Atherosclerotic and Hypertensive Cardiovascular Disease are Associated with Death at Sublethal Carboxyhemoglobin Levels: A Postmortem Study

Residential fires are a significant cause for morbidity and mortality in the United States. Death is often the result of soot and smoke inhalation causing carbon monoxide (CO) toxicity. The approximate lethal level of carboxyhemoglobin (COHb) in healthy adults has been well described. However, a significant number of medical examiner cases involve infirmed decedents, often elderly, with complex cardiovascular disease burdens. It is well known that death in these cases will occur at sublethal levels of COHb; however, increased lethality has been largely documented via anecdotal experience and lacks quantification. Fifty-five cases were identified where death resulted from smoke and soot inhalation suffered in a residential fire. The control group, with no cardiovascular disease, had an age-adjusted mean COHb level of 61.6% at the time of death. Presence of hypertensive cardiovascular disease showed a 30% reduction in COHb (age-adjusted mean 43.2%), atherosclerotic disease showed a 33% reduction (age-adjusted mean 41.5%), and combined disease presentation accounted for 41% reduction (age-adjusted mean 36.3%). When controlling for age, atherosclerotic and hypertensive cardiovascular diseases were each associated with statistically significant decreases in COHb (p < 0.01). Increasing age was associated with decreased COHb levels at 2.8% per 10 years of life (p < 0.01), even when modeled with hypertensive and atherosclerotic disease. These findings carry important public health significance, as well as practical significance for the medical examiner when interpreting COHb levels in cases of suspected deaths due to smoke and soot inhalation.     

The relationship between schemas and offence supportive attitudes in mentally disordered sexual offenders

Abstract

The study of schemas in sexual offenders is a relatively new approach in attempts to understand the deviant beliefs and attitudes of sexual offenders. Emerging findings suggest that offence supportive attitudes may be the product of an offender's underlying schemas. This study aims to establish the relationship between offence supportive attitudes and schemas in a sample of mentally disordered sexual offenders (MDSOs). Thirty-one male sexual offenders held within low through high security forensic mental health units were assessed using the Young Schema Questionnaire - Short Version 3 and the Questionnaire on Attitudes Consistent with Sex Offending. Correlational analyses suggested a pattern of relationships in which Insufficient Self-control, Entitlement and Enmeshment arose as the schemas associated with most offence supportive attitudes. This supports a relationship between schemas and offence supportive attitudes in MDSOs and is consistent with the literature to date. Implications for further research and treatment are considered.     

‘First Among Equals’: Breaking the Deadlock in Parental and Sibling Funeral Disputes

Family disputes over a loved one’s funeral arrangements are increasingly frequent, with courts intervening if consensus cannot be reached. In many common law jurisdictions, the law favours the executor where the deceased made a will and the highest ranking next-of-kin where the deceased died intestate. But what if two or more people fall within the same kinship tier and have equal rights to determine the deceased’s fate—who has the final say? Adopting a uniquely comparative approach which draws the authorities together for the first time, this article analyses the factors devised by judges in Australia and England, and contrasts them with the discrete statutory tests adopted in parts of Canada and the United States. Having evaluated the various approaches, the article proposes its own hybrid legal solution for breaking the deadlock in so-called ‘equal kinship disputes’.     

Frozen Corpses and Feuding Parents: Re JS (Disposal of Body)

In October 2016, a dying teenager won the legal right to have her remains cryogenically frozen and stored indefinitely in an American clinic. The cryonics aspect was novel, posing questions around the legality of this particular method of corpse ‘disposal’ in the UK and the processes involved. More significantly, the case raises other substantive legal issues around the fate of the dead, including the status of funeral instructions under English law, and how courts adjudicate parental disputes over the funeral arrangements for a dead child.