A review of blunt force injury homicides of children aged 0 to 5 years in bexar county, Texas, from 1988 to 2009

ABSTRACT: It is essential that clinical physicians, medical personnel, medical examiners, and law enforcement agencies understand the types of injuries seen and demographics of children affected by intentional blunt force as this understanding can be crucial to the death and/or criminal investigations. An understanding of the injuries can also assist in drawing conclusions regarding how those injuries could have been sustained. This study discusses the types and patterns of injuries seen in blunt force homicides in children younger than 6 years. The study found that male infants are more often intentionally injured than are female infants and that fatal head injuries most frequently occur in the first year of life, whereas most fatal thoracoabdominal injuries occur in the first 3 years of life. In children with head injuries, subdural hemorrhage was the most common finding, followed by subarachnoid hemorrhage. In 2.5% of deaths due to head injury, concurrent neck injury was seen, a percentage far lower than previous literature would suggest if shaking was the primary mechanism of injury. Twelve legal confessions were also reviewed, none of which disclosed a pure mechanism of shaking the infant.     

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.     

Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers

Estimates of intimate partner violence (IPV) during pregnancy vary by population being studied, measures, and other methodological limitations, hindering the ability to gauge the relationship between IPV and negative birth outcomes. The authors report aggregated data from a subsample (n = 148) of the first three waves of the Women's Employment Study. The authors compared groups of women who did and did not give birth to low birth weight infants on demographic, material deprivation, risk behavior, mental health, and IPV factors. The prevalence of domestic violence was more than twice as high for women with low birth weight infants as those women who had a normal weight infant. When considering additional risk factors, including food insufficiency, substance dependence, and depression and/or posttraumatic stress disorder, IPV remained a significant indicator, but it was most strongly associated with low birth weight among women also experiencing depression and/or posttraumatic stress disorder.     

决议行为效力规则之构造

社团决议行为并非法律行为,无法直接适用法律行为规则.物权法、公司法虽设有特别规则,但二者关于决议行为效力类型及瑕疵事由的规定均不周延且相互冲突,无法满足司法需求.非公司法人等的决议行为更面临法律规制漏洞.未来民法典总则亟需增设决议行为规则.规制决议行为的伦理基础并非程序正义,而系社团自治,应围绕社团自治建构规则.应区分决议成立认定与效力判断,经有召集权者召集会议作出多数决,方形成决议.已成立的决议需满足有决议权限、真实性、合法性、合理性要件,方具有法律效力.与之对应,无决议权限、程序瑕疵、表决瑕疵、内容违法、违反规约及侵害成员合法权益将导致决议效力待定、可撤销或无效.     

Book Review: How Mediation Works: Theory,Research, and Practice by Stephen B. Goldberg,Jeanne M. Brett,Beatrice Blohorn‐Brenneur,With Nancy H. Rogers

This is a book review of How Mediation Works: Theory, Research, and Practice by Stephen B. Goldberg, Jeanne M. Brett, Beatrice Blohorn‐Brenneur, with Nancy H. Rogers. How Mediation Works is intended for a wide range of audiences: practicing mediators; aspiring mediators; those who may refer cases to mediation; participants in mediation, including parties and attorneys; managers who facilitate disputes; and those interested in mediation without a specific plan to engage in the practice (who the authors call “mediation learners”). The book is a well‐written, thoughtful, easy‐to‐read, organized, and concise overview of mediation practice. The book is divided into six chapters: (1) conflicts, disputes, and their resolution; (2) dispute resolution processes; (3) the roles of the mediator and the disputing parties at each step of the mediation process; (4) dealing with difficulties; (5) mediation and the law; and (6) suggestions for aspiring mediators. Though not an authority for family law mediation, the book provides many insightful observations and suggestions that would be instructive and helpful to any mediator or individual with an interest in mediation.     

Bilateral First Rib Anomalous Articulations with Pseudarthroses Mimicking Healing Fractures in an Infant with Abusive Head Injury

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X‐rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus‐like bone nodules in first‐rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2‐week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology.     

