Season and suicide: recent findings from Italy

Seasonal asymmetry in yearly suicide occurrence is a long-observed phenomenon in psychiatric, suicidological, and sociological research, and the effects of seasonal factors on suicidal behavior have been the focus of a number of earlier studies. Taking into account limitations of data and methods, these studies have generally favored interpretations based on psychosocial factors. Recent studies have challenged the widely held notion that seasonal effects on suicide are a unitary phenomenon, not influenced by age, gender, or circumstances of the act. In particular, the seasonal occurrence of suicides has been found to differ significantly between the young and the elderly, and differences have also been found between male and female cycles of occurrence. Suicides using violent methods have been shown to follow clearer seasonal patterns than suicides by less violent methods (such as drug or gas poisoning), possibly reflecting the greater impulsive component involved in the choice of a violent lethal means. In this paper, findings from Italy are used to illustrate the clinical implications of studies into the topic of season and suicide, with the aim of developing more effective preventative strategies.     

Computerized craniofacial reconstruction using CT-derived implicit surface representations

In forensic craniofacial reconstruction, facial features of an unknown individual are estimated from an unidentified skull, based on a mixture of experimentally obtained guidelines on the relationship between soft tissues and the underlying skeleton. In this paper, we investigate the possibility of using full 3D cross-sectional CT images for establishing a reference database of densely sampled distances between the external surfaces of the skull and head for automated craniofacial reconstruction. For each CT image in the reference database, the hard tissue (skull) and soft tissue (head) volumes are automatically segmented and transformed into signed distance transform (sDT) images, representing for each voxel in this image the Euclidean distance to the closest point on the skull and head surface, respectively, distances being positive (negative) for voxels inside (outside) the skull/head. Multiple craniofacial reconstructions are obtained by first warping each reference skull sDT maps to the target skull sDT using a B-spline based free form deformation algorithm and subsequently applying these warps to the reference head sDT maps. A single reconstruction of the target head surface is defined as the zero level set of the arithmetic average of all warped reference head sDT maps, but other reconstructions are possible, biasing the result to subject specific attributes (age, BMI, gender). Both qualitative and quantitative tests (measuring the similarity between the 3D reconstructed and corresponding original head surface) on a small (N = 20) database are presented to proof the validity of the concept.     

Definitions of suicidal behavior: lessons learned from the WHo/EURO multicentre Study

Based on the experience matured during the 15 years of the WHO/EURO Multicentre Study on Suicidal Behavior, this paper provides an excursus on main elements that characterize components for definitional needs. It describes the rationale for choosing the initial set of definitions within the study and the subsequent problems and developments. As a result, unifying terminologies are proposed.     

Acute flurazepam intoxication: a case report

A fatality due to ingestion of flurazepam is reported. Flurazepam is a benzodiazepine, a widely prescribed hypnotic drug for use in sleep disorders. There are only few documented reports of the disposition of flurazepam in deaths due to overdose. A 68-year-old woman was found deceased at home with no evidence of trauma or asphyxia. Toxicologic analyses were performed and drug levels measured by means of gas chromatography coupled to mass spectrometry. The flurazepam concentration in each specimen was as follows: heart blood 2.8 microg/mL, bile 323 microg/mL, and urine 172 microg/mL. Presence of flurazepam into gastric content was observed too. Based on the autopsy findings, patient history, and toxicologic results, the cause of death was determined to be acute intoxication of flurazepam and the manner, suicide.     

Medicolegal aspects of an unusual uterine perforation with multiload-Cu 375R

Perforation of the uterus is one of the most serious complications associated with insertion of intrauterine contraceptive devices (IUD). According to recent studies, this lesion occurs in 0.87 per 1000 cases, but statistics generally fluctuate between 0.05 and 13 per 1000 insertions. "Primary" perforations occur at the time of IUD insertion, and "secondary," or delayed, perforations are usually assumed to be caused by reactive uterine contractions. We report an unusual case of uterine perforation, which occurred 9 days after the insertion of a Multiload-Cu 375 IUD. The criteria for differential diagnosis between primary and secondary complications are discussed, particularly from the perspective of medical malpractice cases.     

