bluuebunny/crossref_metadata_2025 huggingface dataset:
Tightropes and Tragedies: 25 years of Tarasoff
Authors: Jones Chris
Published: February 2010

In 1976 the California Supreme Court decided the case of Tarasoff v Regents of the University of California. That case has had very significant effects on psychiatric practice on both sides of the Atlantic, and its very name is instantly recognizable to most psychiatrists. Yet the details of the case are often misunderstood or misquoted; as a legal precedent it was rapidly superceded, and is now largely redundant. Twenty-five years on it seems appropriate to revisit the case itself, and its impact on contemporary psychiatric practice. English law has yet to impose a similar duty, but two leading cases raising similar issues are also described.
A Novel PCR Method for Identifying Plankton in Cases of Death by Drowning
Authors: Abe Sumiko , Suto Miwako , Nakamura Hidemasa , Gunji Hirobumi , Hiraiwa Kouichi , Suzuki Toshiyuki , Itoh Toshimitsu , Kochi Hideo , Hoshiai Gen-Ichi
Published: February 2010

We present a new PCR method for identifying plankton in cases of death by drowning. We designed four primer pairs for chlorophyll-related genes of Euglena gracilis (EG) and Skeletonema costatum (SK), which are commonly distributed in water. The primers were selected from sequences coding chloroplast/chlorophyll apoprotein of EG (EG1 and EG2) and fucoxanthin-chlorophyll a/c harvesting protein of SK (SK1 and SK2). With EG1 or EG2, up to 2 fg of EG-DNA was identified, and 0.2 pg of SK-DNA was detectable with SK1 or SK2. No PCR products were amplified from green vegetables (komatsuna, spinach, parsley) or human DNA with the four primer pairs. Regardless of the origin, seawater or fresh water, most diatoms were detectable with primer pairs of EG1 and EG2. With SK1, only Centrales diatoms were identified, and five diatom strains originating from seawater were detectable with SK2. EG1 and EG2 gave rise to PCR products from most water samples. By using Percoll®, plankton was easily isolated from human tissue or blood samples and good results of PCR analysis were obtained in cases of death by drowning.
Control and Restraint Techniques in the Management of Violence in Inpatient Psychiatry: A critical review
Authors: Wright Steve
Published: February 2010

Violence has long been a matter of concern in inpatient psychiatry. While research suggests that training in physical restraint techniques can reduce the number and severity of violent incidents and assault-related injuries, the recent Cochrane Review is critical of the methodological inadequacies which characterise these studies.

This paper considers issues pertinent to understanding research in this controversial area, critically evaluates research on the effectiveness of the predominant approach to training in physical restraint in the UK, and examines some of the methodological problems inherent in this research.
Astrological Birth Signs in Suicide: Hypothesis or speculation?
Authors: Salib Emad
Published: February 2010

Astrology is no longer regarded as a science by many, because its claims are almost impossible to test empirically in controlled laboratory conditions and it can not meet the scientific need to be reproducible.

However, the majority of those who read their `star signs' can identify aspects of their personality in what they read and it is possible that this may influence their attitudes and actions. The literature has neglected astrological signs as a possible predictor of suicide ideation.

To see whether astrological birth signs are associated with suicide and the method used, data was collected from the Public Health Department in North Cheshire representing all the Cheshire Coroner's verdicts of suicide, and open verdicts, in all deceased aged 60 and above between 1989 and 2000.

The observed occurrence of deaths due to natural causes, and suicide, in relation to birth signs did not differ significantly from what would be expected from chance.

However, the distribution of suicide by hanging appeared significantly higher in those with a birth sign of Virgo and lowest in Sagittarius and Scorpio.

The distribution of violent and non-violent suicides in relation to star signs showed higher occurences of violent death in persons born in the summer months.
Child Homicide
Authors: Dolan Mairead , Guly Olivia , Woods Peter , Fullam Rachael
Published: February 2010

Between 1967 and 1988, 69 cases of single perpetrator/single victim child homicide resulted in remands into custody in the Yorkshire region. Sixty-four of these cases were examined retrospectively to identify the characteristics of the perpetrators and of victims under 16 years, the relationship of the victim to the accused and the circumstances of the offence.

Sixty-four men singly accused of killing a single child victim are described in detail. They were characterized by relatively young age and a lack of long-term stable relationships. Previous psychiatric contact and/or a history of self-harm was noted in one-third of cases. Over half of the group had a criminal record and previous violence to children was noted in 28% of cases. Fathers or surrogate fathers accounted for nearly two-thirds of the accused.

