Delayed left anterior and middle cerebral artery hemorrhagic infarctions after attempted strangulation: a case report

The 2 common carotid arteries bifurcate in the neck into the internal and external carotid arteries. The internal carotid artery enters the skull and further divides into the anterior and middle cerebral artery. During its short course in the neck, the carotid artery travels encased in the carotid sheath along with the vagus nerve and the internal jugular vein. During its course in the neck, the carotid artery is quite superficial, making it vulnerable to both penetrating and blunt traumatic injuries. We report here a case of a 40-year-old man who presented to the emergency department after sudden collapse and loss of consciousness a day after an attempted strangulation. Imaging revealed large hemorrhagic infarcts in the left anterior cerebral artery and middle cerebral artery territories as well as a smaller infarcts in the right anterior cerebral artery territory necessitating emergency decompressive hemicraniectomy. Our case report adds to the existing literature on nervous system injury due to strangulation. Physicians should be aware of the possibility of delayed presentation of neurological deficit after attempted strangulation.     

Health care financing reforms in Germany: the case for rethinking the evolutionary approach to reforms

Health care reform has been a perpetual issue in German politics since reunification. Reform initially focused on restructuring the health care system of the former East Germany. It has subsequently focused on questioning whether the financing of the German social health insurance (SHI) system is sustainable, in light of economic malaise that characterized the 1990s and heightened global competition. In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.     

Satanism and suicide in adolescence--2 case reports

Death cases--suicides as well as homicides--within the context of satanism are meanwhile becoming routine casework for forensic pathologists. Therefore the investigators should be aware of satanic signs and items associated with the occult to identify a satanic background. Based on two suicides of young persons, satanic signs helpful for classification are pointed out.     

Schizophrenia and suicide: a 10-year review of Kentucky medical examiner cases

The risk of suicide is significantly increased in schizophrenics; it is estimated that 10-13% of individuals suffering from schizophrenia commit suicide. Schizophrenia is marked by psychotic exacerbations and remissions, with persistent deterioration in baseline functioning with each relapse. We present a 10-year (1993-2002) retrospective review of Medical Examiners' cases of suicide of schizophrenic victims. Twenty-nine cases were between the ages of 20 and 75 (mean age of 41.6 years). The majority of victims were male (62.1%) and Caucasian (86.2%). The leading method of suicide for both males and females was firearm injury (48.3%) mostly of the head, followed by overdose (20.7%), and hanging (13.8%). A comprehensive investigation of the biopsychosocial factors is warranted in cases of schizophrenics who commit suicide. This study offers an insightful analysis pertaining to the determination of intent in formulating the manner of death in this unique population.     

谈谈医疗纠纷案件的举证责任——王连玉等诉太原市某医院医疗纠纷案

医疗行业属高风险行业，近年来随着人们维权意识的不断增强，医事纠纷呈逐年上升趋势，已经演化成为社会的热点问题之一。由于医患双方在医学知识掌握上的不平衡，造成了医疗纠纷处理过程中患方举证困难。2002年4月1日起实施的最高人民法院《民事证据规定》第4条第8项明确规定“因医疗行为引起的侵权诉讼，适用举证责任倒置”，即采取过错推定原则，成为医疗赔偿纠纷案件举证责任的一大进步。本文以一起医疗纠纷侵权诉讼为例，深刻剖析了医疗纠纷处理过程中的民事证明责任适用问题。     

Police-probation partnerships: Professional identity and the sharing of coercive power

As formal police-probation partnerships become more commonplace, the occasional incompatibility of police and probation functions becomes increasingly obvious. Understanding how police-probation partnerships create unique pressures on officers and ultimately reconciling the real or perceived incompatibility of police and probation objectives is an important prerequisite to partnership success. Few studies had considered how inter-agency collaborations have the potential to alter the role distinctions between police and probation officers and how the quality, diversity, and effectiveness of the services that they provide may be compromised or enhanced. This study, based on interviews with police and probation officers participating in a formally organized police-probation partnership in Spokane, Washington considered how close working relationships may influence the professional orientations of the participating officers. Findings suggest that tension between organizational objectives threatens to create an imbalance of power between partnership participants.     

Emergency suicide care in France: the psychiatrist's liability as seen in case law

In France, in general emergency departments, psychiatric consultations are on the increase and suicidal behavior represents a frequent reason for consultation. Psychiatrists treat patients whose behavior may be impulsive and irrational, and whose critical judgment is impaired. In emergency units, the reception and initial assessment of the patient determines his or her future pathway through the healthcare system. By its very nature, emergency medicine deals with inherently unstable situations, which may lead to the risk of medical malpractice. The aim of this article is to provide a summary of the initial management of suicidal patients by general emergency units and to comment on the medical malpractice that may expose the practitioner to risk of liability. An analysis of case history has shown that in suicide cases, malpractice due to inadequate supervision is the most frequent ruling.     

