Empirical evidence for AMBER alert as crime control theater: a comparison of student and community samples

While the AMBER Alert system is intended to facilitate the rescue of abducted children, it has practical and psychological limitations. Participants indicated their emotions and perceptions about Alerts before and after reading a vignette that manipulated details about a child abduction. Results indicate that the Alert system fits some criteria of Crime Control Theater (CCT). CCT polices are emotion-based legal actions that appear to address crime but fail to do so and have unintended consequences. Participants experienced panic about child abduction and believed the system is an effective tool which should be used no matter the unintended consequences. Emotions and panic positively related to perceptions of the system. Still, perceptions were not particularly positive, indicating that some participants recognize the system's limitations. Female and community participants generally had more positive perceptions than males and students, especially when experiencing high emotions or panic. Reading about an abduction reduced emotions overall and led to more positive perceptions (but only in the ‘AMBER Alert success’ condition). Reading about an ‘Alert failure’ did not affect perceptions. Results highlight the role of emotion in shaping perceptions of the system. As with other CCT policies, lawmakers should rely less on community sentiment and more on science when adopting legislation.     

Canadian compulsory community treatment laws: recent reforms

This paper addresses the principles underlying compulsory community treatment (CCT) and discusses the different provisions in Canada's twelve jurisdictions. Comparisons with different models of CCT in other countries are also drawn. CCT is not only intended to reduce relapses it is also a "least restrictive" alternative to in-patient detention. Seven of the twelve Canadian mental health acts allow conditional leave from hospital. Two jurisdictions provide community treatment orders, but require two or three previous in-patient admissions. Criteria for CCT, in most jurisdictions, includes that there is a "likelihood of significant mental or physical deterioration". The requirement for previous hospitalization for CCT in Canada, unlike other countries, precludes CCT for use with first episode patients. Some jurisdictions require consent for CCT. Most jurisdictions explicitly state that the services necessary for the CCT conditions must be available.     

上肢运动诱发电位研究

目的 :上肢运动神经诱发电位 (MEP)记录及分析方法。方法 :采用电磁刺激技术跨颅刺激大脑皮质运动区（ Cz）及颈脊髓神经根（ C7）,在拇短展肌 (APB)及小指展肌 (ADM)肌腹处记录复合肌肉动作电位（ CMAP）。结果：健康人 MEP正常值： Cz－ APB潜伏期左右两侧分别为 25.23ms和 25.19ms,两侧潜伏期差为 2.24ms,两侧波幅比和面积比分别为 0.45和 0.37。 C7－ APB潜伏期左右两侧分别为 16.46ms和 16.73ms,两侧潜伏期差为 1.60ms,两侧波幅比和面积比分别为 0.49和 0.39,两侧中枢传导时间（ CCT）分别为 11.79ms和 11.75ms,两侧差为 2.00ms。 Cz－ ADM潜伏期左右两侧分别为 25.18ms和 24.80ms,两侧潜伏期差为 1.82ms,两侧波幅比和面积比分别为 0.47和 0.46。 C7－ ADM潜伏期左右两侧分别为 16.70ms和 17.44ms,两侧潜伏期差为 1.69ms,两侧波幅比和面积比分别为 0.41和 0.42,两侧中枢传导时间（ CCT）分别为 11.71ms和 11.80ms,两侧差为 1.86ms。结论：健康人跨颅电磁刺激 MEP潜伏期具有相对的稳定性及良好的重复性,可作为神经电生理学检测的一个可靠指标,但波幅及面积变异性较大,能否作为一个可靠的检测指标尚有待于进一步研究。     

Forensic and medical evaluation of vascular malformations of the brain in cranio-cerebral trauma

A classification of vascular malformations (VM) is defined in the article including a differentiation between their macroscopic and histological variations; an independently-authors-observed case of arterial-and-venous malformation (AVM) in a minor cranial-cerebral trauma (CCT) is described. Published data reflecting the forensic-and-medical value of AVM and cavernous malformations as well as of telangectasias and of arterial-and-venous fistulas in minor head traumas are analyzed. Issues of the forensic-and-medical expertise of VM and remote consequences of CCT are under consideration. VM are assessed in CCT patients with epilepsy and other pathologies. An algorithm of the forensic medical expertise of VM is suggested.     

