State v. Cullen ( 2015 )


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  •                                      - 30 -
    Nebraska A dvance Sheets
    292 Nebraska R eports
    STATE v. CULLEN
    Cite as 
    292 Neb. 30
    State of Nebraska, appellee, v.
    Sarah A. Cullen, appellant.
    ___ N.W.2d ___
    Filed November 6, 2015.   No. S-14-509.
    1.	 Motions for Mistrial: Appeal and Error. Whether to grant a motion
    for mistrial is within the trial court’s discretion, and an appellate court
    will not disturb its ruling unless the trial court abused its discretion.
    2.	 Rules of Evidence: Other Acts: Appeal and Error. It is within the
    discretion of the trial court to determine relevancy and admissibility of
    evidence of other wrongs or acts under Neb. Evid. R. 404(2), 
    Neb. Rev. Stat. § 27-404
    (2) (Cum. Supp. 2014), and the trial court’s decision will
    not be reversed absent an abuse of discretion.
    3.	 Sentences: Appeal and Error. An appellate court will not disturb a sen-
    tence imposed within the statutory limits absent an abuse of discretion
    by the trial court.
    4.	 Judgments: Words and Phrases. An abuse of discretion occurs when a
    trial court’s decision is based upon reasons that are untenable or unrea-
    sonable or if its action is clearly against justice or conscience, reason,
    and evidence.
    5.	 Effectiveness of Counsel: Appeal and Error. Whether a claim of inef-
    fective assistance of trial counsel may be determined on direct appeal
    is a question of law. In reviewing claims of ineffective assistance of
    counsel on direct appeal, an appellate court decides only questions of
    law: Are the undisputed facts contained within the record sufficient to
    conclusively determine whether counsel did or did not provide effec-
    tive assistance and whether the defendant was or was not prejudiced by
    counsel’s alleged deficient performance?
    6.	 Rules of Evidence: Other Acts. Under Neb. Evid. R. 404(2), 
    Neb. Rev. Stat. § 27-404
    (2) (Cum. Supp. 2014), evidence of other crimes, wrongs,
    or acts is not admissible to prove the character of a person in order to
    show that he or she acted in conformity therewith. It may, however, be
    admissible for other purposes, such as proof of motive, opportunity,
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    intent, preparation, plan, knowledge, identity, or absence of mistake
    or accident.
    7.	 ____: ____. Neb. Evid. R. 404(2), 
    Neb. Rev. Stat. § 27-404
    (2) (Cum.
    Supp. 2014), does not apply to evidence of a defendant’s other
    crimes or bad acts if the evidence is inextricably intertwined with the
    charged crime.
    8.	 ____: ____. Inextricably intertwined evidence includes evidence that
    forms part of the factual setting of the crime, or evidence that is so
    blended or connected to the charged crime that proof of the charged
    crime will necessarily require proof of the other crimes or bad acts, or if
    the other crimes or bad acts are necessary for the prosecution to present
    a coherent picture of the charged crime.
    9.	 Criminal Law: Trial: Evidence: Appeal and Error. An error in admit-
    ting or excluding evidence in a criminal trial, whether of constitutional
    magnitude or otherwise, is prejudicial unless the error was harmless
    beyond a reasonable doubt.
    10.	 Verdicts: Juries: Appeal and Error. Harmless error review looks to
    the basis on which the jury actually rested its verdict; the inquiry is
    not whether in a trial that occurred without the error, a guilty verdict
    would surely have been rendered, but whether the actual guilty verdict
    rendered was surely unattributable to the error.
    11.	 Trial: Appeal and Error. In order to preserve, as a ground of appeal,
    an opponent’s misconduct during closing argument, the aggrieved party
    must have objected to improper remarks no later than at the conclusion
    of the argument.
    12.	 Trial: Evidence: Appeal and Error. An objection, based on a specific
    ground and properly overruled, does not preserve a question for appel-
    late review on any other ground.
    13.	 Appeal and Error. Plain error may be found on appeal when an error,
    unasserted or uncomplained of at trial, but plainly evident from the
    record, prejudicially affects a litigant’s substantial right and, if uncor-
    rected, would result in damage to the integrity, reputation, and fairness
    of the judicial process.
    14.	 Trial: Prosecuting Attorneys: Juries. Prosecutors are charged with the
    duty to conduct criminal trials in such a manner that the accused may
    have a fair and impartial trial, and prosecutors are not to inflame the
    prejudices or excite the passions of the jury against the accused.
    15.	 ____: ____: ____. A prosecutor’s conduct that does not mislead and
    unduly influence the jury does not constitute misconduct.
    16.	 Sentences. When imposing a sentence, a sentencing judge should con-
    sider the defendant’s (1) age, (2) mentality, (3) education and experi-
    ence, (4) social and cultural background, (5) past criminal record or
    record of law-abiding conduct, and (6) motivation for the offense, as
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    STATE v. CULLEN
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    well as (7) the nature of the offense, and (8) the amount of violence
    involved in the commission of the crime.
    17.	   ____. The appropriateness of a sentence is necessarily a subjective judg-
    ment and includes the sentencing judge’s observation of the defendant’s
    demeanor and attitude and all the facts and circumstances surrounding
    the defendant’s life.
    18.	   Postconviction: Effectiveness of Counsel: Proof: Appeal and Error.
    In order to show ineffective assistance of counsel under Strickland v.
    Washington, 
    466 U.S. 668
    , 
    104 S. Ct. 2052
    , 
    80 L. Ed. 2d 674
     (1984),
    a defendant must show, first, that counsel was deficient and, second,
    that the deficient performance actually caused prejudice to the defend­
    ant’s case.
    19.	   Effectiveness of Counsel: Proof: Presumptions: Appeal and Error.
    The two prongs of the ineffective assistance of counsel test under
    Strickland v. Washington, 
    466 U.S. 668
    , 
    104 S. Ct. 2052
    , 
    80 L. Ed. 2d 674
     (1984), may be addressed in either order, and the entire ineffective-
    ness analysis should be viewed with a strong presumption that counsel’s
    actions were reasonable.
    20.	   Effectiveness of Counsel: Proof. Prejudice caused by counsel’s defi-
    ciency is shown when there is a reasonable probability that but for
    counsel’s deficient performance, the result of the proceeding would have
    been different.
    21.	   Proof: Words and Phrases. A reasonable probability is a probability
    sufficient to undermine confidence in the outcome.
    22.	   Effectiveness of Counsel: Records: Appeal and Error. The fact that
    an ineffective assistance of counsel claim is raised on direct appeal does
    not necessarily mean that it can be resolved. The determining factor is
    whether the record is sufficient to adequately review the question.
    23.	   Trial: Effectiveness of Counsel: Evidence: Appeal and Error. An
    ineffective assistance of counsel claim will not be addressed on direct
    appeal if it requires an evidentiary hearing.
    24.	   Motions to Strike: Jury Instructions. When an objection to or motion
    to strike improper evidence is sustained and the jury is instructed to
    disregard it, such instruction is deemed sufficient to prevent prejudice.
    Appeal from the District Court for Douglas County: W.
    M ark Ashford, Judge. Affirmed.
    Barry S. Grossman and Michael J. Fitzpatrick for appellant.
    Douglas J. Peterson, Attorney General, and Stacy M. Foust
    for appellee.
