirty-seven per cent of the patients in England and Wales had a diagnosis of personality disorder, compared with 6% in Zimbabwe. There were 53% of homicides in Zimbabwe, compared with 20% in England and Wales. Employment in the two countries was similar: 34% in Zimbabwe and 33% in England and Wales.

There were differences in the socio-demographic characteristics in the two countries, except for employment status. Differences were also noticed in the diagnoses of the patients, types of crime and the methods of assault.
Medical litigation as a result of awareness during general anaesthesia
Authors: Porzionato Andrea , Manani Giovanni , Montisci Massimo
Published: February 2010

In the literature, little attention has been paid to the medico-legal implications of awareness during general anaesthesia, a complication which has been reported with an incidence of 0.5-2%. We present the case of a 39-year-old nurse who experienced awareness during salpingo-adnexectomy for tubo-ovarian pregnancy. The operation was performed as an emergency, due to severe haemorrhage. Anaesthesia was induced with 125 mg of thiopental sodium and 60 mg of succinylcholine, and then maintained with repeated doses of fentanyl and 7 mg of vecuronium. In the court settlement, medical liability was rejected, because her awareness during anaesthesia was ascribed to the need to use small quantities of anaesthetics, due to severe hypotension, and not to medical error. The case presented here and a brief review of the literature indicate that awareness during anaesthesia is not always a consequence of medical negligence.
Advance decision
Authors: Samuels Alec
Published: February 2010

In the UK, patients have a statutory right to refuse treatment. Parliament has authorised ‘advance decision’ whereby a person can specify his or her wishes regarding further medical treatment. Although the advance decision may give a person peace of mind, it could create real problems for doctors and other healthcare professionals. This article will examine the conditions and procedures surrounding the drawing up of an advance decision as well as some of the problems that could arise such as layman's language.
Challenges to implementation of the new Coroners' (Amendment) Rules 2005: experience from a tertiary paediatric pathology centre
Authors: Weber M.A. , Epstein J. , Simons J. , Malone M. , Ashworth M. , Sebire N.J.
Published: February 2010

In the UK sudden unexpected childhood deaths are referred to Her Majesty's Coroner (HMC) for postmortem examination during which small tissue samples are obtained for diagnostic purposes. Recent changes to regulate tissue use include the Coroners' (Amendment) Rules 2005. We audited the impact of these at a specialist paediatric centre.

A retrospective audit of HMC tissue forms for autopsies was performed between 1 June 2005 - 31 May 2006, with regard to the options provided to, and chosen by, parents. Of 213 coronial autopsies, 178 were non-forensic. Tissue forms were submitted pre-autopsy in 25 (14%). An additional 47 were received after sending follow-up letters for a total of 72/178 (40%). Forms varied between coroners, but most failed to distinguish between blocks, slides, and other tissue samples and 6/40 (15%) forms did not specifically allow an option for research consent. Forty-three (60%) parents opted for retention, with 34 (79%) also consenting to research. Only six (8%) requested return of tissue.

A simple, unified tissue disposal form and information sheet for all HMC districts, which includes appropriate options, would ensure that parents' wishes are met, to achieve best practice, maximise sample availability for positive societal outcomes such as teaching and research, and to comply with new regulations.
Analysis of 756 cases of sexual assault in Tours (France): medico-legal findings and judicial outcomes
Authors: Saint-Martin Pauline , Bouyssy Marie , O'Byrne Patrick
Published: February 2010

We describe the medico-legal findings in a population of sexual assault cases assessed in an urban French referral centre, analyse the subsequent legal dispositions in each case and determine whether the characteristics of the assault and the medico-legal findings were associated with conviction of the assailant.

We performed a retrospective study of medico-legal reports in all the sexual assault cases reported in Tours (France) during a seven-year period. We defined two groups of victims: children under 15 years old and victims aged 15 years or more. Legal outcomes were obtained from courtroom proceedings. The relationship between the outcomes and the circumstances of the case was analyzed by logistic regression.

We enrolled a total of 756 cases during the study period. The mean age of the study population was 16.5 years and 68.3% of the cases involved children under 15 years old. In 57% of these cases, the assailant was a family member. 31.7% of all the victims were aged 15 years or more. The assailant was an acquaintance of the victim in 62.2% of the cases. Drug-facilitated assault was suspected in 2.9% of the cases. In 46.2% of the cases, formal criminal charges were not filed due to insufficient evidence; 36.3% of the assailants were convicted. Examination at the request of the police authorities and previous acquaintance of the assailant by the victim were significantly associated with conviction. Allegations of penetration, the presence of general body trauma and the presence of genital trauma were not necessarily associated with conviction.

