Under-recording of ethanol intoxication and poisoning in cause-of-death data: causes and consequences

In the present study we examined how consistently and completely the role of acute alcohol (ethanol) intake as a cause of death is reported on death certificates, how complete and specific the statistical recording of cause-of-death data on acute alcohol-induced deaths is, and how the information ultimately appears in the national mortality statistics. Data on all alcohol-positive deaths with blood alcohol concentration of ≥ 0.5‰ (g/kg) in Finland in 2005 (N = 2348) were reviewed. Overall, a concentration-dependent association was found between forensic-toxicologically determined blood alcohol concentrations and acute alcohol-specific cause-of-death diagnoses. Based on a medico-legal re-evaluation of death certificates, acute alcohol-specific causes were found to be underreported nationally at a rate of 8%. For accidental alcohol poisonings alone, the figure was about 1%. This underreporting was not corrected during recording of the cause-of-death data, though individual corrections and changes were observed. Especially, recording of multiple causes suffers from this underreporting of acute alcohol-specific causes. ICD-10 seems to do well in fulfilling the demands for a specific classification of uncomplicated alcohol poisoning. In combined alcohol-drug poisonings, however, ICD-10 shows a bias towards drugs over alcohol, even when alcohol has been specified and reported as the most toxic component by the medico-legal pathologist. Since the national statistics is based on the underlying causes, this state of affairs is likely to result in the underestimation of the role of acute alcohol intake as a cause of death. This observation of underreporting of acute alcohol-specific causes on death certificates should result in a harmonisation of education and principles and practices used in death certification. To increase the coverage and specificity of mortality statistics, based on the underlying causes of death, the coding of all components of alcohol-drug combinations and their classification according to the most important intoxicant or combination of intoxicants is recommended.     

Headspace solid phase microextraction for the gas chromatographic analysis of methyl-parathion in post-mortem human samples. Application in a suicide case by intravenous injection

A simple and rapid procedure for the determination of methyl-parathion (m-p) in post-mortem biological samples was developed using headspace solid phase microextraction (SPME) and gas chromatography (GC) with nitrogen-phosphorous detection (NPD). Methyl-parathion was extracted on 85 microm polyacrylate SPME fiber. Salt addition, extraction temperature, and extraction time were optimized to enhance the sensitivity of the method. The linearity (y = 0.0473x - 0.0113, R2 = 0.9992) and the dynamic range (0.1-40 microg/ml) were found very satisfactory. The recoveries of methyl-parathion were found to be 46% in spiked human whole blood, 53% in spiked homogenized liver tissue, and 54% in spiked homogenized kidney tissue compared with samples prepared in water. The coefficients of variations for 2, 4, and 20 microg/ml of methyl-parathion in blood ranged from 0.9 to 5.1%, whereas the detection limit of the method was satisfactory (1 ng/ml in aqueous samples, 50 ng/ml in whole blood). The developed procedure was applied to post-mortem biological samples from a 21-year-old woman fatally poisoned (suicide) by intravenous injection of methyl-parathion. The intact insecticide was found in the post-mortem blood at a concentration of 24 microg/ml. No methyl-parathion was detected in the liver, kidneys, and gastric contents.     

Last performance with VIAGRA: post-mortem identification of sildenafil and its metabolites in biological specimens including hair sample

A 43-year-old man was found dead in a hotel room during a sexual relation with a colleague.He was treated both for cardiovascular disease and for erectile dysfunction with VIAGRA. A pillbox was found in the room with several tablets of verapamil (Isoptine), trimetazidine (Vastarel), yohimbine and bromazepam (Lexomil). A box of VIAGRA 25mg was found in his raincoat and two tablets were missing. His wife declared during the investigation that he was also treated by trinitrine. Autopsy revealed severe coronary artery sclerosis as well as signs of previous myocardial infarctions. Blood, urine, bile, gastric content and hair and representative tissues for histology were collected for toxicological analysis.Sildenafil and yohimbine were screened with liquid chromatography/mass spectrometry (LC/MS) and trinitrine with headspace injection (HS)/GC/MS. Verapamil and trimetazidine were identified and quantified with LC/diode array detection (DAD).Sildenafil was identified in blood, urine, bile and gastric content at 105, 246, 1206 and 754ng/ml, respectively. Hair concentration was 177pg/mg. The desmethyl metabolite was quantified in urine at 143ng/ml. Blood concentrations of verapamil and trimetazidine were measured at 659 and 2133ng/ml, respectively and were above therapeutic ranges. Trinitrine and yohimbine were not identified.These results confirm the absorption of sildenafil, verapamil and trimetazidine before the death and hair analysis indicates the chronic use of sildenafil.To the author's knowledge, this is the first report of a fatal sildenafil-verapamil association, probably by hypotension and cardiac dysrhythmia.     