In terms of the victims, children under six months were at greatest risk. Nearly one-third of victims were the biological offspring of the accused. Sexually motivated homicide accounted for approximately 18.7% of deaths. Victim behaviours and domestic disharmony acted as precipitants in 64% of the cases, with 54.7% of the victims dying as a result of physical beatings. Alcohol consumption at the material time was more common than noted in previous studies of child homicide.
Long-Term Psychiatric Morbidity in the Aftermath of CS Spray Trauma
Authors: Nathan Rajan , Wood Harry , Rix Keith , Wright Eric ,   The Grange Consulting Rooms
Published: February 2010

The physical effects of CS spray are well documented. However, less is known about the impact of its use by the police on the psychological health of those exposed. In this study we explored the psychiatric morbidity of a group of 30 individuals who experienced the same trauma, a significant part of which was exposure to CS spray. Just over a quarter suffered post-traumatic stress disorder. It is proposed that more attention needs to be paid to the psychological effects of the use of CS spray by the police. Consistent with other studies, a past psychiatric history and a more external locus of control was associated with post-traumatic morbidity. The latter finding may have implications for psychological interventions after exposure to trauma.
Undetermined Drowning
Authors: Lunetta Philippe , Smith Gordon S , Penttila Antti , Sajantila Antti
Published: February 2010

Drowning is one of the leading causes of death when the manner of death remains undetermined. In the present study, we examined the epidemiological and medico-legal profile of 276 undetermined deaths (M:F = 3.4:1; mean age 41.9 ± 16.0 SD) among 1,707 consecutive bodies found in water and autopsied at the Department of Forensic Medicine, University of Helsinki, from 1976 to 2000. We also describe the differences between the police investigator's initial opinion and the forensic pathologist's death certification, and the different approaches among forensic pathologists when determining the cause of death. There was considerable variation among individual pathologists in the percentage of deaths considered undetermined but these differences were not significantly related to their level of training. Medico-legal training should focus on a standardised diagnostic approach to borderline cases, in which essential factors in determining the manner of death are often ambiguous.
First Compulsory Admissions under Part II of the Mental Health Act 1983: A retrospective five-year study
Authors: Law-Min R , Oyebode F , Haque M S
Published: February 2010

The aim was to explore what happened during a five-year period to a group of patients with no previous psychiatric admissions, who were detained for the first time in a psychiatric hospital under part II of the Mental Health Act 1983. Subjects (n=189) who were detained under Section 2 or 3 in 1996 and 1997 in Queen Elizabeth Psychiatric Hospital, Birmingham were identified from computerised inpatient admission records. The mean age was 40.0 years (range 21-65). Nearly half of the cohort had a diagnosis of psychoses. Asians had the highest proportion of psychoses (64%) compared to African-Caribbean patients (48%) and White patients (41%). Almost half of the sample had a further admission, with Asian and African-Caribbean patients more likely to be readmitted than their white counterparts. Nearly a third of the cohort had a further compulsory detention. On re-admission, African-Caribbean subjects were more likely to be detained compared to Asian and White subjects. Fifty per cent had a further compulsory admission within a year of the index admission. The high number of psychoses in the Asian group may be due to their psychosis being more serious at presentation as a result of denial of illness and an increased co-morbidity with drug use in Asian men.
Psychiatric Support to Magistrates' Courts
Authors: Vaughan Phillip , Austen Christine , Le Feuvre Mary , O'Grady John , Swyer Barbara
Published: February 2010

There are many problems associated with magistrates' courts obtaining psychiatric advice when faced with defendants with mental health problems. Often the disposal of such individuals is less than ideal because of the unavailability of expert advice. In order to overcome these difficulties in Hampshire, a protocol has been developed to guide the court towards other sources of expert psychiatric advice as an alternative to the traditional route of using a consultant psychiatrist. By using existing court diversion schemes, prison mental health teams and care co-ordinators in community mental health teams, it is hoped that this will result in a more timely and reliable flow of psychiatric information. Not only will this provide an improved service to the courts but the mentally disordered defendant should benefit from a better informed bench when they are considering his/her disposal.
Child Sexual Abuse in Singapore with Special Reference to Medico-Legal Implications: A review of 38 cases
Authors: Yiming Cai , Fung Daniel
Published: February 2010

There is a paucity of studies on child sexual abuse in Asia. This study reviews the trends of child sexual abuse in Singapore and discusses the medico-legal considerations in the identification, assessment and management (including forensic implications) of such cases. It is a retrospective case review of 38 consecutive cases of child sexual abuse seen at a child guidance clinic in Singapore. Our study showed that most of the children were young (74% below age 9) and female (78.9%) with perpetrators who are males and usually known to the victims. There is a need to have integrated protocols to streamline assessment and reduce the need for repeated questioning. Adequate support of the victims in the form of specialised handling during the Court proceedings and in the use of new technology (such as video conferencing) for obtaining the child's testimony may be necessary. A child's fitness to testify is determined by the credibility and competence of the child. Repressed memories are of questionable validity.
Sudden Unexpected Death of a Methamphetamine Abuser with Cardiopulmonary Abnormalities
Authors: Nishida Naoki , Ikeda Noriaki , Kudo Keiko , Esaki Rie
Published: February 2010