The structure of medical malpractice decision-making in Japan

The article summarises the problems in the medical malpractice litigation systems in the United Kingdom and Japan, demonstrating the similarities and identifying the length of time between initiating an action and its decision and other factors responsible for lengthy litigation. Based on analysis of decisions of medical malpractice cases between 1986 and 1998 in Japan, the functioning of the Japanese medical malpractice litigation system is discussed. Lengthy litigation is shown to be correlated with outcome and implies that the Japanese medical dispute resolution mechanism favours those who can endure lengthy litigation, namely the defendants, who are physicians or hospitals. In view of the similarities between the two systems, it is likely that the same bias--that the wealthier party in the litigation is more likely to win the case--also occurs in medical malpractice litigation in the United Kingdom and Australia.     

Negotiation, Power in Conciliation, and Review of Compensation Claims

Workers Compensation claims are not interpersonal disputes. Almost always they are disputes between individuals and corporations. Compensation insurers are "repeat players" in the system. Workers are often "one–shotters" who have little or infrequent contact with the system. Power inequality between the worker, employer, insurer, and those who are required to facilitate negotiations and resolve and settle disputes under compensation legislation are matters of considerable importance. This paper examines the effects of the implementation, in 1993, of informal dispute resolution processes in the Western Australian workers compensation system under the Workers Compensation and Rehabilitation Act 1981(WA), which excluded lawyers from the process. It argues that preexisting power imbalances have been aggravated by these procedural changes, and in particular, by the exclusion of legal practitioners from the dispute resolution process. The issues raised herein have general application to most workers compensation systems.     

The Institution of a Standardized Investigation Protocol for Sudden Infant Death in the Eastern Metropole,Cape Town,South Africa,,

The rate for the sudden infant death syndrome (SIDS) in Cape Town, South Africa, is estimated to be among the highest in the world (3.41/1000 live births). In several of these areas, including those of extreme poverty, only sporadic, nonstandardized infant autopsy, and death scene investigation (DSI) occurred. In this report, we detail a feasibility project comprising 18 autopsied infants with sudden and unexpected death whose causes of death were adjudicated according to the 1991 NICHD definitions (SIDS, n = 7; known cause of death, n = 7; and unclassified, n = 4). We instituted a standardized autopsy and infant DSI through a collaborative effort of local forensic pathology officers and clinical providers. The high standard of forensic investigation met international standards, identified preventable disease, and allowed for incorporation of research. We conclude that an effective infant autopsy and DSI protocol can be established in areas with both high sudden unexpected infant death, and elsewhere. (SUID)/SIDS risk and infrastructure challenges.     

医患关系的形成与扩展:对美国法上几则新近案例的释读

在美国法中,存在医患关系是主张医疗损害赔偿的一个先决条件。医患关系是一种基于双方自愿的契约关系。医生没有直接接触患者并不妨碍医患关系的建立,医疗建议可以启动医患关系。与一个想分娩健康婴儿的孕妇形成医患关系的医生也与胎儿形成了医患关系。与医生这一职业人员存在相互关系的人可包括没有与职业人员建立严格/直接的契约关系的人群。医生的注意义务可扩展到与其不存在直接的医患关系但存在特殊关系的非患者。如果通行的注意标准所创设的义务明显有益于某些可以确定的第三方,该第三方处于可预见的危险区域,而医生知道此类第三方的存在,那么医生的义务将指向该第三方。当医生仅仅提供检查而没有对受雇者提供医疗和照护时,医生与被检查人员之间不存在医患关系。     

Sexual murderers of children: developmental, precrime, crime, and postcrime factors

The amount of empirical research on men who commit sexual murders is scarce, and no distinction has been made between those who have victimized adults and those who have victimized children. Therefore, to better understand specifically sexual murderers of children (n = 11), comparisons were performed with a group of sexual murderers of adult women (n = 66) on developmental, precrime, crime, and postcrime factors. It appears that sexual murderers of children are more often victims of sexual abuse during childhood and present more often deviant sexual fantasies as compared to sexual murderers of women. The results show also that sexual murderers of children more often use pornography prior to crime, have contact with the victim prior to crime, and commit a crime more often characterized by premeditation, strangulation, the hiding of the body, and its dismemberment than the sexual murderers of women.     

