Simulation of an assault with self-tying and vaginal insertion of metal objects

Usefulness of portable, handheld breath analysers equipped with electrochemical sensor was assessed. Breath- and blood-alcohol concentrations in drunken drivers were taken from 370 expert opinions elaborated at the Institute of Forensic Research between January 1st 2002 and February 28th 2007. The results of second and subsequent measurements were re-calculated using mean elimination rates. The readings of portable instruments were in very good agreement with the results of confirmatory analyses performed by stationary devices (r=0.978, p<0.001, y=0.969x-0.0002). The correlation with the results of blood analysis was weaker (r=0.940, p<0.001, y=1.722x+0.214), but comparable with the correlation between the readings of stationary devices and the results of blood analyses (r=0.936, p<0.001, y=1.790x+0.091). The readings of portable and stationary breath analysers were also compared by the Bland-Altman plots. The differences in results were independent of alcohol concentration (absolute difference (mg/L): r=0.054, p>0.1, y=0.011x+0.013; relative difference (%): r=0.020, p>0.1, y=0.90x+2.36).     

Segmental determination of ethyl glucuronide in hair: a pilot study

Ethyl glucuronide (EtG) is a minor metabolite of ethanol. Its detection in hair is more and more studied in both clinical and forensic context for the purpose of alcohol abuse monitoring. In this pilot study, hair specimens from 15 patients included in a treatment program after alcohol abuse cessation, were segmented and analyzed for EtG. The results were then compared to their self-reported past alcohol consumption and to their blood biomarkers values (GGT, MCV, ASAT, ALAT). EtG concentrations measured in hair varied from 8 to 261 pg/mg. The pattern of EtG concentration detected in the different hair segments matched with the drinking history of patients, displaying variations (increase and decrease) in alcohol consumption and also time of cessation. Results also demonstrated the existence of a significant correlation (r(p)=0.5357; p=0.0390) between EtG concentration in hair and the amount of alcohol intake. Variations in the EtG concentrations with respect to hair segments may provide an overview of the drinking history of patients. Moreover, EtG concentration in hair may help to estimate the daily alcohol intake.     

Pathological intoxication and alcohol idiosyncratic intoxication--Part II: Legal aspects

The law does not generally allow alcohol intoxication as a defense in a criminal matter. Among the exceptions may be pathological intoxication, or PI, or its current psychiatric correlate, alcohol idiosyncratic intoxication (AII). Because of the lack of specificity in the medical concept and the varying approaches by different authors, careful analysis and adherence to current standards are necessary. Relevant laws, particularly that of the model penal code, are reviewed, as are three cases which demonstrate the issues involved. Actual testimony is presented to illustrate possible misuse or inappropriate use of the concept.     

Focal neurological complications of handcuff application

The application of handcuffs may result in compression neuropathies at the wrist. The frequency of these complications is unknown. Twelve of 190 (6.3%) consecutive subjects kept in police custody presented distal neurological symptoms possibly related to handcuff application. The duration of handcuffing was significantly longer in patients with neurological symptoms than in patients without neurological symptoms (mean +/- SD: 3.7+/-5.2 h vs. 1.8+/-2.6 h, P = 0.02). A long duration of handcuff application and, possibly, the existence of somnolence or acute alcohol intoxication could be predisposing factors to handcuff neuropathy. A prospective study of clinical and electrophysiological detection and follow up is needed.     

Injuries due to deliberate violence in areas of Denmark. IV. Alcohol intoxication in victims of violence. The Copenhagen Study Group

A material of 1316 victims of deliberate violence was collected prospectively during a one year period in three Danish emergency wards covering a provincial/rural area and two metropolitan areas. The frequency of alcohol intoxication was determined. Forty-one percent of the patients were intoxicated. The highest frequency was found in male victims, in the provincial/rural area, in restaurants or their vicinity, in the age group 35-49, during evenings and nights and in May. It is difficult to indicate specific preventive measures. However, a more restrictive attitude is suggested with regard to serving alcohol to intoxicated persons in restaurants.     

