Iatrogenic Burns of the Neckline in a Patient with Tetraparesis During Tracheotomy

The paper presents a case of an atypical iatrogenic complication after tracheotomy analyzed on the basis of the case dossier materials submitted to the authors by the court of justice to prepare a forensic medical opinion concerning the correctness of the medical procedure. A 37‐year‐old woman was brought by the ambulance service to the hospital with acute respiratory failure due to post‐tracheostomy tracheal stenosis. Tracheotomy was performed on an emergency basis. The patient suffered severe burns of the chest and neck. The experts concluded that the most probable cause of the incident was electrocautery‐induced ignition of the disinfectant used for cleaning the skin before the surgery. It was established that with correct handling of the procedure, the aforementioned incident should not have taken place. Therefore, it cannot be regarded as a normal complication inherent in the risk associated with the procedure, but as a consequence of a medical error.     

The role of openness in explaining innovation performance in a regional context

We investigate the role of search strategy in shaping firms’ innovation performance. Firms use a wide range of external actors and sources to help them achieve and sustain innovation. In particular, the extension (breadth) and the relevance (depth) of such sources determine firms’ ability to extract and exploit knowledge and new ideas and, thus, to be innovative. Using a sample of firms in a regional context active in R&D, we built separate measures of breadth and depth for local (on a regional scale) and global (outside the regional context) search. This allows us to investigate whether localized or global knowledge spillovers are in place. We find that a wider set of partners increases coordination costs, while greater depth in search strategies contributes to innovation. We find that a more diversified search strategy at the local level (greater breadth of search) results in significant payoffs in terms of innovation, while diversifying the partnership with Italian partners has a smaller, although still positive, effect. In contrast, the benefits of depth of innovation are greatest at the global level. In addition, a broader set of information sources for R&D projects has a significant positive effect on innovation. Finally, firms that resort to R&D subsidies are less innovative.     

Self-reported and performance-based measures of executive functions in interned youth

This study address three questions: (a) Do interned adolescents exhibit general or specific deficits in the core executive functions, as compared to an age-matched control group? (b) Do interned adolescents report more executive problems in everyday life, as compared to an age-matched control group? And (c) are performance-based measures of executive functions related to self-reported executive problems? Thirty-one interned youths and 40 non-interned controls participated in the study. To this end, we measured the three constituents (inhibition, shifting, and updating) of the Unity/Diversity model of executive functioning, as well as the participants’ self-reported everyday executive functioning using the Behavior Rating Inventory of Executive Functions scale. The interned group performed less well compared to the control group on the majority of performance-based tasks but did not show more pronounced deficits in any one executive function, reflective of a more general deficit. Compared to the controls, the interned adolescents also reported more dysfunction in executive behaviors related to the ability to inhibit action, behavioral flexibility, working memory, and the ability to follow through with tasks. Overall, correlations between self-report and performance-based measures were weak. These findings suggest that performance-based and self-report measures may assess different, albeit important, aspects of executive functioning.     

Psychopathy (PCL-R) in a forensic psychiatric sample of homicide offenders: some reliability issues

Several studies have shown that psychopathy is overrepresented among homicide offenders. There is a consensus that Hare's Psychopathy Checklist-Revised PCL-R is currently the most valid and useful tool for rating psychopathy (e.g., [Fulero, S. M. (1995). Review of the Hare Psychopathy Checklist-Revised. In J. C. Conoley & J. C. Impara (Eds.), Twelfth Mental Measurements Yearbook (pp. 453-454). Lincoln, NE: Buros Institute]). Usually, when making a rating of psychopathy, both an interview and an examination of the subject's files are used. However, it has been discussed what is really required to be able to rate psychopathy in a reliable manner. The aim of the present study was to retrospectively rate the degree of psychopathy in 35 homicide offenders being subjected to forensic psychiatric assessment. These ratings of psychopathy were carried out using forensic psychiatric files and courts'; verdicts only. Another aim was to examine the reliability of PCL-R in this specific Swedish sample of homicide offenders. There was a good agreement between the two raters with respect to the categorical diagnosis of psychopathy (Cohen's kappa=.81, p<.001), which indicates that retrospective ratings of psychopathy are well suited for research purposes. The prevalence of psychopathy among the homicide offenders was 31.4% (using a cut-off score of 30), which means that the construct of psychopathy may contribute to the understanding of the phenomenon of homicide. In the planning of treatment for homicide offenders, a consideration of possible psychopathy is necessary. As criminal psychopaths are known to relapse into violent criminality, it is very important that they are given efficient treatment, placement and management.     