Medical examiners need to be circumspect when they record non-medical variables. Physical evidence of trauma was neither predictive nor essential for conviction. Successful prosecution depends on the quality of the testimony provided by the victim.
Referrals to the Glasgow sheriff court liaison scheme since the introduction of referral criteria
Authors: Orr Eilidh M , Baker Melanie , Ramsay Louise
Published: February 2010

This study is an audit of a court liaison scheme operating in Glasgow sheriff court. It represents a follow-on of previous work after the introduction of referral criteria to delineate more closely the appropriate population to be seen. Results were compared with the previous audit. The total number of referrals decreased by 66%, however, the proportion with a psychotic illness increased to 33%. A high referral rate of prisoners with addictions continued, although the service was not primarily designed for them. Fewer patients with no psychiatric diagnosis were referred to the scheme. Outcomes were, however, similar with approximately the same admission rate to hospital. The introduction of criteria appears to have reduced the numbers of inappropriate referrals without excluding the population with serious mental disorder. The introduction of referral criteria seems to have been beneficial to the scheme. The scheme has since changed again and so there may be benefit for a further audit to monitor the continuing appropriateness of referrals. The provision of specific interventions targeting prisoners with addictions is also supported by this audit.
HIV infection among victims of sexual assault using condoms and other contraceptive methods: a comparative study
Authors: MEEL B.L.
Published: February 2010

The aim was to study the incidence of HIV among victims of sexual assault who have been using condoms and other contraceptive methods. Retrospective review of cases who presented to the Sinawe Centre following sexual assault was carried out. There were 157 sexually active cases between 17 and 49 years of age in the study group. The mean age of the victims was 22.7 years. All had practised some form of contraception. One had a tubal ligation, 65 (41.8%) had used condoms, 22 (13.9%) oral contraceptives (OC), 55 (35.4%) injectables, and 12 (7.6%) both barrier method and hormonal. The highest number (28-17.7%) of HIV positive cases were in the age group of 17 to 26 years. A total of 42 (27%) were HIV positive of whom 26 (16.6%) had only used condoms, ten (6.4%) had used OCs and injectables, and six (3.8%) used both hormonal and barrier methods. In conclusion, HIV prevalence is commoner among condom users.
Traumatic heart perforation by a D5 osteophyte
Authors: Sauvageau Anny , Kremer Célia , Racette Stéphanie
Published: February 2010

Osteophytes are bony outgrowths usually found in the context of osteoarthritis and diffuse idiopathic skeletal hyperostosis (DISH). Even if they are usually asymptomatic, they may present with complications such as spinal stenosis, myelopathy and radiculopathy. We here present the case of a 56-year-old woman found dead from a homicidal traumatic heart perforation by a D5 osteophyte.
An unusual suicide with parenteral copper sulphate poisoning
Authors: Behera C. , Rautji Ravi , Dogra T.D.
Published: February 2010

A 22-year-old unmarried, male painter was found by neighbouring shopkeepers to be rolling on the ground inside his shop due to severe abdominal pain. The man had tried to commit suicide by intravenously injecting a solution of copper sulphate, used as an antifouling agent in paints. He was taken to the local hospital with severe epigastric pain, vomiting and diarrhoea. His condition worsened after three days and he was transferred to the All India Institute of Medical Sciences, New Delhi, but the victim died on his way to the hospital. His relatives and neighbours confirmed that he had recently been suffering from depression.
Coke v. Bumble – comments on some aspects of unlawful killing and its disposal
Authors: Prins Herschel
Published: February 2010

The publication of the Law Commission's Consultation Paper and final proposals for the reform of homicide legislation has prompted the author to review some clinical and legal aspects of homicidal behaviour. It is suggested that the complexities of this behaviour are not well served under current legal provisions.
Offending in the learning disabled population: a retrospective audit of Tayside learning disability service court reports
Authors: Smith Helen , White Tom , Walker Phyllis
Published: February 2010

The literature regarding offending in the learning disabled population is limited; the effects of normalisation and deinstitutionalisation on offending behaviour is not yet determined. We retrospectively examined 93 court reports completed by the Tayside learning disability service since 1986.