The emergency petition process in Maryland

Maryland's Emergency Petition statute allows a violent or suicidal person with a mental disorder to be brought to an emergency facility for rapid evaluation regarding the need for emergency treatment. Although many states have similar laws, little has been written in the psychiatric literature about the emergency petition process. The investigators evaluated emergency petition documents, demographic data, and the adequacy of emergency room records for all patients brought to a large county hospital in Prince Georges County, Maryland, by emergency petition during a one-month period. All emergency petition patients in Prince Georges County are brought to this hospital site. Of 94 petitioned patients examined during the study period, 92 records were available for review. The emergency petition was found to meet appropriate legal criteria in 94 percent of cases. More than half of all patients evaluated were intoxicated on alcohol or illicit drugs, and the majority of these patients were released from the emergency room as no longer dangerous after their acute intoxication resolved. In contrast to previous studies most of the patients evaluated were affluent, had health insurance, and were employed.     

Alcohol and Parasomnias: The Statistical Evaluation of the Parasomnia Defense in Sexual Assault,Where Alcohol is Involved

Sleep sex may be a defense for alleged sexual assault. The International Classification of Sleep Disorders (ICSD3) states: “Disorders of arousal should not be diagnosed in the presence of alcohol intoxication… The former [alcohol blackouts] are exponentially more prevalent.” A panel member of ICSD3, quoting ICSD3 asserts: “alcohol intoxication should rule out a sleep-walking defense”. This implies extremely strong support for a prosecution hypothesis (H_p) over a defense hypothesis (H_d). I use Bayesian methodology to evaluate the evidential probity of alcohol intoxication. The likelihood ratio, LR, measures the amplification of prior odds of guilt, . By Bayes' theorem, . I use data from cross-sectional studies of sexual assault and prevalence of alcohol use, in college students, with data from longitudinal studies, and data from the epidemiology of parasomnias to evaluate LR (alcohol). LR ~1.5 or 5, depending whether alcohol does, or does not, increase the risk of parasomnias. The proposition of extremely strong support for H_p implies a LR ~1,000,000, so the proposition in ICSD3 is not supported by formal analysis. The statistical reasoning in ICSD3 is unclear. There appears to be inversion of the Bayesian conditional (confusing intoxication given assault, and assault given intoxication) and failure to evaluate alcohol intoxication in H_d. Similar statistical errors in R. v Sally Clark are discussed. The American Academy of Sleep Medicine should review the statistical methodology in ICSD3.     

Morphological signs of ethanol poisoning, alcohol abstinence and chronic alcoholic intoxication in the mesocorticolimbic dopaminergic system

Forensic medical diagnostics of ethanol poisoning, alcohol abstinence, and chronic alcoholic intoxication of the mesocorticolimbic dopaminergic system remains an unresolved problem and encounters difficulties. This situation is due not only to the marked vulnerability of the neurons of the dopaminergic system but also to the fact that its mechanisms are poorly understood. The objective of the present work was to substantiate and develop diagnostic criteria for ethanol poisoning, alcohol abstinence, and chronic alcoholic intoxication of the neurons both in the mesocorticolimbic dopaminergic system and in other brain regions. The object of the study was the brain of healthy adult subjects who died from alcohol intoxication (in the period of ethanol resorption) and under conditions of alcohol abstinence (completion of the abstinence course). The purpose of the study was to elucidate factors responsible for the different degree of damage to the neurons of various identification groups (intact, hypochromic, picnomorphic, shadow) and macrogliocytes. The cells of all these types were counted at an area of 0.25 sq. mm within 4 squares each having a side of 250 mcm in length. The absolute and relative number of neurons in each group as well as the number of polyneuronal satellite cells per one intact neuron was determined. It was shown that alcohol intoxication is associated with acute swelling of and severe damage to brain neurons caused by the combination of such factors as toxic effect of ethanol, excessive production of catecholamines, and functional overstrain of dopaminergic neurons. The severity of acute alcohol damage to the neurons decreased with the distance from the mid-brain dopaminergic nuclei. Restoration of neurons during alcohol abstinence was due to compensatory activation of interactions between neurons and glial cells. It decreased in the sequence from the paranigral nucleus of the ventral portion of mesencephalic tegumentum to the medial portion of the accumbence nucleus (field 24b, layer III of field la, layer V of field 1) depending on the initial severity of acute damage in the brain region being examined. The severity of damage to the neurons of the mesocorticolimbic dopaminergic system under conditions of chronic alcohol intoxication estimated from the number of shadow neurons was similar to the degree of acute swelling associated with ethanol poisoning and decreases from a maximum in the nuclei of the mesocorticolimbic dopaminergic system to a minimum in layer III of field 1.     