The Ideologies of Mediation: The Movement's Own Story

This paper has three aims. First, it describes the ideologies of six organizations that have been and continue to be prominent in the alternative dispute resolution (ADR) movement in the United States. These organizations all feature the use of mediation as a central component of their work and as a solution to larger social problems.
Second, it elaborates some points of similarity and difference in these ideologies in light of a debate that emerged in the late 1970's between "community" and "agency" models of mediation, that is, between programs that chose to closely affiliate with the formal justice system and those that chose not to. Several years after the start of this debate, we believe there are important points of convergence and divergence that have not received enough attention by those who advocate for or against alternative dispute processing.
Finally, the authors wish to use the opportunity this study provides to speculate more openly on the contemporary meaning of legal informalism and the ways in which formal and informal legal structures now seem to be linked.     

Beta-tryptase and quantitative mast-cell increase in a sudden infant death following hexavalent immunization

The association between sudden infant death syndrome and immunization is frequently discussed. Serious adverse events following vaccination have generally been defined as those adverse events that result in permanent disability, hospitalization or prolongation of hospitalization, life threatening illness, congenital anomaly or death. They are generally referred to the inherent properties of the vaccine (vaccine reaction) or some error in the immunization process (programme error). The event could also be totally unrelated but only temporally linked to immunization (coincidental event). A fatal case of a 3-month-old female infant, who died within 24 h of vaccination with hexavalent vaccine is presented. Clinical data, post-mortem findings (acute pulmonary oedema, acute pulmonary emphysema), quali-quantitative data collected from immunohistochemical staining (degranulating mast cells) and laboratory analysis with a high level of beta-tryptase in serum, 43.3 microg/l, allows us to conclude that acute respiratory failure likely due to post hexavalent immunization-related shock was the cause of death.     

POVERTY,INFANT MORTALITY,AND HOMICIDE RATES IN CROSS-NATIONAL PERSPECTIVE: ASSESSMENTS OF CRITERION AND CONSTRUCT VALIDITY*

This article assesses the extent to which the infant mortality rate might be treated as a “proxy” for poverty in research on cross-national variation in homicide rates. We have assembled a pooled, cross-sectional time-series data set for 16 advanced nations from the 1993–2000 period that includes standard measures of infant mortality and homicide and contains information on the following commonly used “income-based” poverty measures: a measure intended to reflect “absolute” deprivation and a measure intended to reflect “relative” deprivation. With these data, we assess the criterion validity of the infant mortality rate with reference to the two income-based poverty measures. Also, we estimate the effects of the various indicators of disadvantage on homicide rates in regression models, thereby assessing construct validity. The results reveal that the infant mortality rate is correlated more strongly with “relative poverty” than with “absolute poverty,” although much unexplained variance remains. In the regression models shown here, the measure of infant mortality and the relative poverty measure yield significant positive effects on homicide rates, whereas the absolute poverty measure does not exhibit any significant effects. The results of our analyses suggest that it would be premature to dismiss relative deprivation in cross-national research on homicide, and that disadvantage is conceptualized and measured best as a multidimensional construct.     

Stun gun injuries in the abuse and death of a seven-month-old infant

The author autopsied a seven-month-old infant who was shocked repeatedly with a stun gun by his foster mother, in an attempt by the foster mother to get the infant to stop crying. The stun gun injuries were round, well-circumscribed, erythematous macular lesions, which were found in pairs. The lesions were 2 in. apart, and were found to match the distance between the electrodes of the stun gun found in the foster mother's purse. Based on the electrical output of the stun gun, the small size of the infant, location of stun gun discharge, and the decreased resistance of the infant's skin, it can be concluded that the stun gun injury is responsible for the infant's death.     

Infant mortality in town and countryside: northern Germany, ca. 1750–1850

The discussion still continues among researchers about the causes for the decline in infant mortality in widespread parts of Europe at the turn of the 19th century. This article is based on sources such as unpublished statistical material from Prussia, parish registers, and lineage and village genealogies. As these sources are broken down by town and countryside and into various phases of infant mortality, they provide evidence for further reflection that may be fruitful. Thus, several causes for the decrease in infant mortality and ways of diffusion can be excluded and the impact of others delimited. The present study concludes that research should pay more attention to changes in infant care than it usually does.     

