Souvenir knife: a retained transcranial knife blade

Upon necroscopic examination of a homeless male found comatose in the street and pronounced dead at a medical center 12 hours later, a sharp tip of a knife lodged in the right parietal region of his skull was incidentally discovered. The blade transected the diploe and penetrated the cerebral cortex. Subsequent police investigation revealed that this was the remnant of a stabbing attempt on his life several months prior to his death. The cause of death was determined to be unrelated to the metallic blade fragment, thus making it a truly incidental and rare finding of a "souvenir knife." Nevertheless, since the injury sustained in the stabbing was potentially life threatening, the investigation into that assault was reopened.A case report is presented, along with a brief review of the literature on "souvenir objects."     

Medical care of individuals residing in substance abuse and recovery homes: an analysis of need and utilization

The current study examined medical care need and utilization patterns among a substance abusing and recovering population (n = 876), investigating factors such as employment and drug use categories (e.g., pharmaceutical use, cocaine use, heroin use, alcohol use). It was found that those who were unemployed needed and utilized greater medical care than those who were employed. Results indicated that heroin, cocaine, and/or alcohol use was not predictive of medical care need or utilization, whereas pharmaceutical drug use was predictive of medical care need and utilization. Trauma and risky use of substances were not significant predictors of medical care need or utilization whereas the suicide severity composite was significant. Potential implications for misuse of medical services (e.g., to obtain pharmaceutical drugs of use) and federal medical care expenditure allocation are discussed.     

Analysis of pilot-related equipment and archaeological strategy in the recovery of aircrew losses from the Vietnam War

Determining the location and distribution of cockpit and aircrew-related equipment within the wider debris field of a military aircraft crash site is an essential first step in planning and executing the recovery of missing aircrew members presumed still to be on the site. Understanding the spatial relationship of these materials improves the likelihood of finding and recovering the remains of the aircrew during the excavation of an aircraft crash site. Since the greater portion of these unaccounted for crewmembers were involved in aircraft with single-seat cockpits or cockpits with two or three seats in tandem, pre-analysis of the debris pattern may be more-or-less straightforward. Larger, multiple-personnel aircraft, on the other hand, create a potentially more complex analytical situation given the aircrew's greater freedom of movement within the aircraft. Nevertheless, the same fundamental principles apply and, indeed, have been successfully so for some time in the civilian arena. But older aircraft crash sites, i.e., those dating to World War II, Korea, or the Vietnam conflict, have been and still are undergoing taphonomic processes that progressively alter these relationships. The following will illustrate that exchange of information between the anthropologist/archaeologist and the life-support analyst is required to maximize the effectiveness of field recovery and demonstrates the relationship between the recovery of life-support equipment and human remains and the effect that aircraft type has on this relationship.     

Compensation for medical injury in New Zealand: does "'no-fault" increase the level of claims making and reduce social and clinical selectivity?

The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems. This article reports on the analysis of two data sources-a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, the level of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care. It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.     

A review of methadone deaths in Jefferson County,Alabama

Interpretation of the concentration of a drug is more difficult when a combination of drugs is present in a decedent's blood. An increase in deaths resulting from co-intoxication with methadone and a benzodiazepine led the authors to perform a retrospective study of cases examined at the Jefferson County Coroner/Medical Examiner Office. They found 101 deaths wherein methadone was detected in the blood. Based on the drugs detected in the blood, these 101 cases were grouped into four categories: (1) pure methadone intoxication, (2) intoxication with methadone and benzodiazepine, (3) intoxication with methadone and other drugs excluding benzodiazepine, and (4) intoxication with methadone, benzodiazepines, and other drugs. Methadone was the sole intoxicant in 15 cases, with a mean concentration of 0.27 mg/L. Benzodiazepines were the most frequently detected co-intoxicant (60 of 101 cases). Benzodiazepine was the only co-intoxicant in 30 cases, and the mean methadone concentration in those 30 cases was 0.599 mg/L. Higher levels of methadone may occur in acute intoxication with methadone and benzodiazepine because benzodiazepines compete with methadone for methadone receptors. Higher levels of methadone may occur with chronic abuse of methadone and benzodiazepines because over time, benzodiazepines inhibit the hepatic enzymes that metabolize methadone.     

Presidential popularity in a context of economic crisis and political change: The case of Mexico

The study shows how presidential approval ratings in Mexico during an era of crisis have been shaped by citizen reactions to environmental conditions but also by the effects of the transition toward a more competitive electoral system. Regime transitions toward greater democracy in Latin America and elsewhere may hold important implications for the formation of public opinion and mass political behavior. Charles L. Davis is associate professor of political science at the University of Kentucky. His interests include comparative politics, political psychology, and Latin America. Ronald E. Langley has been affiliated with the department of political science at the University of Kentucky. His recent research interests are public opinion and presidential politics.