Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high‐detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.     

Bone Area Histomorphometry

Quantifying the amount of cortical bone loss is one variable used in histological methods of adult age estimation. Measurements of cortical area tend to be subjective and additional information regarding bone loss is not captured considering cancellous bone is disregarded. We describe whether measuring bone area (cancellous + cortical area) rather than cortical area may improve histological age estimation for the sixth rib. Mid‐shaft rib cross‐sections (n = 114) with a skewed sex distribution were analyzed. Ages range from 16 to 87 years. Variables included: total cross‐sectional area, cortical area, bone area, relative bone area, relative cortical area, and endosteal area. Males have larger mean total cross‐sectional area, bone area, and cortical area than females. Females display a larger mean endosteal area and greater mean relative measure values. Relative bone area significantly correlates with age. The relative bone area variable will provide researchers with a less subjective and more accurate measure than cortical area.     

Complex Congenital Heart Malformation Including Transposition of the Great Vessels,Presenting as Sudden Unexplained Infant Death

Transposition of the great vessels (TGV) is a common congenital heart defect that is difficult to diagnose before birth. Antenatal diagnosis is associated with increased survival. Unusual features such as anomalous pulmonary artery origin may delay cyanosis, decreasing clinical suspicion. A three‐week old female infant who had never been cyanotic presented for forensic autopsy due to onset of unresponsiveness at home. History included risk factors for TGV and signs of heart enlargement that were not recognized during life. Cardiac pathology consultation identified D‐type TGV with additional rare anomalies. TGV may present as sudden unexplained infant death (SUID) for forensic autopsy if variant features prevent development of cyanosis. Cardiac pathology consultation is helpful in clarifying these features.     

A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan

Fentanyl transdermal patches have been used to treat cancer‐ and noncancer‐related chronic pain. However, its inappropriate or illegal application may cause fatal poisoning. We herein present the case of a Japanese woman in her 40s who was found dead with seven 25‐μg/h fentanyl transdermal patches on her body. We established a detailed toxicological analysis procedure to quantify fentanyl, and its metabolite norfentanyl, and other drugs (acetaminophen, allylisopropylacetylurea, celecoxib, estazolam, promethazine, and sertraline) in human whole blood by ultra‐high‐performance liquid chromatography–tandem mass spectrometry. The measured fentanyl and norfentanyl concentrations in the femoral and cardiac blood were 0.051 and 0.072 μg/mL and 0.033 and 0.076 μg/mL, respectively. The decedent's fentanyl concentrations were consistent with previously reported postmortem blood levels for fatal cases of poisoning by fentanyl transdermal patches. Based on the decedent's case history, autopsy findings, and toxicological analyses, the cause of death was identified as intoxication with transdermal fentanyl.     

Medical–Legal Partnerships: How Legal Services can Dramatically Improve Health Outcomes,and the Missed Opportunity to Help Women Seeking Abortions

There are significant health disparities in the United States, with low‐income and minority Americans experiencing higher rates of chronic disease and autoimmune disorders. Research has firmly established that social factors ‐ such as malnutrition, limited access to healthcare, and safe housing ‐ play a critical role in these health disparities. Medical‐Legal Partnerships are a relatively new approach to improving the health of people living in poverty by addressing the root causes of these health‐harming social factors. This article discusses the benefits of Medical‐Legal Partnerships and argues for continued expansion of the model, particularly in pediatricians’ offices, because parents are more likely to seek medical care for their children than themselves. This article further discusses how legal constraints prevent federal funding for Medical‐Legal Partnerships in abortion clinics; this creates a missed opportunity to work with women who are seeking abortions, many of whom face considerable social and economic challenges that could be addressed through legal assistance. This article digs into the legal restrictions that create this missed opportunity and proposes potential solutions to better serve the vulnerable population of abortion‐seeking women.     

Reducing Domestic Violence and Improving Outcomes for Children: Funding Civil Legal Aid to Maximize Impact

Domestic violence survivors and children in foster care often experience significant unmet civil legal needs. Legal aid services, when adequately funded, can help close the justice gap for these two populations while improving safety, stability, and court efficiencies. However, despite ample literature demonstrating how legal aid can improve outcomes, almost half of those seeking legal aid services are turned away due to lack of resources. This article reviews the research and data about how legal aid can improve outcomes for people in the domestic violence and child welfare contexts. It also discusses how several state‐administered federal funding opportunities—including the Victims of Crime Act (VOCA) Victim Assistance Formula Grant Program, Title IV‐D child support funds, and Temporary Assistance for Needy Families (TANF) basic block grants—can fund the needed civil legal help.     

Guiding Principles for Family Justice Programs

The Association of Family and Conciliation Courts and Relate, UK, co‐convened a 24‐hour consultation at St George's House, Windsor, UK, on modern family justice issues across Europe. This article identifies a preliminary set of guiding principles for family justice programs developed by consultation participants.