Medical aspects of capital punishment executions

Between 1976 and the middle of 2001, approximately 718 human executions occurred in the U.S. (a small segment of worldwide executions). Data regarding the medical aspects of these executions are not readily available. We searched all public domain data in the U.S. to obtain specific data for all persons executed in the U.S. since 1976. Of the five methods of execution used (lethal injection, lethal gas, electrocution, hanging, and firing squad), significant differences emerged as measured by rate of complications, duration of time spent by the condemned in the "death chamber," as well as duration of time from the onset of execution procedures to pronouncement of death. These data suggest that human executions are difficult to carry out. Human executions are associated with significant physical complications. These data may help inform future discussions on human executions.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Adjusting to New Ways of Working: Experiments with Service Delivery in the Public Sector

In response to the perceived failure of both the state and market models of service delivery, governments have embarked on a reform program that draws on the community sector to expand the suite of available policy and service delivery arrangements. This paper explores and identifies the nature of changed relationships between government and the community sector. It uses a case study that examines the operation of a new type of community organisation, and analyses the affectivity and outcomes from the experience of a community based networked arrangement. Although there is evidence of a shift to more relationship‐ oriented models of operation because of either mandate or preference both community and government sectors have found it difficult to make the necessary adjustments to these new ways of working. Community has begun the shift to this new relational approach but finds it difficult to sustain the momentum and tends to revert to more independent and competitive modes. Governments find it difficult to make the necessary adjustments to power‐sharing and resource allocation and continue to operate as ‘business as usual’ through the traditional bureaucratic authority of command and control. In this way, the rhetoric of collaboration and partnership between government and the community sector is not necessarily matched by policy and action supporting the practice of ‘new ways of working’ although these ‘experiments in service delivery’ have opened the way for adopting more innovative and effective approaches to service delivery.     

Social Support, Risk-Level and Safety Actions Following Acute Assessment of Suicidal Youth

The purpose of the pilot study was to examine the interrelationship between social support, risk-level, and safety actions for 2 groups of suicidal adolescents (50 attempters and 50 ideators), who had presented for an acute assessment at an outpatient mental health service. A social support model was proposed in which it was thought that information related to patients' social support would impact upon the types of risk-level and safety actions made by clinicians. Data was collected from a total of 100 patient files, utilizing the acute assessment reports (e.g., reports assessing risk of self-harm). Findings show that groups differed significantly on indices of negative support severity, positive support, and risk-level. Limited support was found for the proposed social support model. Limitations and implications for future research are discussed.