Legal medicine and the medical establishment

Formal medical discipline-based regulation and professional support for legal medicine practitioners have been a long time coming. While informal associations and societies of like-minded doctors and dentists have existed for some time, they have not had the sort of "establishment credibility" that is required to influence policy-makers and drive formal processes for professional training and regulation in this area. The recent creation of formal medical College status for medico-legal specialists within the medical establishment is described and the advantages discussed. The creation of formal career pathways, organised training structures and policy advisory systems in legal medicine for government has the potential to support recruitment to this difficult and challenging area of medical practice. This can only be of benefit to the legal profession who rely on these medical practitioners in so many areas. The standards setting, recertification, revalidation and accreditation activities of a formal Royal Medical College are likely to have significant influence on the work of health and legal policy regulators at a time of considerable change.     

A Bayesian Multilevel Modeling Approach to Time-Series Cross-Sectional Data

Joseph Bafumi Department of Government, Dartmouth College,6108 Silsby HallHanover, NH 03755 e-mail: joseph.bafumi{at}dartmouth.edu Luke Keele Department of Political Science, Ohio State University,2137 Derby Hall, 154 N Oval Mall, Columbus, OH 43210 e-mail: keele.4{at}polisci.osu.edu David Park Department of Political Science, George Washington University,1922 F Street, N.W. 414C, Washington, DC 20052 e-mail: dkp{at}gwu.edu e-mail: bshor{at}uchicago.edu (corresponding author) The analysis of time-series cross-sectional (TSCS) data hasbecome increasingly popular in political science. Meanwhile,political scientists are also becoming more interested in theuse of multilevel models (MLM). However, little work existsto understand the benefits of multilevel modeling when appliedto TSCS data. We employ Monte Carlo simulations to benchmarkthe performance of a Bayesian multilevel model for TSCS data.We find that the MLM performs as well or better than other commonestimators for such data. Most importantly, the MLM is moregeneral and offers researchers additional advantages. Authors' note: A previous version of this article was presentedat the 2005 Midwest Political Science Meeting. We would liketo thank the following for comments and advice in writing thispaper: Andrew Gelman, Nathaniel Beck, Greg Wawro, Sam Cooke,John Londregan, David Brandt. Any errors are our own.     

Psychopathy and Violent Crime: A Prospective Study of the Influence of Socioeconomic Status and Ethnicity

The relationship between psychopathy and violence is well-established. However, few studies have examined the extent to which this relationship is influenced by sociodemographic predictors of violent criminality. In this prospective study we examine the power of psychopathy to predict criminal violence across ethnicity and levels of socioeconomic status in 199 European American and African American U.S. county jail inmates. A Psychopathy x SES x Ethnicity interaction was identified such that among European Americans psychopathy predicted recidivism at lower levels of SES but was unrelated to recidivism at higher levels of SES. The predictive power of psychopathy was relatively stable across SES among African Americans. The implications of our results for psychopathy and violence prediction are discussed.     

Knocking at the wrong door: insured workers' inadequate psychiatric care and workers' compensation claims

ObjectiveTo describe the prevalence of inadequately evaluated and treated psychopathology among insured workers making workers' compensation claims for psychiatric disability whose cases were reviewed by one forensic psychiatrist. To assess the relationship of inadequate evaluation and treatment to the outcomes of these workers' compensation claims.MethodsRecords of a series of 185 workers' compensation cases reviewed in 1998 and 1999 by a California forensic psychiatrist were abstracted. Patient factors (gender, Axis II pathology, psychosocial circumstances, substance abuse), case factors (psychiatric injury secondary to physical injury, or secondary to psychological stresses), type of provider (mental health, or other), adequacy of evaluation and treatment, forensic psychiatrist's recommendation, and claim outcome were categorized. The relationships between case characteristics, adequacy of care, and claim outcome were described.Results22% of cases had adequate evaluation, 48% superficial, and 30% had no evaluation. 11% had adequate treatment, 67% superficial, and 22% had no treatment. Compared to claims for psychiatric disability related to a physical injury, claims related to psychosocial stresses more often had superficial diagnostic evaluations and treatments. Those with superficial treatment were less likely to have their claim granted (19.3%) than those with no treatment (47.5%) or those with adequate treatment (36.8%). Success of claim was not related to provider type.ConclusionsThe majority of the studied workers with employer-provided health insurance who sought workers' compensation for disability due to mental illness did so inappropriately, in that the workplace did not cause the psychopathology. Their seeking workers' compensation was plausibly due to the observed inadequate evaluation and treatment available through their employer-provided health insurance. The adequacy of their care influenced the likelihood their claim would be granted. The relations observed here merit further research to establish their generality and to determine their causes.     