Fatal unintentional intoxications with tramadol during 1995-2005

Tramadol is an extensively used centrally acting analgesic and is considered a safe drug devoid of many serious adverse effects of traditional opioids. However, recently, toxicity and an abuse potential of tramadol have been reported. This study examined fatal unintentional tramadol intoxications among Swedish forensic autopsy cases between 1995 and 2005. All fatal intoxications were selected, in which toxic concentrations of tramadol (>1 microg/g femoral blood) had been detected, and where the forensic pathologist considered the intoxication unintentional and the fatal outcome at least partly explained by tramadol. Toxicology analyses, police reports, autopsy protocols and medical records were scrutinized. A total of 17 cases (eleven men and six women) of fatal unintentional tramadol intoxications were identified. For these cases the median age was 44 years (range 18-78 years) and the median tramadol concentration was 2.0 microg/g (range 1.1-12.0 microg/g). Other pharmaceutical substances, illicit drugs or ethanol were detected in addition to tramadol in all of these cases. In fact, intoxication with multiple drugs was considered the cause of death in 10 (59%) cases. However, in seven cases tramadol was the only substance present in toxic concentrations. A history of substance abuse was identified in 14 (82%) subjects and a present tramadol abuse in 8 (47%). These results suggest that fatal intoxications with tramadol may occur unintentionally and that subjects with a history of substance abuse may be at certain risk. Precaution is therefore warranted when prescribing tramadol in such patients.     

Suicide in Police Work: Exploring Potential Contributing Influences

Police officers are considered at increased risk for suicide. The objective of this study was to explore potential influences on suicide ideation among 105 randomly selected men and women urban police officers. Depression, gender, and marital status appeared to be most strongly associated with police suicidal ideation. Depressive symptoms were higher among women than men officers (12.5 percent vs. 6.2 percent). For each standard deviation increase in depressive symptoms, the prevalence ratio (PR) of suicide ideation increased 73 percent in women (PR?=?1.73, 95% CI?=?1.32–2.27) and 67 percent in men (PR?=?1.67, 95% CI?=?1.21–2.30). The association between depression and ideation was stronger among unmarried women officers (PR?=?4.43; 95% CI?=?2.19 – 8.91) than married women officers (PR?=?1.39, 95% CI?=?1.09 – 1.79). While depression has previously been associated with suicide, such results are unusual in a healthy working population such as the police.     

Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards

Statutory responsibility for health care and social care has long been separated between National Health Service (NHS) bodies and local government authorities. Repeated policy attempts to promote service integration through collaboration between such authorities have achieved little. The latest of such policy interventions are the Health and Wellbeing Boards (HWBs) established by the 2012 Health and Social Care Act (HSCA) alongside a range of other organisational innovations, including Clinical Commissioning Groups (CCGs). These organisations await full legal and operational status but have begun to develop structures and processes. HWBs are intended to lead the integrated assessment of local needs to inform both NHS health and local authority social care commissioners. We undertook detailed qualitative case studies in eight CCGs during 2011–2012 and here report observational and interview data related to CCGs’ perspectives and observations of early HWB developments. We found that developing HWBs vary greatly in their structure and approach, but we also identified a number of significant issues that are familiar from earlier research into health and social care integration. These include heavy dependence on voluntary agreements to align the strategic plans of the many different new statutory bodies; a significant role for mundane organisational processes in determining the extent of effective co-operation; and problems arising from factors such as size and the arrangements of local boundaries.     

A review of quality procedures in the UK forensic sciences: What can the field of digital forensics learn?

With a reliance on the various forms of forensic science evidence in complex criminal investigations, the measures for ensuring its quality are facing increasing scrutiny. Improvements to quality management systems, to ensure both the robust application of scientific principles and the accurate interpretation and reporting of results, have arisen as a consequence of high-profile rebuttals of forensic science evidence, combined with process improvements driven by evaluation of current practice. These improvements are crucial to ensure validity of results as well as providing assurance for all those involved in the Criminal Justice System. This work first examines the quality management systems utilised for the examination and analysis of fingerprint, body fluid and DNA evidence. It then proceeds to highlight an apparent lack of comparable quality assurance mechanisms within the field of digital forensics, one of the newest branches of forensic science. Proposals are provided for the improvement of quality assurance for the digital forensics arena, drawing on the experiences of, and more well-established practices within, other forensic disciplines.     

‘The referring court asks,in essence’: Is reformulation of preliminary questions by the Court of Justice a decision writing fixture or a decision‐making approach?

The Court of Justice can rephrase or otherwise depart from the questions referred to it by national courts under Article 267 of the Treaty of the Functioning of the European Union. It does so routinely: a practice known as reformulation. Legal literature often argues that reformulation is used to clarify national court questions and bring them within the scope of European Union law. The aim of the present article is to explore this claim systematically. To this end, it compiles a unique dataset consisting of the Orders for Reference, in which the referring courts embed the preliminary questions, and the judgments, in which the Court of Justice communicates the answers. The findings suggest that reformulation is a decision‐making approach rather than a fixture of decision writing. It's main function is to neutralize conflicts and Europeanise disputes. It underlines the Court's power to shape the preliminary ruling procedure and its outcomes.