Crime control teams: An alternative to the conventional operational procedure of investigating crimes

Crime control teams (CCT) have been operational in Syracuse, New York, since 1968. The CCT concept of policing places the responsibility of disposing of criminal incidents on a single individual—the CCT officer assigned the initial complaint. The effectiveness of this method of crime investigation, as measured by clearance rate, is compared with the effectiveness of the conventional method in which the responsibility is shared by the patrol officer and the investigator. Specific strategies responsible for the difference in effectiveness are also discussed.     

Forensic medical assessment of acute blood loss in combination with craniocerebral trauma and alcohol intoxication

Forensic medical findings have been analysed retrospectively for 242 deceased of acute blood loss: 186 (76.8%) corpses were male and 56 (23.2%) corpses were female. It was found that in acute blood loss (ABL) duration of the terminal period (TP) depended on its combination with craniocerebral trauma (CCT) or alcohol intoxication (AI). A short TP (several minutes) was observed in ABL patients with CCT (39.6%), a long-term TP--in ABL associated with AI (20-60 min, 40.4% cases; several hours, 56.3%; over 24 hours, 54.5%). Slow TP occurred primarily in mild AI (TP for several hours 55.6%, over 24 hours--83.3% cases). In severe AI the number of cases with a short TP exceeded the number of cases with a long TP (over 24 hours) by 53.7%.     

A case of sudden infant death due to massive hemorrhage in primitive neuroectodermal tumor.

A case of the sudden death of a 14-month-old girl due to massive hemorrhage in a primitive neuroectodermal tumor (PNET) is presented along with a review of the relevant literature. PNET is a rare, malignant brain neoplasm occurring predominantly in children.     

Position paper on fatal abusive head injuries in infants and young children

This article represents the work of the National Association of Medical Examiners Ad Hoc Committee on shaken baby syndrome. Abusive head injuries include injuries caused by shaking as well as impact to the head, either by directly striking the head or by causing the head to strike another object or surface. Because of anatomic and developmental differences in the brain and skull of the young child, the mechanisms and types of injuries that affect the head differ from those that affect the older child or adult. The mechanism of injury produced by inflicted head injuries in these children is most often rotational movement of the brain within the cranial cavity. Rotational movement of the brain damages the nervous system by creating shearing forces, which cause diffuse axonal injury with disruption of axons and tearing of bridging veins, which causes subdural and subarachnoid hemorrhages, and is very commonly associated with retinal schisis and hemorrhages. Recognition of this mechanism of injury may be helpful in severe acute rotational brain injuries because it facilitates understanding of such clinical features as the decrease in the level of consciousness and respiratory distress seen in these injured children. The pathologic findings of subdural hemorrhage, subarachnoid hemorrhage, and retinal hemorrhages are offered as "markers" to assist in the recognition of the presence of shearing brain injury in young children.     

A biomechanical analysis of the causes of traumatic brain injury in infants and children

There is significant disagreement among medical professionals regarding the mechanisms for infant brain injury. This disagreement is due in part to the failure by some to acknowledge and incorporate known biomechanical data and models into hypotheses regarding causes. A proper biomechanical understanding of the mechanisms of traumatic brain injury (TBI) challenges many published and testified assumptions regarding TBI in infants and children. This paper analyzes the biomechanical relationship between the causes of TBI in infants and children, and their physiological consequences. Loading characteristics, injury parameters and criteria, scaling, failure characteristics, differences between infants and adults, and impact due to falls are described and discussed in the context of the laws of mechanics. Recent studies are critiqued with reference to their contribution to an understanding of brain injury mechanisms. Finally, methods for improving our currently incomplete knowledge of infant head injuries, and their mechanisms, consequences and tolerances are proposed. There is an urgent need for close collaboration between physicians and biomechanicians to objectively and scientifically evaluate infant head injuries to further define their mechanical bases, and to assist in their diagnosis and treatment.     

