Sudden cardiac death and myocardial ischemia indicators: a comparative study of four immunohistochemical markers

The postmortem diagnosis of acute myocardial infarction represents a current challenge for forensic pathologists, particularly when death occurs within minutes to a few hours after the ischemic insult. Among the adult population the single most important cause of sudden cardiac death (SCD) is the well-known atherosclerotic coronary artery disease, commonly asymptomatic or unrecognized. The recognition of early myocardial damage using routine hematoxylin and eosin (H&E) staining is possible only if death has occurred at least 6 hours after the onset of the ischemic injury. The usefulness of immunohistochemical markers to the diagnosis of early myocardial damage has been recently suggested because most of them can be visible even serologically as early as few minutes after the beginning of the symptoms. To evaluate the usefulness of plasma and cellular antigens, their distribution patterns have been studied among a group of 18 SCD cases in which a myocardial ischemia was strongly suspected. For the present study, 4 markers have been selected on the basis of their different diagnostic potential as follows: among the plasma markers the C5b-9 and fibronectin, among the cellular markers the myoglobin and cardiac troponin. The results show that only the study of multiple markers such as those selected can provide enough evidence of myocardial ischemia and/or necrosis, supporting the final diagnosis of SCD. No single immunohistochemical staining is ideal for diagnosing early myocardial ischemia but a set of markers can improve the ability of forensic pathologists to detect ischemic areas when no macroscopic or microscopic evidence of necrosis is available. However, the interpretation of data obtained in each individual cannot be isolated from the overall assessment of the factors (cardiopulmonary resuscitation and/or agonal artifacts) that can affect the expression of each marker.     

Rupture of the spleen or splenic vessels (splenic emergency syndrome) in late pregnancy: a report of two autopsy cases

During the years 2004-2006, seven divers, who had deadly accidents, underwent post-mortem examination at the Institute of Legal Medicine of the University of Munich. The cause of death in all divers was drowning with typical pathomorphological findings. This should be regarded as separated to the triggering reason for drowning. The trigger for accident was established in four of seven cases by technical analysis and police investigation. High risk-taking, lack of technical service, and deficiency of dive equipment care were main reasons for death. We present two of these cases which showed several problems occurring concurrently. Autopsy always is necessary to look for indices for application of force or to exclude competitive reasons for death.     

The European Arrest Warrant and the Sovereign State: A Marriage of Convenience?

The article aims to analyse the extent to which mutual recognition and mutual trust in the criminal law area are developing in the EU in the context of the implementation of the European Arrest Warrant (EAW). First, an overview of the decisions of the Constitutional Courts in Germany, Poland, Cyprus and Czech Republic will be given. These decisions are evidence of a tension, on the one hand, between mutual recognition and state sovereignty and, on the other hand, between the powers of the European institutions in criminal matters and the fundamental rights of the individual. Second, national case‐law in the UK, Belgium, Spain and Italy will be examined. Third, an analysis of the recent decision of the European Court of Justice of 3 May 2007 will be carried out. Finally, a global assessment of the EAW will be made. Is this instrument effectively promoting normative mutual trust among the judicial authorities in the EU? Should it be amended or is it the wrong response at the wrong time? Some suggestions will be put forward, in light of what is considered to be the nature of the EAW and the birth of this instrument as part of the mutual recognition agenda.     

A logistic growth theory of public expenditures: A study of five countries over 100 years

This paper offers a new theory and empirical testing of long-term trends of public expenditures for five countries. While Wagner’s Law would imply an exponential growth process of the ratio between public expenditures and national income (G/Y), the law should be rejected both on theoretical and empirical grounds, because it disregards the role of ever increasing distortionary taxation. However, under some conditions, the combination of Wagner’s Law and the Pigou’s conjecture that the excess burden of taxation constrains the growth of public expenditures can be captured by a non-linear first order differential equation. The equation is the Verhulst’s logistic, originally invented to model Malthusian predictions on population growth. The integration of a Verhulst equation generates an S-shaped curve. This analytical framework combines intuitions from a welfare economics and a public choice perspective, and potentially offers a new research strategy on the dynamics of government expenditures. We offer preliminary econometric estimates on long run trends (around 1870–1990) of G/Y in U.S., U.K., France, Germany, Italy. These estimates confirm a pattern of similar trajectories, in spite of different national parameters, and suggest that the logistic view of growth of government is consistent with observed data.     