Complex suicide by two gunshots to the chest and consecutive hanging: circumstances and aspects of reconstruction

In cases of suicidal gunshots, the capacity to act may be preserved for a certain period of time, so that the suicide may be completed with another method. In the presented case a 74-year-old man was found hanged on the first floor of his house with two gunshot wounds in the chest. Both on the ground and the upper floor traces of suicidal acts were detected. As shots to the precordial region suggest rapid incapacitation, a suicide extending over two floors seemed almost impossible without knowledge of the cause of death and evaluation of the ability to act. The autopsy findings confirmed vital signs of hanging. Moreover, a through-and-through gunshot wound of the chest and abdomen affecting the spleen and a shot lodged in the body without injuring the lung were found. The injury findings thus sufficiently explained the preserved ability to act. The presented case shows characteristics of a complex suicide not yet described so far, but could be clearly classified as suicide in congruity with the pertinent literature.     

Choking on toilet paper: an unusual case of suicide and a review of the literature on suicide by smothering, strangulation, and choking

While reports of suicide by smothering and strangulation are common, suicide by choking is far more rare. In addition to the act being difficult to carry out, suspected cases are not easily distinguished from accidental or homicidal deaths. Here, we present a case of suicide by choking on toilet paper in a patient with a long history of schizophrenia. The case was ruled a suicide based on the patient having been witnessed in a previous unsuccessful attempt of the same act.     

Chronology of a homicide and an attempted suicide by DNA analysis of selected blood stains on the weapon (knife)]

A five-year-old boy was fatally injured by a stab and a cut to the throat. The suspected offender, an acquaintance of the victim's mother, stated that he had been disturbed by the boy while attempting suicide and had therefore killed the boy. The suspect showed superficial cuts on both wrists and three shallow stabs on the right-hand side of the abdomen. The purpose of the forensic investigations was to answer the question if the suspect's statement could be confirmed or if the attempted suicide took place after killing the boy. The blood-smeared blade of the knife was divided into different sectors with the cutting edge and the tip of the blade being examined separately from the sides. The blood traces from the different blade sectors were then typed in 12 different DNA regions by PCR (polymerase-chain-reaction). It could be demonstrated that the strong blood traces on the sides of the blade originated from the victim alone, whereas in the area of the edge and the tip of the blade the amount of the victim's blood was negligible compared with that of the suspected offender. The explanation for this finding is that in the areas of the edge and the tip of the knife the blood of the victim must have been replaced by the blood of the suspected perpetrator, which means that the suicidal injuries were the last to be caused by the knife.     

Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review

A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of death.     

Bridging the gap between facts and norms: mutual trust,the European Arrest Warrant and the rule of law in an interdisciplinary context

The rule-of-law-backsliding in some Member States has subverted not only one of the EU fundamental values but also trust among national authorities when implementing European Arrest Warrants (EAW). However, when evaluating the execution of EAWs issued by countries experiencing rule-of-law crises, the Court of Justice of the EU (CJEU) sought to preserve judicial cooperation and imposed a rather “top-down” view on mutual trust among Member States. This approach seemingly disregards the (dis)trust which has emerged in the EU due to rule-of-law-backsliding and fails to acknowledge the psycho-sociological nature of trust. Drawing on the trust literature, the paper offers novel conceptual elements to rethink mutual trust in the EAW framework. Notably, it critically assesses some of the gaps in the CJEU's interpretation of mutual trust and advances suggestions to embed empirical considerations in the conceptualisation of this principle to bridge the gap between trust in practice and in principle.     

Forensic analysis of soil and sediment traces by scanning electron microscopy and energy-dispersive X-ray analysis: an experimental investigation

This paper reports the results of a series of experiments carried out to determine the precision of soil trace comparisons based on elemental peak height ratios determined by energy-dispersive X-ray analysis (EDXRA) in a variable pressure scanning electron microscope (VP-SEM). Experiments were conducted on 'bulk' soil aggregates, ground powders prepared from the <150 microm soil fractions and on smears of both the bulk soil and <150 microm material placed on cotton cloth. X-ray count data were obtained using area scans and spot analyses at different magnifications. The effects on elemental peak height ratios of varying the SEM chamber pressure, beam spot size, emission current and accelerating voltage were also examined. The peak height ratios for oxygen, silicon, aluminium, potassium, calcium and iron were found to show little variation as a function of chamber pressure, spot size and emission current over the ranges examined, but a strong dependency on accelerating voltage was observed. Within-sample variation in results, expressed by the percentage coefficient of variation, was found to be lowest for area scan analyses of the ground <150 microm fractions and greatest for the spot analyses of the bulk soil aggregates and the <150 microm fractions. We conclude that comparison of elemental peak height ratios determined by EDXRA can be a useful tool for rapid screening of soil samples, especially when combined with investigation of other attributes of the soil traces such as colour, fabric and the composition, shapes and surface textures of individual particles or aggregates within the soil traces. If sufficient material is available and can be readily separated without contamination or loss, higher resolution and more precise elemental data should be obtained by methods such as inductively coupled plasma atomic-emission spectrometry (ICP-AES) or mass-spectrometry (ICP-MS).     