Brain arteriovenous malformation and its implication in forensic pathology

Despite the fact that brain arteriovenous malformations (BAVMs) are a possible cause of sudden and unexplained death, very few papers have discussed their importance in the forensic context. BAVMs consist of tangled masses of tortuous arteries and veins devoid of intervening capillaries that frequently extend from brain parenchyma into the subarachnoid space. Apart from BAVMs, three major groups of vascular malformations of the brain are known: cavernous hemangioma, venous angioma, and capillary telangiectasia. BAVMs and cavernous hemangioma often cause hemorrhages, while venous angioma and capillary telangiectasia are typically asymptomatic. Presented here is the case of a 14-year-old girl who died from a ruptured BAVM. The present case is a reminder that the forensic pathologist should be able to recognize BAVMs and to differentiate it from other types of vascular malformations. Although rare, it is a cause of sudden death not to be overlooked, especially in children.     

Trauma, sport, and malignant cerebral edema

Sudden cerebral swelling and death secondary to craniocerebral trauma has been noted in children and young adults. This is due to an increase in intracerebral blood, either secondary to an increase in cerebral blood volume or a redistribution of intracranial blood from the pial to the intraparenchymal vessels. Sequential craniocerebral trauma has been associated with the syndrome of "malignant cerebral edema"; the possibility of a "compliance compromised brain" has been suggested as the cause. The additional possibility of asymptomatic encephalitis leading to a compliance compromised brain and malignant cerebral edema is discussed.     

Hyperostosis cranii ex vacuo in adults: a consequence of brain atrophy from diverse causes

Hyperostosis cranii ex vacuo is diffuse thickening of the bones of the cranium occurring after successful ventricular shunting in hydrocephalic children, presumably as a compensatory phenomenon. We present three adults with severe brain atrophy and correspondingly severe skull thickening. In each, the cause of cerebral atrophy was well defined, and none had undergone ventricular shunting. In two, brain atrophy resulted from different temporally discrete insults sustained in adult life, ischemic in one and traumatic in the other. In the third case. progressive brain atrophy resulted from a primary neurodegenerative disorder, Hallervordan Spatz disease. Our observations suggest that hyperostosis cranii ex vacuo is a more general phenomenon than has been previously recognized, and point to a relationship between dynamic changes in brain size and skull thickness. We suggest that such relationships should be taken into account in anthropometric evaluation of the skull.     

Skull Fracture with Brain Expulsion in a One-Level Jumping-Fall

Abstract:  Here presented is the case of a one-level jumping-fall with extensive skull fractures and brain expulsion. The body was found on the basement floor at the foot of the stairs. At the autopsy, the skull was extensively fractured, with about half of the brain expulsed several feet away from the body. The cause of death was established as a craniocerebral trauma with brain expulsion. The circumstances and manner of death were still unclear at that time. A low fall seemed very unlikely considering the severity of the skull and brain damage. The police investigation clearly revealed that the man, in a paranoid psychotic state, attacked his wife with a knife and then was witnessed by his children to have hit his head several times with a hammer. Afterwards, they saw him running to the top of the basement stairs and jumping to the bottom of the stairs head first.     

Peculiarities of combined blunt head injuries in children and adolescents

The objective of the present study was to evaluate the frequency and peculiar features of combined head injuries in children and adolescents who suffered the fatal blunt trauma. A total of 101 corpses and 188 archive records were available for the analysis. The control data group was comprised of 227 original observations of adult corpses. It was shown that head injuries prevail over injuries to other parts of the body in children with combined blunt traumas. The craniocerebral injuries are more frequent in children and adolescents than in adult subjects but their extent is smaller. Fractures of the facial bone skeleton in adults occur twice as frequently as in children. A peculiar feature of craniocerebral injuries in children and adolescents is incomplete splintered fractures and folded deformation of the bone plate. Subarachnoidal hemorrhage occurs equally frequently in children and adults with craniocerebral injuries. Other intracranial manifestations of the injury, such as ruptured brain tunics, epidural and subdural hemorrhage, cerebral contusion and ventricular hemorrhage in children occur less frequently than in adults.     

