Discrimination of Falls and Blows in Blunt Head Trauma: A Multi‐Criteria Approach

Abstract: In the discrimination of falls versus blows, the hat brim line (HBL) rule is mentioned in several textbooks as the most useful single criterion. Recent studies, however, have found that the HBL rule is only moderately valid and that its use on its own is not recommended. The purpose of this 6‐year retrospective study was to find additional individually useful criteria in the distinction of falls from blows. Overall, the following criteria were found to point toward blows: more than three lacerations, laceration length of 7 cm or more, comminuted or depressed calvarial fractures, lacerations or fractures located above the HBL, left‐side lateralization of lacerations or fractures, more than four facial contusions or lacerations, presence of ear lacerations, presence of facial fractures, and presence of postcranial osseous and/or visceral trauma. Based on the most discriminating criteria, a decision tree was constructed to be potentially applicable to future cases.     

Respiratory,Circulatory, and Neurological Responses to Hanging: A Review of Animal Models

Abstract: The pathophysiology of hanging is still poorly understood. This article presents a review of eight animal models: four models of isolated occlusion of the vessels of the neck (group 1), one model of combined tracheal and vessel occlusion (group 2), and three models of true animal hanging (group 3). Occlusion of the airway passages in group 2 did not accelerate respiratory arrest compared to group 1. Cessation of cerebral blood flow, rather than airway obstruction, seems to be the main cause of respiratory decline. In general, muscular movements ceased after 1–3.5 min and early generalized tonic‐clonic convulsions were described. Complete circulatory collapse seems to occur between 4 and 8.5 min. These observations from animal models of hanging are compared with the data collected from filmed human hangings. Avenues to improve animal models are discussed.     

Partial Agonist Therapy in Schizophrenia: Relevance to Diminished Criminal Responsibility

Abstract: Pathological gambling (PG), classified in the DSM‐IV among impulse control disorders, is defined as inappropriate, persistent gaming for money with serious personal, family, and social consequences. Offenses are frequently committed to obtain money for gambling. Pathological gambling, a planned and structured behavioral disorder, has often been described as a complication of dopamine agonist treatment in patients with Parkinson’s disease. It has never been described in patients with schizophrenia receiving dopamine agonists. We present two patients with schizophrenia, previously treated with antipsychotic drugs without any suggestion of PG, who a short time after starting aripiprazole, a dopamine partial agonist, developed PG and criminal behavior, which totally resolved when aripiprazole was discontinued. Based on recent advances in research on PG and adverse drug reactions to dopamine agonists in Parkinson’s disease, we postulate a link between aripiprazole and PG in both our patients with schizophrenia and raise the question of criminal responsibility.     

Assessing the Relative Importance of the Child Sexual Abuse Interview Protocol Items to Assist Child Victims in Abuse Disclosure

This study identifies (1) the importance of using the Child Sexual Abuse Interview Protocol for multiple disciplines to obtain detailed information of what the alleged child victims say and claim, and (2) the concurrence of multiple professionals about the relevance of items in the protocol in their practice. A survey with 100 items based on the Child Sexual Abuse Interview Protocol was self administered by 36 professionals working at a child advocacy center including administrators, attorneys, child advocates, support persons, physicians, police, psychologists, and social workers. These respondents unanimously felt it was very important for interviewers to complete two specific items during the course of an investigative interview: “showing the interviewer is listening to the child” and “showing patience with the child.” As indicated by the average rating scores, 89 items were perceived between very important and important, and nine items as somewhat important. No item on this scale was rated as doesn’t matter or unimportant. Social workers and police officers did not differ significantly in their ratings of the importance of these items. Both quantitative and qualitative results support four major considerations when using an interview guide: 1) flexibility in opening and closing the interview, 2) professional and appropriate use of the anatomical dolls, 3) assessment of the age and mental state of the child, and 4) determination of the order of questions based on severity of incidents. This study provides data to identify the importance of using a comprehensive interview protocol for multidisciplinary professionals who work with alleged victims of child sexual abuse. The use of these 100 items will enhance the effectiveness of conducting a one-time interview to avoid repeated interviews. This study that was originally aimed at comparing differences among professionals has, in fact, demonstrated the similarities across disciplines, as agreement among various professional groups was substantial. This finding dissolves the myth that multiple disciplines brought forth diverse opinions and instead encourages the “working together” concept of a team.     

