Weight force during prone restraint and respiratory function

Prone maximal restraint position (PMRP, also known as hogtie or hobble) is often used by law enforcement and prehospital personnel on violent combative individuals in the field setting. Weight force is often applied to the restrained individual's back and torso during the restraint process. We sought to determine the effect of 25 and 50 lbs weight force on respiratory function in human subject volunteers placed in the PMRP. We performed a randomized, cross-over, controlled trial on 10 subjects placed in 4 positions for 5 minutes each: sitting, PRMP, PRMP with 25 lbs weight force (PMRP+25), and PRMP with 50 lbs weight force placed on the back (PMRP+50). We measure pulse oximetry, end-tidal CO2 levels, and forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). FVC and FEV1 were significantly lower in all restraint positions compared with sitting but not significantly different between restraint positions with and without weight force. Moreover, mean oxygen saturation levels were above 95% and mean end-tidal CO2 levels were below 45 mm Hg for all positions. We conclude that PMRP with and without 25 and 50 lbs of weight force resulted in a restrictive pulmonary function pattern but no evidence of hypoxia or hypoventilation.     

An unusual fatality in a child due to oxycodone

An unusual fatality secondary to oxycodone in a child is reported. A 2-year-old female child was conveyed to a local hospital after exhibiting signs of rubbing of the mouth and staggering. A hospital toxicological immunoassay screen for drugs of abuse and tricyclic antidepressants was performed on a urine sample and reported as negative. She was discharged and found unresponsive the next morning. She was conveyed to a second hospital in full cardiopulmonary arrest and despite resuscitative efforts, was pronounced dead upon arrival. An autopsy was performed and postmortem specimens were submitted and screened for drugs using mainly chromatographic techniques. Quantitation was achieved by gas chromatography with nitrogen phosphorus detection. Confirmation was performed by gas chromatography/mass spectrometry. Oxycodone was the only drug detected in the following concentrations: heart blood, 1.36 mg/L; gastric contents, 7.33 mg in 33 mL (222.34 mg/L); liver, 0.2 mg/kg; and urine, 47.23 mg/L (47,230 ng/mL). In addition, immunoassay testing of the urine was positive for the opiate class of drugs. This case report demonstrates an unusual cause of death in a young child with emphasis on potential limitation in hospital urine screening tests and the importance of complete forensic toxicological testing in all child deaths.     

Etiology of pulmonary thromboembolism in the absence of commonly recognized risk factors

Pulmonary thromboembolism is an often fatal complication of venous thrombosis. Any component or combination of the components composing Virchow's triad (venostasis, hypercoagulability, and endothelial damage) increases the propensity for a thrombophilic state. Hypercoagulable states may be inherited or acquired. While the etiology in many cases may be evident either on physical examination or on evaluation of the decedent's medical history, this is often not the case. We conducted a retrospective study of cases presenting to the Jefferson County Coroner/Medical Examiner's Office in Birmingham, Alabama, who were given a diagnosis of pulmonary embolism. A search of cases within the past 23 years yielded 81 cases. An underlying cause was determined in 70 cases (86%). The remaining 11 (14%) cases had no identifiable cause. We believe that a number of these cases may represent an underlying thrombophilic disorder. Since these disorders may be of an inherited or acquired nature, the determination of an etiology may be relevant to the decedent's family. Postmortem blood analyses may in selected cases be useful and appropriate for the detection of some of these disorders. However, such analyses are not practical in all cases, with each case having to be evaluated on its own merits.     

Murder, Extramarital Affairs, and the Issue of Probative Value

A paper previously published in Law and Human Behavior by D. Davis and W. C. Follette (2002) argued that certain "profiling" characteristics commonly admitted into court have little or no probative value. They argued that this is especially likely to be true when the characteristic used as evidence (e.g., having an extramarital affair) is rather common in the population whereas the act in question (e.g., a man murdering his wife) is rare. Their analysis has prompted a strong response by Friedman and Park and by Kaye and Koehler with a rejoinder by Davis and Follette (all three follow this paper in this issue of Law and Human Behavior). This paper describes some of the nature of this controversy.     

