The prevalence of MDMA/MDA in both hair and urine in drug users

The prevalence and age distribution of 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyamphetamine (MDA) in hair samples by gas chromatography/mass spectrometry (GC/MS) were studied. The recoveries obtained from hair were 97% and 99% for MDMA and MDA, respectively. The inter- and intra-assay precision and accuracy were determined. Out of 791 hair samples, 44 (5.6 %) contained MDMA and/or MDA. Out of these 44 subjects, urinalyses from 35 were negative for both MDMA and MDA, while only 9 were positive. We also evaluated concentrations of MDMA and MDA, and the metabolite-to-parent drug ratios. This study showed that the abuse of MDMA or MDA was found principally among young adults and male abusers. We found the epidemiology of ecstasy users in Korea between March 2002 and April 2003.     

Mitochondrial DNA error prophylaxis: assessing the causes of errors in the GEP'02-03 proficiency testing trial

A qualitative and quantitative analytical method was developed and validated for the determination of 49 licit and illicit drugs in oral fluid. Small oral fluid samples, volume 1mL, were collected from volunteers using a modified Omni-Sal device and the analytes were extracted from an oral fluid/buffer mixture using a single Bond Elut Certify solid phase extraction cartridge. Liquid chromatography-tandem mass spectrometry (LC-MS-MS) and gas chromatography-repetitive full scan mass spectrometry (GC-MS) were used in parallel to analyze the extracts for the targeted drugs. Extracts were analyzed by GC-MS in their underivatized form and as their pentafluoropropionyl derivatives. Deuterated internal standards were used for quantification of drugs of abuse by LC-MS-MS to minimize matrix effects. Methadone-d(9) and tumoxetine were used as the internal standards for quantification of non-derivatized and derivatized analytes respectively by GC-MS. Linearity was demonstrated over the range 5-200 ng/mL and limits of detection were less than 4 ng/mL for each drug analyzed. The method demonstrated acceptable recoveries for most of the analytes and good intra- and inter-day precision. Acquisition of data by repetitive full scan GC-MS allows the addition of further analytes to the target menu.     

Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging?

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.     

Fatal steamer accident; blunt force injuries and drowning in post-mortem MSCT and MRI

Steamer accidents, through contact with the bucket wheel, are very seldom today. No publication of such a kind of fatal accident could be found in literature. We present the case of a fatal steamer accident, in which the findings of a blunt traumatization of a person by the ship was completely documented by post-mortem combined multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) examinations. A rupture of the aorta was detected using both radiological methods without use of radiopaque material. Radiological examination revealed a comminuted fracture of the thorax vertebrae at the same level as the aortic rupture. Injuries of the soft tissues of the back, caused by the bucket wheel of the steamer, were also diagnosed. In addition to the signs of blunt force trauma the findings of drowning such as an over inflation of the lungs, fluid in the stomach and duodenum were revealed. Furthermore, algological analysis detected diatoms in the lung tissue and blood from the left heart. Therefore, the cause of death was considered being a combination of fatal hemorrhage, caused by the aortic rupture, and drowning. We conclude that virtual autopsy using combined post-mortem MSCT and MRI is a useful tool for documentation, visualisation and analysis of the findings of blunt force trauma and drowning with a large potential in forensic medicine.     

The paradoxical politics of provider reempowerment

The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.     

Between normality and deviance: the breakdown of batterers' identity following police intervention

With the transformation of intimate violence from private trouble to social problem, police intervention in domestic violence cases became more prevalent. Research has focused mainly on battered women's perception of police intervention, their evaluations, and their level of satisfaction with the intervention. However, there is little research examining the perpetrators' subjective perceptions of such interventions. The purpose of this study is to describe and analyze battering men's perceptions of police intervention. The study is based on semistructured, in-depth interviews with 20 batterers who had repeated encounters with police. Findings show a continuum of self-management, ranging from attempts to preserve a normative identity in the first encounter to struggling against criminalization in the second encounter and adopting a victim identity in the third encounter. The findings are discussed in the context of gender identity and power relations.     

Police referral to victim support: the predictive and diagnostic value of the RISK (10) screening instrument

One of the basic rights of crime victims granted under victim-orientated legislation introduced during the last 20 years in more than 100 countries worldwide is the right to be referred to victim support by the police. The under-utilization of psychological services by crime victims who are objectively in need of external support is substantial. Current legal procedures tend to perpetuate this unwanted condition. Programs aimed at the early detection and prevention of persistent postvictimization distress are more in line with the ideals of therapeutic jurisprudence. The RISK (10) screening instrument, which was specifically developed to be administered by police officers, may provide a basis for early detection. RISK (10) consists of a selection of 10 Risk factors with prior empirical evidence and theoretical significance. The focus of the present study was to examine the predictive and diagnostic power of RISK (10) components to detect persistent future psychological distress, among other things, in terms of Adjustment Disorder. Analyses were based on a sample of 93 crime victims who participated in the police and (3 months) follow-up parts of the study. Findings provided initial validation for the predictive accuracy of most RISK (10) components, and confirm the diagnostic value (in terms of specificity, sensitivity, positive and negative predictive power) of risk factors, such as engaging in character attributions, upward comparison processes, fatalistic appraisals of the episode, and the initial reporting of expected deficiencies in social support. The clinical utility of RISK (10) for early detection in police stations is confirmed.     

Relevance of "psychopathy"-- concepts from the Hare measure for preventive detention

Preventive detention can be ordered, if a person falls back into crime repeatedly and shows a "disposition to commit substantial offences". In the trial and at subsequent points of time expert opinions supporting this personal disposition have to be obtained. However up to now it is not clear on which basis such statements should be made. On the basis of a retrospective investigation of the author's own expert opinions the paper discusses the relevance of Hare's psychopathy concept for opinions on criminal disposition.