The effect of oleoresin capsicum "pepper" spray inhalation on respiratory function

We performed a randomized, cross-over controlled trial to assess the effect of Oleoresin capsicum (OC) spray inhalation on respiratory function by itself and combined with restraint. Thirty-five subjects were exposed to OC or placebo spray, followed by 10 min of sitting or prone maximal restraint position (PMRP). Spirometry, oximetry, and end-tidal CO2 levels were collected at baseline and throughout the 10 min. Data were compared between groups (ANOVA) and with predefined normal values. In the sitting position, OC did not result in any significant changes in mean percent predicted forced vital capacity (%predFVC), percent predicted forced expiratory volume in 1 s (%predFEV1), oxygen, or CO2 levels. In PMRP, mean %predFVC and %predFEV1 fell 14.4 and 16.5% for placebo and 16.2 and 19.1% for OC, but were not significantly different by exposure. There was no evidence of hypoxemia or hypercapnia in either groups. OC exposure did not result in abnormal spirometry, hypoxemia, or hypoventilation when compared to placebo in either sitting or PMRP.     

Ventilatory and metabolic demands during aggressive physical restraint in healthy adults

We investigated ventilatory and metabolic demands in healthy adults when placed in the prone maximal restraint position (PMRP), i.e., hogtie restraint. Maximal voluntary ventilation (MVV) was measured in seated subjects (n=30), in the PMRP, and when prone with up to 90.1 or 102.3 kg of weight on the back. MVV with the heaviest weight was 70% of the seated MVV (122+/-28 and 156+/-38 L/min, respectively; p<0.001). Also, subjects (n=27) were placed in the PMRP and struggled vigorously for 60 sec. During the restrained struggle, ventilatory function (V(E)/ MVV) was 44% of MVV in the resting PMRP. While prone with up to 90.1 or 102.3 kg on the back, the decrease in MVV was of no clinical importance in these subjects. Also, while maximally struggling in the PMRP, V(E) was still adequate to supply the ventilatory needs.     

Physical restraint in polish psychiatric facilities

Physical restraint in the form of direct force, forced feeding and medication, mechanical restriction of bodily movement, or the threat of force was administered to close to 30% of patients admitted and hospitalized for a period of at least fourteen days. In transporting the patient to the admission room and then to his treatment ward, the dominant form of restraint used was direct force, or the threat of such force. During the following fourteen days of hospitalization, mechanical restraint and forced medication predominated. Restraint was applied most often, across each of the four phases of the study, to patients deemed dangerous to self or others. This relationship became significantly stronger as the period of hospitalization continued. Across the four phases, patients who protested their hospitalization were more likely to be restrained than patients who agreed to it or who did not object. During each of the four phases of the study, numerous patients who did not object to their hospitalization and who were not deemed dangerous were nevertheless subjected to restraint. The pervasiveness of physical restraint, the wide inter-hospital differences in its use, the apparent over-prediction of patient dangerousness, and the use of restraint with patients who were not deemed dangerous and who did not object to their hospitalization, confirms the need for legal and ethical regulation of physical restraint of psychiatric patients.     

The relationship between bedding and face-down death in infancy: mathematical analysis of a respiratory simulation system using an infant mannequin to assess gas diffusibility in bedding

Rebreathing is a model for the relationship between a prone sleeping position and sudden infant death syndrome. This study used a mechanical simulation model to establish the relationship between types of bedding and rebreathing potential for an infant placed prone (face down) at different postnatal ages. The infant mannequin was connected to a respirator set to deliver physiologically appropriate combinations of tidal volume (V(T)) and respiratory rates (RR) across a range of postnatal ages (0-18 months). Before measurements were made, CO(2) flow was regulated to 5+/-0.1% of end-tidal PCO(2) (EtCO(2)). After the model was placed in a prone position, any increase in the fractional concentration of inspired CO(2) (FiCO(2)) was measured. FiCO(2) increased immediately and rapidly, and reached a maximum value within a few minutes. The maximum FiCO(2) ranged from under 2% to over 10%, depending on the bedding. FiCO(2) was also affected by V(T) and RR. This model is not applicable to actual infants because of the large tissue stores of CO(2) in infants; however, it is useful for evaluation of gas diffusibility of bedding and will simplify the investigation of sleeping environments when a baby is found dead with its face covered by soft bedding. In general, the higher the FiCO(2), the greater the rebreathing potential. Theoretically, considering the paucity of body stores of O(2), changes in FiO(2) would be affected not by changes in FiCO(2), but by CO(2) production and gas movement around the infant's face. The rapid decrease of FiO(2) is approximated at the inverse of the FiCO(2) timecourse, suggesting the significance of not only CO(2) accumulation but also O(2) deprivation in the potential space around the baby's face.     

