Medicine, Science and the Law最新文献

Medical damage liability is directly related to the diagnosis and treatment behavior of medical institutions. It is the most basic form of liability because patients enter the doctor-patient relationship with the expectation that they will receive highly professional medical services from the medical institution. This paper outlines the features of the development of China's medical damage liability system, points out the problems of the system in practice, and proposes improvements. It explores how to solve the legal dilemma of identifying medical liability in China from three perspectives: perfecting the formation and adoption procedures of expert opinions, standardizing the identification of fault by medical institutions, and standardizing the application of the rules of reducing liability for the cause.

When analysing bodies recovered from a watery environment, all manners of death, a variety of causes of death and the possibility of body disposal have to be considered. Unclear circumstances of death, unidentified victims and body decomposition may hamper a forensic investigation. The lack of specific and sensitive drowning-related autopsy findings and post-mortem blood alcohol levels (blood alcohol concentrations (BACs)) may also lead to erroneous conclusions. We reviewed the autopsy records for all bodies recovered from water in Friuli, northeastern Italy, over a 28-year period, focusing on death circumstances, autopsy findings and blood alcohol levels. Some unusual cases were examined separately. Among the 69 cases, there were 32 accidents, 13 suicides, 4 homicides, 6 natural and 14 undetermined deaths. Causes of death included 51 drownings, 6 undetermined, 5 cardiac deaths and 7 non-drownings. Six deaths in a bathtub and one diving-related death were also included. Acute alcohol intoxication was ascertained in 22 of 40 victims. Some significant limitations in the approach to water-related deaths have been highlighted: although emphysema aquosum and external foam resulted to be the most reliable indicators, a determination of drowning based exclusively on autopsy findings cannot be ascertained with certainty. Furthermore, it was found that the standard definitions of wet and dry drowning in the literature differ widely from a morphological perspective and this may lead to misleading outcomes. Post-mortem BAC changes have been critically analysed only in bodies found in cold water, and, in the absence of an alternative to blood specimens, the use of pre-set cut-off values is still necessary.

A study was undertaken to determine what injuries are associated with the wearing of seat belts and if the presence of cutaneous seat belt markings observed on victims of lethal vehicle crashes increased the likelihood of underlying injury. Autopsy reports from the files at Forensic Science South Australia were reviewed for all fatal motor vehicle crashes from January 2014 to December 2018. A total of 173 cases were included for analysis with 127 occupants wearing seat belts at the time of impact (73.4%) (age range = 18-93; mean = 45 M:F = 81:46). Of these, only 38 had external seat belt markings (29.9%) (age range = 19-83; mean = 49 M:F = 20:18). Logistic regression modelling showed that occupants who were wearing seat belts were more likely to experience closed head injury without skull fractures in addition to mesenteric and gastrointestinal injury. Increasing body mass index increased the incidence of seat belt markings (p < 0.01) and markings were more likely to be found in the presence of bilateral pelvic fractures. Thus, external seat belt markings were observed in only a minority of seatbelt wearers, and more often in individuals with higher BMIs and with bilateral pelvic fractures (possibly associated with greater momentum and impact force).

A rare and fatal complication of suction drainage of secondary spontaneous pneumothorax is reported. The patient, likely by a mistake, arbitrarily connected the oxygen supply tube to the thoracic drain. The sharp increase of intrapleural pressure combined with the atmospheric intraalveolar environment caused diffuse lung injury and cardiopulmonary collapse without a direct lung injury. The conflicting interests of patient autonomy and patient safety require further consideration.