A 51-year-old man suddenly collapsed while being arrested. He was an abuser of methamphetamine (MP) with a history of previous convictions. The blood MP concentration at autopsy was below the lethal level. The heart revealed hypertrophy and endocardial thickening of the bilateral ventricles. On microscopic examination, the typical findings of hypertrophic cardiomyopathy were not seen, however endocardial thickening with increasing elastic fibres was seen in all the ventricles and in the atria. In the conduction system, the AV node artery with luminal narrowing was longitudinally compressed by circumferential tissue. Severe interstitial fibrosis and small scar formation of the superior ventricular septum were also seen. In addition, diffuse hypertensive pulmonary arteriopathy was seen in the lung parenchyma.

We surmise that the AV node artery had been chronically compressed by the circumferential architecture, due to a chronic increase in intracardiac pressure. We believe that the pathological lesions noted in both the cardiac conduction system and the lung in our case may be a complication of MP abuse, and that an MP abuser with such lesions could easily die suddenly upon experiencing emotional stress.
Does Insomnia in Prison Improve with Time? Prospective study among remanded prisoners using the Pittsburgh Sleep Quality Index
Authors: ELGER BERNICE S
Published: February 2010

Insomnia is a frequent health problem in prison, but little is known about its severity and duration. The objective was to find out whether subjective sleep quality improves during time and which factors influence improvement.

Fifty-two randomly chosen prisoners complaining of insomnia at the Geneva remand prison were interviewed (T1) and followed up ten days (T2) and two months (T3) later. They received hypnotics habitually prescribed by prison physicians (benzodiazepines, chloralhydrate, zolpidem).

After ten days 40 patients were still in prison and agreed to participate and after two months 16 prisoners could be re-evaluated. Total Pittsburgh Sleep Quality Index (PSQI) scores at T1 were 12.3 +/4.7. At T2 and T3, PSQI scores improved significantly, whereas General Health Questionnaire (GHQ) scores and conditions of imprisonment were similar. Only 12.5% of patients at T2, and 6.25% at T3, were ‘good sleepers’ (PSQI scores =/< 5). Cocaine users and prisoners with a healthy lifestyle reported the greatest improvement of PSQI scores.

Our study shows that significant improvement of PSQI scores takes place in the first one to two weeks. However, in spite of regular drug treatment during the following weeks, PSQI scores persisted at a clinically significant level two months later. Drug treatment in prison only partially improves insomnia.
2. Identification of Severely Incinerated Human Remains: The need for a cooperative approach between forensic specialities
Authors: BASSED RICHARD
Published: February 2010

Positive identification of incinerated human remains can be a perplexing problem, especially when there is no genetic material remaining for DNA analysis. This paper illustrates the importance of a multi-disciplinary approach to the identification of such remains, and explores the processes involved in the various effects of heat upon human bone and teeth, and the implications this has for positive identification. A case study is presented to illustrate the various problems encountered and the importance of discovering comprehensive ante-mortem records of the deceased. It is submitted that forensic odontologists and anthropologists be included in the body recovery process, both to maximise the recovery of evidence, and to ensure that all possible avenues for positive identification are explored, so as to avoid the need to rely upon the less robust method of circumstantial identification.
Rail Traffic Accidents: A retrospective study
Authors: RAUTJI R , DOGRA T D
Published: February 2010

One hundred and twenty-seven autopsy cases of rail traffic accidents received from South Delhi were studied during the period from 1996-2002. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.41% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, the part of the body involved and the pattern of injuries in different body regions. Death occurred at the scene of the fatal event in twenty-eight cases; another twenty-eight cases were brought in dead to the hospital. Seventy-one cases died after being admitted to the hospital. Ethanol was detected in the blood of 17.4% of cases.
Substance Misuse Services in Secure Psychiatric Units
Authors: WHYTE SEAN , HARRISON CHARLOTTE
Published: February 2010

Substance misuse is prevalent amongst patients detained in secure psychiatric hospitals in England, and is associated with more negative outcomes. However, no data has been published on the availability of substance misuse treatment services in secure units. This questionnaire-based study examined staff impressions of the prevalence and impact of substance misuse problems in secure units, and the availability of treatment services. It found that substance misuse was perceived as a major problem with a substantial impact. However, service provision was poor: some units had no access to treatment services at all and, when services were available, they tended to focus on awareness-raising or relapse prevention rather than treatment of current substance misuse. Few units appeared to be able to refer their patients to the local NHS addictions service.
An Autopsy Study on Medico-Legal Evaluation of Post-Mortem Scavenging
Authors: JANI C B , GUPTA B D
Published: February 2010

