Previously Unreported Complication of Coronary Artery Bypass Grafting: Suture Rupture Resulting in Patient's Death

Traditionally, the manner of death in most hospital autopsy cases is natural, in which death is due to the natural course of disease or reasonably anticipated outcomes of medical interventions. Some cases fall into a potential gray zone between natural and accident, including rare or unanticipated outcomes of medical interventions. We present a case of a patient postcoronary artery bypass graft. Autopsy revealed the proximal anastomosis of the aorta‐to‐first‐diagonal‐coronary‐artery‐to‐second‐obtuse‐marginal‐artery graft was detached from the aorta. A broken suture was present at the disconnected anastomosis, with intact knots but was broken along its length. In‐hospital mortality rates of CABG range from 1% to 3%, with several autopsy studies identifying surgical complications as the cause of death in one‐third of perioperative deaths. No publications were found that described suture rupture as directly relating to the cause of death. This case report describes a previously unreported complication of coronary artery bypass grafting.     

A Comparison of Thresholding Methods for Forensic Reconstruction Studies Using Fluorescent Powder Proxies for Trace Materials

Image segmentation is a fundamental precursor to quantitative image analysis. At present, no standardised methodology exists for segmenting images of fluorescent proxies for trace evidence. Experiments evaluated (i) whether manual segmentation is reproducible within and between examiners (with three participants repeatedly tracing three images) (ii) whether manually defining a threshold level offers accurate and reproducible results (with 20 examiners segmenting 10 images), and (iii) whether a global thresholding algorithm might perform with similar accuracy, while offering improved reproducibility and efficiency (16 algorithms tested). Statistically significant differences were seen between examiners’ traced outputs. Manually thresholding produced good accuracy on average (within ±1% of the expected values), but poor reproducibility (with multiple outliers). Three algorithms (Yen, MaxEntropy, and RenyiEntropy) offered similar accuracy, with improved reproducibility and efficiency. Together, these findings suggest that appropriate algorithms could perform thresholding tasks as part of a robust workflow for reconstruction studies employing fluorescent proxies for trace evidence.     

The Influence of Evidence on Animal Cruelty Prosecution and Case Outcomes: Results of a Survey

Two hundred prosecuting attorneys completed a survey concerning priorities in taking on animal cruelty cases and the factors that help or hinder prosecuting such cases. Respondents commented on the priority given such cases. Questions also addressed specific kinds of evidence that had been used to decide whether to take on a cruelty case and were used in court. Results showed that prosecutors most frequently relied upon “traditional” sources of evidence, including detailed medical and crime scene reports and good quality photographic evidence. Other sources of forensic evidence such as DNA, computer forensics, forensic accounting, blood, and trace evidence were rarely employed. Veterinary forensic evidence, including forensic necropsies and detailed medical reports, was viewed as an important factor by a majority of prosecutors in deciding whether to accept a case for prosecution and in achieving a successful outcome, but a need for additional training for investigators was indicated.     

The Battlefield Behind Bars: How Mental Disorder and Suicidal Behavior Impacts the Prison Experience for Veterans

American Journal of Criminal Justice - Military veteran status has been associated with a variety of criminal justice outcomes as well as higher rates of mental illness and suicide when compared to...     

Being Ms B: B, autonomy and the nature of legal regulation

In this article, we question the apparent simplicity of medical law's construction of 'life and death' cases as a clash between the sanctity of life principle and patient autonomy. Our main purpose in doing so is to try to understand more fully the nature of law's regulation of the existence and non-existence of life. Specifically, we argue that, by broadening the understanding of autonomy in this area beyond a simple concern for patients' rights and self-determination, to include a focus on the individual generally, it becomes possible to identify some of the legal practices that are central to the manner in which law regulates the threshold between life and death. Through an analysis of a recent case in English law--Re B (an adult: refusal of medical treatment)--(although Australian jurisdictions presently disclose no similar, authoritative case, ours presently is almost an arbitrary choice)--we demonstrate the central role played in this regulation by tests for mental capacity, questions of character, explanation, and imagination. We conclude that medical law, at least in this context, can be theorised as a normalising practice--one in which the determination of norms often occurs through patients.     

Self-reported suicidal behavior in juvenile offenders in custody: prevalence and associated factors

Suicide rates in prisons in England and Wales are high, including those in juvenile detention centers. Previous deliberate self-harm (DSH) is the strongest predictor of suicide in the general population. There is limited information on how many juvenile offenders (15 to 18 year-olds) have a history of DSH at the time of entering custody, or on factors associated with previous DSH. We aimed to determine the prevalence of previous DSH and suicidal ideation in a population of juvenile offenders in custody and to identify factors associated with DSH and suicidal ideation. Seven out of 45 subjects (15.6%) reported an act of DSH in the past. Twelve (26.6%) reported past suicidal ideation. Peer relationship difficulties and sexual abuse were significantly associated with DSH (p < 0.05). Other factors showed a trend toward being more common among those with DSH, but the premature ending of the project by the juvenile detention center prevented full investigation of the extent of DSH and associated factors. Nevertheless, the results indicated a much higher rate of DSH in this population than in young males in the community. A larger joint project with juvenile detention centers is required to confirm the extent of previous DSH at the time young offenders are admitted, and the associated risk factors, in order to assist prevention and intervention strategies.     

Gender and Race Differences in Delinquent Careers

Abstract Studies of delinquent careers have often tracked only male offenders, and have almost always failed to explore the interaction of race and gender in delinquency. This study tracks a cohort of youth whose first referral to juvenile court was in 1980, and explores the role played by both race and gender in official delinquent careers. Findings reveal that both race and gender play a significant role in official delinquency. Looking first at female delinquency, this research finds that white and nonwhite females do not differ significantly in the types of offenses they commit. Moreover, if girls are “chronic” delinquents, their offenses are most often trivial rather than serious. With males, racial differences emerge in both seriousness and chronic nature of delinquency. Nonwhite males in this cohort are more likely to be referred for personal offenses and less likely to be referred for public order and victimless offenses. Nonwhite males are also significantly more likely to become recidivists, and to have more seriously delinquent careers. This article discusses the implications of these findings, particularly with reference to the “convergence theory” of delinquency, which suggests that race plays a stronger role than gender in female delinquency. Finally, the article considers the policy implications of the current range of definitions of “chronic” delinquency.