Intensive case management as a jail diversion program for people with a serious mental illness: a review of the literature

This article reviews the research on intensive case management (ICM) programs as a jail diversion intervention for people with a serious mental illness (SMI). The review includes two types of ICM programs: (a) general ICM programs that included an assessment of arrests and incarceration rates for people with an SMI and (b) ICM programs specifically implemented as a component of a jail diversion intervention for people with an SMI. Results indicate that general ICM programs (19) rarely led to reductions in jail or arrest rates over time, and these rates were similar to those found in standard mental health services. General ICM programs that included an integrated addiction treatment component (8) had mixed results but a trend toward reductions in rates of arrests and incarceration over time for individuals with an SMI and a co-occurring substance use disorder. Results were mixed for jail diversion interventions with an ICM program, but most ICM programs (8) led to significant reductions in arrests and incarcerations over time. Specific elements of effective ICM jail diversion programs are discussed.     

The effectiveness of art therapy in reducing depression in prison populations

Major obstacles block the effectiveness of therapy in prison. Many inmates have an inherent mistrust for verbal disclosure. Rigid defenses exist for basic survival. Despite these defenses, there has been support for art therapy as a valuable tool. Unfortunately, there has been little research to measure the effectiveness of art therapy in prison. Two quantitative studies were initiated in a North Florida prison to measure the effectiveness of art therapy with inmates, specifically in decreasing depressive symptoms. This article will present a pilot and follow-up study. The methods, including the Formal Elements Art Therapy Scale (FEATS) and the Beck Depression Inventory-Short Form, will be delineated. What was revealed was that although the FEATS proved more effective as a measurement tool for the pilot than for the follow-up study, ultimately, the results reflected a significant decrease in depressive symptoms in those inmates who participated in the program.     

Glaucoma diagnostic invention ruling puts flesh on bones of G 1/04

The exclusion of diagnostic methods practised on the human bodyfrom patentability was subject to clarification from the EnlargedBoard of Appeal in Case G 1/04 of 16 December 2005. This casegives a practical example of the application of the EnlargedBoard's decision.     

Virtual autopsy and forensic identification-practical application: a report of one case

The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full-body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico-legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse.     

Methyl 3-[3',4'-(methylenedioxy)phenyl]-2-methyl glycidate: an ecstasy precursor seized in Sydney, Australia

Five 44 gallon drums labeled as glycidyl methacrylate were seized by the Australian Customs Service and the Australian Federal Police at Port Botany, Sydney, Australia, in December 2004. Each drum contained a white, semisolid substance that was initially suspected to be 3,4-methylenedioxymethylamphetamine (MDMA). Gas chromatography-mass spectroscopy (GC/MS) analysis demonstrated that the material was neither glycidyl methacrylate nor MDMA. Because intelligence sources employed by federal agents indicated that this material was in some way connected to MDMA production, suspicion fell on the various MDMA precursor chemicals. Using a number of techniques including proton nuclear magnetic resonance spectroscopy ((1)H NMR), carbon nuclear magnetic resonance spectroscopy ((13)C NMR), GC/MS, infrared spectroscopy, and total synthesis, the unknown substance was eventually identified as methyl 3-[3',4'(methylenedioxy)phenyl]-2-methyl glycidate. The substance was also subjected to a published hydrolysis and decarboxylation procedure and gave a high yield of the MDMA precursor chemical, 3,4-methylenedioxyphenyl-2-propanone, thereby establishing this material as a "precursor to a precursor."