The developmental and criminal histories of subgroups of sexual murderers engaging, or not engaging, in post mortem sexual interference, compared to rapists

Purpose Identifying factors that may predict sexual aggression in the context of directly sexual murder, indirectly sexual murder, and non-fatal outcomes is necessary for advancing a field lacking a substantiated multifactorial theoretical model. Methods Eighty-nine sexual murderers engaging in post mortem sexual interference were compared to 92 non-post mortem sexual interference sexual murderers and 72 rapists on developmental factors, adult lifestyle, and criminal history. An overall model was built using a series of multinomial logistic regression analyses. Results Unlike rapists, both groups of sexual murderers experienced a lack of success in sexually intimate relationships. Perpetrators of post mortem sexual interference were rarely necrophiles, but having a history of sadistic behaviors or interests uniquely predicted sexual murder involving post mortem sexual interference. Chronic violent and sexual offending was characteristic of rapists. Psychopathy, measured using the screening version of the Psychopathy Checklist (Hart, Cox, & Hare, 1995), was not predictive of any outcome. Conclusion Results support criticism of existing theoretical models; that they do not apply to non-sadistic sexual murder. Findings are discussed in relation to gaps in theoretical understanding of sexual murder, and concerning implications for forensic policies and practice

“We boil at different degrees”: factors associated with severity of attack in sexual killing

Degree of injury, as measured by the Homicide Injury Scale (HIS), was examined to advance understanding of the dynamics of sexual killing. A total of 350 nonserial, male sexual killers were included, and the different ways that the sexual element of their offenses and the act of killing were connected was accounted for by determining that cases were either directly sexual (the sexual element and killing were closely bound), or indirectly sexual (killing was not a source of sexual stimulation). The two groups, direct and indirect sexual killers, were each subjected to multiple linear regression analyses to examine the group-specific relationship between level of injury and predictor variables previously found to be associated with increased severity of attack. No differences in the mean total HIS scores between the indirect and the direct cases were found, suggesting a comparable emotional intensity between the groups. However, given that the groups differed in terms of the functional role of fatal violence, severity of attack could not be sufficiently explained as driven by anger. In line with this hypothesis, different predictors appeared to be associated with increased degree of injury sustained by victims of indirect compared with direct sexual killers. As such, situational components appear to play a role in the behavior of indirect sexual killers, whereas the behavior of direct perpetrators tends to be linked with the enactment of existing deviant fantasies. The role of anger in sexual homicide is discussed further, and overall, it is argued that irrespective of whether violence was initially driven by anger, evidence of sexual arousal to severe violence must be scrutinized within sexual homicide research as well as in psycholegal contexts

The use of crime scene and demographic information in the identification of non-serial sexual homicide

As with other sexual offenders, sexual homicide perpetrators can be reluctant to talk about their criminal behavior. Therefore, in homicide cases, forensic practitioners frequently rely on crime scene information to identify any sexual behavior associated with the offense. This study aims to identify objective and readily available crime scene information, alongside information about victims and perpetrators, based on 65 cases from England and Wales in the United Kingdom of men convicted of homicide who had committed a non-serial sexual homicide and 64 cases of men convicted of homicide where the available evidence indicated that it was a non-serial non-sexual homicide. Chi-square tests and logistic regression were used to analyze the data. There were few differences in terms of demographic information and criminal histories between the two perpetrator groups. There were crime scene indicators supporting the use of Ressler et al.’s definition of sexual homicide. The victims of sexual homicide were generally found in their home with the lower half of the body exposed and with evidence of vaginal sex. Furthermore, extreme injuries and strangulation were more frequent in sexual homicides. Use of weapon was associated with a non-sexual homicide. Victims of sexual homicide were as likely to know the perpetrator as not. Potential benefits of the characteristics reported to investigators and forensic practitioners tasked with identifying sexual homicides are discussed and areas for further research suggested

Cause of Death in Long-Term Substance Use: A Scoping Study and Review of The Implications For End of Life and Palliative Care

Older people who use substances are more likely than general populations to have complex non-cancer pathologies which are under-represented in palliative care services. Our work explores mortality and morbidity relevant to end of life care and reveals discrepancies in provision for people who use substances, identifying possible explanations. We make recommendations for improved governance to inform policy and practice change

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Sexual murderers: psychological and criminological factors in diverse types

Studies of sexual murder are abundant, but an empirically supported understanding of this type of crime and its perpetrators is limited in important ways. The overall aim of this thesis was to work towards a theoretical model recognising that sexual murder is a heterogeneous concept. Also, the thesis aimed to understand sexual murder in the wider context of sexual aggression against adult women. First, a systematic review was conducted to clarify the existing typologies of sexual murder. Three consistently observed subtypes were found. These were labelled sexualised murder, grievance murder, and rape murder. A behaviour that could be used to differentiate groups was post mortem sexual interference (PMSI), indicative of sexualised murder. Subsequently, a study was conducted comparing subgroups of sexual murderers (those who had engaged in PMSI, and those who had not), and rapists, on developmental factors, adult lifestyle, and criminal career. The main finding was that the groups responded differently to early adversity. Difficulties with social and sexual relationships leading to the development of sadistic interests, as opposed to pervasive antisociality, distinguished PMSI sexual murderers from rapists, while non-PMSI sexual murderers were largely similar to rapists. However, although the role of psychopathy in sexual aggression is debated, no group was strongly characterised by psychopathy in the present study. A secondary study was conducted to verify that this finding was not associated with limitations in the assessment tool used (the Psychopathy Checklist: Screening Version [PCL: SV]; Hart, Cox, & Hare, 1995). Good psychometric properties were found. Next, a case study demonstrated the functional heterogeneity of the act of killing under the broadly defined term ‘sexual murder’, and highlighted the importance of this in forensic case formulation and intervention. Finally, drawing on the findings of the present research, a new model of sexual murder is proposed to address some of the issues discussed in this thesis

Sexual murderers: psychological and criminological factors in diverse types

Studies of sexual murder are abundant, but an empirically supported understanding of this type of crime and its perpetrators is limited in important ways. The overall aim of this thesis was to work towards a theoretical model recognising that sexual murder is a heterogeneous concept. Also, the thesis aimed to understand sexual murder in the wider context of sexual aggression against adult women. First, a systematic review was conducted to clarify the existing typologies of sexual murder. Three consistently observed subtypes were found. These were labelled sexualised murder, grievance murder, and rape murder. A behaviour that could be used to differentiate groups was post mortem sexual interference (PMSI), indicative of sexualised murder. Subsequently, a study was conducted comparing subgroups of sexual murderers (those who had engaged in PMSI, and those who had not), and rapists, on developmental factors, adult lifestyle, and criminal career. The main finding was that the groups responded differently to early adversity. Difficulties with social and sexual relationships leading to the development of sadistic interests, as opposed to pervasive antisociality, distinguished PMSI sexual murderers from rapists, while non-PMSI sexual murderers were largely similar to rapists. However, although the role of psychopathy in sexual aggression is debated, no group was strongly characterised by psychopathy in the present study. A secondary study was conducted to verify that this finding was not associated with limitations in the assessment tool used (the Psychopathy Checklist: Screening Version [PCL: SV]; Hart, Cox, & Hare, 1995). Good psychometric properties were found. Next, a case study demonstrated the functional heterogeneity of the act of killing under the broadly defined term ‘sexual murder’, and highlighted the importance of this in forensic case formulation and intervention. Finally, drawing on the findings of the present research, a new model of sexual murder is proposed to address some of the issues discussed in this thesis