Creating a home to promote recovery: the physical environments of Oxford House

The interior and exterior physical characteristics of substance abuse recovery program dwellings (11 woman, 44 men) from three geographic sections of the United States were assessed at creating a "house-as-home" for residents. Although each house was independently governed and operated by residents, results indicated vast similarities among the interior characteristics, amenities, and structural aspects. These rented dwellings also had similar well-maintained exterior characteristics, despite their geographic locations. Follow-up interviews of former residents indicated that these house characteristics and amenities helped create a sense of home not found in traditional institutional facilities. Results suggested that residents of self-governed independently operated recovery houses may create and maintain safe and sober settings that elicit a sense of home among residents.     

Science, politics, and the regulation of dietary supplements: it's time to repeal DSHEA

Since the turn of the century, resourceful entrepreneurs have advertised a wide variety of purportedly simple and painless cures for cancer, including liniments of turpentine, mustard, oil, eggs, and ammonia; peat moss; arrangements of colored floodlamps; pastes made from glycerine and limburger cheese . . . [T]his historical experience does suggest why Congress could reasonably have determined to protect the terminally ill, no less than other patients, from the vast range of self-styled panaceas that inventive minds can devise. [Individuals have] the right to be treated by a health care practitioner with any medical treatment (including a treatment that is not approved, certified, or licensed by the Secretary of Health and Human Services) that such individual desires or the legal representative of such individual desires. The makers of our Constitution undertook to secure conditions favorable to the pursuit of happiness. They recognized the significance of man's spiritual nature, of his feelings and of his intellect. They knew that only a part of the pain, pleasure and satisfactions of life are to be found in material things. They sought to protect Americans in their beliefs, their thoughts, their emotions and their sensations. They conferred, as against the Government, the right to be left alone--the most comprehensive of rights and the right most valued by civilized men.     

Health care joint ventures between tax-exempt organizations and for-profit entities

Health care exempt organizations have many options regarding their structure and affiliations with for-profit entities. As long as any joint ventures are carefully structured and the nonprofit retains control over the exempt health care activities, the Internal Revenue Service should not question the structure. However, as outlined above, if the for-profit entity effectively gains control over the activities of the venture, the structure is not likely to be upheld by the IRS or the courts, and either the exempt status of the nonprofit will be denied or revoked, or health care income will be subject to the unrelated business income tax. In summary, the health care industry has been severely impacted by many economic forces, including uncertainty in the area of joint ventures between nonprofits and for-profit health care systems. The uncertainty as to whether the joint venture would negatively impact the nonprofit's tax-exempt status undoubtedly caused many nonprofits to form for-profit subsidiaries and otherwise expanded operations in a for-profit marketplace. Fortunately, with the guidance that is currently available in the form of Revenue Ruling 98-15, Redlands, St. David's, and now Revenue Ruling 2004-51, health care institutions can move forward with properly structured joint ventures with greater confidence that the joint venture will not endanger the tax-exempt status of the nonprofit.     

Postbariatric surgery deaths, which fall under the jurisdiction of the coroner

Obesity has attained epidemic proportions in the United States, with more than 50% of adults classified as overweight or obese. If untreated, morbidly obese patients have a 1 in 7 chance of reaching normal life expectancy. The surgical treatment of obesity has emerged as the most effective treatment modality in long-term weight control and has become increasingly popular, with attendant postoperative complications and death. We performed a cross-sectional, coroner based, 2-year retrospective review of archival case records for decedents who died following bariatric surgery for the treatment of obesity to identify underlying causes of death and forensic characteristics of this cohort. Fifteen (0.5%) out of 3097 archival cases died following bariatric surgery, with approximately 73% of decedents dying within 6 months of surgery. The underlying causes of death in 80% of decedents were natural comorbidities of obesity, with cardiovascular diseases (33%) being the most frequent causes of death, followed by gastrointestinal diseases (20%), acute pulmonary thromboembolism (13%), and acute bacterial pneumonia (13%). The majority of decedents were white females who remained morbidly obese after bariatric surgery. Only 2 decedents died of direct inadvertent/accidental surgical complications.     

Bloodstain pattern analysis in a case of suicide with a compound bow and arrow

The incidence of human fatalities due to arrow injuries in the medical literature is rare. We report an incident involving a 46-year-old man who was found in his secured apartment with a fatal arrow wound of his chest and abdomen. The initial scene investigation suggested that the victim impaled himself with an arrow attached to a razor-sharp, 4-bladed broad-head hunting tip before collapsing on the floor. However, analysis of the bloodstain patterns suggested that the victim used the compound bow to propel the arrow.When investigating deaths due to bows and arrows, thorough scene investigation along with bloodstain pattern analysis is essential in determining the mechanism of injury and manner of death.     

The recruitment and retention of indigenous criminal justice agency staff in an Australian state

In Australia, as in other countries that have experienced colonisation, indigenous people are massively overrepresented in all stages of the criminal justice system. If criminal justice agencies are to provide culturally responsive and effective services to this group, it is important that they employ significant numbers of indigenous staff across all levels of their organisations. Despite the positive intentions of many justice agencies to increase the proportion of indigenous staff members they employ, the numbers remain low. In this article, we explore some of the possible reasons for this by reporting the results of focus groups conducted with existing indigenous justice agency employees. The employees raised a number of issues relevant to recruitment and retention. These are discussed in terms of their potential value in improving justice agency indigenous recruitment and retention strategies.     

Practical use of the molecular-genetic technologies in solving the tasks of forensic medical identification of remains in emergencies with huge human death toll

Previously, we have developed different variants, for the expert use, of information technologies, i.e. of computer automated analytical systems, to ensure an effective analysis of huge bulwarks of molecular-genetic expert findings. The results obtained in the above research significantly advanced the possibilities of expert evaluation related with personality identification under the conditions of a big death toll; they also cleaned the ground for the introduction of such methodological approaches in the practice of investigations of emergency accidents involving huge death tolls. Described within the present case study is a practical experience of forensic medical identification of unrecognized remains in air crashes with huge human death tolls implemented through computer-assisted complex molecular-genetic tests on the basis of indirect DNA identification involving the establishment of blood relationship.