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Current Practice in Forensic Medicine, Volume 2


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Table of Contents

List of Contributors ix Preface xix Chapter One: DNA contamination - a pragmatic clinical view 1 Contamination considerations 1 DNA profiling 6 DNA deposits 10 Decontamination 11 General approach to DNA decontamination 20 Contamination 20 Cleaning and the DNA laboratory 22 Cleaning and decontamination of forensic examination suites - the way forward 26 References 31 Chapter Two: The toxicity of the novel psychoactive substances 35 Introduction 35 Acute toxicity 35 Chronic toxicity 40 Deaths 41 References 44 Chapter Three: Postmortem gastric content analysis: its role in determining time since death 47 Introduction 47 The physiology of gastric emptying 48 Gastric motility and emptying 49 Methods for measuring gastric emptying 52 Experimental studies 52 Factors affecting gastric emptying (in adults) 53 Analysis of gastric contents 56 Usefulness of gastric contents in time of death estimations 61 Conclusion 62 Acknowledgments 63 References 63 Chapter Four: Conducted energy devices 67 Overview 67 What are conducted energy devices? 67 Modes of use of the TASER (R) X26, TASER (R) X26P and TASER (R) X2 68 The electrical outputs of the TASER (R) X26, X26P and X2 68 Operationally exploited effects of TASER (R) CEDs: pain and neuromuscular incapacitation 70 Adverse effects associated with use of the TASER (R) X26 71 Conclusions 76 References 77 Chapter Five: Autoerotic deaths 81 Historical context 81 Definition 83 Incidence 85 Investigation of autoerotic deaths 86 Typical methods of autoerotic death 88 Atypical methods of autoerotic deaths 91 Typical and atypical victims 92 Summary 94 References 94 Chapter Six: Excited Delirium Syndrome: aetiology, identification and treatment 97 Introduction 97 Aetiology 101 Diagnosis 103 Initial approach and work ]up 104 Medication treatment options for ExDS 106 Supportive treatment 110 Conclusions 112 References 114 Chapter Seven: Automatism - wading through the quagmire 119 Introduction 119 Definitions of automatism 120 The law 121 Medical conditions capable, or possibly capable, of founding a defence of automatism 123 Sentencing and mitigation 134 Proposals for reform in England and Wales 135 Acknowledgments 135 Law reports 135 References 136 Chapter Eight: Classification of personality disorders, clinical manifestations and treatment 139 Introduction 139 What is personality disorder? 139 Dimensional or categorical diagnostic approaches? 141 Prevalence 142 The hybrid model 143 Assessment 143 Specific issues in forensic medicine settings 149 References 150 Chapter Nine: Driving impairment: the main risk factors 153 Introduction 153 Legislative approaches 155 Sobriety assessment 158 Specific drugs 162 Forensic specimens in drug driving cases 168 Medical conditions and fitness to drive 169 Sleep deprivation 171 Conclusions 172 References 172 Chapter Ten: Risk factors for death or harm to health for detainees in short ]term police custody 179 Introduction 179 The background to healthcare in police custody 179 The nature of health problems of detainees 180 Deaths and harm in police custody 185 Excited Delirium Syndrome 190 Broad principles of care 191 Identification and diversion 197 Prevention of death and harm in police custody 202 References 203 Chapter Eleven: The utility of radiological investigation of suspected abusive head trauma in children 207 Introduction 207 Injury patterns 207 Anatomy of the head 208 Scalp injury 209 Skull injury 209 Estimate of time of injury of skull fractures 213 Mimics of skull fractures 214 Tips for investigating suspected skull fracture 217 Intracranial manifestations of head injury 218 Subdural haemorrhage 219 Subarachnoid haemorrhage 233 Extradural haemorrhage 234 Cortical contusions 235 Diffuse axonal injury (shear injury) 235 Brain oedema, swelling and hypoxic ischaemic brain injury 236 Conclusion 240 References 240 Chapter Twelve: Child maltreatment: detection and diagnosis 243 Introduction 243 Defining child abuse and neglect 244 The physician's role in detecting child abuse 244 Contributing and risk factors for child abuse 246 General signs and symptoms of child abuse 246 Physical signs of child abuse 247 Fabricated or induced illness 257 Specific clinical presentations suspect for child abuse 259 Recognizing neglect 260 Screening instruments for detection of child abuse in Emergency Departments 260 Medical conditions that mimic child abuse 262 Summary and conclusion 262 References 265 Chapter Thirteen: Recovery of remains in potential crimes against humanity investigations - a forensic anthropological approach 269 Forensic anthropology and investigations into human rights violations and crimes against humanity 269 The characteristics of forensic anthropological investigations into human rights violations and crimes against humanity 272 The main mistakes made in forensics 274 Phases of the forensic anthropological investigation in the context of human rights violations 275 A multidisciplinary approach 281 Complex cases 282 Lessons learned and considerations 283 Conclusions 284 Acknowledgments 284 References 285 Chapter Fourteen: Field missions 287 Introduction 287 S: Situation 288 M: Mission 289 E: Execution 289 A: Administration and logistics 291 C: Communications and command 295 S: Security 295 Other mission ]related matters 296 Strategic security assessments 297 Conclusion 311 Appendix A-Mission plan template 312 Appendix B-Example of team functions for personnel required for the exhumation of human remains from a mass grave 314 Index 317

About the Author

Dr John Gall is a consultant forensic physician. He is Director of Southern Medical Services Pty Ltd; Associate Professor in the Department of Paediatrics at The University of Melbourne; Consultant at the Victorian Forensic Paediatric Medical Service at the Royal Children's Hospital and Monash Medical Centre; President of the World Police Medical Officers; and Vice-President of the Australasian Association of Forensic Physicians. Jason Payne-James is a Consultant Forensic Physician & Specialist in Forensic & Legal Medicine. He is Honorary Consultant at the Paediatric & Emergency Medicine at St George's Hospital, London; Honorary Senior Lecturer at the Cameron Forensic Medical Sciences, Barts and the London SMD; President at the Faculty of Forensic & Legal Medicine (Royal College of Physicians); and Director of Forensic Healthcare Services Ltd.

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