Relation of Kinetic Energy to Contact Wounds of the Head by Centerfire Rifles and Shotgun Slugs

Wounds of high‐energy centerfire rifles and shotguns represent distinctive injuries of forensic importance. Previous studies of contact wounds have shown variability in the potential of these weapons to produce bursting wounds of the head. The present study analyzed contact head wounds owing to 26 centerfire rifles and nine shotgun slugs and compared them with respect to weapon, ammunition, entry wound site, and projectile kinetic energy. The bursting effect, defined for this study as disruption of at least 50% of the head, occurred in 25/35 of cases and was related to kinetic energy. Bursting was associated with energies <2700 ft‐lbs in 12/22 cases and energies >2700 ft‐lbs in 13/13 cases. The volume of gunpowder gas injected into the wound was considered as contributing to the bursting phenomenon. There was no relation of bursting to the specific entrance wound site, type of ammunition, or projectile fragmentation.     

Children in motor vehicle collisions: analysis of injury by restraint use and seat location

This study was a retrospective chart review of hospital records and autopsy reports of 499 children nine years old or younger involved in motor vehicle collisions from 1994 to 1998. The objective was to evaluate the frequency and severity of injuries as a function of age, restraint use, and seat position. We found that 33% of the children were unrestrained and 20% were improperly restrained. Unrestrained children had the highest mean Maximum Abbreviated Injury Scores (MAIS) and Injury Severity Scores (ISS), accounted for 70% of the fatalities, and had the highest incidence of head injuries. Although most of the head injuries were superficial, 80% of the fatalities were the result of a head injury. Improperly restrained children had the highest frequency of abdominal injuries. Regardless of restraint use, the back seat was associated with fewer head injuries and lower mean MAIS and ISS scores compared to the front seat. Also, properly restrained children in the front seat had lower mean MAIS and ISS scores than unrestrained children in the back seat, suggesting that restraint use is more beneficial than seat position.     

卧姿笔迹特征的实验研究

目的为卧姿笔迹鉴定提供识别和评断的参考依据。方法比较108个不同书写水平者的仰卧、左侧卧、右侧卧及俯卧笔迹与正常坐姿笔迹特征上的异同点,通过大量实验数据的统计分析,总结出卧姿笔迹特征及其变化规律,探讨可能的变化原因,并分析卧姿笔迹检验的要点。结果卧姿笔迹在字体、写法、错别字、笔顺、字间组合和单字的基本搭配比例等特征上较稳定。这些特征可作为本质特征使用。4种卧姿中,俯卧笔迹特征最稳定;书写水平高者笔迹特征也较稳定。结论卧姿笔迹鉴定应结合卧姿笔迹特征变化规律,准确判断笔迹的形成条件,去伪存真,做出科学的评断。     

Effect of wrist restraint on maximal exercise capacity in healthy volunteers

Each year, reports occur of deaths in individuals, while struggling against physical restraint. The mechanism of these deaths remains unclear. This study aimed to determine the effect of wrist restraint on cardiorespiratory function during maximal exercise. Twelve healthy volunteers underwent 3 incremental maximal exercise tests on a cycle ergometer. In a randomized order, they exercised while unrestrained, with the wrists tied in front of the body or wrists tied behind the back. The primary outcome measures were the number of minutes exercised in each position and heart rate and whole blood lactate level for each stage and on reaching maximum exercise capacity. The mean exercise duration was 19 minutes 6 seconds unrestrained (95% confidence interval [CI] 16 minutes 52 seconds to 20 minutes 57 seconds), 18 minutes 51 seconds (95% CI 17 minutes 51 seconds to 20 minutes 50 seconds) with arms restrained in front and 16 minutes 51 seconds (95% CI 14 minutes 6 seconds to 19 minutes 20 seconds) with the arms restrained behind the body (P = 0.16). There was no significant difference in heart rate or lactate measurements. It is probable that other factors make a more important contribution than wrist restraint behind the body to cardiorespiratory compromise in a struggling and fatigued individual.     

