The retina in forensic medicine: applications of ophthalmic endoscopy: the first 100 cases

The retina reflects a variety of diseases in the living patient. However, the retina is not routinely examined in deceased persons, and therefore it is unknown if routine retinal examination would be a useful adjunct to the forensic autopsy. To examine this issue, the retinae of routine medical examiner cases were examined utilizing an ophthalmic endoscope. The results of the first 100 examinations are reported. Specific attention was given to changes that reflected the postmortem interval, the development of petechiae as related to cardiopulmonary resuscitation, and the association of retinal hemorrhages to subconjunctival hemorrhages. The procedure was helpful in cases of suspected shaken baby syndrome, exsanguination, and carbon monoxide poisoning and in cases with sudden increased intracranial pressure (Terson syndrome). It appears that lividity patterns exist in the retina, and this may be potentially useful in determining body position after death. Some natural disease processes, such as hypertension, were also identified. Finally, the utility of the ophthalmic endoscope as a means of circumventing the problem of corneal clouding is discussed, and ideas for further research using this technology are presented.     

African American Oxford House residents: sources of abstinent social networks

The current study found that African American residents of Oxford House (OH) used Narcotics Anonymous (NA) at high rates, and that both OH and NA strongly contributed to abstinent social networks. Having siblings and other family members in one's network predicted substance use among network members, whereas spouses, parents, and children did not have an effect on the rate of substance use. These findings suggest that OH and NA may be effective sources of abstinent social support for African Americans recovering from substance abuse. However, family members are well represented in the support networks of African Americans in OH.     

Stress and coping: the roles of ethnicity and gender in substance abuse recovery

This study investigated ethnic and gender differences in reported resource losses and gains for recovering substance abusers living in Oxford Houses (OH). Participants (n = 829) completed a version of Hobfoll's (1998) Conservation of Resources (COR) Evaluation. Results indicated significant individual differences in resources, based on gender, ethnicity, and the length of OH residential stay. Men reported fewer resource gains and losses than women. With respect to ethnicity, African-Americans reported greater gains and losses in resources than European-Americans. Individuals with less time in an OH also reported having experienced more losses in the past 3 months.     

Attitudes of a community members as a function of participatory research with Oxford Houses

Citizen participation in research may include involvement in generating original ideas, planning appropriate designs, collecting data, and helping to implement interventions. Unfortunately, little is known about the attitudes of the community members who participate in such research processes. In the present exploratory study, a team of community members (4 men, 3 women; age > 30 years old) who were employed as investigator research associates to evaluate an innovative substance abuse recovery home were asked for their perspectives about their involvement in the research effort. Findings indicated that these community members felt their participation was a positive experience. Moreover, while their understanding and sense of participation in the research process increased, their identification and affiliation with their support organization was not reduced. Results imply that there is a need to better understand how citizen members of community organizations are affected by their involvement in the research process.     

Creating a home to promote recovery: the physical environments of Oxford House

The interior and exterior physical characteristics of substance abuse recovery program dwellings (11 woman, 44 men) from three geographic sections of the United States were assessed at creating a "house-as-home" for residents. Although each house was independently governed and operated by residents, results indicated vast similarities among the interior characteristics, amenities, and structural aspects. These rented dwellings also had similar well-maintained exterior characteristics, despite their geographic locations. Follow-up interviews of former residents indicated that these house characteristics and amenities helped create a sense of home not found in traditional institutional facilities. Results suggested that residents of self-governed independently operated recovery houses may create and maintain safe and sober settings that elicit a sense of home among residents.     

Simultaneous separation of different types of amphetamine and piperazine designer drugs by capillary electrophoresis with a chiral selector

The recent emergence of a new class of piperazine-type compounds has brought about the need for laboratory screening methods for both seized drugs and toxicological samples. These piperazine compounds, which include 1-benzylpiperazine (BZP) and 1-(3-trifluoromethylphenyl)piperazine (TFMPP), exhibit comparable physiological effects and can be substituted for the classic amphetamine-type drugs. We have optimized a chiral capillary electrophoresis (CE) separation that detects a set of 6 piperazine and 4 chiral amphetamine compounds in under 23 min using a 200 mM phosphate buffer at a pH = 2.8 with 20 mM hydroxypropyl- beta-cyclodextrin (HPbeta3CD). In addition to the above compounds, a series of "clandestine" BZP diHCl samples were also analyzed using this method to assess the ruggedness of the procedure. The novel CE separation was tailored to simultaneously detect these piperzine compounds in addition to amphetamine-type drugs. Distinct migration time and UV-spectral data were obtained for all compounds of interest.     

Investigation of elderly deaths in nursing homes by the medical examiner over a year

Despite death being one of the most common reasons for discharge from a nursing home, fewer than 1% of nursing home resident deaths are autopsied. To evaluate our role as medical examiner in nursing home deaths, we conducted a retrospective review of all decedents in Jefferson County, Alabama, for the year 2001. Death certificate data indicate that 995 deaths occurred in nursing homes in Jefferson County in 2001. Of those 995 deaths, 119 (12%) were reported to the Jefferson County Coroner/Medical Examiner Office. Jurisdiction was accepted in 5 cases in which the circumstances already made clear that the death was a nonnatural event. In the remaining 96% of nursing home deaths reported to the medical examiner, the statements of the reporting person were taken to be true concerning the expected nature of the death. An independent scene evaluation was provided by a police officer or paramedic in 82% of the cases reported to the medical examiner's office. Elderly individuals, as a group, are expected to die, but the death of a particular elder may or may not be expected. In our jurisdiction, only 12% of all nursing home deaths are reported to our office, and only 4% of reported deaths are actively investigated. Actively investigating each nursing home death would overwhelm the resources currently available to our office. We advocate the study and development of criteria to aid in determining whether the death of an individual elder is sudden and unexpected.