Vitreous humor sodium levels in immersion deaths

To determine whether vitreous humor sodium levels might be of use in evaluating deaths associated with immersion, samples of vitreous humor were prospectively evaluated at autopsy over a 4-year period from 2006 to 2009. There were 19 cases of saltwater immersion (age range 9-76 years; mean age 44 years; M:F, 2.8:1) and 16 freshwater immersions (age range 2-81 years; mean age 27 years; M:F, 2.2:1). In the group of saltwater drownings, vitreous humor sodium levels were elevated, ranging from 145 to 184 mM (mean = 160.2 ± 9.9 mM), and in the cases of freshwater drowning, the levels were reduced, ranging from 73 to 148 mM (mean = 129.8 ± 17 mM; p < 0.0001). Alterations in electrolyte levels may have been because of hemoconcentration or dilution from electrolyte fluxes in the lungs, or from passive diffusion during immersion. This study has demonstrated that vitreous sodium level is an easily performed test that may be a useful adjunct to the investigation of possible immersion deaths.     

The Issue of Ethics and Authority for Licensed Mental Health Professionals Involved in Parenting Coordination

We examine the ethics of licensed mental health professionals accepting the authority inherent in binding arbitration when acting as parenting coordinators (PCs). PCs execute their duties under the umbrella of their professional identity and standards of practice. Fundamental differences exist in how the law and the behavioral sciences conceive human behavior and authority, in particular, authority by role and authority by status. Ethical concerns arise when licensed mental health professionals accept the authority to render binding judgments and ask clients to surrender their autonomy through informed consent. We offer recommendations for PCs to avoid these ethical complications.     

Strategies of police cooperation: comparing the Southern Chinese seaboard with the European Union

A number of police cooperation strategies have developed around the Southern Chinese seaboard, which encompasses the coastal provinces of Mainland China, Taiwan, and the Special Administrative Regions of Hong Kong and Macau. Cooperation mechanisms in the region encompass intelligence sharing strategies and establishment of the Electronic Communal Information Sharing Platform (ECISP), common investigations, regular meetings, practitioner exchanges, and training. Although conducted on a regular basis, these cooperation strategies mostly lack a formally binding legal basis, relying purely on informal practitioner efforts at best supported by Memoranda of Understanding. Due to their historical independence all police forces involved in cooperation at the Southern Chinese seaboard have had to establish strategies to overcome legal, organisational and cultural differences. This region could therefore be compared to cooperation networks between sovereign nation-states in other regions. The historical development of Greater China’s highly informal, practitioner driven approach to cooperation is reminiscent of early forms of cooperation between the police agencies of states that are now members of the European Union (EU). This paper explores the development of both informal and formal strategies established among police agencies around the Southern Chinese seaboard and compares them with the EU to enhance the historical, political and legal understanding of the two regions.     

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses. Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items. Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without. Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.     

Use of a pig model to demonstrate vulnerability of major neck vessels to inflicted trauma from common household items

Commonly available items including a ball point pen, a plastic knife, a broken wine bottle, and a broken wine glass were used to inflict stab and incised wounds to the necks of 3 previously euthanized Large White pigs. With relative ease, these items could be inserted into the necks of the pigs next to the jugular veins and carotid arteries. Despite precautions against the carrying of metal objects such as knives and nail files on board domestic and international flights, objects are still available within aircraft cabins that could be used to inflict serious and potentially life-threatening injuries. If airport and aircraft security measures are to be consistently applied, then consideration should be given to removing items such as glass bottles and glass drinking vessels. However, given the results of a relatively uncomplicated modification of a plastic knife, it may not be possible to remove all dangerous objects from aircraft. Security systems may therefore need to focus on measures such as increased surveillance of passenger behavior, rather than on attempting to eliminate every object that may serve as a potential weapon.     

Tippins and Wittman Revisited: Law,Social Science,and the Role of the Child Custody Expert 14 Years Later

It has been 14 years since Tippins and Wittmann ( 2005 ) voiced concern for the overreaching role the expert may play in matters of family law. This article sets their levels of inference within the context of the culture of both law and social science. We examine how inferences are impacted by the relative emphasis child custody experts give to the five stakeholders involved in child custody evaluations (CCEs): courts, lawyers, parents, children, and professional governing bodies. Acculturation of the assessor to law contributes to more egregious inferences, versus the more modest ones Tippins and Wittmann advocated. How evaluators prioritize stakeholders shapes their opinion and methodology. We offer an expanded perspective that views how their levels of inference are manifest in reports, methodology, and recommendations and the influence of the culture of law and the mindset of the clinician. We hope to encourage clinicians to find ways to operationalize clinical humility, assume their proper role, and remain true to their master identity as licensed mental health professionals and their proper sphere of authority.