Walk and Die: An Unusual Presentation of Head Injury

Abstract:  We report three deaths in young adult males following closed blunt trauma to the head and face where the affected individuals were able to walk away from the incident, before subsequently collapsing and dying a short distance from the site of the assault. In each case, due to the rapidity of the posttrauma collapse, the pathologist was faced with a diagnostic difficulty at autopsy; the external examination revealed multiple injuries to the head and face, but internal examinations showed limited findings with no structural explanation for the death. We discuss possible mechanisms that could account for this scenario, the implications of alcohol consumption with a concussive head injury, and parallels that can be drawn with the so-called "talk and die,""talk and deteriorate," and "second impact syndrome." Finally, the possible role of so-called "postexercise peril" is discussed in relation to these deaths.     

DNA recovery after sequential processing of latent fingerprints on copy paper

Forensic examiners must determine whether both latent fingerprint development and DNA profiling can be performed on the same area of an evidence item and, if only one is possible, which examination offers the best chance for identification. Latent fingerprints can be enhanced by targeting different components of fingerprint residues with sequential chemical treatments. This study investigated the effects of single-reagent and sequential latent fingerprint development processes on downstream DNA analysis to determine the point at which latent fingerprint development should be stopped to allow for DNA recovery. Latent fingerprints deposited on copy paper by one donor were developed using three sequential processes: 1,8-diazafluoren-9-one (DFO) → ninhydrin → physical developer (PD); 1,2-indanedione-zinc (IND-Zn) → ninhydrin → PD; and IND-Zn → ninhydrin → Oil Red O (ORO) → PD. Samples were examined after the addition of each chemical treatment. DNA was collected with cotton swabs, extracted, quantified, and amplified. DNA yields, peak heights, number of alleles obtained, and percentage of DNA profiles eligible for CODIS upload were examined. DNA profiles were obtained with varying degrees of success, depending on the number and type of treatments used for latent fingerprint development. The treatments that were found to be the least harmful to downstream DNA analysis were IND-Zn and IND-Zn/laser, and the most detrimental treatments were DFO, DFO/laser, and PD. In general, as the number of treatments increase, the opportunities for DNA loss or damage also increase, and it is preferable to use fewer treatments when developing latent fingerprints prior to downstream DNA processing.     

Trends in Converted Firearms in England & Wales as Identified by the National Firearms Forensic Intelligence Database (NFFID) Between September 2003 and September 2008

Abstract: The National Firearms Forensic Intelligence Database (NFFID © Crown Copyright 2003‐2008) was developed by The Forensic Science Service (FSS) as an investigative tool for collating and comparing information from items submitted to the FSS to provide intelligence reports for the police and relevant government agencies. The purpose of these intelligence reports was to highlight current firearm and ammunition trends and their distribution within the country. This study reviews all the trends that have been highlighted by NFFID between September 2003 and September 2008. A total of 8887 guns of all types have been submitted to the FSS over the last 5 years, where an average of 21% of annual submissions are converted weapons. The makes, models, and modes of conversion of these weapons are described in detail. The number of trends identified by NFFID shows that this has been a valuable tool in the analysis of firearms‐related crime.     

Empowering women through the positive birth movement

Childbirth has been positioned as a life changing event that has profound long-term psychological effects upon women. This paper adopts a community psychology approach to explore the role that the Positive Birth Movement (PBM) may have in tackling negative birth experiences by supporting women before and after birth. Six women who all regularly attend UK-based PBM meetings and had given birth to at least one child participated in one to one semi-structured interviews designed to explore the support they received before, during and after their birth, as well as their experiences with the PBM. A Foucauldian inspired discourse analysis explores themes relating to the lack of support and information provided by the NHS and the function of the PBM as a transformative community space which offers social support and information. Within these themes a focus on neoliberalism, choice and the woman’s position as an active consumer of health care is critically discussed. It is argued that the PBM has the potential to prepare women for positive birth experiences but more attention needs to be paid to the wider contexts that limit women’s ability to make ‘free’ choice.     

Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,

Intraosseous T1-weighted (T1W) and short-tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so-called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2-weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board-certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.     

Positional Asphyxia in Opioid-Related Deaths: Is It Being Overlooked?

The contribution of positional asphyxia in opioid-related deaths is currently unknown. Diagnostic criteria for positional asphyxia include finding the decedent in a position that does not allow for adequate respiration and an inability to extricate themselves from the position due to various conditions. Our primary objective was to assess whether positional asphyxia and the resulting airway compromise were a contributing factor to death due to the toxic effects of opioids. We evaluated 225 deaths where the death scene investigation contained adequate information to evaluate for positional asphyxia and performed a Pearson chi-square test to determine if the proportion of deaths found in an airway compromising position was higher when opioid(s) caused the death. The proportion of decedents found in a potential airway compromising position was greater when the death was related to opioid use (p < 0.0001). Further, narrowing the dataset to decedents who were definitely in an airway compromising position [Yes (24.49%) vs. No (11.02%)] showed a statistically significant association between positional asphyxia and deaths related to opioid use (p = 0.0021). Carefully documenting the position in which the decedent was initially found may be a significant factor in accurate reporting and in harm reduction efforts to decrease the opioid mortality rate.