After death a body may be mutilated in various ways. Animal scavenging is one of the causes. This scavenging creates difficulties with the interpretation of various medico-legal questions such as identity of the victim and cause of death and, as a consequence, criminal charges against the perpetrator cannot be framed or proven. The present study was undertaken to find out the incidence of scavenging in the Saurashtra region (part of west India) and also to see how it affects the interpretation of medico-legal evidence. We are of the opinion that scavenging does affect various medico-legal parameters and knowledge of this fact and careful autopsy examinations helped us to reach a logical conclusion. A study comprising 13 cases observed during a period of one year is presented.
Interobserver Variability in Analysis of Asbestos Fibres and Asbestos Bodies in Human Lung Tissue
Authors: ROBERTS F , MACKINNON J L , CHERRIE L , BURNETT R A , HARPER C M
Published: February 2010

Two different methods of quantifying asbestos fibre burden were assessed and the counts obtained were compared with semi-quantitative asbestos body counts in corresponding tissue sections. Comparison of the two methods found significantly different asbestos fibre counts between specimens. Each technique showed wide limits of agreement for reproducibility and interobserver variability as assessed by Bland-Altman plots, such that a repeated count could not necessarily be expected to lie within the same exposure category. Asbestos body counts in tissue sections were reproducible with good correlation between observers. Asbestos body and asbestos fibre counts showed correlation in some samples but not others. Counting of asbestos bodies is a valuable screening technique as the finding of asbestos bodies is accepted as a marker of significant asbestos exposure. When no asbestos bodies are identified asbestos fibres estimations may be useful in proving asbestos exposure. Different techniques are not interchangeable and each laboratory should establish a background range from unexposed individuals.
4. Occlusion of a Coronary Ostium by an Ingrowing Endocardial Vegetation
Authors: FERNANDO DINESH M G , De ALWIS LALANTHA B L
Published: February 2010

A 21-year-old primi, with a period of gestation of 35 weeks, was found collapsed in the toilet of a maternity hospital in Colombo, Sri Lanka. She had been admitted five days previously and echocardiography had detected a tight aortic stenosis with grade I aortic regurgitation. At autopsy, the heart showed multiple, large (>10mm), friable vegetations on a stenosed, bicuspid aortic valve. A 5mm long part of a vegetation had extended into the ostium of the left main coronary artery and caused an obstruction. Histopathology showed scattered fibrosis and focal inflammatory cell infiltrate in the myocardium. The vegetations on the valve cusp were composed of colonies of bacteria, fibrin exudate and polymorphs. The cause of death was acute myocardial infarction in a pregnant woman due to occlusion of the left coronary artery by an infective endocarditis vegetation. A medline search of the past 25 years failed to find a similar case.
Inference with Legal Evidence: Common sense is necessary, but not sufficient
Authors: MATTHEWS ROBERT A J
Published: February 2010

Recent cases have highlighted the issue of faulty probabilistic reasoning by expert witnesses in courts of law. While concern about potential miscarriages of justice is clearly well-placed, the consequences of such faulty reasoning do not seem to be fully appreciated. These are often counter-intuitive, as we show with two examples: the Interrogator's Fallacy and the Prosecutor's Fallacy. Both demonstrate the danger of relying solely on ‘common sense’ when drawing inferences from legal evidence.
A Study of p53 Expression in Thermal Burns of Human Skin for Determination of Wound Age
Authors: TARRAN SARAH , DZIEWULSKI PETER , SZTYNDA TAMARA , LANGLOIS NEIL E I
Published: February 2010

Early expression of p53 protein in thermal burns of guinea pig skin has been reported. This study sought to determine if expression occurred in thermal burns of human skin and if immunohistochemical demonstration of p53 protein could be utilised to distinguish ante-mortem from post-mortem injuries as well as indicating the age of a lesion in the living subject.

Biopsy samples were obtained from live patients and post-mortem examinations. Immunohistochemistry was used to demonstrate the presence of p53 protein. Staining was assessed by field counting of epithelial cell nuclei. In live subjects there was a tendency for early (six hour to five day) expression, with peak levels occurring around one to two days. Late samples (13 to 23 days) demonstrated minimal or no expression. In contrast, burn wounds from post-mortem examination demonstrated greater staining for p53 protein in the late (28 to 77 day) samples than in the early ones. It appears that expression of p53 protein may assist in the ageing of ante-mortem, but not post-mortem, burn wounds. This implies that results obtained from live subjects may not be applicable to post-mortem material and that any putative method for determining the age of a wound should be tested in both situations.
2. An Autopsy Case of Fatal Anaphylactic Shock Following Fluorescein Angiography
Authors: HITOSUGI MASAHITO , OMURA KAZUNOBU , YOKOYAMA TOMOKO , KAWATO HITOSHI , MOTOZAWA YASUKI , NAGAI TOSHIAKI , TOKUDOME SHOGO
Published: February 2010