Twenty patients were not considered to be learning disabled. Sixty-four of the subjects deemed learning disabled faced charges, the most common being public order offences, which was in common with previous reports. Eighteen per cent of these had a co-morbid mental illness, the majority attracting a diagnosis of schizophrenia. Inpatient assessment, assessment as a day patient or probation were recommended for about two-thirds. Fewer than 50% of cases had no psychiatric recommendation made to the court. There was a predominance of arson and sexual offending. Arsonists were twice as likely as sex offenders to be recommended for inpatient treatment.
Hospital bed related fatalities: a review
Authors: De Letter Els A , Vandekerkhove Bart N W , Lambert Willy E , Van Varenbergh Dirk , Piette Michel H A
Published: February 2010

All medico-legal cases of unexpected death during hospitalisation or accommodation in rest or nursing homes, which were investigated at the Department of Forensic Medicine during a 30-year-period, have been reviewed. In the majority of cases, the fatal outcome was bedrail or restraint related, but falls out of bed or from a patient hoist lift can also trigger a death.

As expected, the manner of death was mainly accidental. In about 70% of cases, mechanical asphyxia (such as smothering and thoraco-abdominal compression) was substantiated as the mechanism of death. A substantial number of the patients had important medical antecedents, such as cognitive impairment due to cerebro-vascular accidents. In about half of the cases, human negligence was clearly related to the event whereas in only 15% of cases was there a technical mistake.

We believe that some sudden and unexpected fatalities, due to physical restraint or other devices (such as a patient hoist lift), are under-reported because of the medico-legal implications. However, reporting such events could induce better precautions and prevent recurrences. Therefore, this study may be important not only for forensic pathologists, but also for a larger group of social workers.
A comparison of external and internal injuries within an autopsy series
Authors: Yartsev Alex , Langlois Neil E.I.
Published: February 2010

The relationship between external injuries and internal injuries was investigated, with the aim of determining whether potentially lethal internal injuries could be reliably inferred from external findings alone. From a database of post-mortem reports, 291 were extracted and examined. The external and internal injuries were coded according to region, type and severity. Analysis of the data consisted of Spearman correlations for severity and positive predictive values for internal injuries of high lethality. Overall, the correlation between external and internal injuries was poor. The most predictive external injuries were multiple lacerations, large abrasions with lacerations, and gross distortions. Predictably, the most severe external injuries were the most reliable predictors of lethal internal injuries. External injuries of the head were more predictive of internal damage than external injuries elsewhere. Minor external injuries (such as bruises, small abrasions or small lacerations) did not predict lethal internal injuries. In conclusion, external examination findings are largely unreliable as markers of lethal internal injuries in the forensic investigation of victims of motor vehicle trauma, especially in situations where the external injuries are minor. Further research into non-invasive methods of forensic investigation is warranted.
Sections 37/41 Mental Health Act 1983: a study of judges' practice and assessment of risk to the public
Authors: Qurashi Inti , Shaw Jenny
Published: February 2010

Previous studies have reported that a significant proportion of forensic psychiatrists have had experience of restriction orders being made contrary to medical recommendations. Judges were interviewed to ascertain their experiences, sentencing practice and the factors taken into consideration when determining whether or not to attach a restriction order. In particular, the reasons why a restriction order might be made contrary to medical opinion were explored. Twelve judges sitting in crown courts in England were interviewed. The interviewees were unanimous in their view that where a hospital order was being considered involving a serious offence a psychiatrist should take a firm view on whether a restriction order was also required. Furthermore, the interviewees stated that they would anticipate a positive recommendation from psychiatrists in cases involving homicide, arson and serious sexual and violent offences. Demographic factors, including ethnicity, were irrelevant in their deliberations. The experience of this sample is that restriction orders are rarely made contrary to medical recommendations and in the rare circumstances they are made, insufficient emphasis has been placed on previous offending behaviours or the issue of public protection. In addition to the primary intention to protect the public nearly half the sample stated that an additional intention was to ensure compliance with both after-care services and medication.
Section 5(2) MHA 1983: results of a three-year rapid cycle clinical audit
Authors: Rashid Ambreen , Musunuri Padmapriya , Coupe Tim
Published: February 2010

The aim of this paper was to establish whether section 5(2) of the Mental Health Act 1983 was being used appropriately in an inpatient psychiatric unit in the UK. A clinical audit was conducted over three consecutive years. Peer review of decisions to use section 5(2) on the hospital's adult and old age wards was conducted by junior medical staff.