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    STATE v. CULLEN
    Cite as 
    292 Neb. 30
    Heavican, C.J., Wright, Connolly, McCormack, Miller-
    Lerman, Cassel, and Stacy, JJ.
    Cassel, J.
    I. INTRODUCTION
    In this direct appeal, Sarah A. Cullen challenges her convic-
    tion, pursuant to jury verdict, and her sentence for intentional
    child abuse resulting in death.1 An infant died after being in
    Cullen’s care. She primarily argues that evidence of the child’s
    prior injuries while in her care should have been excluded
    as prior bad acts under rule 404 of the Nebraska Evidence
    Rules.2 We conclude that the prior injuries were inextricably
    intertwined with the fatal ones. We also reject Cullen’s asser-
    tions of improper closing argument, prosecutorial misconduct,
    excessive sentence, and ineffective assistance of trial counsel.
    Accordingly, we affirm.
    II. BACKGROUND
    1. Cash’s Injuries and Death
    Cash Christopher Bell, born in October 2012, was the son
    of Christopher (Chris) Bell and Ashley Bell. Prior to the events
    summarized below, Cash had no medical issues.
    In January 2013, the Bells hired Cullen to work temporarily
    as a nanny for Cash in their home, pending the opening of a
    new daycare in June 2013. Cullen’s first day alone with Cash
    was on January 7, when Ashley returned to work from mater-
    nity leave. Cash was about 3 months old.
    On the morning of February 28, 2013, Chris woke up at
    approximately 6 a.m. He changed Cash’s diaper, fed him a
    bottle, and then brought him downstairs to Ashley. Ashley put
    Cash in a bassinet while she finished getting ready for work.
    The Bells testified that it was a typical morning. Cash was
    active, making eye contact, smiling, cooing, and laughing.
    1
    See 
    Neb. Rev. Stat. § 28-707
     (Cum. Supp. 2012).
    2
    See Neb. Evid. R. 404(2), 
    Neb. Rev. Stat. § 27-404
    (2) (Cum. Supp. 2014).
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    Chris left for work between 6:45 and 7 a.m. Cullen arrived
    for work at the Bells’ home at 7:15 a.m. Ashley left for work
    around 7:40 a.m.
    Shortly after 9:19 a.m., Chris returned home to get his
    checkbook. As Chris entered the house, he yelled out to
    Cullen that he had forgotten his checkbook. He then heard
    Cash breathing. He turned and found Cash lying face down
    in the Pack ’N Play nearby. Chris rolled him over. Cash did
    not open his eyes, and he took “a little breath.” Cash’s blanket
    was around his face and chest area, and Chris moved it down
    to his waist. Chris believed that Cash was sleeping. At about
    the same time he heard Cash breathing, Chris heard Cullen in
    the nearby bathroom. After he rolled Cash over, Chris grabbed
    his checkbook. As he was leaving, he heard Cullen ask him if
    he woke Cash up. Chris estimated that he was in the house not
    more than a minute. As Chris was getting into his car, Cullen
    came to the door with Cash in her arms and asked Chris what
    he said when he first walked in the house. Chris could see only
    the back of Cash’s head.
    At approximately 10:15 a.m., Cullen called her boyfriend,
    Andrew Ullsperger, and told him that Cash was not breathing
    and that his feet were blue. Ullsperger immediately proceeded
    to the Bell residence to take Cash and Cullen to a local hospi-
    tal. When Ullsperger arrived at the Bell residence, Cash was
    not responsive, but he was breathing. Cullen told Ullsperger
    nothing about the events of that morning on the way to the
    hospital. When they arrived at the hospital’s emergency room,
    Cullen stated that she found Cash “sleeping on his belly and
    he doesn’t normally sleep like that.”
    Previously, Ashley had requested that Cullen log Cash’s
    diaper changes, feedings, naps, and anything else of note, and
    the last entry in the log was at 8 a.m. on February 28, 2013,
    when Cullen noted that Cash began to nap. At 10:18 a.m.,
    Cullen called Ashley and frantically told her that she was
    taking Cash to the hospital because Cash had just woken up
    from a 1- to 11⁄2-hour nap and was not breathing right. Ashley
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    and Chris later arrived at the emergency room where they
    waited with Cullen and Ullsperger. Ashley testified that she
    questioned Cullen during that time about whether anything
    had happened that morning after Ashley left, but Cullen main-
    tained that Cash woke up from his nap in that condition. A
    nurse eventually summoned Ashley and Chris to be with Cash
    until “Life Flight” transported him to a pediatric hospital due
    to the extent of his injuries.
    Deputy Brenda Wheeler and Sgt. John Pankonin of the
    Douglas County Sheriff’s Department interviewed Cullen at
    the sheriff’s office on February 28 and March 1, 2013.
    During her February 28, 2013, interview, Cullen told pri-
    marily four different versions of what occurred to Cash that
    morning. Initially, she stated that Cash started the day acting
    normally, but that when he woke up from his nap, his breath-
    ing was not normal. Cullen denied to Wheeler that Cash had
    an accident or fell that morning. Wheeler then informed Cullen
    that Cash’s skull was fractured and that his head had to have
    hit something or something had to have hit his head. Cullen
    eventually told Wheeler that when she was walking out of the
    back door with Cash, she may have accidentally hit his head
    somewhere on the door. When she came back in, Cash was not
    “breathing right.”
    After consulting Dr. Suzanne Haney, a pediatrician, outside
    of Cullen’s presence, Wheeler informed Cullen that Cash’s
    injuries could not have been caused by hitting his head on the
    door. Cullen continued to deny that anything else happened
    that morning, but then she told Wheeler that Cash had fallen
    out of his swing at about 8:15 a.m. According to Cullen, Cash
    whimpered but then fell asleep at about 8:45 a.m.
    While Wheeler was again absent consulting Haney,
    Ullsperger and Cullen communicated via text messages.
    Ullsperger texted Cullen, “They said [C]ash is going to be ok.”
    Cullen replied, “I know. But it’s still my fault. I didn’t buckle
    him in the swing, he flopped out of it . . . idk.” (“Idk” is a
    texting term that means “I don’t know.”) Ullsperger responded,
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    STATE v. CULLEN
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    292 Neb. 30
    “Oh really? What all did they say then?” Cullen wrote, “Idk,
    that’s the very only thing that happened out of the ordinary but
    he didn’t even really cry so [I] didn[’]t think it did anything!
    She’s talking to the doctor now.”
    After talking to Haney, Wheeler informed Cullen that
    Cash’s injuries could not have been caused by a short fall
    from the swing. Wheeler and Pankonin informed Cullen that
    Cash’s injuries were consistent with shaking and that he was
    set down or thrown down hard. Cullen began to cry and
    admitted that she had lied. She stated that Cash had fallen out
    of the swing the day before. According to Cullen, at about
    8:15 a.m. on February 28, 2013, she had slipped on the stairs
    while carrying Cash and he had fallen onto the tile floor
    below without hitting any of the steps. Cullen stated that Cash
    landed on his back with his hands clenched but did not cry.
    She put a bag of frozen vegetables on the back of his neck
    and then put him in his Pack ’N Play after he fell asleep on
    her chest.
