Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Polyclonal systemic immunoblast proliferation: an unusual hematologic entity presenting as a medical examiner case

A 43-year-old woman who was receiving oral antibiotics for several days for a superficial foot infection developed a persistent rash, fever, and lymphadenopathy, despite discontinuation of the antibiotic and administration of steroids for a presumed drug reaction. Hours after a subsequent visit to the emergency room for worsening symptoms, she died at home. At autopsy, there was a florid, systemic proliferation of polyclonal plasma cells and immunoblasts infiltrating nearly every organ and tissue of the body, most notably the lymph nodes and spleen. The polyclonal nature of the process was confirmed by immunofixation electrophoresis and immunohistochemistry. Cases of fatal polyclonal systemic immunoblast proliferations are extremely rare, and the trigger for such proliferations is not always known. We review the literature on this unusual entity and discuss the clinical and pathologic findings.     

A novel hunting accident. Discharge of a firearm by a hunting dog

The authors report the case of a 21-year-old man who was killed while duck hunting when a shotgun accidentally discharged, shooting him in the head. The loaded weapon, which had been lying on the ground with the safety off and the muzzle pointed toward a river a few feet away, discharged when a hunting dog stepped on the trigger. Scene investigation confirmed that the victim had been standing in the river, planting decoys, with his head approximately level with the adjacent bank. Autopsy examination and ballistic testing confirmed a range of fire consistent with the witness' statements. Examination of the weapon in question documented a light trigger pull but no mechanical defects. The authors review the epidemiology and causality of hunting accidents and discuss the various safety rules that were violated in this highly unusual case. The importance of a complete death investigation, including autopsy, when dealing with a firearm death is emphasized.     

Police grantsmanship: A case study

Police leadership is increasingly dependent on community oriented policing (COPS) federal grants because of diminishing financial resources. This paper demonstrates the importance of excellent police grantsmanship skills while simultaneously providing theoretical and concrete steps for achieving a successful grant package. Furthermore, a case study example is presented where COPS grants and federal funding assisted in the acquisition of community-oriented and problem-solving strategic objectives.     

Entrepreneurial Regulatory Legal Strategy: The Case of Cannabis

This article develops the concepts of regulatory legal strategy, a resource-based view of government agencies, and regulatory entrepreneurship. These ideas are explored through a case study of the limited (if any) access that legal cannabis-related businesses have to the banking system due to the clash between federal law and laws in those states that have legalized some uses of cannabis. This article argues that regulators’ entrepreneurial regulatory legal strategies can have a material impact on regulated entities and give them a competitive advantage. To demonstrate, this article claims that regulators’ adoption of permissive regulatory legal strategies has facilitated access of some cannabis-related businesses to the banking system. Conversely, if regulators adopted obstructive regulatory strategies, this would act as a constraint on such access in the future, even if Congress resolves the federalism issue largely responsible for the current limitations these businesses face.     

What Levels of Racial Diversity Can Be Achieved with Socioeconomic‐Based Affirmative Action? Evidence from a Simulation Model

This paper investigates to what extent socioeconomic status (SES)‐based affirmative action in college admissions can produce racial diversity. Using simulation models, we investigate the racial and socioeconomic distribution of students among colleges under the use of race‐ or SES‐based affirmative action policies, or targeted, race‐based recruitment policies. We find, first, that neither SES‐based affirmative action nor race‐targeted recruiting on their own produce levels of racial diversity achieved by race‐based affirmative action. However, the two policies in combination, although likely expensive, may yield racial diversity comparable to race‐based affirmative action. Second, the use of affirmative action policies by some colleges reduces the diversity of similar‐quality colleges without such policies. Third, the combination of SES‐based affirmative action and race recruiting results in fewer academically‐overmatched Black and Hispanic students than under race‐based affirmative action, but the schools that use both also see a reduction in the academic achievement of enrolled students.     

Teaching criminal investigation: A critical thinking approach

The purpose of this paper is to explore the “critical thinking” approach to teaching and develop those concepts into meaningful instructional activities in the classroom. The authors offer practical suggestions based on the critical thinking philosophy for implementing an active learning approach. The case study method serves as the foundation for an investigative process course and lead-up activity to the simulated preliminary and follow-up investigation. The instructor presents the critical thinking process and content information that enables students to perform five basic progressions: (1) case studies; (2) the preliminary investigation; (3) follow-up; (4) suppression hearing; and (5) moot court criminal justice simulations.