Intellectual disability and mental illness in the NSW criminal justice system

There has been increasing international, national and local recognition of the need for more appropriate responses and services for individuals who come in contact with the criminal justice system and who have an intellectual disability and mental health issues. This article provides an overview of prevalence data that indicates a significant over representation of people with intellectual disabilities in correctional facilities and reviews the problems facing this population. Findings from two specific evaluation studies undertaken by the Centre for Developmental Disability Studies are presented, along with recommendations for future provision based on these results. One of these projects trialled a case management approach to supporting offenders with an intellectual disability upon their release from prison. The 20-month follow-up found that a number of serious barriers were encountered within the overall system of provision for this population; the most serious of which related to lack of adequate accommodation upon release. The second project involved a two-stage evaluation of one model of provision for individuals with intellectual disabilities who are sex offenders, only some of whom were on parole. This service provided both residential and therapy services in a small group home located in the community. Residents were found to have high levels of emotional and behavioural difficulties, in addition to offending behaviour, that continue to require support and supervision. Critical issues, including guardianship involvement, restrictive practices and retrieval, therapy provision, and risk management issues are discussed in relation to overall clinical and lifestyle outcomes.     

The role of beta-amyloid precursor protein (beta-APP) staining in the neuropathologic evaluation of sudden infant death and in the initiation of clinical investigations of subsequent siblings

This report highlights the importance of undertaking immunohistochemical staining of the brains of infants who die unexpectedly, as it may not only assist with the evaluation of the cause of death in an individual infant but may also help with the clinical management of subsequent siblings. A 5-month-old male infant who died suddenly was found to have diffuse beta-amyloid precursor protein (beta-APP) staining in the brain, with no unusual features in his history, death scene examination, routine autopsy dissection, and ancillary tests to suggest any definite cause of death. Due to the beta-APP staining, the possibility of previous episodes of occult trauma, apparent life threatening events (ALTEs), and accidental or inflicted suffocation was raised in the autopsy report. As detailed analyses and investigations provided no supportive evidence for trauma or inflicted injury, hypoxia was clinically considered the most likely cause. Because of these concerns, sleeping oxygen saturation levels were monitored following the birth of a subsequent sibling who had normal APGAR scores and no evidence of any health problems. Oxygen desaturation to 70% occurred in association with a color change while on the postnatal ward, and a subsequent polysomnogram showed multiple episodic significant desaturations to around 80% in association with central apnea. Other testing was unremarkable. These cases demonstrate that beta-APP staining of the brain may not only provide clues as to possible mechanisms of death in pediatric forensic cases but may indicate a need for careful clinical evaluation of subsequent siblings for possible central apnea requiring oxygen therapy.     

RHODES' CONTRIBUTION TO GOVERNANCE THEORY: PRAISE,CRITICISM AND THE FUTURE GOVERNANCE DEBATE

This article discusses Rod Rhodes' contribution to governance theory. Rod Rhodes' work on governance has been much quoted. He has contributed to setting a new governance agenda and to an ongoing governance debate. This debate has also had an impact on political practice. However, as this paper argues, Rhodes' definition of governance is problematic in that it is narrowly identified with networks, and it is not consistently applied. Rhodes' concept of governance remains too narrow for it to be able to include a comparative analysis of a variation of governance forms. In addition, the governance concept needs to be equipped with tools from political economy in order be able to incorporate important aspects of interests, power and conflict. The way forward for governance theory would seem to involve the inclusion of political economy analysis of context as it affects beliefs and dilemmas.     

Controlling the variable of pressure in the production of test footwear impressions

Footwear impression lifting and enhancement techniques may be affected by several variables introduced during the production of test footwear impressions, thus limiting the usefulness of enhancement technique comparisons and the results obtained. One such variable is the force applied when the impressed mark is being made. Producing consistent test impressions for research into footwear enhancement techniques would therefore be beneficial. This study was designed to control pressure in the production of test footwear impressions when mimicking a stamping action. Twenty-seven volunteers were asked to stamp on two different surfaces and the average stamping force was recorded. Information from the data obtained was used to design and build a mechanical device which could be calibrated to consistently deliver footwear impressions with the same force onto a receiving surface. Preliminary experiments using this device and different contaminants on the footwear sole have yielded consistent and repeatable impressions. Controlling the variable of pressure for the production of test impressions in this study demonstrated that the differences observed were visual (due to the amount of contaminant transferred and subsequent enhancement) and did not affect the replication of outer sole characteristics. This paper reports the development of the device and illustrates the quality of the impressions produced.     

Fatal childhood vascular injuries associated with seat belt use

The deaths of two children who were passengers in motor vehicles involved in accidents were directly attributable to vascular injuries derived from seat belts. In the first case, a 10-year-old boy died as a result of abdominal aortic transection by a lap seat belt, and in the second case a 15-year-old boy died as a result of transection of his common carotid artery by a lap-shoulder seat belt. Although these cases demonstrate rare fatalities associated with seat belt use, there is no doubt that seat belts have significantly reduced mortality and morbidity from traffic accidents. Although it is possible that a fatal outcome might have occurred in each of these cases from other injuries that might have been sustained had seat belts not been worn, appropriate positioning and size of seat belt harnesses might have avoided the lethal injuries.     

Dehydration and heat-related death: sweat lodge syndrome

A 37-year-old Caucasian male died of dehydration and heat exposure following a sweat lodge ceremony in outback Australia. The case demonstrates difficulties that may arise in the determination of the cause of death at autopsy due to nonspecific pathologic findings in hyperthermic deaths. There are also a number of features that characterize this particular "sweat lodge syndrome," including prolonged exposure to elevated temperatures in a relatively uncontrolled environment, failure to ensure adequate hydration, failure to appreciate the significance of loss of consciousness, use of ineffective alternative methods of treatment, and delay in seeking appropriate medical care. Unfortunately, the adoption of rituals and practice from other cultures may not be a completely safe undertaking. Participants in this type of activity must be cognizant of the types of medical problems that may arise. Individuals with significant cardiovascular disease, those who are taking certain medications that predispose to hyperthermia, or those who have had large amounts of alcohol should not enter sweat lodges.