Fatal malignant hyperthermia--delayed onset and atypical course

A case of malignant hyperthermia (mh) in a 27-year-old man is described. In a first anaesthesia using isoflurane and succinylcholine, the end-tidal CO(2) rose from 39 to 49 mmHg 2.75 h post-intubation and the body temperature rose to 39.8 degrees C 14 h post-intubation but was normal again the next day. In a second anaesthesia using the same medication, the maximal end-tidal CO(2) was 44 mmHg and the body temperature rose to 39 degrees C after 9 h. After 4 days, the fever rose to 40 degrees C, and to 42 degrees C when death occurred 10 days after the second anaesthesia. Masseter spasms or muscle rigidity were never present. According to the death certificate, death was due to multi-organ failure from sepsis. At autopsy, the skeletal muscles were pale and oedematous. Histology demonstrated focal necroses in the skeletal muscles, shock kidneys with myoglobin excretion and myoglobin clots in small blood vessels of the lungs. Hence, the postmortem diagnosis "malignant hyperthermia" was established but accusations of medical maltreatment were rejected because of the atypical and protracted clinical course and because uncharacteristic signs of malignant hyperthermia were attributable to the clinically suspected sepsis.     

Positional Asphyxia without Active Restraint Following an Assault

Deaths due to positional asphyxia are most often accidental, associated with alcohol and/or drug intoxication. A 19‐year‐old male is reported who was assaulted and placed in a head‐down position in the back of a car were he was later found dead. Brush abrasions indicated that he had been dragged to the vehicle. The head and right shoulder were wedged into the foot well with the body uppermost. At autopsy, there was marked congestion of the face, neck, and upper chest with conjunctival ecchymoses, bruising of the face and scalp, focal subarachnoid hemorrhage, minor cerebral contusion, and diffuse cerebral swelling with early hypoxic ischemic encephalopathy (HIE). Toxicology was negative. Death was attributed to HIE resulting from the unusual positioning of the body. Cases of positional asphyxia involving others may not always include restraint, and when encountered should initiate a careful evaluation of the possible events and lethal pathophysiological processes.     

Suicide by intravenous injection of a veterinary euthanasia agent: report of a case and toxicologic studies

Previously reported cases of suicide by intravenous barbiturates, as well as two other unusual cases [5,6], are compared in Table 2. All decedents were either medical or paramedical personnel and familiar with the drugs and the routes of administration used for their suicides. Lethal is used in veterinary euthanasia at an intravenous dose of 1 ml per 5 kg (10 lbs) body weight. Unconsciousness usually occurs during injection and death supervenes within a matter of seconds. The decedent in the present case weighed 90 kg (200 lbs) and had injected at least 40 ml of the drug, approximately twice the recommended lethal dose. There appears to be little doubt of the victim's suicidal intent, since he had used Lethal in his daily occupational duties. Additionally, the physical configuration of the supports devised to hold the syringe was quite stable, and injection stopped only when the decedent's hand came to rest upon the towels. To our knowledge, the present case represents the only one of its kind in the literature.     

论清代徽州禁约合同——兼议与禁约告示、禁约碑之区别

中国古人习惯于用合同的方式来解决各种财产纠纷和社会矛盾。禁约合同是古代合同类型之一种,多是同族、同村人等为禁止盗窃、禁止砍伐树木、保护荫木来龙水口等事务,共同立约承诺并议定罚则的合同文书。部分禁约合同,由于请求官府支持,而转化成禁约告示、禁约碑,约束范围扩大、效力上升,已可视为乡规民约。禁约合同本身没有外部约束力,其内部约束力是传统合同"信"价值的表达。禁约合同是私人间由于财产的共有或公有产生一种调和权利纠纷的自发秩序,也是地缘社会维护生活安宁,将一些陋习予以禁止,共同约束自身和抵御外来侵犯的约定。然而,从禁约合同、禁约告示、禁约碑等的整个体系来看,禁约产生和运行是需要外部保证的,这种外部保证就是国家法或官方的支持。据此,禁约合同才能发挥基层社会调和权利纠纷的作用。     

