Flail Chest Following Failed Cardiopulmonary Resuscitation

Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occurrence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from the files of Forensic Science SA over a 7‐year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were found in 35 cases (14.8%). The majority occurred in the 60‐79‐year‐old age group. These data suggest that flail chest injuries are a more common sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly.     

Sudden Infant and Early Childhood Death and Sinus of Valsalva Pseudoaneurysms

Two cases of occult pseudoaneurysms of the sinus of Valsalva (SoV) are reported to demonstrate different etiologies and lethal mechanisms. A previously well 9‐month‐old boy who suffered an unexpected fatal cardiorespiratory arrest was found at autopsy to have a ruptured pseudoaneurysm of the left SoV resulting in lethal hemopericardium. A 13.5‐month‐old boy died soon after presenting with a 24‐h history of poor feeding and reduced urine output. At autopsy, destruction of the noncoronary cusp of the aortic valve by bacterial endocarditis was found with extension of the inflammation into a pseudoaneurysm of the SoV with surrounding abscess formation involving the atrioventricular node. Death was most likely due to an arrhythmia. Pseudoaneurysms of the SoV are exceedingly rare but may result in sudden/unexpected death in infancy and early childhood from rupture or involvement of the conduction system or myocardium. Detailed cardiac examination is essential in all unexpected deaths in early life.     

Developmental Changes in Conflict Resolution Styles in Parent–Adolescent Relationships: A Four-Wave Longitudinal Study

In this study, changes in three conflict resolution styles in parent–adolescent relationships were investigated: positive problem solving, conflict engagement, and withdrawal. Questionnaires about these conflict resolution styles were completed by 314 early adolescents (M = 13.3 years; 50.6% girls) and both parents for four consecutive years. Adolescents’ reported use of positive problem solving increased with mothers, but did not change with fathers. Fathers reported an increase of positive problem solving with adolescents, whereas mothers reported no change. Adolescents’ use of conflict engagement was found to temporarily increase with mothers, but showed no change with fathers. Mothers and fathers reported a decrease in conflict engagement with adolescents. Adolescents’ use of withdrawal with parents increased, although this increase was temporarily with mothers. Mothers reported no change in withdrawal, whereas fathers’ use of withdrawal increased. Generally, we found that both adolescents and their parents changed in their use of conflict resolution from early to middle adolescence. These results show that conflict resolution in parent–adolescent relationships gradually change in favor of a more horizontal relationship.     

Social Network Analysis to evaluate organisational networks on sexual health and rights

There are many challenges in evaluating international networks. The use of conventional tools can be difficult and often provides less than useful information. Social Network Analysis offers benefits for network evaluators by allowing for documentation and analysis of inter-relationships between individuals and organisations. This paper describes the use of this approach in the evaluation of a major international project entitled the Global Dialogues on Sexual Health and Well-being. It highlights the value of maps in enabling clear visual representations of networks, the identification of areas needing greater focus and the basis on which networks are constructed.

Analyse des réseaux sociaux pour évaluer les réseaux organisationnels sur les droits et la santé génésiques

L’évaluation des réseaux internationaux présente de nombreux défis. L'utilisation d'outils conventionnels peut être difficile et fournit souvent des informations qui ne sont pas des plus utiles. L'analyse des réseaux sociaux comporte des avantages pour les évaluateurs des réseaux, car elle permet la documentation et l'analyse des corrélations entre individus et organisations. Cet article décrit l'utilisation de cette approche dans l’évaluation d'un important projet international intitulé Global Dialogues on Sexual Health and Wellbeing (Dialogues mondiaux sur la santé et le bien-être génésiques). Il met en relief la valeur des cartes pour permettre des représentations visuelles claires des réseaux, l'identification de zones nécessitant un axe central plus marqué et la base sur laquelle les réseaux sont construits.

Análise de Rede Social para avaliar redes organizacionais sobre saúde sexual e direitos

Existem muitos desafios para se avaliar as redes internacionais. O uso de ferramentas convencionais pode ser dificil e frequentemente oferece informações que não são úteis. A Análise de Rede Social oferece benefícios para avaliadores de rede ao considerar a documentação e análise das inter-relações entre indivíduos e organizações. Este artigo descreve o uso desta abordagem na avaliação de um grande projeto internacional chamado Diálogos Globais sobre Saúde Sexual e Bem-Estar. Ele destaca o valor de mapas para permitir representações visuais claras de redes, a identificação de áreas que estejam precisando de um maior enfoque e a base sobre a qual as redes são construídas.

El Análisis de Redes Sociales para evaluar redes de organizaciones que trabajan en salud y derechos sexuales

A la hora de evaluar las redes internacionales surgen muchos retos. Los métodos tradicionales pueden presentar dificultades y a menudo proporcionan información poco útil. El Análisis de Redes Sociales presenta ventajas para los evaluadores de redes ya que ofrece la posibilidad de documentar y analizar relaciones entre individuos y organizaciones. El presente ensayo examina cómo se utilizó este método para evaluar un importante proyecto internacional llamado “Diálogos globales sobre salud sexual y bienestar”. También ilustra cómo los mapas son valiosos porque muestran una clara representación visual de las redes, revelan las áreas que necesitan mayor atención y señalan las bases sobre las que se construyen las redes.     

Wandering Dementia—A Syndrome with Forensic Implications

Wandering behavior in dementia may result in significant injury or death. Search of files at Forensic Science South Australia over a 20‐year period (1998–2018) identified nine individuals with dementia who were found deceased having been reported as missing from home/residential facilities (M:F, 6:3; age range, 54–92 years; average, 77.7 years; median, 80 years). The established clinical diagnoses were of dementia in seven cases and Alzheimer disease in two. Deaths were unnatural in six cases: hypo/hyperthermia three, drowning two, train impact one; natural in two cases due to ischemic (N=1) and valvular heart disease (N=1); and undetermined in one case due to marked decomposition. There were five fatalities in winter. Exposure and drowning were significant causes of death. The increasing aging population means cases of lethal wandering dementia will be more often encountered among forensic cases in future. Issues around duty of care and suicide should be considered in evaluating cases.