Ninety-eight per cent of the uses of section 5(2) were felt to be appropriate and most were reviewed within 72 hours. Very few patients (5%) were placed on this section again during their admission. The number placed on section 5(4) prior to section 5(2) increased from 2% to 12%. The proportion reviewed within the first 24 hours of detention nearly doubled over the audit period and fewer patients subsequently went on to sections 2 or 3 by the third year. There was no evidence of inappropriate use of section 5(2). Changes in the shift system for junior medical staff may have inadvertently led to a more frequent use of section 5(4). The use of further formal detention after section 5(2) declined, although this decline was not statistically significant.
Trivial trauma, heart disease and medico-legal interpretation of death
Authors: Kohli Anil , Mishra Kiran
Published: February 2010

Forensic experts are often required to give an opinion on the cause of death and its medico-legal interpretation in cases where an individual dies after receiving non-fatal injuries and at autopsy is discovered to have had a natural disease that alone could have caused death. The significance of this varies in different countries depending on the local laws relating to death in cases of trivial trauma associated with natural disease. This paper discusses this issue from an Indian perspective with the help of an illustrative case report and highlights the importance of the forensic pathologist in such cases.
Fast eating syndrome
Authors: Kumar M.V. Pradeep , Venkatesh V.T. , Jagannatha S.R.
Published: February 2010

Choking while consuming food is a cause of death that has long been known and studied. Such deaths were popularly known as `café coronary deaths', which denoted a fatal occlusion of the upper airway by food substances. The event commonly occurs while also consuming large quantities of ethyl alcohol or drugs, or in a psychiatric patient. Here, we present a case of an individual who choked to death while on duty and the main reason for choking was his eating habit which deviated from the known common causes of choking. We also discuss some causes of choking in elderly individuals.
The use of multiple exostoses in the identification of incinerated human remains
Authors: Wilcher Glenn
Published: February 2010

A case of roentgenographic medical identification of an incinerated deceased sixteen-year-old male is reported.

Comparison of ante-mortem and post-mortem radiographs of the fibula, tibia and femur for purposes of identification was based on the deceased person's recent radiographic medical history, recorded less than two months prior to the death, with a diagnosis of multiple exostoses.

Radiographic evaluation of the anatomic variants of the lower limb bones associated with this neoplastic process provided a positive identification in a visually unidentifiable person with no ante-mortem dental records, and an inability to fingerprint due to soft tissue destruction.
Decapitation with egg shelling of the skull in a road traffic accident
Authors: Behera C. , Rautji Ravi , Dogra T.D.
Published: February 2010

A 40-year-old lady was found dead on a road early one morning. She had allegedly been run over by a speeding vehicle. The head of the deceased had been decapitated, with egg shelling of the skull from the scalp and face. The skull was lying a little distance away from the rest of the body. Although decapitation is not an unknown entity in a road traffic accident, subsequent egg shelling of the skull, leaving behind scalp and face tissue, has not been reported in a road traffic accident in the forensic literature.
An investigation of the interface between the office of the police ombudsman for Northern Ireland and local forensic physicians
Authors: Cathcart Mark E.H. , McGrath Patrick , Goodall Edward , Moore Tara
Published: February 2010

The interface between forensic physicians and the police ombudsman of Northern Ireland is an area where there is little published research. In particular there has been no attempt to inquire into the role of forensic physicians in the procedures employed to investigate alleged police maltreatment of prisoners at the time of arrest or later in the custodial setting.

A questionnaire was distributed to all forensic physicians in Northern Ireland to assess their level of engagement with the ombudsman's office and shed light on the attitudes of forensic physicians to the police ombudsman's handling of the complaints procedure.

The results published represent the opinion of the majority of forensic physicians in Northern Ireland and show a broadly supportive attitude to the role of the police ombudsman in the investigation of alleged police officer misconduct. However, a majority of forensic physicians felt that their involvement in the investigative process was an under-used resource.
Determination of age from pubic symphysis: an autopsy study
Authors: Sharma Gaurav , Gargi Jagdish , Kalsey Gurdeep , Singh Dalbir , Rai Hakumat , Sandhu Raminder
Published: February 2010

