reading

Cover
Title Page
List of Contributors
Preface
1 DNA contamination – a pragmatic clinical view
1. Contamination considerations
2. DNA profiling
3. DNA deposits
4. Decontamination
5. General approach to DNA decontamination
6. Contamination
7. Cleaning and the DNA laboratory
8. Cleaning and decontamination of forensic examination suites – the way forward
9. References
2 The toxicity of the novel psychoactive substances
1. Introduction
2. Acute toxicity
3. Chronic toxicity
4. Deaths
5. References
3 Postmortem gastric content analysis: its role in determining time since death
1. Introduction
2. The physiology of gastric emptying
3. Gastric motility and emptying
4. Methods for measuring gastric emptying
5. Experimental studies
6. Factors affecting gastric emptying (in adults)
7. Analysis of gastric contents
8. Usefulness of gastric contents in time of death estimations
9. Conclusion
10. Acknowledgments
11. References
4 Conducted energy devices
1. Overview
2. What are conducted energy devices?
3. Modes of use of the TASER® X26, TASER® X26P and TASER® X2
4. The electrical outputs of the TASER® X26, X26P and X2
5. Operationally exploited effects of TASER® CEDs: pain and neuromuscular incapacitation
6. Adverse effects associated with use of the TASER® X26
7. Conclusions
8. References
5 Autoerotic deaths
1. Historical context
2. Definition
3. Incidence
4. Investigation of autoerotic deaths
5. Typical methods of autoerotic death
6. Atypical methods of autoerotic deaths
7. Typical and atypical victims
8. Summary
9. References
6 Excited Delirium Syndrome
1. Introduction
2. Aetiology
3. Diagnosis
4. Initial approach and work‐up
5. Medication treatment options for ExDS
6. Supportive treatment
7. Conclusions
8. References
7 Automatism – wading through the quagmire
1. Introduction
2. Definitions of automatism
3. The law
4. Medical conditions capable, or possibly capable, of founding a defence of automatism
5. Sentencing and mitigation
6. Proposals for reform in England and Wales
7. Acknowledgments
8. Law reports
9. References
8 Classification of personality disorders, clinical manifestations and treatment
1. Introduction
2. What is personality disorder?
3. Dimensional or categorical diagnostic approaches?
4. Prevalence
5. The hybrid model
6. Assessment
7. Specific issues in forensic medicine settings
8. References
9 Driving impairment
1. Introduction
2. Legislative approaches
3. Sobriety assessment
4. Specific drugs
5. Forensic specimens in drug driving cases
6. Medical conditions and fitness to drive
7. Sleep deprivation
8. Conclusions
9. References
10 Risk factors for death or harm to health for detainees in short‐term police custody
1. Introduction
2. The background to healthcare in police custody
3. The nature of health problems of detainees
4. Deaths and harm in police custody
5. Excited Delirium Syndrome
6. Broad principles of care
7. Identification and diversion
8. Prevention of death and harm in police custody
9. References
11 The utility of radiological investigation of suspected abusive head trauma in children
1. Introduction
2. Injury patterns
3. Anatomy of the head
4. Scalp injury
5. Skull injury
6. Estimate of time of injury of skull fractures
7. Mimics of skull fractures
8. Tips for investigating suspected skull fracture
9. Intracranial manifestations of head injury
10. Subdural haemorrhage
11. Subarachnoid haemorrhage
12. Extradural haemorrhage
13. Cortical contusions
14. Diffuse axonal injury (shear injury)
15. Brain oedema, swelling and hypoxic ischaemic brain injury
16. Conclusion
17. References
12 Child maltreatment
1. Introduction
2. Defining child abuse and neglect
3. The physician’s role in detecting child abuse
4. Contributing and risk factors for child abuse
5. General signs and symptoms of child abuse
6. Physical signs of child abuse
7. Fabricated or induced illness
8. Specific clinical presentations suspect for child abuse
9. Recognizing neglect
10. Screening instruments for detection of child abuse in Emergency Departments
11. Medical conditions that mimic child abuse
12. Summary and conclusion
13. References
13 Recovery of remains in potential crimes against humanity investigations – a forensic anthropological approach
1. Forensic anthropology and investigations into human rights violations and crimes against humanity
2. The characteristics of forensic anthropological investigations into human rights violations and crimes against humanity
3. The main mistakes made in forensics
4. Phases of the forensic anthropological investigation in the context of human rights violations
5. A multidisciplinary approach
6. Complex cases
7. Lessons learned and considerations
8. Conclusions
9. Acknowledgments
10. References
14 Field missions
1. Introduction
2. S: Situation
3. M: Mission
4. E: Execution
5. A: Administration and logistics
6. C: Communications and command
7. S: Security
8. Other mission‐related matters
9. Strategic security assessments
10. Conclusion
11. Appendix A‐Mission plan template
12. Appendix B‐ Example of team functions for personnel required for the exhumation of human remains from a mass grave
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Summary and comparison of sterilization and effective cellular DNA decontamination.