    According to Cullen, she called Ullsperger instead of the
    911 emergency dispatch service because Cash “wasn’t that bad
    right away” and because it was her fault. Cullen denied shak-
    ing Cash. She wrote a statement about Cash’s falling down the
    stairs and generally maintained this version of events during
    the interview with Wheeler on March 1, 2013.
    Haney is a child abuse pediatrician who specializes in the
    diagnosis and care of suspected abused and neglected children.
    She consulted on Cash’s case. When she examined Cash on
    February 28, 2013, she noticed that he was “not acting well.”
    He was irritable and not focusing his eyes, and he had “an
    obnoxious shrill kind of a scream.” At that time, Cash was
    breathing on his own. He had injuries that concerned Haney on
    a 4-month-old, including a bruise on the left side of his fore-
    head, two tiny circular abrasions under his chin, and a bruise
    on his tongue. Wheeler confronted Cullen during the March 1
    interview about the abrasions under Cash’s chin. Cullen told
    Wheeler that she first saw them on Monday, February 25, and
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    that Ashley told her the abrasions occurred over the weekend
    when Ashley put Cash’s bib on him. The abrasions matched
    metal clasps on the inside collar of the “Onesie” that Cash
    wore on February 28.
    Between March 1 and 5, 2013, Cash’s neurological condition
    rapidly deteriorated as evidenced by his lack of responsiveness
    and an onset of frequent seizures that could be controlled
    only through high doses of medication. Doctors determined
    that Cash would not have any significant neurologic recovery.
    Ashley testified that Cash’s doctors gave them the long-term
    prognosis that Cash would never be able to see, hear, walk, or
    be without a feeding tube and a ventilator and that he would
    likely never understand his parents. Based on this information,
    the Bells decided to take Cash off of life support on March 5,
    and that day, he died.
    Several medical experts testified about the extent of Cash’s
    injuries and their possible causes. That evidence demonstrates
    that Cash sustained a large hematoma on the right back of his
    head, a smaller bruise on the back of his head, a skull fracture
    on the back of his head, a second skull fracture on the right
    side of his head that extended to the base of his skull, subdural
    and subarachnoid hemorrhages in and around all surfaces of
    his brain, actual injury to his brain including torn blood vessels
    and long filaments as well as bruising to both sides, and mul-
    tiple retinal hemorrhages that extended to the back of his eyes.
    Doctors testified that Cash sustained a global or diffuse brain
    injury, meaning that it affected his entire brain. Ninety percent
    of his brain was permanently damaged and abnormal due to a
    lack of oxygen.
    The medical experts agreed that Cash’s injuries were
    con­sistent with nonaccidental trauma caused by shaking or
    impacts to the head or both. There was testimony comparing
    the significant force involved in Cash’s injuries to a one- to
    two-story fall, a high-speed motor vehicle accident, and a
    television falling on a child’s head and crushing it. There
    was testimony that separation between the two skull fractures
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    indicated that they were caused by two separate forces. While
    none of the experts could pinpoint an exact date and time
    of injury, they estimated that Cash’s brain and eye injuries
    occurred within 0 to 2 days of February 28, 2013, and that
    his skull fractures occurred within 0 to 14 days of that date;
    though in light of Cash’s brain injury, it was highly unlikely
    that the fractures occurred 14 days before February 28.
    Based on the history given by the Bells, Cullen’s statements,
    and the medical evidence, two medical experts opined that
    Cash’s brain injury occurred sometime after Ashley left for
    work on February 28, 2013. They testified that children with
    Cash’s type of brain injury are immediately unwell and do
    not respond appropriately and that symptoms would manifest
    fairly quickly and may be intermittent, but would be notice-
    able and cause concern. Several medical experts testified that
    Cullen’s versions of events could not have accounted for all of
    Cash’s injuries.
    2. Charge
    The State charged Cullen with intentional child abuse occur-
    ring on or about January 1 through February 28, 2013, that
    resulted in Cash’s death, a Class IB felony in violation of
    § 28-707(1) and (8). The district court conducted a trial, and
    we have already summarized part of the evidence relevant to
    this appeal. Additional evidence relevant to specific issues on
    appeal is summarized below.
    3. Rule 404 Evidence
    Prior to trial, the State filed its notice of intent to offer evi-
    dence of prior bad acts pursuant to rule 404. A rule 404 hear-
    ing was held where the State presented evidence that Cullen
    had injured children at two daycares where she had worked
    prior to working for the Bells. At this hearing, the State did not
    present evidence of prior injuries that Cash suffered while in
    Cullen’s care.
    The State explained that its approach was intentional. The
    prosecutor informed the court that the State did not consider
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    evidence of prior injuries that Cash suffered while in Cullen’s
    care to be rule 404 evidence. Rather, the State believed this
    evidence was inextricably intertwined with the charged offense.
    For that reason, the rule 404 hearing was confined to the prior
    daycare evidence.
    The district court ruled the prior daycare evidence inadmis-
    sible. While the court found that the evidence would be proba-
    tive regarding absence of mistake, it determined that the risk of
    unfair prejudice substantially outweighed its probative value.
    It attributed the unfair prejudice to the dissimilarities in the
    severity and cause of the injuries between the children at the
    daycares and Cash.
    4. Cash’s Prior Injuries
    During trial, Cullen made an oral motion in limine seeking
    to prohibit the State from offering text messages and photo-
    graphs of injuries that Cash sustained prior to February 28,
    2013. Defense counsel argued that the injuries constituted prior
    bad acts evidence and should have been excluded under the
    district court’s order on the rule 404 evidence.
    The State responded that the text messages showed that
    Cullen previously notified Ashley of any accidental injuries
    Cash sustained but did not disclose any accident to her on
    February 28, 2013. Thus, the State argued, the evidence was
    inextricably intertwined with the charged offense, because
    Cullen’s inconsistent conduct was highly relevant to whether
    the injuries that resulted in Cash’s death were intentional
    or accidental.
    The district court ruled that the State could not offer evi-
    dence of specific injuries to Cash unrelated to his cause of
    death, but that it could offer evidence in general about the
    arrangement between Ashley and Cullen to communicate about
    Cash and any accidents as well as the frequency of those com-
    munications. However, the district court further ruled that it
    would revisit the issue if Cullen’s statements about the prior
    injuries were received into evidence.
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    At trial, Ashley testified that she and Cullen communi-
    cated with each other by text or telephone call almost every
    day while Ashley was at work. Ashley testified that between
    January 7 and February 27, 2013, Cash sustained minor inju-
    ries. Despite Ashley’s instructions to contact her or Chris
    about any accidents, Cullen notified Ashley about only three
    of six injuries.
    After Cullen’s statements to law enforcement were admit-
    ted at trial, the State recalled Ashley to testify about the minor
    injuries that Cash sustained while in Cullen’s care. Before
    Ashley could testify about the minor injuries, defense counsel
    requested to approach the bench where an off-the-record dis-
    cussion was held. The district court overruled Cullen’s objec-
    tion and allowed her a continuing objection.
    Ashley testified that Cash’s first injury while in Cullen’s
    care occurred on January 9, 2013. Cullen texted Ashley on
    that day that the Bells’ dog, named “Mugsy,” trampled Cash
    and her on the floor after a noise outside “freaked Mugsy out.”
