Prone restraint death: Possible role of the Valsalva maneuver.

There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint death is essentially the end-result of a violent physical altercation wherein a combative individual suddenly loses consciousness while trying to counteract an opposing force. The direct correlations of increased static weight force with decreased inferior vena cava diameter, decreased cardiac output, and decreased stroke volume in prone restraint studies suggest that decreased venous return and decreased cardiac output could have a significant role to play in prone restraint death. Although the degree of changes observed in those studies might not be sufficient to cause cardiac arrest, they could predispose people who instinctively try to free themselves of the restraints to severe complications. The Valsalva maneuver, or forceful expiration against a closed airway, is frequently performed spontaneously in daily activities involving straining and resistance exercise, but has never been considered in restraint death. Pre-existing diminished venous return could increase the risk of major complications in individuals performing the Valsalva maneuver. A substantial decrease in venous return and cardiac output could increase the risk of cerebral hypoperfusion, loss of consciousness, hypoventilation, and sudden death. By increasing the risk of increased intra-abdominal pressure and its negative effect on venous return, high body mass index may be a significant risk factor in prone restraint death. The Valsalva maneuver may have different roles in prone restraint cardiac arrest and might be overlooked in prone restraint death.

Myxomycete biodiversity on five islands of the Seychelles.

A survey of myxomycete diversity on five islands of the Seychelles yielded 105 species and 10 infra-specific taxa, which included 89 species on La Digue, 66 on Praslin, 63 on Mahé, 31 on Curieuse and 4 on Félicité. Among these records, 64 species are new for the Seychelles and together with data from the literature, 143 species of myxomycetes are now known for all of the Seychelles. Most collecting on all five islands was carried out in low elevation areas. Forty-four species (73% of all specimens of myxomycetes) were found in low-elevation localities, and among these were Arcyria helvetica, Dictydiaethalium dictyosporum, Echinostelium paucifilum, Physarum aeneum, Ph. echinosporum, Reticularia olivacea, and Stemonaria longa. From 54 species of plants used by myxomycetes as substrates, eight species provided 63% of the specimens of myxomycetes, with most samples recorded from Calophyllum inophyllum. On the basis of substrate type, myxomycetes were distributed as follows: 37% of specimens were collected on dead wood and decaying palm stems, 16% on the bark and stems of living plants, 25% on ground litter, and 22% on aerial litter. A comparison of the assemblages of myxomycetes found in zones with different levels of human impact indicated that 84 species were found in forests, 74 in anthropogenic areas, and 62 in recreational coastal areas. The Seychelles provide a good background for a high level of myxomycete diversity, as a consequence of favorable climatic conditions and their location between Asia and Africa.

Restraint related deaths and excited delirium syndrome in Ontario (2004-2011).

Restraint related death in individuals in excited delirium syndrome (ExDS) is a rare event that has been the subject of controversies for more than 3 decades. The purpose of this retrospective study was to retrieve data on all restraint related deaths (RRD) that occurred in Ontario during an 8-year period and compare them with an earlier study on RRD in ExDS covering the period 1988-1995 in Ontario. The Office of the Chief Coroner of Ontario website was consulted under verdicts and recommendations. The Canadian Legal Information Institute website was used to consult verdict explanations and coroner's summary of evidence. During the period 2004-2011, RRD occurred in 14 individuals in ExDS, a 33% reduction. Psychiatric illness as a cause of ExDS decreased from 57% to 14%. Cocaine was the cause of ExDS in 11 (79%) individuals. The number of RRD following a violent encounter in cocaine-induced ExDS (8) was identical in the 2 periods. RRD occurred in 6 individuals without ExDS following a violent encounter. Final restraint position preceding cardiorespiratory arrest was available in 36% of individuals with ExDS and 83% of individuals without ExDS. In both groups, cardiorespiratory arrests could be classified as immediate or delayed. All 4 individuals without ExDS who had immediate cardiorespiratory arrests were restrained in the prone position. Delayed cardiorespiratory arrest occurred in the non-prone position in both groups. Although many hypotheses may be put forward to explain changes in the epidemiology of RRD in ExDS in Ontario, multiple warnings and recommendations from coroners' inquests cannot be ignored. There is probably not a unique pathophysiological pathway leading to cardiorespiratory arrest in RRD. The death rate in RRD in ExDS is so low that drawing any conclusions based on statistical studies or on isolated case report could be hazardous.