Children don't always tell the truth

Although children are being more frequently called as witnesses in court proceedings, they often do not tell the truth. If lying is defined as giving a false statement for personal gain, then lying is only one of several causes for children not giving an accurate account of events. Other reasons include an immature brain, a congenitally acquired defect in the central nervous system, or the presence of an emotional disturbance such as psychosis or hysteria. The desire of a child to please others--that is, parents, therapists, or lawyers--may also result in an invalid statement. These factors and motivations should be considered in trying to interpret a youngster's statement.     

摇晃婴儿综合征争议及研究进展

摇晃婴儿综合征是常见的虐待性颅脑损伤,其病理表现为三联征:脑实质病变、硬脑膜下出血、视网膜出血。虽然摇晃婴儿综合征被广泛运用于医学及法律领域,但是由于目前尚无直接证据证实成人摇晃儿童能造成严重脑损伤甚至死亡的后果,因此摇晃婴儿综合征存在学术争议。争议内容包括摇晃婴儿综合征的生物力学机制、病理生理机制等方面。由于某些疾病也能导致病理三联征,因此在诊断摇晃婴儿综合征过程中,应当注意外伤史、案情调查等。     

Trauma,Psychiatric, Substance Use,and Thought Disorders Among Youth in the Juvenile Justice System and How to Deal with Them

The personal stories that youth in juvenile facilities report to their counselors are heartbreaking because they are filled with accounts of excessive trauma resulting from neglect, physical, sexual, and emotional violence perpetrated on these children. Perry found that trauma develops from severe neglect, abuse, and living in terrorizing environments. Trauma changes the neural processing ability within the child's developing brain which can lead to hypervigilance and dysfunctional behavior. ¹ Widom found that children who had been abused or neglected as children have 30% higher arrests as a juvenile and as an adult for a violent offense. ²      

The shaking trauma in infants - kinetic chains

The findings in three children who died as a consequence of shaking and those in another child who survived are presented. In the three fatal cases, a combination of anatomical lesions were identified at autopsy which appear to indicate the sites where kinetic energy related to the shaking episodes had been applied thus enabling the sequence of events resulting in the fatal head injury to be elucidated. Such patterns of injuries involved the upper limb, the shoulder, the brachial nerve plexus and the muscles close to the scapula; hemorrhages were present at the insertions of the sternocleidomastoid muscles due to hyperextension trauma (the so-called periosteal sign) and in the transition zone between the cervical and thoracic spine and extradural hematomas. Characteristic lesions due to traction were also found in the legs. All three children with lethal shaking trauma died from a subdural hematoma only a few hours after the event. The surviving child had persistant hypoxic damage of the brain following on massive cerebral edema. All the children showed a discrepancy between the lack of identifiable external lesions and severe internal ones.     

Technical communication: rationale and technique for examination of nervous system in suspected infant victims of abuse

Most victims of fatal child abuse are under the age of 2 years and have a fairly typical pattern of injuries that involve the brain and spinal cord. Documenting these injuries in a systematic fashion is of paramount importance in establishing the cause and manner of death. Although the importance of recognizing these injuries is widely understood, there are few guidelines for the optimal examination of the central nervous system to document these changes. A standard procedure for postmortem dissection of the brain and spinal cord that preserves the anatomy of the cervicomedullary junction is outlined. Changes in the cervicomedullary junction and spinal cord are an underappreciated marker for shaking injury in children. This technique, along with examination of the eyes and optic nerves, will optimally identify the injuries associated with shaking injuries. A standard series of histologic sections are also outlined to document the corresponding microscopic changes.