Doctors as fiduciaries--revisiting the past with an eye on the future

A substantial proportion of the body of literature dealing with the question of whether or not a doctor stands in a fiduciary relationship with a patient in Australia assumes or asserts that this should be the case, despite strong indications to the contrary in Australian case law. Three key bases for making such assertions, the internationalist, revisionist and remedialist approaches, are identified and critiqued. It is argued that each of these approaches to justifying the characterisation of the doctor-patient relationship as a fiduciary one is flawed and unlikely to meet with success in future litigation. Additionally, there are issues of economic and resource allocation conflict in doctor-patient relationships. The implications for these conflicts in the doctor-patient fiduciary debate are briefly considered. It is concluded that, contrary to the dominant assertion in the extant literature on the subject, in Australia at least, the scales tip against, rather than towards, the characterisation of the doctor-patient relationship as a fiduciary one.     

Convergence Criteria for Participation in the Flexible Mechanisms of the Kyoto Protocol

We suggest a multi-layered system of three convergence criteria – similar to those used in the run-up to the European monetary union – that define the notion of "demonstrable progress" towards reaching the emission commitments under the Kyoto Protocol. These are the existence of an independently evaluated national emissions inventory, the level of domestic policies and measures, and the quantitative convergence of emissions towards the Kyoto target. While the first of these criteria constitutes a necessary condition for use of the Kyoto Mechanisms, the other two should determine the degree of participation allowed for any given Annex I country.     

Combined homicide-suicide in Galveston County

Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). To further understand the nature of this tragic phenomenon and to test the validity and practicality of a previously suggested classification system, investigators systematically collected data on all combined homicide-suicide events that occurred in Galveston County, Texas over a continuous 18-year period (n = 20). The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of these, as predicted, were of the consortial type, possessive subtype. As expected, due to the small sample size, the less common types of combined homicide-suicide were not represented in this sample.     

SPME/GC-MS characterization of volatiles associated with methamphetamine: toward the development of a pseudomethamphetamine training material

The headspace profiles of eleven methamphetamine (MA) samples have been analyzed using solid-phase microextraction/gas chromatography-mass spectrometry (SPME/GC-MS). Nine of the eleven are illicit MA seizures from the Southwest U.S. border. One sample is methamphetamine base synthesized in the Drug Enforcement Administration (DEA) Southwest Laboratory, and the remaining sample is pharmaceutical-grade methamphetamine hydrochloride that is used to make training aids for drug detecting canines. In addition. volatiles associated with 1-phenyl-2-propanone (P2P), a methamphetamine precursor, have been identified for comparison with those found in methamphetamine seizure and the two reference samples. Eighty-seven different compounds were identified from all the samples, not including simple hydrocarbons and aldehydes. Only seven occur consistently in all seizure samples, and these are: acetic acid, benzaldehyde, acetophenone, P2P, 1-phenyl-1,2-propanedione (P12P), 3-phenyl-3-buten-2-one, 1-chloro-1-phenyl-2-propanone. Dimethyl sulfone, a common cutting agent in methamphetamine. was found in six of the nine seizure materials. When the reference methamphetamine and P2P samples are included, only two compounds are common to all twelve samples, and these are benzaldehyde and P2P. As such, these two compounds are likely candidates for use in a pseudomethamphetamine (PM) formulation, and their effectiveness in eliciting a canine response is being evaluated before actual deployment.     

Deposition of 7-aminoflunitrazepam and flunitrazepam in hair after a single dose of Rohypnol

In recent years, there has been a notable increase in the number of reports on drug-facilitated sexual assault. Benzodiazepines are the most common so-called "date-rape" drugs, with flunitrazepam (Rohypnol) being one of the most frequently mentioned. The aim of this study was to determine whether flunitrazepam and its major metabolite 7-aminoflunitrazepam could be detected in hair collected from ten healthy volunteers after receiving a single 2 mg dose of Rohypnol using solid phase extraction and NCI-GC-MS. Such data would be of great importance to law enforcement agencies trying to determine the best time interval for hair collection from a victim of drug-facilitated sexual assault in order to reveal drug use. Ten healthy volunteers (eight women and two men, 21 to 49 years old) participated in the study. The following hair samples were collected from each volunteer: one before flunitrazepam administration, and 1, 3, 5, 14, 21, and 28 days after. In five volunteers, 7-aminoflunitrazepam was detected 24 h after flunitrazepam administration and remained in hair throughout the entire 28-day study period (0.6-8.0 pg/mg). In two cases, 7-aminoflunitrazepam appeared in hair 21 days after drug intake (0.5-2.7 pg/mg), and in two subjects 14 days later (0.5-5.4 pg/mg). In one volunteer, 7-aminoflunitrazepam was detected on day 14 and 21 but concentrations were below the quantitation limit. Flunitrazepam was detected in some samples but all concentrations were below the quantitation limit (0.5-2.3 pg/mg).     