Chapter 02
1. Table 2.1 Main classes of new psychoactive substances (NPS).
Chapter 03
1. Table 3.1 Gastric emptying times of different sized meals, as stated in the literature. The validity of these is questionable, particularly for ‘larger’, ‘heavy’ and ‘gigantic’ meals since estimates are not consistent with controlled physiological studies. Determination of gastric emptying time should not be made from meal size alone.
2. Table 3.2 Factors that may (not necessarily will) affect gastric emptying.
3. Table 3.3 Perper’s protocol for analysis of gastric contents.
Chapter 06
1. Table 6.1 2013 ICD‐10 diagnostic codes.
2. Table 6.2 ExDS brief differential diagnosis.
3. Table 6.3 SMASHED: mnemonic for differential diagnosis of altered mental status.
4. Table 6.4 AEIOU TIPS: mnemonic for abbreviated differential diagnosis of altered mental status.
5. Table 6.5 Sedative medications for use in ExDS.
Chapter 08
1. Table 8.1 Features to assist identification of personality disorder.
Chapter 09
1. Table 9.1 Estimated road traffic death rate per 100,000 population, 2010.
2. Table 9.2 UK proposals for drug threshold limits.
Chapter 11
1. Table 11.1 Evolution of subdural haemorrhage on CT.
2. Table 11.2 Evolution of intracranial blood on MRI.
Chapter 12
1. Table 12.1 Risk factors for child maltreatment.
2. Table 12.2 General signs and symptoms of child abuse.
3. Table 12.3 Fractures likely to be caused by inflicted trauma.
4. Table 12.4 Features alerting for fabricated or induced illness.
5. Table 12.5 Clinical presentations of child neglect.
6. Table 12.6 Medical conditions that have been mistaken for child abuse.
Chapter 13
1. Table 13.1 Examples of Truth Commissions around the world.
2. Table 13.2 Comparison of two types of investigation.
3. Table 13.3 Examples of different sources of background information.
4. Table 13.4 Recommendations for investigations.

List of Illustrations

Chapter 03
1. Figure 3.1 Emptying patterns of a test solid meal in normal males and females. Note: Females are represented by the open squares and males by the filled squares.
2. Figure 3.2 Scanning electron micrograph (× 280) of chewed onion cells showing their characteristic elongate rectangular shape.
3. Figure 3.3 Dispersed raphides from pineapple. Raphides occur as neat bundles within intact pineapple parenchymal cells.