Chronology of a homicide and an attempted suicide by DNA analysis of selected blood stains on the weapon (knife)]

A five-year-old boy was fatally injured by a stab and a cut to the throat. The suspected offender, an acquaintance of the victim's mother, stated that he had been disturbed by the boy while attempting suicide and had therefore killed the boy. The suspect showed superficial cuts on both wrists and three shallow stabs on the right-hand side of the abdomen. The purpose of the forensic investigations was to answer the question if the suspect's statement could be confirmed or if the attempted suicide took place after killing the boy. The blood-smeared blade of the knife was divided into different sectors with the cutting edge and the tip of the blade being examined separately from the sides. The blood traces from the different blade sectors were then typed in 12 different DNA regions by PCR (polymerase-chain-reaction). It could be demonstrated that the strong blood traces on the sides of the blade originated from the victim alone, whereas in the area of the edge and the tip of the blade the amount of the victim's blood was negligible compared with that of the suspected offender. The explanation for this finding is that in the areas of the edge and the tip of the knife the blood of the victim must have been replaced by the blood of the suspected perpetrator, which means that the suicidal injuries were the last to be caused by the knife.     

Climate change and adaptive capacity in fisheries management: the case of Norway

Climate variability and change drive changes in marine ecosystems, such as growth in and geographic distribution of living marine resources. Mitigating measures in response to anthropogenic climate change are insufficient, and more attention must be directed toward adaptation to climate change. In the management of living marine resources, successful management will rest on the capacity of management regimes to be adaptive and flexible. This article addresses the management of living marine resources, and how management regimes cope with change and bolster the resilience of ecosystems. Experiences from the Norwegian management regime for living marine resources are used to illustrate how an existing regime can respond to change. We conclude that management regimes with sufficient capacity, in terms of robust science, regulatory frameworks that contribute to reduced fishing effort and maintenance of sustainable stock levels, and enforcement capability, are more likely to respond adequately to the challenges posed by climate change than those that do not.     

医疗损害赔偿纠纷案件法律适用的冲突与调适

医疗损害赔偿是当今社会的热点问题,也是司法审判实践中的重点、难点问题。由于该类案件处理中现行法律适用原则存在的误区,导致审判实践中同案不能同判的现象时有发生。这不仅损害当事人的合法权益,而且严重损害我国法律的尊严。文中阐述了现行法律适用原则存在的主要问题及由此产生的严重影响,并从理论上通过对现行适用原则中区分对待的医疗事故以及其它医疗损害的剖析,明确了医疗损害的内涵及其责任性质,进而提出对《条     

Toxicologic findings in suicide: a 10-year retrospective review of Kentucky medical examiner cases

Toxicologic analysis is an integral component in the investigation of suicide and requires correlation with a detailed scene inspection, with an extensive exploration into the decedent's medical and social background to uncover suicidal ideation or intent and a postmortem examination of the body. In this review, the authors analyzed 2864 cases classified as suicide upon autopsy and toxicologic examinations between 1993 and 2002 in the Kentucky Division of Medical Examiner's Services. Blood and urine were collected in 95.0% and 72.3% of cases, respectively. A total of 32.5% of the victims had negative blood toxicologic results, and 52.7% of urine toxicology screens yielded no drugs. Analysis of the data indicated that 3 times as many women had taken antidepressants and more than twice as many had consumed opioids. Drug toxicity ("overdose") ranked as the third (9.9%) leading cause of suicide after firearm injury (67.5%) and hanging (13.7%). Women succumbed to drug toxicity more than men (27.5% versus 5.9%). Of the overdose deaths, 66.5% had a negative blood alcohol concentration (BAC), while antidepressants, opioids, and benzodiazepines were detected in blood in 54.4%, 37.4%, and 29.2% of the subjects, respectively. The collection of these data serves the goals of public health and clinicians in devising strategies for suicide prevention.     

Prodromal psychosis as an etiology of suicide: a case report and review of the literature

Suicides without apparent antecedent causes present great difficulties for medical examiners and families alike. A case is presented of a young male suicide victim whose antemortem course did not demonstrate apparent psychopathology to either his family or fellow students. A journal written by the decedent was found, however, which revealed extensive ruminations on death, depressive symptomatology, and evidence of possible delusions, and hallucinations. We opine that this represents the prodrome of a psychotic process, possibly schizophrenia, and the decedent's suicide was a response to his awareness of his deteriorating mental status. The prodrome of schizophrenia is a well-described entity that manifests as a decline in social and occupational functioning, along with increasingly bizarre behavior. Prodromal psychosis could represent an explanation for some cases of suicide seemingly without causation.     

Choking on toilet paper: an unusual case of suicide and a review of the literature on suicide by smothering, strangulation, and choking

While reports of suicide by smothering and strangulation are common, suicide by choking is far more rare. In addition to the act being difficult to carry out, suspected cases are not easily distinguished from accidental or homicidal deaths. Here, we present a case of suicide by choking on toilet paper in a patient with a long history of schizophrenia. The case was ruled a suicide based on the patient having been witnessed in a previous unsuccessful attempt of the same act.