We present a rare autopsy case of fatal anaphylactic shock following fluorescein angiography. A 71-year-old Japanese woman undergoing retinal angiography to evaluate diabetic retinopathy died immediately after an injection of sodium fluorescein. Forensic autopsy and post-mortem biochemical analyses revealed an elevated serum level of tryptase which, in the absence of morphologic changes suggesting injury or disease, confirmed the diagnosis of fatal anaphylactic shock. Although serious adverse effects are rare after fluorescein angiography, patients should be observed, with appropriate resuscitation equipment available, for several hours after the administration of fluorescein.
4. Milk Aspiration in an Infant During Supine Bottle Feeding
Authors: KIBAYASHI KAZUHIKO , IWADATE KIMIHARU , SHOJO HIDEKI
Published: February 2010

A two-month-old infant died during bottle feeding in the supine position in the caregiver's absence. Scene investigations and autopsy examinations, including α-lactalbumin immunohistochemistry of the lungs, revealed the cause of death to be asphyxia due to aspiration of milk pooled in the naso-oral cavity, as a result of unsupervised supine feeding. This case emphasizes the need for an investigation into feeding positions and immunohistochemical examinations for the diagnosis of asphyxia due to milk aspiration.
The Detection and Treatment of Substance Abuse in Offenders with Major Mental Illness: An intervention study
Authors: RITCHIE GORDON , BILLCLIFF NATASHA , McMAHON JOHN , THOMSON LINDSAY
Published: February 2010

Previous research demonstrated that alcohol and drug misuse prior to admission to special (high and medium) security psychiatric care in Scotland was high. Evidence from clinical practice subsequently suggested that the situation was worsening. In response, a three-pronged strategy was implemented: staff were trained in alcohol and drug issues in mentally disordered offenders, an admission screening programme was introduced to detect those at risk, and specific interventions were developed. This paper presents data on the admission screening programme and on a specific intervention.

Study 1 describes the admission data on 86 male patients admitted to the State Hospital, Carstairs. It confirmed that alcohol (81%) and drug (75%) misuse were rising in this population. Combined drug and alcohol abuse was common resulting in the development of joint treatment interventions.

Study 2 describes an eight-week drug and alcohol education and awareness programme. An evaluation of this intervention showed that subjects' knowledge of alcohol and drug issues rose significantly pre to post-intervention. However no difference was found in the stage of change or locus of control measures. A number of possible explanations for this finding are discussed, including the validity of the instruments and the effect of detainment in a high security psychiatric environment on the opportunity to change. In spite of the limitations of the environment, the prevalence of alcohol and drug misuse and its association with violence emphasise the need for specific programmes.
Criminalizing Suicide Attempts: Can it be a deterrent?
Authors: LATHA K S , GEETHA N
Published: February 2010

Suicidal behaviour constitutes a serious public as well as mental health problem all over the world. Many developed countries have done away with the legal provision of punishing attempted suicides. However, in India this continues to be a punishable offence under the Indian Penal Code (1833). This review discusses the various issues related to criminalizing suicide and their implications.
What is the Significance of Haemosiderin in the Lungs of Deceased Infants?
Authors: FORBES ADAM , ACLAND PETER
Published: February 2010

In infants, pulmonary haemosiderin has been put forward as a marker of previous asphyxic abuse and possible grounds for suspicion of homicide. Review of the available literature does not provide a strong enough evidence base to support this claim. Further research is needed before instigation of criminal proceedings can be justified on this pathological finding.
Factors Associated with the Recent Decline in Suicide Rates in the Elderly in England and Wales, 1985-1998
Authors: Lodhi Lubbaba Mahmood , Shah Ajit
Published: February 2010

Elderly suicide rates have declined in recent years in several countries including England and Wales. This study examined the association between a trend of decline in age-specific suicide rates in the elderly in England and Wales and changes in various health and social factors for the period 1985 to 1998.

Data on age-specific suicide rates was ascertained from the annual mortality statistics for the years 1985 to 1998. Data on the various health and social variables was ascertained from both the Statistics Division at the Department of Health and the Health and Personal Social Services Statistics, the yearly publications of the Department of Health from 1985 to 1998.