Fatal incidences during arrest of highly agitated persons

We report on four cases of sudden circulatory arrest during the physical restraint of extremely excited and repugnant men by the police. Three persons died, and one became apallic. The excited states resulted from acute schizophrenic disorder in one case, from intoxications (ethanol and drugs including cocaine respectively) in two others, and from encephalitis in the fourth case. In only one case one of the police officers was condemned for involuntary mansloughter, responsability was excluded in the remainder. Similar lethal events in "excited delirium" are given in the American literature, the main etiologic factors being acute psychosis and cocaine intoxication. Most of these events occurred, differing from ours, under "hogtying" which is a technique of physical restraint in a prone position with the wrists and ankles bound behind the back. These events are thought to be cardiac in origin and to result from oxygen-consuming motor hyperactivity, excessive catecholamine release, and impaired breathing. Police officers are recommended to restrict all measures of restraint to a mininum in extremely excited persons, and to avoid any compression of the trunk or neck. A continuous monitoring for vital signs is postulated in order to recognize a medical incident as quick as possible.     

Negative Modulation of NO for Diaphragmatic Contractile Reduction Induced by Sepsis and Restraint Position

In practice of forensic medicine, potential disease can be associated with fatal asphyxia in restraint position. Research has demonstrated that nitric oxide （NO） and nitric oxide synthase （NOS） are plentifully distributed in skeletal muscle, contributing to the regulation of contractile and relaxation. In the current study, respiratory functions, indices of diaphragmatic biomechanical functions ex vivo, as well as NO levels in serum, the expressions of diaphragmatic inducible NOS （iNOS） mRNA, and the effects of LNNA on contractility of the diaphragm were observed in sepsis induced by cecal ligation and puncture （CLP） under the condition of restraint position. The results showed that in the CLP1218 h rats, respiratory dysfunctions; indices of diaphragmatic biomechanical functions （Pt, ＋dT/dtmax, dT/dtmax, CT, Po, force over the full range of the forcefrequency relationship and fatigue resistance ） declined progressively; the NO level in serum, and iNOS mRNA expression in the diaphragm increased progressively; force increased significantly at all stimulation frequencies after LNNA preincubation. Restraint position 1 h in CLP12 h rats resulted in severe respiratory dysfunctions after relative stable respiratory functions, almost all the indices of diaphragmatic biomechanical functions declined further, whereas little change took place in NO level in serum and diaphragmatic iNOS mRNA expression; and the effects of LNNA were lack of statistical significance compared with those of CLP12 h, but differed from CLP18 h group. These results suggest that restraint position and sepsis act together in a synergistic manner to aggravate the great reduction of diaphragmatic contractility via, at least in part, the negative modulation of NO, which may contribute to the pathogenesis of positional asphyxia.     

Calculation of tension exerted on a ligature in incomplete hanging.

The study is devoted to one of the numerous factors (namely, body posture), which determine the strength of the neck compression in hanging. Mathematical modeling method and achievements of biomechanics were used. Human body was supposed to consist of 16 freely joined hard parts. The possibility of ligature tension calculation in any position in incomplete hanging is shown. Weight ranges for hanging of male persons in different body positions are presented: in standing posture the ligature is stretched by more than 65% of the body weight, in kneeling position by 64-74%, in sitting by 17-32%, in recumbent posture by less than 18% of the body weight. The importance of the accurate recording of a corpse posture at the place of accident is emphasized, as well as the necessity of the corpse mass evaluation. Significance of the work for medico-legal practice is illustrated by the study of the neck organocomplex trauma in 108 cases of suicidal hanging. Injuries were revealed stereomicroscopically after the complete preparation of the hyoid bone and laryngeal cartilages, preliminary fixed in the formalin solution. Trauma to the neck complex (fractures, infractions, fissures) was found in more than 64% of cases, differences in many of the groups compared are significant, P<0.05. Vulnerability index hyoid bone/thyroid cartilage was 1.75 in complete hanging of the body, 0.88 in standing position, 0.63 in kneeling, 0.33 in sitting, 0.25 in recumbent posture. Results of the study may be used for investigation of dying processes and morphology of hanging.     