    When Ashley returned home from work, Cash had a bruise
    under his left eye and a scratch on the left side of his neck.
    Ashley explained that she and Chris trained Mugsy to respect
    Cash’s space and that she never observed Mugsy run over or
    trample Cash. Although Ashley had never observed Mugsy
    “freak out” over a noise outside, she testified that she believed
    Cullen’s explanation.
    One week later, on January 16, 2013, Cullen texted Ashley
    that Cash had a fever. On January 29, Cullen texted Ashley,
    “Oh Ashley I have no idea what just happened but theres [sic]
    a big mark under Cash eye :( I went to answer the door and he
    started crying!” Ashley testified that according to Cullen, Cash
    was on his toy mat on the floor when the doorbell rang, which
    caused Mugsy to jump off the couch. Cullen told Ashley that
    she did not know what had happened, but that Cash sustained
    a bruise and scratch under his left eye. Ashley testified that
    she believed it was plausible that Mugsy jumped off the couch
    when the doorbell rang.
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    Ashley testified that she and Chris were out of town
    between February 7 and 11, 2013. Cullen cared for Cash dur-
    ing the day, while Ashley’s mother cared for him at night.
    When the Bells returned on February 11, Cash had a bump
    and a bruise on the right side of his head above his eyebrow.
    Ashley did not address the injury with Cullen because she
    understood that her mother had. Rose Bergerson, Ashley’s
    mother, testified over Cullen’s continuing objection that she
    came to the Bells’ home from work on February 7 to find
    Cash with the bruise and bump. Defense counsel stated the
    grounds for the objection to be relevance and rule 404: “The
    same objection that we had to Ashley Bell’s testimony.”
    Bergerson testified that when she confronted Cullen about
    the injury, Cullen told her that she had Cash on her hip when
    she was taking Mugsy outside. According to Cullen, the wind
    caught the door and hit Cash in the head. Bergerson docu-
    mented Cash’s injury by taking photographs of it with her cell
    phone, and those photographs were received into evidence
    over Cullen’s objections.
    In mid-February 2013, Chris and Ashley observed a broken
    blood vessel on the inside of Cash’s eye. Cullen told Ashley
    that she had never seen it before. On February 15, Cullen
    texted Ashley, “Cash must have scratched himself? We ran and
    ate a late lunch, when we got back there was a small mark on
    him but it was not there when [I] put him in . . . he wad [sic]
    rubbing his eyes awfully hard though . . . have a good week-
    end!” Ashley could not recall if Cullen was referring in the text
    to a new scratch or the broken blood vessel.
    On the evening of Monday, February 25, 2013, Chris and
    Ashley noticed that Cash had two round abrasions under his
    chin and a bruise on his temple. Ashley confronted Cullen
    about the abrasions, and Cullen told her that they did not hap-
    pen during her care and that she had not seen them. Ashley
    testified that she told Cullen on February 28 that she hoped
    she did not cause the abrasions over the weekend with his
    wet bib. Ashley testified that she dismissed the idea after she
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    said it, because the bib would not have caused the two abra-
    sions under Cash’s chin or the bruise on his temple. Therefore,
    according to Ashley, Cullen was inaccurate when she told
    Wheeler that Ashley admitted causing the two abrasions.
    Ashley testified that Cullen never notified her that Cash fell
    out of the swing on February 27, 2013, as Cullen had claimed
    during her interview with police.
    The record contains no motion for mistrial based on the
    admission of evidence of Cash’s prior injuries.
    5. Motion for Mistrial
    During Chris’ testimony, Cullen’s counsel objected, based on
    hearsay grounds, before Chris could testify about what a nurse
    had told him and Ashley. The district court permitted Chris to
    continue, because “[i]t may be a diagnostic statement.” Chris
    then testified, “[The emergency room nurse] grabbed my wife
    Ashley . . . and said, She did this to him, meaning [Cullen].”
    After this testimony, Cullen’s counsel immediately said, “Okay,
    Judge.” The district court struck the testimony, and counsel
    approached the bench for an off-the-record discussion. The
    jury was excused briefly, and Cullen’s counsel made a motion
    for mistrial. The district court denied the motion. Before pro-
    ceeding with the trial, the district court admonished the jury
    “totally to disregard that comment entirely.”
    The only other reference to a mistrial occurred during a dis-
    cussion about striking jurors, but it did not result in a motion.
    At the close of the State’s case in chief, Cullen renewed
    “[t]wo motions” for mistrial, immediately after which the
    district court noted for the record that it had allowed Cullen
    ongoing objections during testimony about Cash’s injuries that
    occurred prior to February 28, 2013. It then denied Cullen’s
    “motions” for mistrial.
    6. Closing Statements
    During closing statements, the prosecutor argued:
    Let’s look at [Cullen’s] demeanor in this trial, because
    that’s something you can take into consideration.
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    I don’t know about you, ladies and gentlemen, but
    I was watching her every minute that I could. I didn’t
    see one ounce of emotion out of her, not when we were
    looking at photographs of Cash, this baby she claims
    to have loved and cared for, not one ounce of emotion.
    Not in that interview, not during this trial, not when the
    autopsy pictures are being presented, not when we’re
    looking at his brain or his subdural brain bleeds. Not
    once. Is that reasonable? She’s completely detached.
    She’s completely unaffected. No emotion whatsoever.
    It’s unbelievable.
    Let’s compare that demeanor to Andrew Ullsperger’s
    demeanor, because, again, he represents a reasonable
    person. Andrew Ullsperger who had had two interactions
    with baby Cash before the 28th, very limited contact
    with this baby versus Sarah Cullen, who spent from 7:15
    to 5:00 in the evening every day with Cash for seven
    weeks. Andrew Ullsperger is visibly distraught during
    his interviews, Sergeant Pankonin tells you and Andrew
    told you himself. I asked him, Why were you so upset?
    What was your number one concern? And without hesita-
    tion, he said, Cash. Because why wouldn’t it be? He said,
    This is a baby we’re talking about. Completely different
    physical and emotional response than this woman (point-
    ing), the one who was paid and entrusted with the care
    of a life.
    Cullen’s attorney did not object.
    Cullen’s attorney objected only during closing statements
    when the prosecutor spoke about the Bells’ loss:
    And [Cullen] did it. She did it with her own hands,
    nobody else’s. In those moments when this woman was
    taking out her rage on a child, a four-month-old helpless
    baby in her care, shaking him, slamming him, she broke
    his body, she shattered that child’s body, she shattered
    that child’s life and she shattered the lives of everybody
    who loved Cash Bell.
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    You know what? At the close of this we all get to go
    home. We get to go home to our kids and our grandkids.
    We get to get our children dressed for school and pick out
    Halloween costumes when it rolls around and open pres-
    ents and celebrate birthdays.
    Cullen’s counsel objected stating, “[T]his is improper closing
    argument and it’s asking for sympathy and that’s inappropri-
    ate.” The district court overruled the objection.
    7. Conviction and Sentence
    The jury convicted Cullen of intentional child abuse result-
    ing in death. The district court sentenced Cullen to a term of
    imprisonment of 70 years to life.
