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.     

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.     

Identification and analysis of smallholder producers’ constraints: applications to Tanzania and Uganda

This article puts forward a method for the analysis of constraints faced by developing countries’ smallholder producers. It is consistent with theories of constraints, efficient in terms of cost and researchers’ time, and accessible to a non-technical audience. A hybrid of workshop discussion and individual data collection, it also draws on data and analyses available in most developing countries. The article presents an application to smallholder livestock systems in Tanzania and Uganda, reporting results and analysis relating constraints to households’ characteristics and conditions, and their stated goals. While limitations are identified, it is proposed for application in other development fields.