Chapter 05
1. Figure 5.1 This man was found hanging in the basement of his secured house after family members went to check on his welfare. The decedent was suspended by a large chain, hooked through a sawed hole in an upstairs floor board, and secured to a wooden basement ceiling beam. The decedent was also suspended by a ratchet strap attached to the large chain near the beam via a steel hook. Both the chain and strap were tied to his waist; the decedent was wearing a plastic refuse bag at his waist, which covered the chain and strap tied to his waist. His right wrist was chained and locked to the waist chain. His left arm was free. His legs were secured with duct tape at the knees and strapped at the ankles. Parts of a plastic bag were found on his head. This was secured at the neck with duct tape (the plastic bag was already open at the face when the decedent was found). The duct tape and plastic bag at the neck acted as a ligature and the cause of death was hanging.
2. Figure 5.2 The decedent was found in the bathroom. The mother, worried about the welfare of her son, had asked the decedent’s brother to force open the door. The decedent was found fully suspended by two ligatures. One was tied bilaterally from his ankles to the shower stall; the second was tied from the shower stall to his neck. The second ligature was cut by the brother after forcing the door. The decedent’s right wrist was bound to an elastic material tied to his upper thighs. The left wrist and arm were free. A trolley was found nearby, with multiple towels. The trolley was apparently use by the decedent to set up the suspension and then pushed away. The cause of death was hanging.
Chapter 06
1. Figure 6.1 ExDS response measures and indicators.
Chapter 08
1. Figure 8.1 The interpersonal circumplex and personality disorders.
Chapter 10
1. Figure 10.1 Total number of deaths in or following police custody (England and Wales), 1998/9–2008/9.
2. Figure 10.2 Primary cause of death in custody in England and Wales, 1998/9–2008/9.
3. Figure 10.3 Excited Delirium Syndrome pocket card (front and back) for law enforcement and EMS providers created by the work of the National Institute of Justice Technology Working Group (TWG) on Less‐Lethal Devices.
4. Figure 10.4 Example of a completed Risk assessment questionnaire used in the Metropolitan Police Service, London, (modified continuously): similar to many across the United Kingdom.
5. Figure 10.5 Reasons why the deceased was taken to hospital following an arrest, England and Wales, 1998/9–2008/9.
6. Figure 10.6 PolQuest.
7. Figure 10.7 Pathways following the PolQuest questionnaire.
Chapter 11
1. Figure 11.1 Diagrammatic representation of a sagittal midline section through the brain demonstrating the relationship of the major venous sinuses, cerebrospinal fluid spaces and meningeal layers.
2. Figure 11.2a Lateral skull radiograph in a young infant demonstrating multiple complex, diastatic occipital and posterior parietal skull fractures (white arrows).
3. Figure 11.2b Lateral skull radiograph demonstrating a large parieto‐occipital scalp haematoma (A) overlying a posterior parietal (B) and occipital (C) skull vault fractures.
4. Figure 11.2c Three‐dimensional CT model of the skull vault demonstrating multiple complex diastatic skull vault fractures (arrows) of the parieto‐occipital region.
5. Figure 11.3a Frontal Townes view skull radiograph demonstrating multiple bilateral skull vault fractures (arrows) which cross sutures.
6. Figure 11.3b Posterior view of a three‐dimensional CT model of the skull vault demonstrating multiple bilateral skull vault fractures (arrows) extending to the asymmetrically widened sagittal suture (A).
7. Figure 11.4 Lateral three‐dimensional CT model of the skull vault demonstrating a curvilinear frontal fracture (single arrow) and a diastatic posterior parietal fracture (two arrows).
8. Figure 11.5 Axial CT slice of the skull vault demonstrating a depressed right parietal fracture (arrow).
9. Figure 11.6 Three‐dimensional CT model of the skull vault demonstrates indentation in the right posterior parietal region, the so‐called ping‐pong fracture (arrows).
10. Figure 11.7 Frontal skull radiograph demonstrating normal cranial vault sutures (arrows), which should not be mistaken for fractures.
11. Figure 11.8 Frontal skull radiograph demonstrating bilateral, short, linear lucencies (arrows) which persisted, confirmed to be accessory sutures.
12. Figure 11.9 Lateral skull radiograph demonstrating a branching linear lucency in the frontal region from a prominent vascular impression.