Attributions of responsibility,blame and justifiability to a perpetrator and victim in an acquaintance rape scenario: the influence of Marijuana intoxication

Abstract

Marijuana is a commonly used illicit drug by young adults and has been implicated in about one third of sexual assaults. However, the influence of Marijuana intoxication on rape attributions has not been previously investigated. This study examined the effects of perpetrator and victim Marijuana intoxication and participant sex on rape attributions. Young adults (N = 285) read an acquaintance rape scenario where Marijuana intoxication was manipulated and completed measures of perpetrator (responsibility, blame and justifiability) and victim attributions (responsibility and blame). The results revealed that an intoxicated, compared to sober, perpetrator was attributed less responsibility for his sexual aggression. When the victim was intoxicated, compared to sober, the perpetrator and victim were attributed less and more blame for the assault, respectively. These findings demonstrate that, irrespective of perceiver sex, Marijuana intoxication, like alcohol intoxication, results in an attributional double standard in favour of the perpetrator.     

Forced marriage: an analysis of legislation and political measures in Europe

Forced marriage is of current international concern in Europe. As many cases involve a transnational component linked to migration, it is increasingly receiving attention at the government level. The serious consequences for women, including sexual violence, and the physical and psychological health risks associated with it, seem to receive little consideration. Recent years have seen a rise in initiatives and measures taken by policy makers throughout Europe. As the focus is placed on criminalization and stringent immigration policies, ethnic minority population groups bear the greatest burden. It is argued that specific criminal laws make it more difficult for victims to come forward, while offering very little or no protection in return. The widespread 21-year age rule in immigration law has been denounced by scholars, institutes and magistrates alike for infringing on the fundamental human right to family life guaranteed by article 8 ECHR. The discourse on forced marriage appears to have reached a crossroads. European governments are faced with the challenge to create policies that protect and support victims, while simultaneously cracking down on perpetrators and safeguarding their borders from abuses in obtaining visas. There is a very pressing need to work more closely with those at risk, involving service provisions to directly support them, instead of a one-side top-down policy framework through which minority communities feel targeted and stigmatized.     

Financial development policies in Uzbekistan: an analysis of achievements and failures

This paper provides a detailed analysis of Uzbekistan’s performance in liberalising its financial system. Two major areas are considered in the paper. First, we review financial development reform in Uzbekistan from independence until 2006, including the banking sector, non-bank financial institutions and securities markets. Second, it examines the policy achievements and failures of the Uzbek path and the sequence of reforms in each of these areas. Policy recommendations are then offered to remedy the existing problems that we identify. This paper is first to make a detailed analysis of policy successes and failures in Uzbekistan financial reform.     

Beyond incubation: an analysis of firm survival and exit dynamics in the post-graduation period

With regard to the survival rates of business incubator (BI) firms, the literature mainly presents findings of failure rates only during the incubation period. Little is known about the survival or exit dynamics of firms after leaving the incubator facilities. This study approaches this research question by examining the survival of 352 firms from five German BIs after their graduation. The findings suggest that graduation causes an immediate negative effect on survivability that lasts up to 3 years after leaving the incubators. Furthermore, heterogeneous patterns of post-graduation exit dynamics between the BIs were observed. It was also found that performance during the incubation period is an indicator of the propensity of business closure after graduation. This study offers valuable insights and implications for all stakeholders of BI-initiatives.      

Tax rates and tax evasion: an empirical analysis of the long-run aspects in Italy

We use official time series of the Italian evaded VAT base (Ministry of Finance) for the period 1980:1–2006:4 to investigate empirically the long-run characteristics of tax evasion and the relationship with the tax burden. Three hitherto unexplored issues are addressed. First, using different measures of aggregate economic activity as reference variables in estimating the average tax burden, we examine the size and dynamics of the overburden traceable back to tax evasion. Second, exploiting cointegration techniques, we quantify the elasticity between tax evasion and the average tax rate in Italy. We then comment on the complex dynamic interaction between the tax burden and tax evasion to ascertain whether in the Italian experience there is evidence for any “vicious circle” between them.     

Real Life Heroes in Residential Treatment: Implementation of an Integrated Model of Trauma and Resiliency-Focused Treatment for Children and Adolescents with Complex PTSD

Real Life Heroes (RLH) engages children and caregivers to rebuild (or build) emotionally supportive relationships, develop self-regulation and co-regulation skills, reduce traumatic stress reactions, and integrate a positive self-image through conjoint life story work. RLH includes psychoeducation, a life story workbook, multi-modal creative arts, and a toolkit to help practitioners implement National Child Traumatic Stress Network recommended components of treatment for Complex PTSD as a child and family transition from residential treatment to home and community-based programs. A case study and results from pilot studies highlight utility of the model for residential treatment and how RLH can help residential treatment programs implement evidence-supported trauma and resiliency-focused treatment including incorporation of NCTSN curricula to provide an integrated framework for practitioners, residential counselors, county case managers, educators, resource parents, home-based counselors, mentors, and other caring adults.