Unusual fentanyl patch administration

Fentanyl is an extremely potent narcotic analgesic that is becoming more popular as a drug of abuse. Because of the unique way in which the drug is packaged and delivered, the potential for unusual methods of abuse exists. We report the first case of true fentanyl patch ingestion in the medical literature. Initially, though unusual, cases of fentanyl ingestion were thought to have been reported, but further investigation of the literature revealed that in other case reports the patches had been held in the mouth and chewed. Because no reports of swallowing the patch had been published, suicide was initially a strong consideration in this case; however, further investigation showed that the decedent and his brother enjoyed swallowing the patches for quick "highs." Cases such as these serve to remind medical examiners and law enforcement officials of the value of performing thorough death investigations by performing complete autopsies with toxicological testing and correlating with investigation information to form an opinion with regard to the cause and manner of death.     

Medical professionals convicted of accessing child pornography--presumptive lifetime prohibition on paediatric practice? Health Care Complaints Commission v Wingate

Health Care Complaints Commission v Wingate [2007] NSWCA 326 concerns an appeal from the New South Wales Medical Tribunal regarding its findings on professional misconduct outside the practice of medicine in relation to a doctor convicted of possessing child pornography. The latest in a number of cases on this issue in Australia, it highlights the complexity of such decisions before medical tribunals and boards, as well as the diversity of approaches taken. Considering both this case and the recent Medical Practitioners Board of Victoria case of Re Stephanopoulos [2006] MPBV 12, this column argues that Australian tribunals and medical boards may not yet have achieved the right balance here in terms of protecting public safety and the reputation of the profession as a whole. It makes the case for a position statement from Australian professional bodies to create a presumption of a lifetime prohibition on paediatric practice after a medical professional has been convicted of accessing child pornography.     

Hair analysis for cocaine: factors in laboratory contamination studies and their relevance to proficiency sample preparation and hair testing practices

Since the introduction in 2001 of a urine-based detection method for recombinant erythropoietin (rHuEPO), transfusion-doping practices have regained interest. To address this problem, an efficient antidoping test designed to obtain direct proof of allogeneic blood transfusion was developed and validated. This test, based on flow cytometry analysis of red blood cell (RBCs) phenotypes, was used to determine the absence or the presence of numerous RBCs populations in a blood sample. A such, it may constitute a direct proof of an abnormal blood population resulting from homologous transfusion. Single-blind and single-site studies were carried out to validate this method as a forensic quality standard analysis and to allow objective interpretation of real cases. The analysis of 140 blood samples containing different percentages (0-5%) of a minor RBCs population were carried on by four independent analysts. Robustness, sensitivity, specificity, precision and stability were assessed. ISO-accredited controls samples were used to demonstrate that the method was robust, stable and precise. No false positive results were observed, resulting in a 100% specificity of the method. Most samples containing a 1.5% minor RBCs population were unambiguously detected, yielding a 78.1% sensitivity. These samples mimicked blood collected from an athlete 3 months after a homologous blood transfusion event where 10% of the total RBCs present in the recipient originated in the donor. The observed false negative results could be explained by differences in antigen expression between the donor and the recipient. False negatives were more numerous with smaller minor RBCs populations. The method described here fulfils the ISO-17025 accreditation and validation requirements. The controls and the methodology are solid enough to determine with certainty whether a sample contains one or more RBCs populations. This variable is currently the best indicator for homologous blood transfusion doping.     

Risk assessment in offenders with intellectual disability: a comparison across three levels of security

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.     

Exhibitionism: findings from a Midwestern police contact sample

This study used a police sample to examine offense characteristics, recidivism rates, and other types of sexual offending among individuals suspected of exhibitionism. The sample consisted of 202 incidents of indecent exposure perpetrated by 106 identified individuals. Demographic information showed that one quarter of the sample had symptoms of a mental illness and one quarter had a history of substance abuse. More than 84% of the sample had other nonsexual criminal charges. Approximately 30% of the perpetrators were charged for more than one exposure incident. Masturbating during the offense, exposing to child victims, and speaking to the victim did not show any relationship to the occurrence of more sexually aggressive behaviors. However, individuals who had subsequent rape or molestation charges (16.9%) were more likely than those who did not to have had multiple exposure incidents and a history of physical assault charges.     

Experimental evaluation of rigor mortis IX. The influence of the breaking (mechanical solution) on the development of rigor mortis

In criminal proceedings involving illegally manufactured substances, evidence demonstrating the manufacture is required for successful prosecution. In many circumstances the presence of manufacturing equipment and 'recipes' are clear indicators. However establishing chemical links between starting materials and products would be beneficial additional evidence in such circumstances. Isotope analysis is becoming more commonly employed in disputes over authenticity and provenance of materials such as food stuffs or pharmaceuticals [S. Benson, C. Lennard, P. Maynard, C. Roux, Forensic applications of isotope ratio mass spectrometry--a review, Forensic Sci. Int., 157 (2006) 1-22]. We report here the results of an isotope study investigating a link between hexamine used as a starting material and the product explosive RDX, manufactured using the Woolwich process. Isotopic composition of hexamine and RDX was analysed by stable isotope ratio mass spectrometry. Five different hexamine samples were selected from a group of eleven for use in this study. One of the five hexamine samples was used twice, providing data on the reproducibility of the synthesis. Carbon and nitrogen isotope analysis of the hexamine starting material and RDX products reveals a reproducible relationship between reactant and product.     

Longitudinal Predictors of Restrictive Eating and Bulimic Tendencies in Three Different Age Groups of Adolescent Girls

This study examined longitudinal predictors of future eating problems in 435 female adolescents in Grades 7, 8, and 10, who were tested at two time points 8 months apart. Restrictive eating and bulimic tendencies were found to be relatively stable from Time 1 to Time 2, particularly in older grade levels. Partial correlations predicting Time 2 restrictive eating and bulimic tendencies indicated a role of body dissatisfaction, depression, and weight-related teasing, with findings being most clear in Grade 7. Path analyses indicated that the relationships among predictors were more complex and that some of the relationships were mediated by other variables.     

The Demand for Land Title Registration: Theory with Evidence from Kenya

This article examines the role of title registration in providingsecurity of property rights for landowners. A simple model isdeveloped to examine the trade-off between increased securityof registering title against the administrative costs of accessingthe system. The model predicts that the demand for registrationshould be increasing in the value of the land, the educationof the landowner, and proximity to the central government (thelatter two being measures of the cost of accessing the system).Evidence on land registration in Kenya provides support forthe model.