    III. ASSIGNMENTS OF ERROR
    Cullen assigns that the district court erred in (1) denying her
    motion for mistrial on the basis of allowing admission of prior
    bad acts evidence pursuant to rule 404 and overruling Cullen’s
    objection to the prosecutor’s closing argument, (2) failing to
    sustain Cullen’s objection and to order a mistrial due to pros-
    ecutorial misconduct during closing argument, and (3) abus-
    ing its discretion by imposing an excessive sentence. Cullen
    additionally assigns that she received ineffective assistance
    of counsel.
    IV. STANDARD OF REVIEW
    [1-4] Whether to grant a motion for mistrial is within the
    trial court’s discretion, and an appellate court will not disturb
    its ruling unless the trial court abused its discretion.3 It is
    within the discretion of the trial court to determine relevancy
    and admissibility of evidence of other wrongs or acts under
    rule 404, and the trial court’s decision will not be reversed
    absent an abuse of discretion.4 We will not disturb a sentence
    3
    State v. Oliveira-Coutinho, 
    291 Neb. 294
    , 
    865 N.W.2d 740
     (2015).
    4
    State v. Pullens, 
    281 Neb. 828
    , 
    800 N.W.2d 202
     (2011).
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    imposed within the statutory limits absent an abuse of discre-
    tion by the trial court.5 An abuse of discretion occurs when a
    trial court’s decision is based upon reasons that are untenable
    or unreasonable or if its action is clearly against justice or con-
    science, reason, and evidence.6
    [5] Whether a claim of ineffective assistance of trial coun-
    sel may be determined on direct appeal is a question of law.7
    In reviewing claims of ineffective assistance of counsel on
    direct appeal, an appellate court decides only questions of
    law: Are the undisputed facts contained within the record
    sufficient to conclusively determine whether counsel did or
    did not provide effective assistance and whether the defend­
    ant was or was not prejudiced by counsel’s alleged defi-
    cient performance?8
    V. ANALYSIS
    1. Evidence of Cash’s Prior Injuries
    At trial, the State presented evidence of injuries Cash
    sustained while in Cullen’s care during the weeks prior to
    the fatal injuries he sustained on February 28, 2013. Cullen
    assigns that the district court erred in denying her motion for
    mistrial in response to this evidence, which was based on the
    improper admission of prior bad acts evidence pursuant to
    rule 404.
    We begin by clarifying the evidence at issue in this assigned
    error. First, Cullen argues in her brief that a pretrial order
    concerning rule 404 evidence addressed Cullen’s statements
    to law enforcement. However, the rule 404 hearing addressed
    only Cullen’s abuse of children at prior daycares, not her state-
    ments to law enforcement concerning Cash’s prior injuries
    while in her care. Although one of Cullen’s pretrial motions
    5
    State   v.   Ortega, 
    290 Neb. 172
    , 
    859 N.W.2d 305
     (2015).
    6
    State   v.   Bauldwin, 
    283 Neb. 678
    , 
    811 N.W.2d 267
     (2012).
    7
    State   v.   Abdullah, 
    289 Neb. 123
    , 
    853 N.W.2d 858
     (2014).
    8
    State   v.   Castillo-Zamora, 
    289 Neb. 382
    , 
    855 N.W.2d 14
     (2014).
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    did address whether her statements to law enforcement were
    made freely, voluntarily, and intelligently, no error is assigned
    to the court’s ruling determining that the statements were
    voluntary. Cullen opposed the admission of her statements to
    law enforcement before and during trial, but her opposition
    addressed the voluntariness of her statements and not their
    admissibility under rule 404. Thus, we will not consider her
    statements to law enforcement in analyzing her assignment of
    error based on rule 404.9
    Second, Cullen claims that she made a motion for mistrial in
    response to evidence of Cash’s prior injuries. While a motion
    for mistrial may have occurred off the record, the record before
    this court does not contain a motion for mistrial premised upon
    evidence of Cash’s prior injuries. However, Cullen’s coun-
    sel did make a motion in limine to prevent the admission of
    the text messages concerning Cash’s prior injuries pursuant
    to rule 404, as well as timely and specific continuing objec-
    tions during testimony about those injuries. On this basis, we
    now evaluate the admissibility of testimony by Ashley and
    Bergerson and text messages and photographs pertaining to
    Cash’s prior injuries.10
    Before considering Cullen’s argument about rule 404, we
    observe that all of the questioned injuries occurred during the
    period of time charged in the information as a single offense.
    As we have already stated, the information charged Cullen
    with intentional child abuse occurring on or about January
    1 through February 28, 2013. Thus, Cullen was clearly on
    notice that all of these events were within the scope of the
    charged crime.
    Cullen argues that the risk of prejudice produced by evidence
    of Cash’s prior injuries outweighed the evidence’s probative
    9
    See State v. Newman, 
    290 Neb. 572
    , 
    861 N.W.2d 123
     (2015) (objection,
    based on specific ground and        properly overruled, does not preserve
    question for appellate review on   any other ground).
    10
    See State v. Freemont, 
    284 Neb. 179
    , 
    817 N.W.2d 277
     (2012).
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    value under rule 404. The State counters that because the
    evidence of Cash’s prior injuries was intrinsic or inextricably
    intertwined with the injuries that resulted in his death, rule 404
    did not apply. We agree with the State.
    [6] Rule 404 provides, in part:
    (2) Evidence of other crimes, wrongs, or acts is not
    admissible to prove the character of a person in order to
    show that he or she acted in conformity therewith. It may,
    however, be admissible for other purposes, such as proof
    of motive, opportunity, intent, preparation, plan, knowl-
    edge, identity, or absence of mistake or accident.
    (3) When such evidence is admissible pursuant to
    this section, in criminal cases evidence of other crimes,
    wrongs, or acts of the accused may be offered in evidence
    by the prosecution if the prosecution proves to the court
    by clear and convincing evidence that the accused com-
    mitted the crime, wrong, or act. Such proof shall first be
    made outside the presence of any jury.
    [7,8] Rule 404(2), however, does not apply to evidence
    of a defendant’s other crimes or bad acts if the evidence is
    inextricably intertwined with the charged crime. Our juris-
    prudence initially adopted a broad concept of this class of
    evidence.11 Although in other cases we have partially backed
    away from the inextricably intertwined exception and instead
    applied a broader notion of rule 404, the exception is still
    viable.12 Recently, in State v. Ash,13 we articulated our nar-
    rowed concept of the exception, stating that inextricably inter-
    twined evidence
    “includes evidence that forms part of the factual setting
    of the crime, or evidence that is so blended or connected
    to the charged crime that proof of the charged crime
    11
    See State v. Wisinski, 
    268 Neb. 778
    , 
    688 N.W.2d 586
     (2004).
    12
    See, e.g., State v. Freemont, supra note 10; State v. Ash, 
    286 Neb. 681
    , 
    838 N.W.2d 273
     (2013).
    13
    State v. Ash, supra note 12, 286 Neb. at 694, 838 N.W.2d at 283.
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    will necessarily require proof of the other crimes or bad
    acts, or if the other crimes or bad acts are necessary
    for the prosecution to present a coherent picture of the
    charged crime.”