Results of a proposed breath alcohol proficiency test program

Although proficiency test programs have long been used in both clinical and forensic laboratories, they have not found uniform application in forensic breath alcohol programs. An initial effort to develop a proficiency test program appropriate to forensic breath alcohol analysis is described herein. A total of 11 jurisdictions participated in which 27 modern instruments were evaluated. Five wet bath simulator solutions with ethanol vapor concentrations ranging from 0.0254 to 0.2659 g/210 L were sent to participating programs, instructing them to perform n = 10 measurements on each solution using the same instrument. Four of the solutions contained ethanol only and one contained ethanol mixed with acetone. The systematic errors for all instruments ranged from -11.3% to +11.4% while the coefficient of variations ranged from zero to 6.1%. A components-of-variance analysis revealed at least 79% of the total variance as being due to the between-instrument component for all concentrations. Improving proficiency test program development should consider: (1) clear protocol instructions, (2) frequency of proficiency testing, (3) use lower concentrations for determining limits-of-detection and -quantitation, etc. Despite the lack of a biological component, proficiency test participation should enhance the credibility of forensic breath test programs.     

ASSAULTIVENESS AND ALCOHOL USE IN FAMILY DISPUTES

Systematic naturalistic observation often contradicts experimental laboratory findings and idiosyncratic personal perceptions. In this study, family disputes managed by police officers trained in interpersonal conflict management yielded uniform observational data on 1,388 cases. The view shared by police and by social scientists that family disputes are likely to involve assaultiveness and that such behavior is typically caused by alcohol use was not supported by these data. Instead, the findings suggest that: assaults do not usually precede arrival of police; disputes are not usually influenced by alcohol use; and, indeed, assaults are less common when alcohol has been used.     

Methcathinone: a new postindustrial drug

Methcathinone, a methyl derivative of cathinone, is an illicit drug also known as ephedrone. It is a stimulant found in the "khat" plant, Catha edulis, which can easily be synthesized from pseudoephedrine. Its intoxication is difficult to diagnose and cure properly for two reasons: (i) target consumers are usually "well-educated people" aware of the risks and precautionary measures and (ii) intoxication by cathinone derivatives of synthetic or natural (derived from the khat) origin induce misleading symptoms. As a result, documented reports of methcathinone intoxication that are based on reliable analyses are rare. This paper describes a case of reiterated coma due to an overdose of methcathinone dissolved in alcohol that was taken with bromazepam. A 29-year-old woman was admitted to an emergency department for a coma of toxic origin. Medical files showed that it was her second such episode to occur that month. Moreover, the family indicated signs of depression, incoherent behaviour and intake of "amphetamine-like" drugs. Clinical examination revealed a Glasgow coma score of 9, symmetrical reactive pupils with mydriasis and no convulsions. The patient presented with rapid respirations and her blood pressure was 93/53 mmHg. The ionogram and the blood gas analyses were normal, while the blood alcohol level was 0.167 g/dL. Urinalysis revealed the presence of benzodiazepines and a high concentration of amphetamines (methcathinone: 17.24 mg/L, ephedrine: 11.60 mg/L and methylephedrine: 11.10 mg/L). In addition, serum analysis revealed bromazepam (8.89 mg/L), methcathinone (0.50 mg/L) and methylephedrine (0.19 mg/L). This case showed that the consumption of bromazepam and alcohol altered the typical clinical symptoms of cathinone derivative intoxication, namely hypertension and convulsions. Methylephedrine, an impurity resulting from the alkylation of a primary amine, can be considered a chemical tag indicating fraudulent synthetic origin of the drug. This case describes a documented example of new addictive behaviour of "well-educated" people involving the intake of methcathinone, a postindustrial psychostimulant intentionally combined with an anticonvulsant benzodiazepine. However, this specific case suggests that in spite of a very high bromazepam concentration in presence of the potentiator alcohol, the vital respiratory function would be probably maintained, thanks to the association with methcathinone.     