The present study was conducted on three hundred and thirty-six cases brought for autopsy to the Department of Forensic Medicine, Government Medical College, Amritsar, Punjab, India, during the period 2000-2002. Pubic bones of either sex were analysed according to Todd's method (1920; 1921a,b,c) as modified by McKern and Stewart (1957) to assess and compare the known age of the corpses. Cases belonged to both sexes, i.e. 79.46% males and 20.54% females. All the cases were above the age of 17 years. No difference was noted in the scoring of right and left pubic bones. The age estimation from different components in males and females up to the total score of 10 (23-28 years) was ±6, whereas above a score of 10 the estimated age was ±12 in males and ±9 in females. The age range given for scores of 14 and 15, which were 29+ and 36+ respectively, did not account for variability of age after 40 years. Therefore, the age assessment from pubic bones in the fourth decade age group and beyond is not reliable which is in variance to the study by McKern and Stewart (1957).
Suicide by drowning after two gunshots to the head
Authors: Racette Stéphanie , Sauvageau Anny
Published: February 2010

Differentiation between suicide and homicide can be problematic for forensic pathologists, especially when a complex method of suicide is used by the victim. Multiple gunshot suicides have been previously reported in the forensic literature. However, multiple gunshots combined with other suicidal methods are rare. In this article the authors report the unusual case of a floating body recovered from a river, with two gunshot wounds to the head. The autopsy showed that both gunshot wounds were non-lethal and the cause of death was attributed to drowning. Though homicide was strongly suspected at first, the manner of death was later established as suicide.
Fatality due to amisulpride toxicity
Authors: Lynch Matthew J. , Woods Jessica , George Natalia , Gerostamoulos Dimitri
Published: February 2010

Amisulpride is an atypical antipsychotic agent effective in the treatment of schizophrenia. There are few cases in the literature relating to the toxicity of this agent and reported fatalities are rare. Drug induced prolongation of the QT interval of the electrocardiograph (ECG) is increasingly recognised with various classes of drugs and in particular with antipsychotics. Cardiotoxicity can manifest as ventricular tachyarrhythmia, including torsades de pointes (TdP), complicating QT prolongation. We report a case of fatal amisulpride toxicity where the post-mortem blood concentration was 48 mg/L. Hitherto under-recognised toxic effects of novel chemotherapeutic agents can pose challenges for the forensic pathologist charged with performing medico-legal autopsies in cases of sudden unexpected death in young adults and particularly in those with schizophrenia. A knowledge of the ability of antipsychotic agents to induce fatal cardiac arrhythmias should inform the approach to the autopsy (including determination of the cause and mechanism of death) in such cases, as should an appreciation of the dangers inherent in the interpretation of post-mortem toxicology.
Mediastinal emphysema due to an isolated facial trauma
Authors: Gouda Hareesh S. , Shashidhar  , Mestri C.
Published: February 2010

A case of mediastinal emphysema due to an isolated facial trauma, which contributed to the death of an adult male, is reported in this article. A thorough search in the literature reveals only 19 cases of mediastinal emphysema occurring secondary to facial injury, none of which was fatal.
Euthanasia: a summary of the law in England and Wales
Authors: Simillis Constantinos
Published: February 2010

When medical treatment becomes futile, or the patient's suffering is intractable, doctors face the agonising dilemma of whether to proceed with euthanasia. It is important for a doctor to be familiar with the law surrounding euthanasia, in order to avoid prosecution. This paper explores the law in England and Wales regarding the different categories of euthanasia: voluntary euthanasia, nonvoluntary euthanasia, passive euthanasia, and active euthanasia.
Practitioner sex abuse: occurrence, prevention and disciplinary sanction
Authors: Jousset Nathalie , Gaudin Arnaud , Penneau Michel , Rougé-Maillart Clotilde
Published: February 2010

Studies put forward figures for male practitioner sex abuse of around ten per cent. This practice, which is contrary to medical ethics, is highly reprehensible in ethical terms. The assaults range from uninvited meddling in patients' sexual lives to proven rape and inappropriate touching.

The majority of this type of abuse is perpetrated by psychiatrists, but in more recent times a growing number of cases have been uncovered involving general practitioners or obstetric gynaecologists. For the most part, the abusers are men, aged between 45 and 64, who are insufficiently trained in terms of the “practitioner-patient” relationship, or who are suffering from a mental pathology or who are in a situation of personal or professional crisis.

Raising awareness of this issue is the driving force behind the implementation of prevention strategies, based on initial and ongoing training for practitioners in France, whistle-blowing on fellow practitioners in the United States and professional help in Canada.

Disciplinary sanctions are more severe than those given within the framework of non-sexual misconduct in the United States. In France, the Order of Practitioners does not appear to be taking its role of defending patients seriously, since it seldom issues anything more substantial than minor penalties.