    We summarized four types of circumstances under which we
    had previously upheld the admission of such intrinsic evidence:
    (1) The defendant’s other bad acts showed his pattern
    of sexually abusing a child or exposing the child to sex­
    ually explicit material; (2) the defendant destroyed evi-
    dence of the crime soon afterward; (3) the defendant’s
    arrest for a different theft resulted in the discovery of
    evidence of the charged theft, and the evidence estab-
    lished that the items were stolen; and (4) the defendant
    was using a controlled substance at the time that the
    crime was committed.14
    The first circumstance refers to our holdings in State v. Baker15
    and State v. McPherson.16
    In Baker, we held that the inextricably intertwined excep-
    tion to rule 402(2) applied where the defendant’s other bad
    acts showed his pattern of sexually abusing a child. There, the
    State’s evidence included testimony that the defendant threat-
    ened the victim with harm if she reported him, the mother’s
    testimony that the defendant threatened her and physically
    assaulted her if she did not bring the victim to the bedroom
    at his direction, and the mother’s testimony that the defendant
    became sexually aroused while watching the victim administer
    a massage. The defendant claimed this evidence was inadmis-
    sible under rule 404(2). On appeal, we considered whether the
    evidence was intrinsic to the charged crimes of first degree
    sexual assault and third degree sexual assault of a child and
    concluded the State was entitled to present this evidence as
    part of a coherent factual setting of the crime. We observed
    14
    Id. at 695, 838 N.W.2d at 283.
    15
    State v. Baker, 
    280 Neb. 752
    , 
    789 N.W.2d 702
     (2010).
    16
    State v. McPherson, 
    266 Neb. 734
    , 
    668 N.W.2d 504
     (2003).
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    that the evidence was not offered to prove the defendant’s
    propensity or character to act a certain way.
    In reaching our conclusion in Baker, we relied on McPherson,
    where the defendant was convicted on two counts of child
    abuse and two counts of first degree sexual assault on a child.
    The victims were his two minor daughters. The girls testified
    about sexual activity that occurred in their home. On appeal,
    the defendant argued that evidence about sexual devices and
    sexually explicit videos in the home was inadmissible under
    rule 404(2). We disagreed, concluding that the evidence was
    “so closely intertwined with both crimes charged that it cannot
    be considered extrinsic.”17
    Similarly, in the recent case of State v. Smith,18 the defend­
    ant was convicted of one count of murder in the first degree,
    four counts of assault in the second degree, and five counts
    of use of a deadly weapon to commit a felony. On appeal, we
    concluded that the trial court did not err in admitting evidence
    that the defendant threatened the shooting victims each time
    he saw them after they had entered plea agreements with the
    federal government. We determined that this evidence was
    inextricably intertwined with the shooting and not subject to
    rule 404. We likened the scenario to the one in Baker, inter
    alia, and reasoned that such evidence was part of the factual
    setting of the crimes and was necessary to present a coherent
    picture. Further, we explained that the evidence of the prior
    encounters did not show propensity for the shootings, but,
    rather, established that the defendant had made threats and
    acted on them.
    Like the disputed evidence in Baker, McPherson, and Smith,
    the evidence of Cash’s prior injuries was necessary to estab-
    lish the factual setting of the fatal injuries Cullen inflicted
    on Cash on February 28, 2013. Furthermore, there was a pat-
    tern or history in this case that is similar to the scenarios in
    17
    Id. at 744, 
    668 N.W.2d at 513
    .
    18
    State v. Smith, 
    286 Neb. 856
    , 
    839 N.W.2d 233
     (2013).
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    Baker and McPherson. Although the abuse here was physical
    rather than sexual, we see no reason not to apply the same
    rationale to cases of intentional physical abuse of children
    as we have in sexual abuse cases. Evidence of Cash’s prior
    injuries presented a picture of Cullen’s relationship with Cash
    and his parents on the day of Cash’s fatal injuries and placed
    those fatal injuries in the context of an escalating pattern of
    abuse, rather than presenting them as wholly isolated incidents
    which, considering the severity of Cash’s injuries, would have
    told an incomplete story of the crime charged. Further, the evi-
    dence of Cash’s prior injuries shed light on whether Cullen’s
    actions were intentional or negligent.
    We recognize that in State v. Freemont,19 we chose not to
    allow the intrinsic or inextricably intertwined exception where
    the prior bad acts occurred several days to a week before the
    charged offense. In that case, the defendant was convicted of
    second degree murder, use of a deadly weapon to commit a
    felony, and possession of a deadly weapon by a prohibited
    person. On appeal, this court held that the State’s evidence that
    several days before the murder at issue, the defendant, who
    was a felon, had been in the possession of a firearm was inad-
    missible under rule 404(2). The majority concluded that the
    intrinsic or inextricably intertwined exception to rule 404(2)
    did not apply, holding that “[t]he prior misconduct did not
    provide any insight into [the defendant’s] reason for allegedly
    killing” the victim and “was not part of the same transaction
    and occurred several days or a week before” the murder.20 This
    court determined that holding otherwise would “open the door
    to abuse” of the exception and noted that several federal courts
    have limited or rejected the exception.21
    The instant case is distinguishable from Freemont. In
    that case, the character of the offense that the State sought
    19
    State v. Freemont, supra note 10.
    20
    Id. at 192, 817 N.W.2d at 291.
    21
    Id.
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    to put in evidence—possession of a firearm—was entirely
    different from the most serious charged offense—murder.
    However, in this case, both the evidence that the State sought
    to introduce and the crime charged involved the same type of
    offense, child abuse, and it involved the same victim, Cash.
    As such, as we have already observed, evidence of non­fatal
    injuries perpetrated on Cash by Cullen prior to the fatal
    injuries he sustained on February 28, 2013, painted a coher-
    ent picture of an increasing pattern of abuse and tended to
    show that Cullen’s fatal actions were intentional rather than
    merely negligent.
    Further, the State argues that the instant case is also dis-
    tinguishable from two child abuse cases in which we held
    that prior injuries, as extrinsic evidence, were subject to rule
    404(2). In State v. Kuehn,22 we held that evidence of two prior
    incidents in which a 10-month-old child was injured while
    in the defendant’s care was properly admitted under rule
    404(2) as proof of absence of mistake or accident as to the
    charged offense of intentional child abuse. In State v. Chavez,23
    we concluded that evidence of remote injuries indicative of
    battered child syndrome as seen in a nearly 4-month-old
    child’s autopsy was properly admitted under rule 404(2) as
    proof of intent or absence of mistake or accident as to the
    charged offense of intentional child abuse resulting in death.
    We assumed without deciding in Chavez that evidence of a
    prior bruise on the child’s forehead while in the defendant’s
    care was erroneously admitted under rule 404(2) as proof of
    intent or absence of mistake or accident, but concluded that its
    admission was harmless.
    We agree that the case before us differs from Kuehn and
    Chavez. Kuehn was limited to two prior injuries occurring over
    a month prior to the charged offense. Chavez addressed remote
    injuries unconnected to the defendant and only one injury
    22
    State v. Kuehn, 
    273 Neb. 219
    , 
    728 N.W.2d 589
     (2007).
    23
    State v. Chavez, 
    281 Neb. 99
    , 
    793 N.W.2d 347
     (2011).
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    while in the defendant’s care occurring a month before the
    charged offense. The case before us, however, presents injuries
    occurring almost weekly over approximately 7 weeks while
    Cullen cared for Cash. Moreover, they were part of an escalat-
    ing pattern of abuse that ended in Cash’s death.