From Fingers to Faces: Visual Semiotics and Digital Forensics

International Journal for the Semiotics of Law - Revue internationale de Sémiotique juridique - Identification is a primary need of societies. It is even more central in law enforcement. In...     

Searching for the source of technical inefficiency in Italian judicial districts: an empirical investigation

In this paper, we conducted a two-stage analysis of technical efficiency in Italian judicial districts by focusing on civil cases in 2006. Unlike most of the works that apply the Data Envelopment Analysis technique to study the justice sector, in the first stage, we employed the smoothed bootstrap procedure to generate unbiased technical efficiency estimates. In the second stage, we used a semi-parametric technique (Simar and Wilson in J Econom 136(1): 31–64, 2007) that produces a robust inference for an unknown serial correlation between efficiency scores. Our results show that technical efficiency is explained by demand factors and supports the conclusion that opportunistic behaviour from both claimants and lawyers negatively affects technical efficiency in Italian judicial districts.     

Mental Capacity in Patients Involuntarily or Voluntarily Receiving Psychiatric Treatment for an Acute Mental Disorder

Despite the growing amount of data, much information is needed on patients' mental capacity to consent to psychiatric treatment for acute mental disorders. The present study was undertaken to compare differences in capacity to consent to psychiatric treatment in patients treated voluntarily and involuntarily and to investigate the role of psychiatric symptoms, competency, and cognitive functioning in determining voluntariness of hospital admission. Involuntary patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT‐T), the 24‐item Brief Psychiatric Rating Scale (BPRS), the Mini Mental State Examination (MMSE) and the Raven's Colored Progressive Matrices, and their data were compared with those for age‐ and sex‐matched voluntary patients. Involuntary patients performed worse in all MacCAT‐T subscales. Capacity to consent to treatment varied widely within each group. Overall, involuntary patients have worse consent‐related mental capacity than those treated voluntarily, despite capacity to consent to treatment showing a significant variability in both groups.     

Dynamics of Science-based entrepreneurship

This article introduces the rationale for the special issue, summarizes the main themes covered by the papers presented and suggests areas for further research. Previous research has focused on the creation of Science-based entrepreneurial firms (SBEFs) but there is little research relating to their growth and the challenges in ensuring growth occurs. At the macro-level, there is a need to distinguish general versus specific policies and how these vary between different institutional environments. At the firm level, there is a need to consider the factors influencing the development of boards, the growth of SBEFs and their dynamics in terms of acquisitions and IPOs.     

Low blood alcohol levels. Experimental study on attention and body sway control functions

Objective

Attempting to prevent alcohol-related road accidents requires sensitive, reliable and easy-to-use methods and instruments for ascertaining drivers’ state of intoxication. This paper examines the scientific validity of a method for assessing psychomotor performance combining measurement of neurosensory functions with the effect of low blood alcohol levels: body sway control and attention functions.

Methods

A double-blind, placebo-controlled study, with cross-over and random distribution on the effects of low blood alcohol levels. Psychomotor performance and body sway control were studied in 16 healthy volunteers after they had drunk a small dose of ethyl alcohol (0.5 g/kg) or placebo. Neurosensory and psychomotor functions were assessed by a Divided Attention Test (DAT), composed of the association between one test exploring short-term memory (Memory Test) and one exploring attention (Response Competition Test). Alterations in body sway were recorded by stabilometry. Tests were administered at 30, 60, 120 and 180 min after intake of alcohol. After a wash-out period of at least one week, subjects repeated the test after taking a second dose of alcohol or placebo. Blood alcohol concentrations were monitored by analysis of concentrations in expired air.

Results

A BAC under 50 mg/dL did not reveal statistically significant impaired memory capacities or motor coordination. Instead, statistically significant oscillations of body sway were measured (p-values = 0.0001), especially when stabilometry was associated with deviant stimuli like those of the DAT (p-values = 0.0001).

Conclusions

This study showed: (1) impaired performance, at the limits of statistical significance, on a complex psychometric test like the DAT; (2) some cognitive, attentive and visual perceptive functions are not compromised or at least not in a statistically significant manner; (3) a considerable alteration in the capacity for control of body sway after intake of alcohol becomes further and massively impaired when deviant stimuli are given; (4) this impairment appeared early and was more marked 1 and 2 h after intake of alcohol.