Abusive Pediatric Thoracolumbar Fracture Due to Forced Hyperextension: Case Report,Biomechanical Considerations,and Review of the Literature

Pediatric thoracolumbar fractures are rare due to the physiological differences which afford greater resilience to the immature spine. Most pediatric thoracolumbar fractures occur as the result of high energy trauma, such as motor vehicle accidents, and modes of reasonable accidental injuries are limited by age and developmental capabilities of the child. These fractures can occur as the result of inflicted blunt force trauma and child abuse, and in most cases, the mechanism of injury to the spine is not known. We report the death of a 29-month-old man due to blunt force trauma to the back and forced hyperextension of the thoracolumbar spine causing fracture of the fourth lumbar (L4) vertebral body. A complete forensic examination revealed a previous healing fracture of the anterior aspect of the L4 vertebral body, with acute disruption of the anterior longitudinal ligament overlying the fracture site, complete fracture of the vertebral body, and fatal retroperitoneal hemorrhage. We present a review of the biomechanical considerations of the pediatric spine, a survey of pediatric spinal fractures, and a review of the literature on pediatric abusive thoracolumbar fractures. In this case, there was never a provided explanation for how the injury occurred; however, understanding the biomechanics of the pediatric spine allowed for the determination of the mechanism, force required to produce this specific pattern of abusive spinal injury, and the manner of death.     

Physical Restraint and Near Death of a Psychiatric Patient

Physical restraint is used as a last resort emergency measure to calm and safeguard agitated and/or aggressive psychiatric patients. This can sometimes cause injuries, and rare fatalities have occurred. One mechanism of injury and death while in physical restraint is that of severe asphyxiation. We present the case of a hospitalized man in his mid‐30s, suffering from schizophrenia. The patient was obese. He became aggressive and had to be manually restrained with a “takedown.” After having been put in the prone position on the floor with a significant weight load on his body, he lost respiration and consciousness. Subsequently, he was given CPR. He regained consciousness and respiration, while the cyanosis receded in 1–2 min. Psychiatrists and pathologists should be aware that physically restraining a patient in the prone position with a significant weight load on the torso can, in rare cases, lead to asphyxiation.     

Appearance of chemical burns resulting from the washing of a deceased body with bleach

The authors report on a case of postmortem washing of a body with bleach. An adult female victim was found nude in an alleyway with both hands removed in the City of Westminster, CO. Cause of death was attributed to severe blunt force trauma to the head. The victim had been dumped in the alleyway within 7 h of discovery. Evidence discovered at the crime scene and autopsy indicated that the murder and subsequent washing of the body with bleach occurred at a secondary location(s). The victim was wet to the touch, presenting a strong odor of bleach. Several "ribbon"-like burn patterns were observed on the victim's back and upper thighs. These burn marks were replicated by dowsing a deceased pig with an over-the-counter concentration of bleach.     

‘Sustaining the Character of a Judge’: Conflict within the Legal Thought of British India

Judicial roles provided the raj with major dilemmas. One persistent dispute related to civil servants sitting as judges. Critics argued that civil servants had a superficial legal education and lacked appropriate practical experience of work in the courts. Defenders of their judicial role contended that the best training for judges lay in administrative work on the plains of the sub-continent. Governors-general, viceroys, and others in executive positions claimed that such work provided officials with an understanding of Indian society and that this social knowledge made them effective judges. Professional judges drawn from the ranks of barristers and sitting in the major cities of Calcutta, Bombay and Madras frequently contested this view and the result was sustained disagreement. At the heart of the debate lay competing visions of justice.     

The Influence of Lying Body Position on Handwriting

Although the problem of handwriting variability due to lying body position has practical significance, particularly for last will cases, it has not been sufficiently studied. The presented experiment aimed to recognize how such posture may influence handwriting features. Samples of text and signatures were collected from 50 healthy individuals, aged 23–58, produced in three postures: typical sitting position (SP) and two different lying positions (LP1 & LP2). Using the SP sample of each individual as a specimen, eleven characteristics in LP1 and LP2 samples were evaluated as similar or different. Nine other features were measured with a specialized software, and their conformity was tested with Student's t‐test. Although none of the characteristics differed significantly in most cases, variation occurred in pen pressure, margins, baselines, and heights of letters. Additionally, a series of blind tests revealed that lying position of the individuals did not hinder the possibility to identify their writings.