Factors related to suicide in New York state prisons

OBJECTIVE: Examine factors related to prison suicides to aid prevention. METHOD: Review the mental health records of all 76 suicides that occurred between 1993 and 2001 in New York State Department of Correctional Services (NYSDOCS) prisons that had some contact with mental health services during their incarceration. (This represented 84% of all NYSDOCS suicides.) Extract data from the psychological autopsies for a sample of 40 of these suicides. RESULTS: Of the suicide victims with some mental health contact, 95% had a substance abuse history, 70% displayed agitation or anxiety prior to the suicide, and 48% had a behavioral change. Common stressors preceding the suicide were inmate-to-inmate conflict (50%), recent disciplinary action (42%), fear (40%), physical illness (42%), and adverse information (65%) such as loss of good time or disruption of family/friendship relationships in the community. Forty-one percent had received a mental health service within 3 days of the suicide. Compared to the about 7200 inmates actively receiving mental health services in state prison, African-Americans and patients with a Major Mood (Bi-polar or Major Depression) were under-represented. Adjustment Disorder, Schizophrenia, and Personality Disorder diagnoses were over-represented. Suicide victims were more likely to have been incarcerated for a violent crime. CONCLUSION: Mental illness, anxiety/agitation, behavior change, stressors, history of substance abuse, and non-African-American were important risk factors.     

Reference ballistic imaging database performance

Ballistic imaging databases allow law enforcement to link recovered cartridge cases to other crime scenes and to firearms. The success of these databases has led many to propose that all firearms in circulation be entered into a reference ballistic image database (RBID). To assess the performance of an RBID, we fired 4200 cartridge cases from 600 9mm Para Sig Sauer model P226 series pistols. Each pistol fired two Remington cartridges, one of which was imaged in the RBID, and five additional cartridges, consisting of Federal, Speer, Winchester, Wolf, and CCI brands. Randomly selected samples from the second series of Remington cartridge cases and from the five additional brands were then correlated against the RBID. Of the 32 cartridges of the same make correlated against the RBID, 72% ranked in the top 10 positions. Likewise, of the 160 cartridges of the five different brands correlated against the database, 21% ranked in the top 10 positions. Generally, the ranking position increased as the size of the RBID increased. We obtained similar results when we expanded the RBID to include firearms with the same class characteristics for breech face marks, firing pin impressions, and extractor marks. The results of our six queries against the RBID indicate that a reference ballistics image database of new guns is currently fraught with too many difficulties to be an effective and efficient law enforcement tool.     

Globalization and Fiscal Federalism: Does Openness Constrain Subnational Budget Imbalances?

Recent research has shown that more globalized countries—defined as those with stronger international trade and financial linkages—tend to have larger governments. The empirical evidence reported in this paper shows that globalization is also associated with the government's fiscal stance, nationally and subnationally. Greater access to external sources of finance, which can be facilitated through globalization, is associated with increased market scrutiny over policies, resulting in a higher premium on fiscal discipline.     

A tale of two policies: The politics of climate forecasting and drought relief in Ceará, Brazil

This paper evaluates the use of climate-based information in drought mitigation in Ceará, Northeast Brazil. It examines two policies – a seed-distribution program (Hora de Plantar) and the Emergency Drought-Relief Program – that use climate information produced by FUNCEME (Cearás Foundation for Meteorological and Hydrological Resources) to implement drought planning. It argues that, in politically charged policy-making environments, the use of climate forecast information may go beyond its problem-solving function to influence broader issues of accountability and democratization. In Cearás politically charged environment, technocrats rely on scientific information about climate to insulate policy-making from both political meddling and public accountability. However, insulation afforded by the use of climate information has played different roles in the policy areas examined in this study. While in drought emergency-relief planning the use of climate information critically contributed to the democratization of policy implementation, in agricultural planning, it worked towards further insulating decision-making from public accountability and client participation. Thus, the use of climate information is context-dependent, that is, the distribution of costs and benefits associated with information use in policymaking depends on the social, political, and cultural context in which information producers and users work. Moreover, climate information can be used in ways – positive or negative – significantly different from the use that information producers intended.