Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

The role of environmental factors in the causation of sudden death in infants: two cases of sudden unexpected death in two unrelated infants who were cared for by the same babysitter

We report two cases of sudden unexpected death in two unrelated African American female infants, 2 months and 4 months old. Both infants were attended to by the same babysitter in the same apartment and died 39 days apart in the same bed and in the same bedroom. The autopsy of the first infant revealed sudden unexplained death in an infant. Toxicologic analysis for carbon monoxide (CO) was not performed because it was not suspected. When the second infant died, investigation into the ambient air quality within the apartment revealed high levels of CO emanating from a poorly ventilated and defective hot water heater, which was located across a hallway from the bedroom where the two babies died. CO saturation levels in the postmortem blood samples of the two babies were elevated and were similar (13% and 14%). Nicotine and cotinine were not detected in the blood sample of the two infants. Cherry-red livor mortis was absent. Acute CO intoxication was determined to be the underlying cause of these two unexpected deaths. These two cases underscore the need to integrate ambient air analysis and postmortem CO analysis as routine components of the comprehensive death investigation of infants who die suddenly and unexpectedly.     

Giant berry aneurysms in a forensic setting: a series of 14 cases

This is a series reviewing 14 cases of giant saccular aneurysms diagnosed at the Office of the Chief Medical Examiner of New York City collected over an 11-year period. Data collected on all 14 cases included neuropathological findings, comorbidities, and toxicological findings. Of these 14 cases, 8 were in women, and the ages ranged from 3 to 79 years, with a mean and a median of 50 years. Women were overrepresented in the sixth through eighth decades. Of the 14 cases described, 11 presented with a subarachnoid hemorrhage; 3, no hemorrhage; 2, subdural hemorrhage; 8, intraventricular hemorrhage; 2, intracerebral hemorrhage; and 8, more than 1 hemorrhage type. Location of the aneurysms varied with 6 in the left side of the brain, 6 present in the right side of the brain, and 2 at the midline. We described the clinical, pathological, and toxicological findings associated with these giant aneurysms.     

Privacy of bodily samples

Privacy law in Victoria does not cover human tissue and other bodily samples. To ensure that individuals have some control over how their samples are collected, used and transferred, legislative amendments are required. Can concerns raised by the Australian Law Reform Commission about the lack of privacy protection afforded to bodily samples be addressed in the Human Tissue Act 1982 (Vic)?     

Demography and Instability in the Developing World

Demography provides a framework for analyzing the effect of population on national security and a tool to assess how demographic trends in the developing world will influence conflict over the next twenty years. Population is connected to national security as an indicator of challenge and opportunity, a multiplier of conflict and progress, and a resource for power and prosperity. This indicator-multiplier-resource framework is then applied to the three influential demographic issues of the developing world: (1) youthful populations; (2) transitional age structures; and (3) urbanization. These diverse demographic trends reveal a growing divergence among states in the developing world and the need to continue to plan for the spectrum of warfare, though there will be an increasing number of supportive and capable states.     

Protecting victims of intimate partner violence: Swedish prosecutors’ experiences of decision-making regarding restraining orders

Restraining orders can be used as a risk management strategy to reduce the likelihood of intimate partner violence (IPV) re-victimisation. The aim of this study was to examine how prosecutors work with cases of IPV, with a focus on their collaboration with police, use of violence risk assessment and implementation of restraining orders. A qualitative analysis was conducted based on semi-structured interviews with five prosecutors operating in two northern police districts in Sweden in 2016. Data were analysed using latent content analysis. Three overarching themes arose: The case, Organization of resources and Interpretation of the law. Each theme was discussed in the context of the prosecutors’ work with IPV. Prosecutors pointed to several inadequacies in the legislation and offered potential solutions that would ameliorate their work. Results also showed that prosecutors seldom used violence risk assessments conducted by police as a basis for issuing restraining orders. The primary reason for this was a lack of clear routines governing cooperation between police and prosecutors in the application process. The results from this study can be used when training criminal justice personnel in order to obtain a better understanding of the difficulties that prosecutors face when trying to protect victims of IPV.     

The Static-99R predicts sexual and violent recidivism for individuals with low intellectual functioning*

A current debate is whether actuarial risk assessment tools predict sexual recidivism in sexual offenders with intellectual disabilities (SOIDs). Since intellectual functioning exists on a spectrum, the present study examined the predictive validity of the Static-99R across the range of intellectual functioning. The sample was comprised of 454 adult sexual offenders assessed at an outpatient clinic and followed for an average of 10 years. Offenders in the extremely low/borderline group had higher scores on the Static-99R than other offenders, largely due to their score on the detachment subscale of the Static-99R, but did not have significantly higher recidivism rates. Calibration analyses suggested that the expected and observed recidivism rates did not differ significantly. Intellectual functioning did not add incremental validity to the Static-99R. Further, there was no interaction between intellectual functioning and actuarial risk score. The results suggested that the Static-99R can be used across the range of intellectual functioning, albeit somewhat more cautiously for those at the lowest and highest end of the intellectual functioning distribution.