Rape-myth congruent beliefs in women resulting from exposure to violent pornography: effects of alcohol and sexual arousal

Previous research findings indicate that women suffer a variety of detrimental effects from exposure to violent pornography. This study used an experimental paradigm to examine the effects of a moderate alcohol dose and alcohol expectancies on women's acute reactions to a violent pornographic stimulus. A community sample of female social drinkers (N = 134) read an eroticized rape depiction after completing an alcohol administration protocol. As predicted, intoxicated participants were less likely to label the depicted events as rape than their sober counterparts. A path analytic model illustrated that participants' self-reported sexual arousal to the stimulus, as influenced by alcohol consumption and expectancies, resulted in increased rape myth congruent perceptions of the victim and decreased labeling of the incident as rape. Findings suggest that acute alcohol intoxication during violent pornography exposure may ultimately result in women developing more calloused attitudes toward rape and rape victims.     

Sleep deprivation does not mimic alcohol intoxication on field sobriety testing

Previous research shows that sleep deprivation (SD) produces cognitive impairment similar to that caused by alcohol intoxication. Individual studies suggest that SD also causes deficits in motor skills that could be mistaken for intoxication. Consequently, SD often is used as a defense when an impaired driver is charged with driving while intoxicated. Twenty-nine adult subjects participated in two test sessions each, one after a full night's rest and the other after wakefulness of at least 24 h. Subjects consumed prescribed amounts of alcohol during each session. Law enforcement officers conducted field sobriety tests identical to those with which a driver would be assessed at roadside. Researchers also measured clinical responses of visual function and vital signs. The presence and number of validated impairment clues increase with increasing blood alcohol concentration but not with SD. Thus, SD does not affect motor skills in a manner that would lead an officer to conclude that the suspect is intoxicated, unless intoxication also is present.     

Crime and Punishment in Norwegian Mid-adolescents: A Normal Population Study

Does the 'penal eye' of our society most easily catch sight of those with scant resources and lower-class backgrounds? In a national representative sample of Norwegian adolescents, we investigated the selection process to the penal system. Of the adolescents studied, 2.8% had received a penal sanction during the last year, 3.7% of the boys and 1.9% of the girls. The sanctions varied in seriousness, from a ticket fine to a prison sentence. These adolescents had much higher crime participation than other adolescents. In particular, substance-related offences were of importance. They had a high frequency of alcohol intoxication, and they often had a previous history of police contacts. No links were found to parental social class, but there was an association with parental history of unemployment. Furthermore, numerous other parental risk factors were found, such as marital breakup, low level of care, lack of monitoring and frequent alcohol intoxication. However, these factors were also associated with the development of crime. Were such extra-legal factors predictors of penal sanctions, when crime, alcohol intoxication and a previous history of police contacts were controlled for? Poor parental monitoring was the only (marginally) significant predictor. On the other hand, criminal behaviour had a highly significant effect, as early as at the lowest level of participation, and this effect increased steeply at higher levels. Alcohol had an effect, but only when the adolescents reported a rather high number of intoxication episodes. Thus, a problematic family background and small resources obviously play a role in the development of crime, but are less important as direct factors of being caught by the police and punished by the penal system. However, the subjects in our sample were still in their midteens and it might well be that development in late adolescence and young adulthood takes a different course.     

