A Fatal Mediastinitis Due to a Neck Trauma from an Undeclared Assault

History of neck trauma should be promptly investigated in patients with severe infections of the chest as mediastinitis. We present a forensic case of a death due to a mediastinitis in a patient with an undetected fracture of the superior horn of the thyroid cartilage that was exclusively revealed at autopsy examination. Histological analyses of the neck tissues showed signs of pharyngeal mucosal microperforation caused by the fracture and surrounded by an inflammatory reaction. The fracture was caused by a not declared manual strangulation attempt, happened several days before medical evaluations. We share our experience to emphasize the importance of revealing the etiologies of fatal infections of the mediastinum both for clinical and forensic purposes.     

The welfare courts: A socio-legal analysis of risk management through modern strict liability

The aim of the essay is to offer an adequate theoretical framework for a socio-legal analysis of risk management by the legal system. Law and risk are the two most important concepts to be clarified. Unlike the law, whose function consists in the temporal stabilisation of normative expectations, the perspective of risk is characterised by the possibility of changing the criteria for decisions based upon the evaluation of the consequences of those decisions. In the context of a modern society, characterised by an increasing demand for protection for people injured by new technologies, one observes certain difficulties in the attempt to adopt a risk perspective within the legal system. The result of this process is the new law of tort based upon the modern principles of strict liability. While strict liability can be shown to be effective in managing conflicts relating to technological accidents, its most negative effects are the increasing instability of legal structures and interference with the activities of other subsystems of society, such as medicine and the economy.     

Multi-Rater Agreement Using the Adapted Fracture Healing Scale (AFHS) for the Assessment of Tubular Bones on Conventional Radiographs: Preliminary Study*

Better understanding of the timing of fracture healing may help in cases of interpersonal violence but also of personal identification. The intra- and inter-rater agreement for the adapted fracture healing scale (AFHS) assessing the post-traumatic time interval on radiographs were tested. This is a preliminary study, providing essential information on method reliability for upcoming studies using the AFHS. Five raters (two radiologists, a forensic pathologist, an orthopedist, and an anthropologist) were presented with a test in three parts consisting of 85 radiographs (from 30 adults) of fractures of tubular bones in different stages of healing purposefully selected from more than 1500 radiographs. The raters were firstly asked to assess 15 features describing fracture healing as present, absent, or not assessable. Thereafter, the raters were asked to choose from the AFHS a single-stage best representing the observed healing pattern. The intra- and inter-rater agreement were assessed using single-rating, absolute agreement, two-way mixed-effects intra-class correlation (ICC) coefficients. The intra-rater ICC of radiologist 1 ranged from 0.80 to 0.94. The radiologists’ inter-rater ICC ranged from 0.68 to 0.74, while it ranged from −0.01 to 0.90 for the other raters. The good to excellent ICC among the radiologists and forensic anthropologist provides good foundation for the use of the AFHS in forensic cases of trauma dating. The poor to good results for the other physicians indicate that using the AFHS requires training in skeletal anatomy and radiology.     

The autonomy of law in the war on terror: A contribution from social systems theory

The article analyses the impact of post-2001 counterterrorism policies on the autonomy of law, focussing on American and British measures and adopting social systems theory as a theoretical framework. Contemporary societies are conceptualised as social systems in which law operates as an autonomous subsystem. Its autonomy primarily is based on constant reference by decisions to the binary coding “legal/illegal” associated with the application of specific legal principles and procedures. Following the terrorist attacks of 2001, the structure of societal differentiation has been under attack from a twofold risk. A political risk is posed by armed organisations such as Al-Qaeda because of their threats to states sovereignty. An additional risk in relation to law depends on extraordinary powers, such as those established by certain recent antiterrorism legislation and several executive provisions. States attempt to subordinate decisions related to the new counterterrorism policies to the test of their “efficiency/inefficiency” in guaranteeing security, at the expense of questions about their “legal/illegal” nature and legal constraints. An analysis of the special detention at Guantanamo Bay provides evidence of a complex set of decisions endangering the autonomy of law.     

Delay of clinical manifestation and medical malpractice in a serious vascular complication of proximal locked tibial nailing

We are reporting on a case of complex lesion of the popliteal neurovascular bundle in a young woman, resulting from an operation for reduction and synthesis of a closed spiroid fracture of the mid-distal third of the left tibia by means of a Grosse-Kempf nail, with significant delay of clinical manifestation. Determining whether this is an "unavoidable complication" or "medical malpractice" is the target of the forensic investigation. In this case, the investigation leads to the conclusion that medical malpractice was the only explanation of the damage.     

Violent behavior and the factors associated with the decision to report it: a retrospective study

An ample volume of research evidence supports the conclusion that severe mental illness is correlated with violent behavior. While episodes of violent behavior are included in medical notes, not all episodes of violent behavior are officially reported to the police, even when they are actual crimes. We conducted a retrospective study on the already existing clinical files of four public psychiatric outpatient facilities, based in Southern Italy, in order to assess how many cases of violent behavior are actually reported and which variables are more frequently connected with the decision to report. The data shows that the episodes known to the health services, in number and seriousness, vastly outnumber the complaints actually made towards their patients.     

Gender Role Ideologies and Marriage Promotion: State Policy Choices and Suggestions for Improvement

The 1996 Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA) lists marriage as one of the major strategies for reducing welfare dependency among clients of the Temporary Assistance for Needy Families (TANF) Program along with work requirements and time limits. President George W. Bush has allocated over $240 million to the individual states to create programs to promote and sustain marriages, with specific attention given to encouraging marriage among the low‐income, welfare‐reliant population. We suggest that this policy is based upon a specific gender ideology that seems to ignore the reality of the lives of poor women with children and may be, as some critics suggest, an attempt at “legislating patriarchy.” In this work, we trace the social changes that shaped this ideology, present the options the states have taken to encourage marriage, discuss flaws in the philosophy and implementation of these policies, and provide suggestions for improving program design.     

The economic policies in Japan during the last 30 years: An econometric analysis

This paper analyses the Japanese economic growth since 1970 with particular attention for the last decade.After a brief discussion on the qualitative behaviour of macroeconomic variables, a survey of literature presents the ideas of various models.This is useful for the econometric analysis applied here, which consists in a smooth transition model, such as LSTAR.For the last decade a deeper analysis is carried out with a VAR model to test if lending view is necessary in explaining the business cycle.These models suggest that both fiscal and monetary policies were not very efficient. Total lending also accelerated the crisis.To Pietro and Martina.I would like to thank Prof. Barbara Chizzolini and Prof. Carlo Filippini for their comments.