Suicide by skull stab wounds: a case of drug-induced psychosis

Suicide by stabbing to the head and/or driving sharp objects into the skull is of extreme rarity. This article reports the case of a 27-year-old man, who committed suicide by multiple knife stabs and cuts to the head, the torso, one shoulder and the forearms. Autopsy showed a perforating wound of the skull and the 10-cm long broken blade of the knife being still embedded in the right temporal lobe of the brain. The deceased had no history of psychiatric illness but was currently treated by mefloquine, a quinine derivative associated with a high rate of psychiatric adverse effects. Toxicological examination confirmed a recent intake of mefloquine together with chloroquine, another antimalarial drug. To our knowledge, this is the first report of a completed suicide with very strong evidence of mefloquine implication. Discussion focuses upon mefloquine-induced psychiatric disorders and highlights the importance of performing toxicological investigations in cases of unusual suicides.     

Scanning electron microscopy analysis of experimental bone hacking trauma of the mandible

The authors report on a macroscopic and microscopic study of human mandible bone lesions achieved by a single-blade knife and a hatchet. The aim of this work was to complete the previous data (scanning electron microscopy analysis of bone lesions made by a single-blade knife and a hatchet, on human femurs) and to compare the lesions of the femur with those of the mandible. The results indicate that the mandible is a more fragile bone, but the features observed on the mandible are quite similar to those previously observed on the femur. This work spells out the main scanning electron microscopy characteristics of sharp (bone cutting) and blunt (exerting a pressure on the bone) mechanisms on human bone. Weapon characteristics serve to explain all of these features.     

Policy change and health care research

Explaining policy change is one of the most central tasks of contemporary policy analysis. Reacting to overly rigid institutionalist frameworks that emphasize stability rather than change, a growing number of scholars have formulated new theoretical models to shed light on policy change. Focusing on health care reform but drawing on the broader social science literature on policy and politics, this article offers critical perspectives on the institutionalist and ideational literatures on policy change while assessing their relevance for analyzing change in contemporary health care systems. The last section sketches a research agenda for studying policy change in health care.     

Evaluation of a Freezer Mill for Bone Pulverization prior to DNA Extraction: An Improved Workflow for STR Analysis

Traditional methods for bone pulverization typically generate heat, risking stability of DNA sample. SPEX? has developed cryogenic grinders which introduce liquid nitrogen to cool the sample and aid in the grinding process. In this study, the Freezer Mill 6970 EFM was used with two DNA extraction methods and routine downstream STR analysis procedures. DNA from as little as 0.1 g of bone powder was used to develop full STR profiles after freezer mill pulverization, and the method was reproducible. Further, no contamination was detected upon cleaning/reuse of the sample vials. There were no significant differences in DNA yield, STR alleles detected, or peak heights using the freezer mill as compared to traditional grinding, and successful DNA profiles were achieved from as low as 0.1 g of bone powder with this method. Overall, this work indicates that this cryogenic mill method may be used as a viable alternative to traditional tissue grinders.     

Environmental Considerations for Trauma‐Responsive Juvenile and Family Courts: A Review of the Literature with Recommendations for Practice

Juvenile and family courts serve some of our most vulnerable populations, many of whom have experienced some traumatic event. People suffering with posttraumatic stress disorder (PTSD) are known to be more sensitive to environmental stimuli, and many of the environmental conditions within courts can be challenging for those suffering traumatic stress. Trauma‐responsive practices help foster conditions of healing, which can benefit both the court user and those who work within the court. Research reviewed in this article demonstrates the likelihood of negative behavioral and emotional responses to specific environmental factors for people suffering PTSD and other stress reactions, and offers recommendations to minimize environmental stressors.     

Serving the creditors after insolvency filings: from value creation to value distribution

This paper provides original empirical evidence on the financial outcome of insolvency filings in Europe. We adopt a cross-country analysis of the determinants of recovery rates isolating three types of creditors (junior, senior, and new money claims). We investigate the structure of recoveries on a unique hand-collected sample of bankrupt firms in France, Germany, and the UK. We initially question value maximization, and study to which extent the legal provisions prevailing after insolvency filing can influence creditors’ overall recoveries. Three procedures differ significantly from our benchmark (UK liquidations). French continuation and UK receivership exert a positive influence onto total repayments, while such influence becomes negative under French liquidation. We relate this finding to the ability of the two former procedures to improve coordination among the creditors, monitoring of the debtor, and/or incentives to file early. We then analyze value distribution by examining competition between the categories of creditors. We show that the insolvency systems do not converge. Junior and senior creditors are better served under the German and the French continuation procedures than in any other bankruptcy path. At the opposite, the UK liquidation procedures fail to satisfactorily serve the junior/senior creditors. Still, nearly all the insolvency procedures support fresh financing by protecting quite well new money claims. Overall, we do not confirm any superiority of one family of insolvency system over another, but rather stress the importance of an appropriate design of the procedures, especially regarding the incentives they create before and after insolvency filing.