The purpose of this study is to assess the accuracy of two multivariate statistical approaches for estimating sex from human external ear anthropometry, namely, discriminant function analysis (DFA) and binary logistic regression (BLR). A cross-sectional sample of 497 participants (233 males and 264 females) aged 18-35 years (24.42 ± 5.17) was obtained from Himachal Pradesh state of North India. Both the ears of the participants (994) were examined for anthropometric measurements. A total of 12 anthropometric measurements were taken independently on the left and right ear of each individual with the help of a pair of sliding calipers using a standard method. The sex of the population groups was discriminated against using binary logistic regression and discriminant function analysis. The predictive percentage of sex estimation computed from both the models were substantially the same, that is, 76.3% from DFA and 76.2% from BLR, with nearly comparable (∼0.02) sensitivity, specificity, positive predictive value, and negative predictive values, whereas the values of correct predicted percentage were 0.1% higher in DFA than BLR. Moreover, the other comparison metrics, such as classification error, B-index, and Matthews correlation coefficient indicated that both models performed equally well. The study highlighted that if the assumptions of the statistical methods are met, both methods are equally capable of discriminating the population depending on sex. The study recommends that the discriminant function analysis and binary logistic regression may be used synonymously in forensic research and case-work pertaining to the estimation of sex and various other forensic situations.

Manual scavenging in India refers to the manual removal of human excreta from private dwellings and facilities maintained by municipal authorities. Human waste is collected from public streets and pit latrines, sewers and gutters, and septic tanks with bare hands, brooms or metal scrapers, placed into woven baskets or buckets, and then carried to disposal sites. The work is generally restricted to those occupying the lowest levels of the Indian caste system. Manual scavengers suffer from considerable societal disadvantages in addition to increased morbidity and mortality, associated with drowning in sewage, and to exposure to asphyxiating gases and to a wide variety of local and systemic infectious diseases. Life expectancy is shortened. Despite the passage of various national laws and periodic intervention by the courts, the 'dehumanising' practice of manual scavenging continues. In 2021 the National Human Rights Commission stated that claims that there are no manual scavengers in particular states in India are simply untrue.

After Japan's post-war reconstruction, in the early 1950s, cases of double suicide, in which two people (particularly young lovers) leave a suicide note and die together, were a relatively frequent occurrence. During the three-year period between 1954 and 1956, 5466 suicides were recorded in the special wards of Tokyo, including 79 cases of double suicides, accounting for 158 deaths. In these double suicide cases (2.89% of all deaths by suicide), the evidence revealed that 65.8% involved lovers and 29.1% involved married couples. By contrast, contemporary data indicate a large drop in suicide pacts between lovers to 15.9% and an increase between spouses to 48.8%. Conceivably, the relatively high double-suicide rate after post-war reconstruction reflected difficulties for the younger generation in reconciling 'marriage based primarily on love' and the traditional family system, specifically marriage problems and stress caused by rapidly changing post-war values. One notable difference between victims of double suicide in 1954-1956 and the contemporary period is the younger average age of the former. Another important shift was found in the most common causes of death among victims of double suicide: in 1954-1956 these were poisoning by cyanide or hypnotic drugs, compared to carbon monoxide poisoning and hanging in modern times. We discuss similarities and differences concerning double suicides in relation to social and economic conditions in Japan in the 1950s and today.

Acid attacks involve dousing a victim with a concentrated acidic or caustic fluid. The head and face are most often targeted to maximize the chances of disfigurement, as the intention is usually to cause life-long disability, pain and lack of psychological wellbeing rather than death. In India it is often regarded as a form of gender-based violence aimed predominantly at women, frequently following the rejection of a proposed sexual relationship, however, a significant subset of cases involve males. Four cases are reported to demonstrate the different reasons for such attacks in males including revenge for reporting criminal activity, intra-familial disputes and apparently random episodes. Male acid attack victims may represent an over-looked subgroup that often does not receive adequate compensation or government support to access disability services, despite this being mandated by recent legislation.

In 1962, the first custodial Democratic Therapeutic Community (DTC) was established in the English prison estate at HMP Grendon. Today, the Category B male prison estate in England and Wales has three DTCs and three 'TC+' units for prisoners with learning disabilities. There is one DTC in the female estate at HMP Send. The services fall under the remit of the Offender Personality Disorder Pathway, a jointly commissioned initiative that aims to provide a pathway of psychologically informed services for a highly complex and challenging group of prisoners who are likely to have a severe personality disorder. Several of these units make clear that prisoners prescribed psychotropic medicines are specifically excluded from entry and participation in the available therapy. This analysis paper explores whether an evidence-based rationale exists for this practice and examines the impact on those whose care pathways may comprise hospitals and prisons.