A cognitive therapy treatment program for repeat DUI offenders

Driving under the influence is a devastating problem in the United States, killing almost 17,000 people in 2005. The present article describes a cognitive treatment program aimed at repeat drinking and driving offenders. Sixty-three participants were court mandated to the four-month outpatient treatment program. Before entering and after completing treatment, participants were administered self-report instruments measuring alcohol problems, readiness to change, self-esteem/efficacy, and criminal thinking patterns. Additionally, arrest histories were examined. Findings suggested that participants were characterized not only by repeated arrests, but elevated blood alcohol content and high levels of self-reported alcohol dependency and problem-drinking behaviors. The majority of clients expressed a readiness to change their drinking and driving behaviors with 87 percent graduating from the program. A DUI recidivism rate of 13 percent was found for graduates of the program at a twenty-one month follow-up. The results demonstrate that the treatment program is a valuable tool in the battle to reduce criminal recidivism.     

Experiences of coercion during investigation and treatment

According to Swedish legislation (LVM) compulsory treatment shall be decided on if someone, due to ongoing abuse of alcohol, drugs or volatile solvents, is in need of care to overcome abuse and if a voluntary intervention is not possible. Very little research has been conducted in Sweden on this particular legislation with regard to the clients' experiences of entire process from assessment to aftercare. We interviewed 74 subjects who were being assessed prior to the court's decision on involuntary care (n=39), or with previous experience of assessment and involuntary care (n=35). The assessment group more often reported having the opportunity to express their opinions to the social worker during the assessment period (55% vs. 21%, p<.05) and they were more positive towards the final decision (60% vs. 24%, p<.05). In spite of the law, 18% were not contacted by the social services while in coercive treatment. The clients who did meet with a social worker, often described the conferences as more of a perfunctory nature with a lack of focus on the actual situation and aftercare planning. This study points at a need of studying the subjects' experiences of the whole continuum of the coercive process: from the investigation, to treatment and to aftercare. It also points at the need for new instruments to be developed covering all aspects of the coercive process and in particular the period of investigation prior to the decision on involuntary care.     

Homicide Rates in Lithuania

Homicide rate in Lithuania between 2004 and 2013 decreased and reached an average of 6.7 per 100,000 people in 2013. The data regarding forensic autopsies of intentional homicide victims were obtained from the State Forensic Medicine Service. Spearman's correlation test was used to assess trends in the homicide rates. A significant correlation was observed between homicide distribution and the following variables: Lithuania's gross domestic product (r = ?0.85, p = 0.003), the number of alcohol intoxication cases of victims (r = 0.97, p < 0.05). After regression model adjustments, these variables remained significantly associated with the homicide distribution (p < 0.05). 73% of victims were men, with a mean age of 45.5 ± 15. Alcohol intoxication was present in 58% of victims. 66% of homicides were carried out indoors, 57% in urban area. The presented findings help decide which prevention programs may be the most effective in homicide rate reduction.     

Now <Emphasis Type="Italic">Everyone</Emphasis> Looks the Same: Alcohol Intoxication Reduces the Own-Race Bias in Face Recognition

Several factors influence the reliability of eyewitness identification evidence. Typically, recognition for same-race faces is better than for different-race faces (the own-race bias), and alcohol intoxication decreases overall face recognition accuracy. This research investigated how alcohol intoxication influences the own-race bias. Asian and European participants completed tests of recognition memory for Asian and European faces when either mildly intoxicated (mean breath alcohol concentration of .05) or when sober. Compared to their sober counterparts, intoxicated participants showed a reduced own-race bias. Specifically, alcohol intoxication had a larger negative effect on the recognition of same-race faces compared to different-race faces. The legal and theoretical implications of these results are discussed.     

Opiate analysis in cadaveric blowfly larvae as an indicator of narcotic intoxication

Specimens of liver were collected from 40 cases in which the cause of death had been determined to be opiate intoxication. Rearings of Calliphora vicina larvae were then promoted on the decomposing liver. A control group of 10 decomposed liver specimens from non-opiate deaths was treated similarly. Analysis of larvae and liver for opiates (morphine) was conducted by radioimmunoassay. Good qualitative and quantitative correlation was observed in both the positive and negative groups. Regression analysis comparing the concentrations of opiates found in the larvae with those found in the liver in the positive group resulted in a correlation of r = 0.790.