The main findings of this study were (i) a significant negative correlation between the number of general practitioners and all categories of whole-time-equivalent (WTE) hospital medical staff and suicide rates for each of the four five-year age bands for males and females after the age of 65; (ii) a significant negative correlation between the number of new outpatient appointments for mental illness and suicide rates in males and females for each of the four five-year age bands between the ages 65-85 years; (iii) a significant positive correlation between the average daily number of available beds for mental illness and elderly suicide rates, for all five-year age bands between the ages 65-85 years; (iv) a significant negative correlation between the number of field social work staff and day centre staff and elderly suicide rates for each of the four five-year age bands after the age of 65 for males and females; and, (v) a significant positive correlation between the total number of elderly in all residential homes and the number of elderly in local authority residential homes and elderly suicide rates for each of the four five-year age bands between the ages 65-85 years for males and females.

A trend of decline in age-specific suicide rates in the elderly in England and Wales from 1985 to 1998 was significantly associated with changes in various health and social variables. These included the number of general practitioners and hospital medical staff, the hospital psychiatric services, the number of local authority staff and the number of elderly residents in accommodation supported by a local authority. The results of this study suggest that changes in these variables may be important factors contributing to the recent decline in suicide rates but this effect should be viewed in the context of other health and social factors.
Elderly Suicide: An analysis of coroner's inquests into two hundred cases in Cheshire 1989 - 2001
Authors: Salib Emad , Rahim Sahar , El-Nimr George , Habeeb Bassem
Published: February 2010

Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death.

This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed.

Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly.

Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.
1. An Unusual Case of Suicide by Broken Glass Pierced Through the Buttocks
Authors: Sauvageau Anny , Yesovitch Rose , Racette Stéphanie
Published: February 2010

Suicidal stabbing to the back and buttocks is very unusual due to the limited accessibility of that region to the victim's hand. The following case report describes a 38-year-old man, known for depression and suicidal ideation, who was found deceased in his home after tearing his right internal iliac artery by stabbing himself through the buttock with a piece of glass from a broken beer bottle. The literature on suicidal stabbing, particularly focusing on the type of weapon and localisation of wounds, is reviewed.
Fatal Occupational Injuries in the South Delhi Construction Industry: A retrospective study
Authors: Rautji R , Lalwani S , Dogra T D
Published: February 2010

One hundred and forty-five unselected autopsy cases of construction site accidents received from South Delhi were studied during the period from 1996-2002. Data for the study was gathered from autopsy reports and hospital records. The cases represented approximately 1.61% of all autopsy cases received from South Delhi at the All India Institute of Medical Sciences, New Delhi (India). Data was analysed with regard to the age and sex of the victim, the part of the body involved, the manner of accident, the cause of death and the pattern of injuries in different body regions. Death occurred at the scene of the fatal event in thirty-four cases; forty-three cases were dead on arrival at the hospital; sixty-eight cases died after being admitted to the hospital. Ethanol was detected in the blood of 16% of the cases.
Bournewood – the Future
Authors: Mackenzie Sheena , Shah Ajit
Published: February 2010

The recent ruling on the Bournewood Case by the European Court of Human Rights could have serious implications for Health and Social Services. We have summarised the pathway that has been followed in reaching this outcome and sought to examine the possible adverse consequences of this ruling, both for the Health Service and for the people whom we seek to treat. Finally, we have also examined ways in which the Mental Capacity Bill and draft Mental Health Bill could possibly provide solutions to this dilemma.
Fatal Head Injury in Homicidal Victims
Authors: Mohanty Sachidananda , Mohanty Manoj Kumar , Panigrahi Manoj Kumar , Kumar Sreemanta
Published: February 2010

Homicide represents one of the leading causes of death, and the head is the target in the majority of cases. The objective of the present study was to analyze the pattern of head injury among homicidal death victims. Information was obtained by interviewing the accompanying persons, post-mortem examination and perusal of hospital records. Most of the victims were predominantly male and belonged in the age group 21-30 years. Blunt weapons caused the majority of the injuries. Defence wounds were present in 48% of the victims. The street was the place of crime in the majority of cases (46.7%) and in most of the cases there was more than one offender. Multiple assaults were seen on the body in 70% of cases. The skull was fractured in more than 80% of victims and intracranial haemorrhages were seen in 47 victims. Out of 77 cases, 55 victims showed intracranial lesions along with injuries to the skull and scalp. Associated fatal injuries were most commonly present on the neck and chest. The majority of the victims died instantly or within 24 hours. Blunt force is commonly used when the head is the target. Defence wounds, when present, are indicative of the homicidal nature of the attack, and multiple strokes present over the body indicate determination on the part of the accused to end the life of the victim.
Assessing Decision-Making and Capacity in Minimally-Aware Patients
Authors: Coughlan Anthony K , Rix Keith J B , Neumann Vera
Published: February 2010

The assessment of decision-making by minimally-aware patients represents an important challenge for medicine, science and the law. This paper seeks to assist the dialogue between these disciplines by discussing three aspects: the difficulties inherent in establishing a reliable means of communication with the patient; the difficulty of exploring understanding and decision-making once a means of communication has been determined; and the legal implications including problems that may arise with the `balance of probabilities' legal standard of proof. These aspects are discussed using the example of patients who have very severe acquired brain damage or are in states which verge on the `persistent vegetative state'. The discussion is informed by existing case law and by reference to clinical method and scientific theory including binomial theory.
Factors Influencing Treatment Entry in Sex Offenders Against Children
Authors: Dolan Mairead , Fullam Rachael
Published: February 2010

The study examined the psychosocial characteristics of 99 sex offenders against children referred for treatment to a forensic community sex offender programme.

