Elevated and similar urinary testosterone/epitestosterone ratio in all samples of a competition testing: suspicion of a manipulation

The case of seven urine samples collected for anti-doping purposes during a cycling stage race with moderately elevated testosterone and epitestosterone ratio (T/E) is reported. The very low probability of having all seven urine samples with such similar elevated T/E ratio (from 3.2 to 4.7) was very suspicious. Different pattern classification tools were tested to categorize the most similar steroid profiles, but none of the models enabled a clear classification of the different urine samples. Subsequently, genetic profiling of all urine samples was performed and demonstrated that three of the seven samples were collected from the same cyclist. Finally, the International Federation confirmed DNA profiling results. This suggests that urinary steroid data using several methodologies are not appropriate for identification purposes and to an extent not unique to individuals.     

Relinquishing custody as a requisite for receiving services for children with serious emotional disorders

A review of the literature was conducted to assess the extent and nature of the practice of requiring parents to transfer custody in order to receive public funding for intensive services needed by their child/adolescent who had a serious emotional disorder. The review focused on the legal and policy basis of this practice as well as its social and psychological impact on child and family. We conclude that the practice of transfer of custody as a requirement for receiving financial aid occurs in a majority of states, though the actual extent of this practice is not known. The major factor influencing the use of transfer of custody appears to be the absence of an appropriate and adequate system of services for children and adolescents with serious emotional disorders. We recommend that the practice of requiring custody transfer for the sole purpose of receiving services be abolished and offer several suggestions for improving acess to services.Preparation of this article was supported in part by the National Institute of Mental Health (NIMH) under contract no. 89MF761903. The authors are grateful to John Burke and Kelly Kelleher of the Division of Biometry and Applied Sciences, NIMH for their assistance on this project. Laurie Flynn, Executive Director for the National Alliance for the Mentally Ill, was very helpful during the informative stage of the project. Barbara Friesen, Director of the Research and Training Center at Portland State University, gave us useful guidance throughout the project. We thank Stephen Hill, Consultant to the National Governors' Association, for his help. We are grateful to Amy Hewitt and Carol Ishler for their assistance in preparing this report. We also would like to acknowledge several individuals who assisted us with research reported in this article. We are grateful to Governor Richard F. Celeste of Ohio for his letter of support for the state survey of custody transfer practices. We appreciate the efforts on behalf of this survey by staff from the State of Ohio, particularly Jean Ellen Stevens, Administrative Assistant to the Director of the Department of Mental Health. Margraret McNally assisted in the compilation of data for both surveys.     

Teaching medical ethics and law

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.     

Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis

In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids.     

Skepticism and Sanction: The Benefits of Rejecting Moral Responsibility

It is sometimes objected that we cannot adopt skepticism about moral responsibility, because the criminal justice system plays an indispensable social function. In this paper, I examine the implications of moral responsibility skepticism for the punishment of those convicted of crime, with special attention to recent arguments by Saul Smilansky. Smilansky claims that the skeptic is committed to fully compensating the incarcerated for their detention, and that this compensation would both be too costly to be practical and would remove the deterrent function from incarceration. I argue that the skeptic is not committed to full compensation of the offender, and that the costs of such compensation would in any case be far smaller than Smilansky thinks. In fact, I claim, the costs of the criminal justice system to which the skeptic is committed might be very much lower than the costs ?C economic, social and moral ?C we currently pay as a consequence of our system of punishment.