Validation of short tandem repeats (STRs) for forensic usage: performance testing of fluorescent multiplex STR systems and analysis of authentic and simulated forensic samples

The amplification and typing conditions for the 13 core CODIS loci and their forensic applicability were evaluated. These loci are CSF1PO, FGA, TH01, TPOX, vWA, D3S1358, D5S818, D7S820, D8S1179, D13S317, D16S539, D18S51, and D21S11. Results were obtained using the multiplex STR systems AmpFlSTR Profiler Plus and AmpFlSTR COfiler (Applied Biosystems, Foster City, CA), GenePrint PowerPlex (Promega Corporation, Madison, WI), and subsets of these kits. For detection of fluorescently labeled amplified products, the ABI Prism 310 Genetic Analyzer, the ABI Prism 377 DNA Sequencer, the FMBIO II Fluorescent Imaging Device, and the Fluorlmager were utilized. The following studies were conducted: (a) evaluation of PCR parameter ranges required for adequate performance in multiplex amplification of STR loci, (b) determination of the sensitivity of detection of the systems, (c) characterization of non-allelic PCR products, (d) evaluation of heterozygous peak intensities, (e) determination of the relative level of stutter per locus, (f) determination of stochastic PCR thresholds, (g) analysis of previously typed case samples, environmentally insulted samples, and body fluid samples deposited on various substrates, and (h) detection of components of mixed DNA samples. The data demonstrate that the commercially available multiplex kits can be used to amplify and type STR loci successfully from DNA derived from human biological specimens. There was no evidence of false positive or false negative results and no substantial evidence of preferential amplification within a locus. Although at times general balance among loci labeled with the same fluorophore was not observed, the results obtained were still valid and robust. Suggested criteria are provided for determining whether a sample is derived from a single source or from more than one contributor. These criteria entail the following: (a) the number of peaks at a locus, (b) the relative height of stutter products, and (c) peak height ratios. Stochastic threshold levels and the efficiency of non-templated nucleotide addition should be considered when evaluating the presence of mixtures or low quantity DNA samples. Guidelines, not standards, for interpretation should be developed to interpret STR profiles in cases, because there will be instances in which the standards may not apply. These instances include (a) a primer binding site variant for one allele at a given locus, (b) unusually high stutter product, (c) gene duplication, and (d) translocation.     

Entrapment in small, enclosed spaces: a case report and points to consider regarding the mechanism of death

The mechanism of death due to confinement in an enclosed space is usually ascribed to asphyxia from oxygen deprivation. We report the case of the decomposed remains of a 23-year-old man discovered in an unused industrial size refrigerator in which the mechanism of death is heatstroke. The investigation of the death indicates the subject most likely voluntarily entered the refrigerator and for unknown reasons, closed the door. Injuries identified at autopsy and damage to the inside of the structure indicate he struggled to exit the cabinet. The autopsy shows no significant natural disease processes and toxicology studies were negative. The diagnosis of heat stroke typically rests on the evaluation of multiple features, including the age and size of the decedent, the ambient temperature, the medical history of the decedent, whole body hydration, body fat content, alcohol and drug use, medication history, general physical condition, and many other factors. The diagnosis of heatstroke due to confinement in an enclosed container requires evaluation of the heat stress of the container, the heat strain experienced by the individual, autopsy findings suggesting signs of a struggle to exit the container, and other factors. In all such cases, a careful death investigation with correlation of autopsy findings is required to accurately determine the mechanism and cause of death. We suggest that for all such deaths, physiological and environmental factors promoting hyperthermia and heatstroke be considered as a possible mechanism of death, along with those associated with the more obvious danger of asphyxiation.     

Microscopic characteristics of hacking trauma

The purpose of this study was to determine if it is possible to associate machetes, axes, and cleavers with the microscopic parallel striations they leave on the cut surfaces of the bone. Hacking trauma was experimentally inflicted on pig bones using machetes, axes, and cleavers. Negative impressions of both the cut surfaces of the bone and the weapon blades were analyzed using scanning electron microscopy. The results of this investigation indicate that it is possible to correlate a class of hacking weapons to trauma inflicted on bone by these weapons.