Medical examiner response to the drug overdose epidemic in King County Washington: “Real-time” surveillance,data science,and applied forensic epidemiology

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real-time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.     

Ballistic impact of hollow-point ammunition on porcine bone

Identifying failure mechanisms in skeletal tissue allows a deeper understanding of the effects of specific projectile impacts on bone. While ballistic trauma in flat bones is largely researched, knowledge of how long bones react to gunshot impacts is limited in the literature. The impacts of deforming ammunition appear to produce higher levels of fragmentation; however, these have not been studied in depth. This study compares the damage to femora bone by HP 0.357 and 9 mm projectiles constructed with both full and semi-metal jackets. Impact experiments were undertaken on a single-stage light gas gun involving the use of a high-speed video camera and full reconstruction of the bones to ascertain fracture patterns occurring in the femora. Higher degrees of fragmentation are likened to the presence of semi-jacketed HP projectiles than jacketed HP projectiles. The observations of external facing beveled edges are believed to be associated with the increased separation of the jacket and lead core of projectiles. Additionally, experimentation has shown that the amount of kinetic energy lost postimpact is likely related to the presence or the absence of a metal jacket on an HP projectile. The observed data, therefore, suggest that the composition, rather than the configuration, of a projectile affects the type and extent of the damage.     

There’s an app for that: Modernizing domestic violence support through the creation of new technologies,tools, and services

With domestic violence (DV) at an all-time high, police departments are drastically underutilizing technology to combat DV. Currently, New York police departments complete a “Domestic Incident Report” at the scene of domestic incidents but fail to adequately facilitate support services. New York State should mandate a services component into police DV protocols, specifically by commissioning: (1) an application linked to DV organizations presented at the scene of domestic incidents; and (2) a gateway application to refer victims to the correct services. Such tools would allow for the rendering of more efficient support to DV victims in times of immediate crisis.     

‘My Eyes Were Open’: Awakened Maternal Identity and Leaving Violent Relationships for the Infant/Children

A qualitative secondary analysis explored stories of mothers (n = 49) who left violent relationships (VRs) through a lens of maternal identity. Constant comparative method identified a theory of Awakened Maternal Identity (AMI) and Leaving VR for the Infant/Children. Mothers described how the VR diminished their maternal identity (DMI). Partners controlled the VR though unrealistic infant care expectations, criticisms of infant care, harsh parenting, and control over mothering decisions. DMI lowered the mother’s capacity to provide emotionally nurturing infant care. Over time, mothers experienced AMI- as their ‘eyes were opened’ they experienced a stronger sense of mothering responsibility, focused more on the infants and children, and eventually prioritized their relationship with the infants and children over the partner. AMI seemed a turning point that led to leaving the VR for the infants/children. Recommendations offered for professionals to foster AMI as potential means to initiate the leaving VRs.     

Mediating Effects of Existential and Religious Well-Being Among Abused,Suicidal African American Women

Intimate partner violence (IPV), an international public health matter, is linked to psychological distress including suicidal behavior. Despite the noted sequelae associated with IPV, many individuals display resilience in the face of IPV exposure. This study examines two potential protective factors in the IPV-suicidal ideation link, namely existential and religious well-being, in a sample of African American women. Low-income, African American, female suicide attempters who were abused by a partner within the previous year (N?=?111) were administered the Conflicts Tactics Scale-2, Spiritual Well-Being Scale, and Beck Scale for Suicide Ideation. Mediational models testing indirect effects through the bootstrapping method revealed that the total effect of IPV on suicidal ideation was positive and significant, confirming suicidal ideation as a consequential outcome of IPV among African American women. This effect was mediated by existential well-being; however, religious well-being was not a significant mediator, suggesting that existential well-being serves a unique protective role in the IPV-suicidal ideation relation. The results provide additional support for the well-known positive effects of existential well-being on mental health among African American samples. Culturally-informed, meaning-making interventions to enhance existential well-being appear to be effective in reducing suicidal ideation in this population.     

12-Month Prevalence,Trends, Gender Differences,and the Impact of Mental Health Services on Intimate Partner Violence Perpetration Among Discharged Psychiatric Inpatients

Minimal research has examined partner violence committed by individuals with severe mental illness. This study examined rates of IPV in the first year post-discharge from psychiatric hospitalization, trends over time, gender differences, and the impact of follow-up mental health services. One in five (20.3 %) patients committed at least one act of IPV in the first year. Whereas women were more than twice as likely to perpetrate IPV, men were nearly twice as likely to be violent toward non-family members. Risk of IPV was highest immediately post-discharge and decreased over time, with the sharpest decline after 20 weeks in the community. Mental health treatment was associated with a 40 % decrease and medication non-adherence a 50 % increase in risk for IPV. Partner violence is a prevalent concern among discharged psychiatric patients, and these findings suggest that coordinated risk management efforts should focus on the time immediately following hospital discharge.     

Are Female Offenders Underreported Compared to Male Offenders? A German-Greek Comparison of Crime Reporting,Rating of Offence Seriousness and Personal Experiences of Victimisation

The difference in official crime statistics between women and men is a constant fact in criminology, but has yet to be explained in a satisfactory way. There are few studies addressing the issue of why this gender gap is larger in registered crime than it is in self-report studies. The study at hand comprises a survey among Greek and German students to examine whether this gap could be attributed to a gender-specific reporting of crime. Participants’ self-reported experiences of victimisation and their rating of the seriousness of offences depicted in case vignettes were used to gain insight into varying tendencies to report a crime depending on the offender’s gender. The act of reporting a crime did not vary gender-specifically.