    We conclude that Cash’s injuries incurred prior to February
    28, 2013, were inextricably intertwined with the charged crime
    and that, therefore, rule 404(2) does not apply. The incidents
    were not used for impermissible propensity purposes, but,
    rather, they formed the factual setting, and they were necessary
    to present a coherent picture of the crime. Furthermore, the fre-
    quency and the increasing severity of Cash’s injuries tended to
    prove that his fatal injuries resulted from Cullen’s intentional
    actions, rather than negligence. The district court did not err in
    admitting this evidence.
    [9,10] Even if the district court had erred in admitting this
    evidence of Cash’s prior injuries, the error would have been
    harmless. An error in admitting or excluding evidence in a
    criminal trial, whether of constitutional magnitude or other-
    wise, is prejudicial unless the error was harmless beyond a
    reasonable doubt.24 Harmless error review looks to the basis
    on which the jury actually rested its verdict; the inquiry is
    not whether in a trial that occurred without the error, a guilty
    verdict would surely have been rendered, but whether the
    actual guilty verdict rendered was surely unattributable to
    the error.25
    In Cullen’s interviews with police, she admitted that Cash
    had previously sustained injuries while in her care. These
    injuries, by her own admission, became increasingly seri-
    ous. Cullen attempted to attribute them to accidental causes.
    But her statements provided powerful evidence that after she
    began caring for Cash, a pattern emerged of increasingly seri-
    ous injuries. Cullen’s own statements illuminated the pattern.
    24
    State v. Ballew, 
    291 Neb. 577
    , 
    867 N.W.2d 571
     (2015).
    25
    
    Id.
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    Testimony by Ashley and Bergerson merely reinforced it.
    Thus, a jury’s conclusion that the pattern of increasingly
    serious injuries demonstrated intentional actions on Cullen’s
    part was surely unattributable to testimony by Ashley and
    Bergerson. Therefore, even if admission of that evidence had
    been in error, it would have been harmless error.
    2. Prosecutorial Misconduct
    Cullen asserts that the district court erred in failing to
    sustain her counsel’s objection and to order a mistrial due to
    prosecutorial misconduct during closing statements. Cullen
    argues that the prosecutor’s statements pointing out her lack of
    emotion during the trial unduly influenced the jury.
    [11,12] Cullen failed to preserve this issue. In order to pre-
    serve, as a ground of appeal, an opponent’s misconduct dur-
    ing closing argument, the aggrieved party must have objected
    to improper remarks no later than at the conclusion of the
    argument.26 Cullen’s counsel did not object to the prosecutor’s
    statements about her lack of emotion and made no motion
    for mistrial during closing arguments. Cullen claims that her
    counsel objected “globally” to the prosecutor’s closing state-
    ments, by objecting to closing statements about the Bells’
    loss.27 However, that objection, stating that the prosecutor’s
    remarks were “asking for sympathy,” was specific to com-
    ments about the Bells’ loss. An objection, based on a specific
    ground and properly overruled, does not preserve a question
    for appellate review on any other ground.28 As such, Cullen
    did not preserve for appeal issues to which she did not object
    at trial.29
    26
    State v. Watt, 
    285 Neb. 647
    , 
    832 N.W.2d 459
     (2013).
    27
    Brief for appellant at 16.
    28
    State v. Newman, supra note 9.
    29
    State v. Hernandez, 
    242 Neb. 78
    , 
    493 N.W.2d 181
     (1992) (any objection to
    prosecutor’s arguments made after jury has been instructed and has retired
    is untimely and will not be reviewed on appeal).
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    [13] Because Cullen did not timely object to the com-
    ments concerning her lack of emotion, we review this issue
    only for plain error. Plain error may be found on appeal when
    an error, unasserted or uncomplained of at trial, but plainly
    evident from the record, prejudicially affects a litigant’s sub-
    stantial right and, if uncorrected, would result in damage to
    the integrity, reputation, and fairness of the judicial process.30
    But, as we have noted, “‘the plain-error exception to the
    ­contemporaneous-objection rule is to be “used sparingly, solely
    in those circumstances in which a miscarriage of justice would
    otherwise result.”’”31
    [14,15] Prosecutors are charged with the duty to conduct
    criminal trials in such a manner that the accused may have
    a fair and impartial trial, and prosecutors are not to inflame
    the prejudices or excite the passions of the jury against the
    accused.32 A prosecutor’s conduct that does not mislead and
    unduly influence the jury does not constitute misconduct.33 In
    the present case, the prosecutor’s remarks about Cullen’s lack
    of emotion could not have misled or unduly influenced the
    jurors. They had observed Cullen’s demeanor for themselves.
    Thus, there was no misconduct by the prosecutor. Obviously,
    if there was no misconduct, there can be no plain error.
    Accordingly, this assignment of error is without merit.
    3. Excessive Sentence
    Cullen argues that her sentence of 70 years’ to life impris-
    onment was excessive. The jury convicted Cullen of a
    Class IB felony, which carries a sentence of 20 years’ to
    30
    State v. Alarcon-Chavez, 
    284 Neb. 322
    , 
    821 N.W.2d 359
     (2012).
    31
    Id. at 336, 821 N.W.2d at 369 (quoting United States v. Young, 
    470 U.S. 1
    ,
    
    105 S. Ct. 1038
    , 
    84 L. Ed. 2d 1
     (1985)). See, also, State v. Barfield, 
    272 Neb. 502
    , 
    723 N.W.2d 303
     (2006), disapproved on other grounds, State v.
    McCulloch, 
    274 Neb. 636
    , 
    742 N.W.2d 727
     (2007).
    32
    See State v. Gresham, 
    276 Neb. 187
    , 
    752 N.W.2d 571
     (2008).
    33
    State v. Iromuanya, 
    282 Neb. 798
    , 
    806 N.W.2d 404
     (2011).
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    life imprisonment. Cullen’s sentence was within the statu-
    tory range. Accordingly, we review the sentence for an abuse
    of discretion.
    [16,17] When imposing a sentence, a sentencing judge
    should consider the defendant’s (1) age, (2) mentality, (3)
    education and experience, (4) social and cultural background,
    (5) past criminal record or record of law-abiding conduct, and
    (6) motivation for the offense, as well as (7) the nature of the
    offense, and (8) the amount of violence involved in the com-
    mission of the crime.34 The appropriateness of a sentence is
    necessarily a subjective judgment and includes the sentencing
    judge’s observation of the defendant’s demeanor and attitude
    and all the facts and circumstances surrounding the defend­
    ant’s life.35
    Cullen contends that in determining her sentence, the dis-
    trict court did not consider her willingness to plead to an
    attempt charge. She points out that she is a mother to two
    children and that she had pursued a degree in early childhood
    development. Cullen asserts that there was no evidence of an
    intent to kill Cash. Cullen further argues that the district court
    abused its discretion by basing her sentence on the prosecu-
    tor’s statements.
    Based upon the relevant sentencing factors, we do not find
    Cullen’s sentence to be an abuse of discretion. Cullen was 25
    years old at the time of the offense. She reported having a
    happy childhood and rewarding and satisfying relationships
    with her family. Cullen, a mother, had experience and edu-
    cation in caring for children and a history of abusing them,
    although her relatively minimal criminal history contains no
    previous convictions for violent crimes. We have recounted the
    details of the current offense and need not repeat them here.
