Medicine, Science and the Law最新文献

In the recent past, human genetics and in vitro fertilization (IVF) have undergone various advances to combat with several congenital and developmental disorders. These advances are a boon for the families and patients who were restricted from having a child due to one or the other reasons. One such reason is the mitochondrial DNA (mtDNA) mutations, which are definitely transmitted from the mother to the child due to uniparental/maternal inheritance of mitochondria. Depending upon the range of the mutation (mutation loads) present, the mtDNA mutation leads to various devitalizing to fatal disorders, all of which are incurable. Scientists and researchers developed a technique known as mitochondrial donation technique or mitochondrial replacement therapy (MRT) to combat with the mtDNA mutations. The technique relies on the replacement of faulty mitochondria in the mother's egg with the normal wild-type from a donor female resulting in a "three-parent baby." On the other side, forensic scientists and anthropologists continuously explore the mtDNA in various medicolegal cases and in uncoupling the mystery of human origin and migration respectively. In this regard, we explored the genetic, forensic and ethical aspects of a "three-parent baby." The present communication also attempts to highlight the importance and limitations of the MRT technique/three-parent baby in a medicolegal context.

Advanced putrefaction causes extensive loss of soft tissue, rendering it difficult to use the diatom test as a reliable diagnostic tool for drowning investigations. A positive diatom test in carrion insect larvae may provide significant assistance in overcoming the challenge of decomposition. The studies determined the utility of diatom test in carrion larvae on severely decomposed bodies. A modified acid digestion method involving nitric acid, K₂Cr₂O₇ and HCl, was used to digest the blowfly larvae feeding on piglet carrion previously drowned in freshwater and sea water, respectively. Extracted diatom frustules were analysed and characterised using light microscopy coupled to a digital camera. Diatoms recovered from maggots on sea-drowned piglets were similar to diatoms from sea water (drowning medium). Centric diatoms recovered in maggots were higher (200 ± 60 diatoms/ mL) than pennate diatoms (80 ± 20 diatoms/mL). Isolated diatoms common to both maggots and water samples included Coscinodiscus sp. and Navicular spp. Albeit, there were no diatoms recovered from maggots on freshwater-drowned piglets. The findings of this study suggest that the diatom test is still a reliable diagnostic tool to determine if drowning was involved in the death of a fully decomposed body. This is the first study that isolated diatoms from maggots feeding on drowned bodies. It serves as the basis for further research into the utility of maggots for drowning investigations.

High levels of service user satisfaction are viewed as a reliable indicator of a service providing good care and treatment. There has been limited research looking into levels of satisfaction in forensic mental health settings with most work focused on staff satisfaction in these settings. This study examined service users' levels of satisfaction with a forensic mental health service in the United Kingdom. The service covered two sites; one a purpose-built secure unit and the other based in an old cottage hospital. Thirty-nine in-patients completed a 60-item validated forensic satisfaction scale. The scale measured seven domains of satisfaction as well as reporting an overall satisfaction score. The results indicated the service users were reasonably satisfied with the care and treatment they received. The domains of rehabilitation, safety, staff interaction and overall care showed the highest level of satisfaction. The high rehabilitation satisfaction score demonstrated the importance of meaningful activities for users accessing forensic services and may have been influenced by the security measures on the wards. The high safety domain score indicated respondents felt safe and secure within the wards and were likely to be influenced by positive interpersonal interactions. Good staff interaction was also an important factor in helping service users feel safe on the wards. These interactions are likely to be associated with longer periods of admission in secure services allowing therapeutic relationships to develop. Financial advice/support was the one domain that recorded negative satisfaction levels. Financial literacy training may help develop money management skills.

Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive 'rigor mortis' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called 'coffin birth' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

This study investigates the legal challenges posed by telesurgery, an emergent healthcare modality facilitated by advancements in 5G and Artificial Intelligence. It highlights the urgent need for a comprehensive legal framework reconciling the complexities of healthcare delivery and technology integration. The paper examines the Chinese adjudication of negligence and the evidentiary hurdles in telesurgery, interrogating the application of the 'reasonable doctor' standard, the intricate causation-negligence nexus and the distribution of evidentiary burdens. The analysis contends that current statutes require revision to apportion telesurgery-induced damages fairly. Further, it proposes the formation of multidisciplinary committees to oversee medical technology, calls for systemic reforms, more reasonable liability differentiation and fortifying medical insurance frameworks.

Cable or zip ties are mass produced inexpensive nylon fasteners, which have a locking mechanism to prevent them from being loosened. Their use in medicolegal cases is infrequent, being involved in situations of neck compression or restraint. The Forensic Science SA Pathology Database (in Adelaide, Australia) and search engines PubMed, Google Scholar and Google were examined for cases where cable ties were documented as either causing death or being potentially lethal, being a contributor to death, or having been used for restraint purposes. Neck compression resulting in ligature strangulation was found in cases of homicide and suicide in adults. Accidental neck compression was rarely reported in children. Cases of restraint again occurred in both homicides and suicides, with nonlethal wrist restraint being used by law enforcement officers in lieu of traditional handcuffs. Cable ties may also be used to fasten ligatures to suspension points in case of hanging. Despite their ready availability, cable ties are only relatively rarely involved in medicolegal cases. More traditional forms of manual or ligature neck compression are still favoured possibly because they require less dexterity.

A whole branch of theoretical statistics devotes itself to the analysis of clusters, the aim being to distinguish an apparent cluster arising randomly from one that is more likely to have been produced as a result of some systematic influence. There are many examples in medicine and some that involve both medicine and the legal field; criminal law in particular. Observed clusters or a series of cases in a given setting can set off alarm bells, the recent conviction of Lucy Letby in England being an example. It was an observed cluster, a series of deaths among neonates, that prompted the investigation of Letby. There have been other similar cases in the past and there will be similar cases in the future. Our purpose is not to reconsider any particular trial but, rather, to work with similar, indeed more extreme numbers of cases as a way to underline the statistical mistakes that can be made when attempting to make sense of the data. These notions are illustrated via a made-up case of 10 incidents where the anticipated count was only 2. The most common statistical analysis would associate a probability of less than 0.00005 with this outcome: A very rare event. However, a more careful analysis that avoids common pitfalls results in a probability close to 0.5, indicating that, given the circumstances, we were as likely to see 10 or more as we were to see less than 10.