Medicine, Science and the Law最新文献

In Italy, the issue of medically assisted suicide is addressed by the sentence number 242 of the Constitutional Court (22^nd November 2019). Further indications of organisational nature are needed, which are under the responsibility of the Italian Parliament and each regional health administration. Recently, the sentence number 135 of the Constitutional Court (1^st July 2024) has provided further specifications regarding 'life-support treatment', which still remains controversial. Regional differences in Italy regarding medically assisted suicide are reported in this article, showing that, on the date of 11^th February 2025, Tuscany is the first and only Italian region to have passed a regional law on medically assisted suicide. One possible approach to discussion and management of this sensitive and controversial issue could be cooperative forms of regionalism while waiting for a national law. To date, after the first Italian case, which refers to Marche region and occurred on 16^th June 2022 (Federico Carboni, also known as 'Mario'), four more individuals in Italy have resorted to medically assisted suicide: 'Gloria' in Veneto, 'Anna' in Friuli-Venezia Giulia, a man in Emilia Romagna, and 'Vittoria' in Veneto. It is hoped that a national law will be approved soon, as strongly urged by the Constitutional Court; if not, efforts should be made to identify and implement shared and standardised procedures throughout the Italian territory, encouraging cooperative forms of regionalism. This would allow patients to know that the request is followed by unambiguous responses from the authorities, within a reasonable time.

There has been limited study to date into the specific patient factors that influence decisions about an individual's need for high-security psychiatric care. Admission to high-security services requires careful assessment and consideration to ensure patients receive the least restrictive care justified, and those who are most likely to benefit from it are admitted. This retrospective case-control study describes the demographic, clinical and risk characteristics of referrals made to the State Hospital in Scotland during a 12-month period, and delineates differences between referrals that were accepted and rejected for admission. It updates the methods of a previous study undertaken at the State Hospital. Six variables differentiated rejected and accepted referrals in univariate analyses. Multivariate logistic regression found that a model with only the individual's age, whether they were prescribed antipsychotic medication at the time of referral, and whether they had a history of violent convictions, best predicted referral outcome. The findings support the conclusion that it is not only an individual's risk of violence or the severity of their mental illness in isolation, but the combination of these factors that is deemed to necessitate high-security care within a stratified forensic mental health system.

Fingerprints are widely used as biometric parameters for identification purposes because of their uniqueness. Moreover, many digital devices have employed fingerprints for security purposes throughout the world. An automatic artificial intelligence-based classification system can reduce the time spent running through the database for fingerprint matching by arranging fingerprints into disjoint classes. It can also help classify fingerprints at the crime scene easily and quickly. The present study proposed a convolutional neural network (CNN) model for the multiclass classification of fingerprint patterns (Arches, Loops, Whorls, and Composites) according to Henry's classification. The model was trained on 2000 fingerprint patterns collected from the fingers of 200 participants. The dataset was split into train, test, and validation part with the ratio of 8:1:1, respectively. The presented CNN model was evaluated by using a confusion matrix for the testing process. Training, validating, and testing the accuracy of the CNN model for classifying fingerprint datasets into four main classes were 89%, 84%, and 85.5%, respectively. This model shows its application as an aiding tool for fingerprint analysis in crime scene investigation, forensic examinations, and fingerprint research.

A medical examiner (ME) system was introduced to England and Wales in 2019 intended to ensure appropriate notification of cases to HM Coroner (HMC). The aim of the study is to determine and compare: (a) the nature of notifications to HMC for Norfolk from the Norfolk and Norwich University Hospital (NNUH) in 2018 compared with 2022; (b) to determine the outcome of those notifications and (c) to establish patterns of change in the number and nature of such notifications. HMC and ME datasets were interrogated to determine differences between notifications to HMC and outcomes in 2018 compared with 2022. From deaths at NNUH (2018 - n  =  2605; 2022 - n  =  2969), there were significantly fewer HMC notifications in 2022 compared with 2018 (25.3% vs. 17.6%). A decrease in notifications was noted for persons undergoing any 'treatment or procedure of a medical or similar nature' (24.0% vs. 16.2%) p < 0.0014. An increase in notifications was noted for neglect, including self-neglect (3.3% vs. 12.2%) p < 0.001. Of the coronial outcomes, there were significant increases in the numbers of post-mortem (PM) examinations (29.3% vs. 35.5%) p  =  0.0276 and inquests (26.0% vs. 31.4%) p  =  0.0485). There was a significant decrease in no further action by HMC (5.7 vs. 2.3) p  =  0.0485. The study shows that the introduction of the medical examiner service has resulted in significant change in the nature of HMC notification categories. The notifications appear to be more appropriate, with an increased proportion of inquests and PM examinations and with a reduction in 100 A or 'no further action' outcomes.

