Methamphetamine in hair and interpretation of forensic findings in a fatal case

Hair analysis for drugs has been developing and is considered a significant tool for distinguishing between recent and long-term drug abuse in forensic and clinical toxicology. Chronic consumption of drugs can gradually induce certain harmful effects on the human organism and can exacerbate some pre-existing diseases. Analysis for drugs in blood or urine in isolation does not provide sufficient information about the history of drug-use by a person and their results cannot be correlated directly with the toxic effects displayed. The chronic abuse of methamphetamine is known to be associated with cardiovascular diseases. During or after autopsy certain types of morphologic alterations are found in the hearts of stimulant addicts. The rapid increase in blood pressure after an intravenous methamphetamine dose can be risky for addicts with arteriosclerosis. However, the anamnestic data about a deceased person may not always be available to explain the pathological findings and to classify the cause of death correctly. The aim of this study was to demonstrate the value of hair analysis for drugs in the context of explaining pathological cardiovascular alterations observed during the autopsy in a case where methamphetamine consumption was involved. In this case, only methamphetamine and metabolites were detected with traces of ephedrine. Ephedrine is the precursor chemical in the illicit synthesis of methamphetamine (known in the Czech Republic as "Pervitin"). The femoral blood level of methamphetamine was 1500 ng/ml. It was documented by a witness that the 31-year-old man died within 1h after an intravenous injection of the drug. The cause of death was established as cerebral edema due to cerebellar bleeding shortly after an intravenous dose of methamphetamine. Findings of methamphetamine in the first three 2-cm hair segments (numbered from the roots) were nearly equal (132+/-9 ng/mg). In the fourth 2-cm segment, it was approximately one-half of previous values. In the remaining, distal 7-cm hair segment sample, the value of methamphetamine was higher and comparable to the third segment. These results provide clear evidence that the man had been a chronic methamphetamine abuser for more than 8 months. This information can help to explain the pathology, the consequence of which could be the bleeding into the cerebellum after the last single methamphetamine dose.     

We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.     

The Role of Spirituality Versus Religiosity in Adolescent Psychosocial Adjustment

This study investigated the interaction between religiosity (defined as church attendance) and spirituality (defined as personal beliefs in God or a higher power) on psychosocial adjustment. Four groups were created capturing 4 different religious/spiritual orientations. Differences were assessed between the groups on a wide range of psychosocial indicators. Participants included 6578 adolescents ages 13–18 encompassing a school district in Ontario, Canada. Results were striking with regards to the consistency with which religious youth reported more positive adjustment than did non-religious youth, regardless of level of spirituality. Spirituality may not be as salient an influence on behavior as religiosity. The secondary analyses indicated that the advantage for religiosity may not be entirely unique to church attendance, but rather a function of being part of any community. However, where religiosity may be uniquely associated with adjustment (over and above benefits associated with participation in any community) is in lower levels of risk behaviors.

Supervisory responsibilities of specialists

The public hospital system in New Zealand is heavily reliant on junior doctors for the day-to-day provision of medical care to hospital patients. Specialists have supervisory responsibilities for junior doctors during the day, as leaders of clinical teams, and after hours when they are on call. Due to changes in the health system over the past 20 years, there has been a change in the nature and level of specialist supervision required. Under the Code of Health and Disability Services Consumers' Rights, where aspects of clinical care are delegated to junior doctors, specialists have a duty to provide supervision with reasonable care and skill and in accordance with professional standards.     

Determination of Sex: Interest of Frontal Sinus 3D Reconstructions

Frontal sinuses (FSs) have been studied in radiology, anthropology, and forensic anthropology. This study aimed to determine whether it was possible to predict the age and sex of an individual using FS volume. Sixty‐nine anonymized CT scans were imported to MIMICS 10.01^® software (Materialise N.V.), and each FS volume was calculated in mm³. There was an absence of significant difference between right and left FS volume (p = 0.173) and an absence of correlation between age and FS volume (Pearson's test; p = 0.705). Sexual dimorphism was significantly different (p = 0.001). However, the most discriminant datum for determining sex was found to be the total FS volume (sum of an individual's right and left FS volumes) with linear discriminant Fisher's function coefficients of ?2.759 for the male group and ?1.275 for the female group. With this model, 72.5% of our sample was correctly classified according to sex.     

The Importance of Microscopic Examination of the Lungs in Decedents with Sustained Central Intravascular Catheters: A Nine‐Case Series

Indwelling intravascular catheters provide convenient access to healthcare personnel and also recreational intravenous drug users who inject suspensions of oral medications. A nine‐case series of autopsies of clinically stable decedents with indwelling catheters and sudden death is herein presented. Pulmonary histologic findings were consistent with intravenous administration of oral medications in all cases. In eight, the mechanism of death was directly attributed to occlusive vascular embolization of foreign material, with or without contribution of acute drug toxicity. In one, the mechanism of death was solely attributed to acute drug toxicity. Acute, massive embolization of foreign material may explain sudden death by vascular obstruction, whereas chronic repeated injections lead to obliteration of the pulmonary vasculature, increased pulmonary vascular resistance, and cardiac failure. Therefore, a complete autopsy with histologic examination of the lungs and toxicology testing is recommended in patients with indwelling catheters to determine the cause and mechanism of death.     

Metric Sex Determination of the Human Coxal Bone on a Virtual Sample using Decision Trees

Decision trees provide an alternative to multivariate discriminant analysis, which is still the most commonly used in anthropometric studies. Our study analyzed the metric characterization of a recent virtual sample of 113 coxal bones using decision trees for sex determination. From 17 osteometric type I landmarks, a dataset was built with five classic distances traditionally reported in the literature and six new distances selected using the two-step ratio method. A ten-fold cross-validation was performed, and a decision tree was established on two subsamples (training and test sets). The decision tree established on the training set included three nodes and its application to the test set correctly classified 92% of individuals. This percentage was similar to the data of the literature. The usefulness of decision trees has been demonstrated in numerous fields. They have been already used in sex determination, body mass prediction, and ancestry estimation. This study shows another use of decision trees enabling simple and accurate sex determination.