13. Figures 11.10a and 11.10b Three‐dimensional CT reformats demonstrating the presence of Wormian bones in the lambdoid sutures bilaterally (arrows).
14. Figure 11.11a Frontal skull radiograph demonstrating the presence of two well‐defined parasagittal lucencies at the apex of the skull vault consistent with parietal foramina (arrows).
15. Figure 11.11b Posterior view of a three‐dimensional CT reformat of the skull vault demonstrating bilateral parasagittal parietal foramina (arrows).
16. Figure 11.12 Diagrammatic representation of the membranes and meningeal coverings around the brain.
17. Figure 11.13 Diagrammatic representation of the spaces into which haemorrhage occurs around the brain.
18. Figure 11.14a Axial T1‐weighted MRI image demonstrating bilateral low‐signal chronic subdural collections (arrows).
19. Figure 11.14b Axial T2‐weighted MRI image demonstrating bilateral high‐signal subdural collections (arrows) with signal slightly lower than that of CSF in the ventricles due to the presence of blood products.
20. Figure 11.15 Axial CT slice through the parietal lobes demonstrating a bright and irregularly thickened interhemispheric fissure due to the presence of interhemispheric fissure subdural blood (arrow).
21. Figure 11.16 Axial CT slice through the parietal lobes demonstrating acute on chronic subdural haemorrhage. Left parietal fracture associated with overlying high‐density scalp haematoma (A). Right frontal low‐density, chronic subdural collection (B). High‐density material in the left frontal subdural space represents acute fresh subdural blood (C). Linear high‐density aligning the left frontal cortex represents acute subarachnoid haemorrhage (D).
22. Figure 11.17 Axial CT of the brain through the temporal lobes demonstrating enlarged, bilateral, low‐density subarachnoid spaces (arrows), which can be difficult to distinguish from chronic subdural collections.
23. Figure 11.18 High‐resolution coronal ultrasound image of the frontal lobes through the anterior fontanelle. Colour Doppler demonstrates a bridging vein crossing the subdural space (A). Ultrasound clearly differentiates between the chronic low‐density subdural collection (B) and the subarachnoid space aligning the brain parenchyma (C) and the intervening arachnoid mater.
24. Figure 11.19a Axial CT image through the brain on conventional soft tissue window settings.
25. Figure 11.19b Axial CT image through the brain at the same level after manipulation of the window to maximize detection of small amounts of blood. The small left frontal SDH is now clearly apparent (arrow).
26. Figure 11.20 Axial imaging through the parietal lobes using the gradient echo sequence which maximizes detection of blood products as extremely low‐signal foci, the so‐called blooming artefact (arrows).
27. Figure 11.21a Axial diffusion‐weighted image (DWI) through the occipital lobes demonstrating the areas of ischaemia depicted as abnormal high signal in the occipital lobes and lateral left thalamus (arrows).
28. Figure 11.21b The areas of abnormal high signal on DWI are matched by a reduction in signal on the apparent diffusion coefficient (ADC) map (arrows), confirming that this is true ischaemia and not artefact.
29. Figures 11.22a and 11.22b Axial images through the parietal lobes of two patients using the FLAIR sequence highlighting the higher‐signal subdural haemorrhages against the low‐signal CSF in the ventricles and subarachnoid space (arrows).
30. Figure 11.23a Coronal T2‐weighted sequence through the posterior parietal lobes demonstrating the presence of differing signal intensities in the subdural space. There is a large intermediate‐to‐low signal intensity collection around the left cerebral hemisphere (arrow A) and mixed high‐ (arrow B) and low‐signal collection around the right hemisphere.
31. Figure 11.23b Axial T2‐weighted image through the parietal lobes demonstrating bilateral mixed‐signal subdural collections due to haemorrhages of differing ages (arrows A, B and C). There is mass effect with compression of the underlying parietal lobes.