The forensic analysis of thermal transfer printing

Thermal transfer printing refers to printing processes that utilize heat to produce an image by either physical or chemical means or by a combination of both. As the technology has improved and the supplies have become less expensive, the use of thermal printing in the personal and business markets has increased significantly. Specifically, dye diffusion thermal transfer and thermal mass transfer have become predominant in the production of counterfeit credit cards, drivers' licenses, and other types of documents produced on plastic media. Chemical analysis by means of thin layer chromatography (TLC) has proven to be useful in characterizing various types of inks (e.g., writing and inkjet inks). In this study, the authors examined 81 different samples that included a total of 54 printer samples (43 photographic prints on paper and eleven plastic card samples) and 27 printer ribbons. A new TLC method was developed and tested utilizing a solvent system (80% n-hexane, 3% methyl ethyl ketone, and 17% ethyl acetate) that is capable of producing excellent resolution.     

Polydrug fatality involving metaxalone

A 29-year old female with a history of depression was found dead in a hotel room. The death scene investigation found empty pill bottles and an empty liter bottle of wine. Metaxalone, a centrally acting muscle relaxant, along with citalopram, ethanol, and chlorpheniramine were identified in the postmortem samples and quantitated by gas chromatography-mass spectrometry. The concentration of metaxalone in femoral vein blood was 39 mg/L. The heart blood concentration was 54 mg/L. Femoral vein blood concentrations of citalopram and chlorpheniramine were 0.77 mg/L and 0.04 mg/L, respectively. Ethanol levels were 0.13 g/dL in vitreous and 0.08 g/dL in heart blood. Other tissue samples were also analyzed. The authors consider the metaxalone concentrations toxic and potentially fatal. The citalopram concentrations were lower than those reported in fatal cases for this drug alone. Death was ascribed to polydrug abuse/overdose with metaxalone a major contributor. This represents the first reported case to our knowledge in which a metaxalone overdose significantly contributed to death.     

Logistic Regression in Rare Events Data

We study rare events data, binary dependent variables with dozensto thousands of times fewer ones (events, such as wars, vetoes,cases of political activism, or epidemiological infections)than zeros ("nonevents"). In many literatures, these variableshave proven difficult to explain and predict, a problem thatseems to have at least two sources. First, popular statisticalprocedures, such as logistic regression, can sharply underestimatethe probability of rare events. We recommend corrections thatoutperform existing methods and change the estimates of absoluteand relative risks by as much as some estimated effects reportedin the literature. Second, commonly used data collection strategiesare grossly inefficient for rare events data. The fear of collectingdata with too few events has led to data collections with hugenumbers of observations but relatively few, and poorly measured,explanatory variables, such as in international conflict datawith more than a quarter-million dyads, only a few of whichare at war. As it turns out, more efficient sampling designsexist for making valid inferences, such as sampling all availableevents (e.g., wars) and a tiny fraction of nonevents (peace).This enables scholars to save as much as 99% of their (nonfixed)data collection costs or to collect much more meaningful explanatoryvariables. We provide methods that link these two results, enablingboth types of corrections to work simultaneously, and softwarethat implements the methods developed.     

An Evaluation of the Use of Videotaped Evidence for Juvenile Witnesses in Criminal Courts in England and Wales

For the first time, the UK Criminal Justice Act (1991) allowed the videotaped evidence of a child to be substituted for the child's evidence-in-chief in a criminal court. The present study is an evaluation of that legislation. One hundred and fifty children were observed testifying in a criminal court in the UK. The use of the videotaped evidence and subsequent cross-examination of the child witness (usually via the closed circuit television system) was also observed. The data base from the Lord Chancellor's Department of all trials involving child witnesses in England and Wales was also analysed. The results showed that the introduction of the video technology into the criminal courts reduced the levels of stress of child witnesses but did not increase the conviction rates.