Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

Failings of Trauma‐Specific and Related Psychological Tests in Detecting Post‐Traumatic Stress Disorder in Forensic Settings

Judges and juries tend to be particularly impressed by test data, especially quantitative test data. Psychometric tests specific for assessing the presence of post‐traumatic stress disorder (PTSD) are commonly employed by forensic mental health evaluators. Most of these instruments, however, have been designed to detect PTSD in treatment or research, and not forensic, settings. Those who rely on these measures without adequate awareness of their often significant limits in correctly identifying malingering may induce finders of fact to inordinately confidently accept the presence of PTSD. This article reviews problematic structural and content components of trauma‐specific and related instruments used to evaluate PTSD and discusses the utility of specific techniques liable to be used in forensic settings to “fool” these measures.     

Color Separation in Forensic Image Processing Using Interactive Differential Evolution

Color separation is an image processing technique that has often been used in forensic applications to differentiate among variant colors and to remove unwanted image interference. This process can reveal important information such as covered text or fingerprints in forensic investigation procedures. However, several limitations prevent users from selecting the appropriate parameters pertaining to the desired and undesired colors. This study proposes the hybridization of an interactive differential evolution (IDE) and a color separation technique that no longer requires users to guess required control parameters. The IDE algorithm optimizes these parameters in an interactive manner by utilizing human visual judgment to uncover desired objects. A comprehensive experimental verification has been conducted on various sample test images, including heavily obscured texts, texts with subtle color variations, and fingerprint smudges. The advantage of IDE is apparent as it effectively optimizes the color separation parameters at a level indiscernible to the naked eyes.     

Sex Determination by Discriminant Function Analysis of Lumbar Vertebrae

Sex determination is critical for developing the biological profile of unidentified skeletal remains. When more commonly used elements (os coxa, cranium) for sexing are not available, methods utilizing other skeletal elements are needed. This study aims to assess the degree of sexual dimorphism of the lumbar vertebrae and develop discriminant functions for sex determination from them, using a sample of South African blacks from the Raymond A. Dart Collection (47 males, 51 females). Eleven variables at each lumbar level were subjected to univariate and multivariate discriminant function analyses. Univariate equations produced classification rates ranging from 57.7% to 83.5%, with the highest accuracies associated with dimensions of the vertebral body. Multivariate stepwise analysis generated classification rates ranging from 75.9% to 88.7%. These results are comparable to other methods for sexing the skeleton and indicate that measures of the lumbar vertebrae can be used as an effective tool for sex determination.     

A Silver‐Stain Modification of Standard Histological Slide Preparation for Use in Anthropology Analyses

The traditional histology method typically employed by forensic anthropologists involves plastic embedding of undecalcified bone. The embedded sample is then cut by a diamond blade saw and ground to the required thickness of ~50–100 microns using a grinder. There are several limitations to this method: Cement lines may be blurred; depth‐of‐field artifacts may result from viewing thick sections; and medicolegal offices with limited budgets may not be able to invest in additional equipment or training for this method. A silver nitrate stain modification of the standard histology preparation technique of decalcified bone is presented. The benefits of this technique are that: Cement lines are viewed clearly; no depth‐of‐field artifacts are present; and because this is a modification of the standard technique used by histology laboratories typically employed by medicolegal offices, no additional equipment or training is required.     

Animal Scavenging and Scattering and the Implications for Documenting the Deaths of Undocumented Border Crossers in the Sonoran Desert,

Since 1998, over 5500 people have died while attempting to cross the U.S.–Mexico border without authorization. These deaths have primarily occured in the Arizona desert. Despite the high volume of deaths, little experimental work has been conducted on Sonoran Desert taphonomy. In this study, pig carcasses were used as proxies for human remains and placed in different depositional contexts (i.e., direct sunlight and shade) that replicate typical sites of migrant death. Decomposition was documented through daily site visits, motion-sensitive cameras and GIS mapping, while skeletal preservation was investigated through the collection of the remains and subsequent faunal analysis. Our results suggest that vultures and domestic dogs are underappreciated members of the Sonoran scavenging guild and may disperse skeletal remains and migrant possessions over 25 m from the site of death. The impact of scavengers and the desert environment on the decomposition process has significant implications for estimating death rates and identifying human remains along the Arizona/Mexico border.     

Comparing Electronic News Media Reports of Potential Bioterrorism-Related Incidents Involving Unknown White Powder to Reports Received by the United States Centers for Disease Control and Prevention and the Federal Bureau of Investigation: U.S.A., 2009–2011

There have been periodic electronic news media reports of potential bioterrorism-related incidents involving unknown substances (often referred to as “white powder”) since the 2001 intentional dissemination of Bacillus anthracis through the U.S. Postal System. This study reviewed the number of unknown “white powder” incidents reported online by the electronic news media and compared them with unknown “white powder” incidents reported to the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Federal Bureau of Investigation (FBI) during a 2-year period from June 1, 2009 and May 31, 2011. Results identified 297 electronic news media reports, 538 CDC reports, and 384 FBI reports of unknown “white powder.” This study showed different unknown “white powder” incidents captured by each of the three sources. However, the authors could not determine the public health implications of this discordance.     

Differences in Handwritings of Schizophrenia Patients and Examination of the Change after Treatment

The aim of this study was to analyze the differences between the handwritings of schizophrenia patients and healthy subjects in addition to the changes that occurred in schizophrenia patients' handwriting in response to the treatment. The test subjects were 29 schizophrenia patients and 29 healthy individuals with the same age, gender, and dominant hand. The changes in the handwritings were examined according to 14 different parameters. On the day of admittance, the percentage of extra letters was 16.7%, and after 7–10 days of hospitalization, it rose to 33.3%. The percentage of skipped words decreased from 29.2% to 16.7% after 7–10 days of hospitalization, and to 10% after 3 weeks. The letters written by schizophrenia patients are significantly larger in height and width compared to the control group. The schizophrenia patients showed a higher incidence of crossed-out letters, adding extra words, missing punctuation as well as missing words.     

Sudden Death Due To Acute Cocaine Toxicity—Excited Delirium in a Body Packer

Excited delirium denotes a life-threatening medical condition characterized by the acute onset of agitated and violent behavior that often results in a sudden and unexplained death. Cocaine-induced excited delirium refers to fatal cocaine intoxication with the following symptoms occurring sequentially: hyperthermia, delirium with agitation, respiratory arrest, and death. We present a case of cocaine-induced excited delirium in a cocaine “body packer” or a “mule”, specifically an individual who attempts to smuggle cocaine within the body. Investigators at the scene initially suspected homicide due to the victim's sharp and blunt force injuries. Three rubber packets containing cocaine were removed from the victim's rectum. Blood toxicological analysis revealed an alcohol concentration of 0.016 g/100 and cocaine >1 mg/L. The forensic pathologist should consider cocaine-induced excited delirium when an individual exhibits aggressive behavior, unexpected strength, and resistance to pain who dies suddenly. Further analysis should be performed during the scene investigation and autopsy for evidence of body packing.