This article describes the utility of postmortem CT and MRI in diagnosing pediatric bowel obstruction (BO) as the cause of septic shock-induced death. Six pediatric cases with confirmed septic shock were retrospectively analyzed. Postmortem CT scans revealed clear signs of BO in all cases, with volvulus, intussusception, diaphragmatic hernia, or Meckel's diverticulum identified. MRI scans, performed in three cases, did not provide additional diagnostic information. The presented case series highlights the potential of postmortem CT for diagnosing BO in children, potentially aiding in understanding the cause and manner of death. While MRI offered limited additional benefits, its role in conjunction with CT and autopsy warrants further exploration. Combining these modalities could enhance diagnostic accuracy and provide a more complete picture of the cause of death in children.

Nonthrombotic pulmonary embolism is defined as the partial or total occlusion of the pulmonary circulation by various nonthrombotic agents, such as biological, nonbiological and foreign body material. A case is reported of lethal embolism of fragments of a renal calculus: A 64-year-old woman collapsed and died following laser lithotripsy. At autopsy calculous debris was found in the calyces of the right kidney with widespread microscopic fragments of birefringent foreign material in keeping with renal calculus within the pulmonary arterioles. Death was due to pulmonary calculus embolism complicating lithotripsy of a right renal calculus. Review of other causes of nonthrombotic pulmonary embolism revealed fat, bone marrow, amniotic fluid, trophoblast, tumours, septic material, hydatid cysts, bone, soft tissue/organ parenchyma, gastrointestinal tract contents/bile, gas, and foreign material that was introduced iatrogenically and non-iatrogenically. All of these possibilities should be considered at autopsy in the appropriate setting, with pulmonary microscopy often being essential to establishing the diagnosis.

Many people are living in prison with a range of social care needs, for example, requiring support with washing, eating, getting around safely, and/or maintaining relationships. However, social care for this vulnerable group is generally inadequate. There is uncertainty and confusion about who is legally responsible for this and how it can best be provided, and a lack of integration with healthcare. We used realist-informed approaches to develop an initial programme theory (IPT) for identifying/assessing social care needs of, and providing care to, male adults in prison and on release. IPT development was an iterative process involving (a) an initial scoping of the international prison literature; (b) scoping prison and community social care policy documents and guidelines; (c) full systematic search of the international prison social care literature; (d) insights from the community social care literature; (e) stakeholder workshops. Information from 189 documents/sources and stakeholder feedback informed the IPT, which recommended that models of prison social care should be: trauma-informed; well integrated with health, criminal justice, third-sector services and families; and person-centred involving service-users in all aspects including co-production of care plans, goals, and staff training/awareness programmes. Our IPT provides an initial gold standard model for social care provision for people in prison and on release. The model, named Empowered Together, will be evaluated in a future trial and will be of interest to those working in the criminal justice system, care providers and commissioners, local authorities, housing authorities, voluntary groups, and service-users and their families.

Opioid abuse is a leading cause of drug-related morbidity and mortality worldwide. It has been suggested that the age of opiate users in Australia is rising. To evaluate this further in a local population, toxicology and pathology case files from Forensic Science SA, Adelaide, South Australia, were examined for all cases with lethal opioid levels from 2000 to 2019 (n = 499; M:F 2.3:1; age range 18-91 years, median age 42 years). The median age of opiate deaths increased significantly by approximately 16 years (p = 0.007, R²= 0.34) with a significant increase in total deaths in the 45-54 years and 55-64 years age groups (p = 0.009, R²= 0.32) (p = < 0.001, R²= 0.54). Deaths due to heroin overdose showed the lowest median age (39 years, n = 184), with deaths from tramadol toxicity having the highest (50.5 years, n = 32). Recent changes in the demographic profile of opioid users in cases of lethal overdose involve an aging population. Forensic and clinical practitioners should be aware of significant opioid abuse in certain individuals at older ages as this raises the possibility that this may exacerbate the effects of age-related chronic diseases in this group and/or contribute to fatalities.

The methods employed to detect latent fingerprints during crime scene investigations are continually refined and enhanced. The implementation of dusting techniques on surfaces that are unfeasible for laboratory transport often yields a lower percentage of identifiable fingerprints. This issue is predominantly due to the inherent properties of these surfaces and their respective levels of contamination. Furthermore, the application of laboratory procedures, typically designated for the cyanoacrylate fuming method, is of paramount importance for efficient fingerprint development in field conditions. In this study, five donors (three males and two females) deposited natural fingerprints on readily available materials in day-to-day life, such as microscope slides, both rough and smooth mica, and galvanized sheet metal. The analysis of fingerprints was conducted at seven distinct time intervals: 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months. Each of the 280 fingerprints used was divided into two equal parts, resulting in a total of 560 fingerprint segments for examination. The findings of the current study showed that 52.9% of fingerprints suitable for identification were developed with the dusting method, 89.3% with the cyanoacrylate fuming method, and 95% especially with the cyanoacrylate spraying method. These results underscore the potential significance of the cyanoacrylate spraying method as an essential scientific technique in the resolution of criminal cases.