Sudden unexpected death in epilepsy: is death by seizures a cardiac disease?

RESULTS: Sudden unexpected death in epilepsy (SUDEP) gains more and more acknowledgment across the various interdisciplinary fields. Accordingly, we performed in a prospective setting a case-control study of all SUDEP cases in a well-defined part of Denmark (Northern Jutland), between January 1998 and September 2000. We attempted to look into the cardiopathologic mechanism behind this phenomenon by assessing the degree of myocardial fibrosis in SUDEP patients versus controls. The histologic evaluation was possible in 65% of the cases (15/23) whose death was attributed to SUDEP and in 71% (15/21) of controls. Forty percent of the SUDEP cases (6/15) presented several foci of fibrotic changes in the deep and subendocardial myocardium in contrast to 1 control (6.6%, P = 0.03). None of the subjects from the SUDEP group showed fibrotic changes in their conduction system as compared with 1 control (6.6%). The quantitative evaluation of fibrosis demonstrated a trend toward more fibrosis in the deep and subendocardial myocardium of the SUDEP cases. Forty percent of cases in the SUDEP group were men (6/15), characteristically young at time of death (mean age 38 years) and with a late epilepsy onset (mean age 21 years). Antemortem, 73% of the SUDEP patients (11/15) had experienced infrequent seizures (self-reported). We conclude that the SUDEP cases displayed significant fibrosis of the myocardium when this was assessed by qualitative means. This fibrosis may be the consequence of myocardial ischemia as a direct result of repetitive epileptic seizures, which, associated with the ictal sympathetic storm, may lead to lethal arrhythmias.     

Homicide attempt with a Japanese samurai sword

The use of Japanese swords for homicidal attempts is rare. A Japanese samurai sword is a sharp and cutting object. When faced with the use of this weapon, one must distinguish between stabs and incised wounds. Incised wounds can rarely lead to death, but because of the size of the weapon, stabs usually cause much more serious injuries. Stabs also imply a penetrating movement, whereas incised wounds can be the consequence of protective circular blows. Therefore, it is important to distinguish clinically between these two kinds of wounds. We report a case where the perpetrator argued he had given a circular blow, unfortunately hitting the victim. The pieces of evidence are discussed.     

An unusual case of sudden unexpected death: postmortem investigation and biomechanical analysis of the cervical spine

A naked man died under peculiar circumstances and the postmortem examination revealed unexpected lesions in the cervical spine. Investigations of the cervical spine (computed tomography, magnetic resonance imaging, and histological examination) showed that a piece of bone was torn of the anterior part of vertebra C6 and that there was fresh bleeding in the surrounding tissue. The cause of death remained unclear but was most likely cardiac arrhythmia initiated by beta-2 agonist inhalation due to an acute asthmatic attack. Data from biomechanical investigation using finite element analysis supported the conclusion that the cervical spine injury was secondary to impact during falling as a consequence of the cardiac arrhythmia.     

Quality of criminal responsibility reports submitted to the Hawaii judiciary

This paper is the third in a series of research reports on quality of forensic mental health evaluations submitted to the Hawaii judiciary. Previous studies examined quality of reports assessing competency to stand trial (CST) and post-acquittal conditional release, in felony defendants undergoing court-ordered examinations. Utilizing a 44-item quality coding instrument, this study examined quality of criminal responsibility reports in a sample of 150 forensic mental health evaluations conducted between 2006 and 2010 by court-appointed panels. Raters attained high levels of agreement in training and quality coding. Similar to the previous studies, overall quality of reports was mediocre, falling below the .80 quality criterion score for report elements, regardless of evaluator professional identification or employment status. Level of agreement between evaluators and judicial sanity determinations was “fair” using Cicchetti's (1994) standards for interpretation of intra-class correlations. Level of agreement was lower than previously published findings for CST reports and better than conditional release reports. Reasons for mediocre report quality and “fair” inter-rater agreement are discussed, including the fact that criminal responsibility evaluations are complex, retrospective in nature, and involve significant degrees of inference. In contrast to CST evaluations, assessment of criminal responsibility involves a mental state at the time of the offense evaluation. Threats to reliability in forensic reports are discussed. Suggestions for improvement of report quality are proffered, including standardization of procedures and report format and use of forensic assessment instruments.     

HMP/YOI Holloway: a lament but also a call to arms

Abstract

London’s oldest women’s prison is to close in 2016. The unexpected speed of the UK Government’s closure plans and the lack of alternatives for London women are a cause for concern but also an opportunity. Ironically, this announcement came at a time when both the prison and its health care were evaluated as better than ever before. Staff constitute a vital source of knowledge and expertise. Good care for women who offend relies on these ingredients. Learning from the last decade should be salvaged and further developed.     

The body-worn camera perspective bias

Objectives

Footage from body-worn cameras (BWCs) is sometimes used to assess the quality of police interventions. This study investigates whether there is a “body-worn camera perspective bias,” in which the point of view provided by the footage influences perception of an intervention.

Methods

Participants with different backgrounds (undergraduate students and police candidates) were randomly allocated to a group that looked at one of two videos showing a fictional police intervention during which lethal force was used against a subject; both videos showed exactly the same intervention, but one had been filmed with a BWC and the other with a surveillance camera installed in a top corner of the room. Participants were then asked to rate the appropriateness of the intervention.

Results

No camera perspective bias was found among university respondents. However a significant camera perspective bias was found among police candidates: respondents’ opinions on the appropriateness of the intervention were significantly different when the film was from the body-worn camera than when it was seen from the surveillance camera. This result may be explained by the finding that viewers of the BWC footage reported that the subject was further from the officer.

Conclusions

Results suggest that the more training individuals have in analyzing police interventions, the more affected they will be by the camera perspective in these interventions. One implication of these results is that the perspective of people assigned and trained to evaluate the appropriateness of an intervention (e.g., members of a committee monitoring police misconduct) might be biased if only video footage from a BWC is presented.