GIRL FRIENDS ARE BETTER: GENDER,FRIENDS, AND CRIME AMONG SCHOOL AND STREET YOUTH*

In recent years, popular media has drawn attention to “mean girls” and their negative treatment of others, particularly other females. But while the attention to girls' aggression and their mistreatment of their peers highlights understudied aspects of female behavior, it neglects the beneficial aspects of female friendship. We argue that compared to relationships with males, friendships with females provide more social control, fewer opportunities and less motivation for offending and may therefore discourage crime. Because an adolescent's gender likely influences the association between the gender of one's friends and crime, we anticipate that the association will be stronger for females than for males. The relationship is also likely affected by the context in which relationships originate; we expect that those that develop in less conventional contexts will have weaker effects on crime. We explore these hypotheses with a comparative analysis of effects of friendships on property crime in two samples of youth: those who live at home and attend school and those who are homeless and spend their days and nights on the street. Our findings support our hypotheses. The relationship between female‐dominated friendship networks and property crime is negative and significant; however, this association is strongest for school females, weaker for school males and females who live on the street, and nonsignificant for homeless males.     

Diffusion of responsibility in crime,punishment, and other adversity

Three studies tested the hypothesis that an individual acting alone, compared with an individual group member, would be held more responsible for behavior leading to a negative consequence. In one study, 240 subjects read scenarios of an event with a negative outcome involving one, two, three, or four individuals. As predicted, there was a significant inverse relationship between the number of participants and the degree of attributed responsibility. The second study investigated subjects' attributions of responsibility for criminals committing a crime alone or with a partner. Single perpetrators were considered more responsible than those acting with a partner, although there was no difference in sentence length assigned. In the third, archival-type study, prison sentences for criminals who had actually committed a robbery alone or with others were examined. Again, there was diffusion of responsibility: criminals acting alone received significantly longer sentences than perpetrators who had committed a similar crime, but who had acted with others.     

Laryngeal basement membrane thickening is not a reliable postmortem marker for SIDS: results from the Chicago Infant Mortality Study.

It has been suggested that laryngeal basement membrane (LBM) thickening is a pathognomonic postmortem marker for sudden infant death syndrome (SIDS) and is not seen in other causes of explained sudden infant death. To test this hypothesis, we evaluated longitudinal sections of the right hemilarynx taken through the midpoint of the true vocal cord from 129 SIDS cases and 77 postneonatal sudden infant death controls. Using a five-point semi-quantitative scale, maximum LBM thickness (LBMT) for SIDS cases and controls was not statistically different (mean, 2.39 + 0.69 and 2.40 + 0.77, respectively). Likewise, scores based on the average thickness along the entire basement membrane (i.e., "average" score), were not found to be different between SIDS cases and controls. Average and maximum LBMT increased with age in both SIDS cases and controls and were not different between SIDS cases and controls within each age interval. Similar trends in the distribution of maximum and average LBMTs were found between black and Hispanic SIDS and controls; the number of white/non-Hispanic infants was too low for meaningful comparisons. Maximum and average LBMTs were not different in SIDS cases and controls exposed to environmental tobacco compared with unexposed infants. The LBMTs also increased significantly with body weight and length in both SIDS cases and controls. Finally, there were no differences in LBMT in infants intubated prior to death compared with those who were not intubated. From these data, we conclude that LBMT is not pathognomonic of SIDS, is present or absent with equal frequency in SIDS and controls, increases with postnatal age, and does not correlate with passive smoke exposure. Therefore, LBMT should not be used to diagnose SIDS.     

Abnormal heart rate response during newborn sucking behavior study: Subsequent sudden infant death syndrome with cardiac conduction abnormality

This report concerns a four-month-old white female infant who exhibited abnormal feeding behavior and EKG irregularities during a newborn sucking behavior study. The immediate post-birth history showed an irregular heart rate on two occasions, but a cardiac consultation elicited no unusual findings. During sucrose sucking conditions, the heart rate increased with a beat-to-beat variation of 50 beats per minute, noted to be due to premature atrial beats. At 39 days, an EKG showed a marked sinus tachycardia of 156, a PR interval of 0.08, QRS of 0.05 and a QT of 0.26. The infant was diagnosed as a sudden infant death syndrome (SIDS) following an unexpected death at home. Subsequent cardiac pathology revealed an anomalous tract between the right atrium and the atrioventricular (AV) bundle which formed an extensive bypass of the AV node (atrio-His tract), and two accessory AV connections between the left atrium and posterior left ventricle. These findings are consistent with the Wolff-Parkinson-White syndrome type A. Only further studies can determine whether such abnormal feeding behavior with EKG irregularities can be used to identify infants who are at high risk for sudden death.