The subjects had high levels of substance misuse problems and personality disorder but low rates of Axis I disorder. Subjects accepted for treatment could not be distinguished from those rejected as unsuitable on the Child Sex Questionnaire (CSQ) (Beckett et al., 1994), apart from the question on whether or not subjects believed it was wrong to have sexual contact with children. Substance misuse, antisocial personality disorder and past criminal history did not determine whether subjects were accepted or rejected. Differences in scores on actuarial measures of risk (STATIC-99) were also not significant. Clinicians' ratings of motivation, level of denial and poor social skills were the key factors determining rejection for treatment. Reconviction rates in the treatment group were low (7%) at five-year follow-up.
1. Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia Mimicking Rape Homicide
Authors: Racette Stéphanie , Sauvageau Anny
Published: February 2010

Arrhythmogenic right ventricular cardiomyopathy (ARVC), also known as arrhythmogenic right ventricular dysplasia, is a known cause of sudden unexplained death in young, otherwise healthy adults. In the forensic setting, several cases of fatal ARVC have been reported, mostly occurring during physical exercise. However, a very few cases present where the death scene is mistaken for a homicide. We report here the case of a 23-year-old woman, found dead, lying in the snow on an isolated property. The woman's genitals were exposed, with her trousers down over her thighs. Rape homicide was strongly suspected, but autopsy findings proved otherwise.
2. An Autopsy Case of Sudden Death in a Boy with Primary Pulmonary Hypertension
Authors: Kawato Hitoshi , Hitosugi Masahito , Kido Masahito , Yufu Tetsuo , Nagai Toshiaki , Tokudome Shogo
Published: February 2010

We report a rare autopsy case of sudden death due to primary pulmonary hypertension. A seven-year-old boy, who had been diagnosed with primary pulmonary hypertension at the age of four years, died suddenly. Forensic autopsy and histopathologic examination revealed extensive obstruction of small muscular pulmonary arteries by plexiform lesions and concentric intimal thickenings, compatible with primary pulmonary hypertension. We concluded that plexiform lesions of pulmonary arteries produced right ventricular hypertrophy and dilatation, decreased the preload of the left ventricle and subsequently led to biventricular failure.

This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to primary pulmonary hypertension in a child.
Homicide in the Canadian Prairies: Spousal killers and recidivism
Authors: MENZIES ROBIN P D
Published: February 2010

This prospective study identifies the rate of recidivism in spousal homicide offenders after release from their sentences for homicide and explores factors associated with re-offending.

A non-selective sample of 131 released spousal killers was studied, using the CPIC (Canadian Police Information Centre) to access post-release criminal convictions. The mean follow-up period was ten years, and ranged from eight months to 37 years.

Fifty-one offenders (38.9%) re-offended. Violent crimes were committed by 27 (20.6%) offenders. Several factors were associated with recidivism but older age at release was the most significant.

Violent recidivism in released spousal killers occurred at the rate of 21%. Ageing was a mitigating factor and should be considered in forensic assessments and given more weight in parole decisions involving any release.
Corporate Manslaughter
Authors: BERRY CHRISTOPHER
Published: February 2010

The Government published its long-awaited draft Bill on the creation of a new criminal offence of corporate manslaughter shortly before the May 2005 general election. The Bill was included in the Queen's Speech after the general election and, with a Labour government back in power, the new offence could be on to the statute book as early as 2006. The Home Affairs Committee and the Work and Pensions Committee announced a joint inquiry to consider and report on the Bill. This is expected to be completed by the end of 2005.