    Suffice it to say, the circumstances surrounding Cash’s death
    were simply abhorrent, and the evidence demonstrates that
    34
    See, e.g., State v. Bauldwin, supra note 6.
    35
    Id.
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    Cullen’s treatment of Cash, a helpless infant, was assaultive
    and violent. This assignment of error clearly lacks merit.
    4. Ineffective Assistance of Counsel
    Cullen argues that her trial counsel was ineffective in these
    respects: (1) failing to timely object when Chris testified that
    he heard a nurse tell Ashley, “She did this to him”; (2) failing
    to timely object to the prosecutor’s statements during closing
    arguments that Cullen lacked emotion during the trial; (3) fail-
    ing to investigate and call an expert medical witness on behalf
    of Cullen; and (4) failing to file a motion for new trial based
    on the improper admission of rule 404 evidence and on pros-
    ecutorial misconduct.
    [18,19] In order to show ineffective assistance of counsel
    under Strickland v. Washington,36 a defendant must show, first,
    that counsel was deficient and, second, that the deficient per-
    formance actually caused prejudice to the defend­    ant’s case.
    The two prongs of this test may be addressed in either order,
    and the entire ineffectiveness analysis should be viewed with
    a strong presumption that counsel’s actions were reasonable.37
    [20-23] Prejudice caused by counsel’s deficiency is shown
    when there is a reasonable probability that but for counsel’s
    deficient performance, the result of the proceeding would have
    been different.38 A reasonable probability is “a probability suf-
    ficient to undermine confidence in the outcome.”39 This court
    follows the approach to the prejudice inquiry outlined by the
    U.S. Supreme Court in Strickland:
    “In making this determination, a court hearing an
    ineffectiveness claim must consider the totality of the
    36
    Strickland v. Washington, 
    466 U.S. 668
    , 
    104 S. Ct. 2052
    , 
    80 L. Ed. 2d 674
    (1984).
    37
    See, State v. Soukharith, 
    260 Neb. 478
    , 
    618 N.W.2d 409
     (2000); State v.
    Buckman, 
    259 Neb. 924
    , 
    613 N.W.2d 463
     (2000).
    38
    See State v. Poe, 
    284 Neb. 750
    , 
    822 N.W.2d 831
     (2012).
    39
    Id. at 774, 822 N.W.2d at 849.
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    evidence before the judge or jury. Some of the factual
    findings will have been unaffected by the errors, and fac-
    tual findings that were affected will have been affected
    in different ways. Some errors will have had a pervasive
    effect on the inferences to be drawn from the evidence,
    altering the entire evidentiary picture, and some will
    have had an isolated, trivial effect. Moreover, a verdict
    or conclusion only weakly supported by the record is
    more likely to have been affected by errors than one
    with overwhelming record support. Taking the unaffected
    findings as a given, and taking due account of the effect
    of the errors on the remaining findings, a court making
    the prejudice inquiry must ask if the defendant has met
    the burden of showing that the decision reached would
    reasonably likely have been different absent the errors.”40
    The fact that an ineffective assistance of counsel claim is
    raised on direct appeal does not necessarily mean that it can
    be resolved. The determining factor is whether the record is
    sufficient to adequately review the question.41 An ineffective
    assistance of counsel claim will not be addressed on direct
    appeal if it requires an evidentiary hearing.42
    (a) Chris’ Testimony
    Cullen argues that her trial counsel failed to timely object
    to Chris’ testimony that a nurse implicated Cullen as the per-
    petrator of Cash’s injuries and that the testimony affected the
    jury’s verdict. We disagree with Cullen’s assertion on appeal
    that trial counsel failed to timely object. In the above section
    titled “II. BACKGROUND,” under the subheading “5. Motion
    for M istrial ,” we have described how this event unfolded
    at trial.
    40
    Id. at 774-75, 822 N.W.2d at 849 (quoting Strickland v. Washington, 
    supra note 36
    ).
    41
    State v. Newman, supra note 9.
    42
    Id.
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    The record shows that trial counsel’s conduct was not defi-
    cient. Not only did he timely make and, in effect, renew a
    specific objection, he also timely moved for a mistrial. But
    more to the point, he succeeded in having the offending testi-
    mony stricken.
    [24] Moreover, Cullen suffered no prejudice. Not only did
    the court strike the evidence, it admonished the jury “totally
    to disregard that comment entirely.” When an objection to or
    motion to strike improper evidence is sustained and the jury is
    instructed to disregard it, such instruction is deemed sufficient
    to prevent prejudice.43 Cullen’s argument fails on both prongs
    of Strickland.
    (b) Motion for New Trial
    Cullen asserts that her trial counsel was ineffective in failing
    to file a motion for new trial based on the improper admission
    of purported rule 404 evidence concerning Cash’s prior inju-
    ries. We have already concluded that because the evidence of
    Cash’s prior injuries was intrinsic or inextricably intertwined
    with the injuries that resulted in his death, rule 404 did not
    apply. Further, even if testimony of Cash’s prior injuries had
    been admitted in error, such error would have been harmless.
    Thus, a motion for new trial based on evidence of Cash’s prior
    injuries would have been unsuccessful. It necessarily follows
    that trial counsel did not provide ineffective assistance by not
    filing a motion that had no merit.
    Cullen also contends that her trial counsel was ineffective
    in failing to file a motion for new trial based on prosecuto-
    rial misconduct during closing statements. We have rejected
    Cullen’s claim that the prosecutor committed misconduct in
    commenting on Cullen’s lack of emotion during trial. Hence,
    we conclude that trial counsel was not deficient in opting not to
    file a motion for new trial based on prosecutorial misconduct.
    Such a motion would have had no merit.
    43
    State v. Aguilar, 
    264 Neb. 899
    , 
    652 N.W.2d 894
     (2002).
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    (c) Closing Statements
    Cullen argues that her trial counsel was ineffective for not
    making a timely objection to the prosecutor’s reference to
    her lack of emotion during trial. We have concluded above
    that these remarks did not constitute misconduct; therefore,
    Cullen’s trial counsel was not deficient in allowing them with-
    out objection.
    (d) Expert Medical Witness
    Cullen argues that the jury’s decision was affected by her
    trial counsel’s failure to investigate and call a medical expert
    to testify on her behalf. The State asserts, and Cullen concedes,
    that the record is inadequate to address this claim. We agree.
    The record contains copious medical evidence, but none of it
    suggests that another medical expert would offer an opinion
    that would support Cullen’s version of events. Without a more
    complete record, we decline to address this issue. We express
    no opinion whether Cullen’s assigned error, if set forth as an
    allegation in a motion for postconviction relief, would be suf-
    ficient to require an evidentiary hearing.
    VI. CONCLUSION
    We find no merit to Cullen’s assertion that the district court
    abused its discretion by imposing an excessive sentence. And
    the district court did not err in admitting evidence of Cash’s
    prior injuries or overruling Cullen’s objection to the prosecu-
    tor’s closing statements. Further, Cullen’s claims of ineffec-
    tive assistance of trial counsel either lack merit or cannot be
    resolved because the record on direct appeal is insufficient. We
    affirm Cullen’s conviction and sentence.
    A ffirmed.