32. Figure 11.24 Axial T1‐weighted image through the parietal lobes demonstrating acute on chronic subdural haemorrhages on a background of parenchymal atrophy and encephalomalacia from prior ischaemic injury. There are bilateral, low‐signal subdural haemorrhages (arrow A). Acute subarachnoid haemorrhage seen as a high‐signal focus is evident on the left (arrow C) aligning with the encephalomalacic parietal lobe (arrow B).
33. Figure 11.25 Coronal CT image through the posterior parietal lobes demonstrating a large, acute, high‐density left parietal extradural haemorrhage (arrow A) associated with high‐density overlying scalp haematoma. There is significant mass effect and the linear high density of the displaced dura is evident (arrows).
34. Figure 11.26 Axial CT demonstrates two small high‐density haemorrhages in the posterior right thalamus (arrow). There is associated scalp haematoma on the right.
35. Figure 11.27 Axial CT image demonstrates brain oedema and swelling with effacement of the sulci and CSF spaces. There is diffuse low density throughout the parenchyma and loss of grey–white matter differentiation.
36. Figure 11.28 Axial CT through the temporal lobes demonstrates increased attenuation within the basal cisterns, the pseudo‐subarachnoid sign (arrows) in association with diffuse brain swelling, sulcal effacement and loss of grey–white matter differentiation.
37. Figure 11.29 Axial CT through the parietal lobes demonstrates the acute reversal sign with abnormally reduced parenchymal density and loss of grey–white matter differentiation, with relative preservation of the density of the thalami centrally. There is a small, low‐density right frontal subdural collection (A), a small left posterior parietal scalp haematoma (B) and high density along the posterior interhemispheric fissure due to the presence of a small acute falx subdural (C).
38. Figure 11.30 Axial CT through the parietal lobes in a patient with diffuse hypoxic brain injury with abnormal parenchymal attenuation (B). There is a bright and irregularly thickened falx due to the presence of an interhemispheric fissure subdural (C). There is a left frontal skull vault fracture (A) associated with a left fronto‐parietal scalp haematoma associated with subarachnoid blood (B).
39. Figure 11.31 Axial CT of a diffusely oedematous brain with loss of grey–white matter differentiation associated with a thin interhemispheric fissure subdural in the midline. There is splaying of the anterior fontanelle (A) and widening of the cranial sutures (B) from the raised intracranial pressure.
Chapter 12
1. Figure 12.1 Large haematoma of the cheek. This patient was said to have fallen in the bath for the second time.
2. Figure 12.2 Same patient as in Figure 12.1 with bilateral periorbital haematoma.
3. Figure 12.3 Bruising on the face and forehead without any explanation from the parents.
4. Figure 12.4 Five‐month‐old baby with multiple bruises on the face. She was found in the home of an inebriated mother who had been detained by the police in the street.
5. Figure 12.5 A typical belt mark.
6. Figure 12.6 A 14‐month‐old boy with an unexplained distal fracture of the right humerus, with periostal reaction.
7. Figure 12.7 The same boy as in Figure 12.16 with fractures of the olecranon and ulna with shortening of the radius and distal humerus of the left arm. The fractures of the olecranon and ulna are considered to be older than the humerus fracture.
8. Figures 12.8 An eight‐year‐old girl burned with a fork at multiple sites as punishment for bedwetting.
9. Figures 12.9 An eight‐year‐old girl burned with a fork at multiple sites as punishment for bedwetting.
10. Figure 12.10 A five‐year‐old girl placed on a gas‐heated radiator as a punishment for bedwetting. The parents said that they did not know the radiator was hot and that the girl did not cry.
11. Figure 12.11 A boy burned on the face with an iron.
12. Figure 12.12 Cigratte burns.
13. Figure 12.13 A one‐month‐old baby with an unexplained mid‐diaphyseal fracture of the left humerus.
14. Figure 12.14 The same infant as in Figure 12.13 one month later, with a fracture of the left femur and a diagnosis of osteogeneis imperfecta type III.