Pressure for reform of the law relating to manslaughter and corporate killing arose out of a series of high profile fatal accidents, including several rail crashes. There has been said to be an increasing concern amongst the public that companies and organisations are not being held sufficiently accountable for deaths caused by their criminal negligence. The author acted in the first of the major cases, representing the directors accused of manslaughter following the Herald of Free Enterprise capsize disaster in 1987.
Possible Predictors of Outcome for Conditionally Discharged Patients – A Preliminary Study
Authors: RIORDAN SHARON , HAQUE SAYEED , HUMPHREYS MARTIN
Published: February 2010

Conditional discharge for restricted hospital order patients is by and large a successful process. The present study aimed to identify variables among a cohort of conditionally discharged patients in the West Midlands that would predict whether an individual was more likely to be readmitted to hospital, involved in a serious incident, to be recalled to hospital or given an absolute discharge. A retrospective case note analysis was undertaken. Logistic regression analysis was used to identify variables that could predict outcome. Patients were six times more likely to be readmitted to hospital if they misused drugs and nine times more likely if they self-harmed. They were also six and four times more likely to be involved in a serious incident if they misused alcohol and drugs respectively. Patients were five times more likely to be recalled to hospital if they did not have close social support and were four and a half times more likely to get an absolute discharge if they lived in supported accommodation. Conditional discharge is an effective model of community care for restricted hospital order patients. Addressing the problems caused by drug and alcohol misuse, self-harming behaviour, recognising the importance of a close social support network and developing more appropriate housing for these individuals will help make the process more successful.
The Mental Health Needs of People with a Learning Disability Detained in Police Custody
Authors: SCOTT DAVID , McGILLOWAY SINEAD , DONNELLY MICHAEL
Published: February 2010

Few research studies examine the prevalence or mental health needs of people with a Learning Disability (LD) detained in police custody. This paper describes the population of detainees with an LD who presented to an inner city inter-agency police liaison service during a three-year period. Two forensically trained Community Mental Health Nurses (CMHNs) screened all custody record forms (n=9014) for evidence of a mental health problem or LD. The CMHNs interviewed positively screened detainees (n=1089) using a battery of measures designed to assess mental health status, risk-related behaviour and alcohol or drug abuse. Almost one-in-ten of those interviewed (95/1089) were judged to have a possible or definite LD. Fifty-two per cent were cases on the General Health Questionnaire (GHQ) whilst 61% attained ‘above threshold’ Brief Psychiatric Rating Scale (BPRS) scores. The majority (63%) had a history of causing harm to others while 56 per cent had a history of self-harm. More than half (56%) regularly consumed harmful levels of alcohol while one-in-four (27%) reported abusing drugs. Higher than expected numbers of detainees have a learning disability and most have complex mental health needs. A police liaison service offers a way of identifying people with LD and connecting them with appropriate health and social care agencies.
Prison Suicides and Self-harming Behaviours in Italy, 1990-2002
Authors: PRETI ANTONIO , CASCIO MARIA TERESA
Published: February 2010

Data on suicides, attempted suicides and other self-harming behaviours that occurred in Italian prisons from 1990 to 2002 was studied on official records, as documented by the Ministry of Justice.

Over the study interval, completed suicide rates in Italian prisons were constantly about ten times higher than among the general population, but over time they did not increase significantly despite nearly a doubling in the absolute number of inmates. The rate of completed suicides in overcrowded prisons was about ten times higher than in non-overcrowded ones. Attempted suicides were about ten times higher than completed suicides, with females being significantly more likely to attempt to take their own lives and males being more likely to complete suicide. Self-injuring acts without the intent to die involve about one in every ten individuals, with foreigners (non-EU citizens mostly) being twice as likely to self-harm than residents.

A better identification of the people suffering from mental disorders and a reduction in prison overcrowding are two key issues that need to be implemented to reduce the impact of suicide and self-harming behaviours among convicts.
Homicidal Sharp Force Injuries Inflicted by Family Members or Relatives
Authors: INOUE HIROMASA , IKEDA NORIAKI , ITO TAKAKO , TSUJI AKIKO , KUDO KEIKO
Published: February 2010

We retrospectively reviewed 35 autopsy cases where death had resulted from homicidal sharp force injuries and compared cases where the injuries had been inflicted by family members or relatives (relative group) with cases where the injuries had been inflicted by an unrelated person (stranger group). We reviewed the age and sex of the victims, the number of stab wounds, the site of the stab wounds, the presence of defence wounds, the detection of alcohol and other drugs and the mental status of the victims and perpetrators. We found the following tendencies: (a) a female victim was more frequently killed by a relative than by a stranger; (b) the percentage of cases receiving a single stab wound and the percentage of cases receiving more than ten stab wounds were both unexpectedly higher in the relative group than in the stranger group, and (c) in the stranger group, when there were no defence wounds, the victim had usually consumed alcohol, whereas when there were neither defence wounds nor alcohol intake, the case usually fell into the relative group. These tendencies will contribute towards our forensic appraisement in autopsy cases resulting from sharp force injuries.
Inter- and Intra-individual Variation in Applied Force When Listening at a Surface, and Resulting Variation in Earprints
Authors: MEIJERMAN L , NAGELKERKE N J D , VAN BASTEN R , VAN DER LUGT C , DE CONTI F , DRUSINI A G , GIACON M , SHOLL S , VANEZIS P , MAAT G J R
Published: February 2010

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