Rapid assessment of existing HIV prevention programming in a community mental health center

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention.     

Hair analysis for diphenhydramine after surreptitious administration to a child

Diphenhydramine is one of the first effective antihistamine agents to have been discovered. The compound is also used for its sedative and antiemetic effects. The first case involving repetitive sedation linked to the use of diphenhydramine as a drug-facilitated crime and subsequent impairment of a 9-year-old female victim is reported. Due to the long delay between the alleged crime and clinical examination, collection of blood or urine was of little value. Hence, the laboratory developed an original approach based on hair testing by LC-MS/MS. A single strand of hair from the victim was sampled about 7 weeks after the last suspected administration and was cut into small segments. After cutting into small pieces, about 20 mg of hair per segment was incubated overnight in a phosphate buffer (pH 8.4). The aqueous phase was extracted with 5 ml of a mixture of methylene chloride/diethyl ether (80/20), in presence of diazepam-d5, used as internal standard (IS). The hair extract was separated on an XTerra MS C18 column using a gradient of acetonitrile and formate buffer. Detection was based on two daughter ions: transitions m/z 256.2-152.1 and 167.1 and m/z 289.9-154.0 for diphenhydramine and the IS, respectively. In the hair of the child, diphenhydramine was detected at concentrations in the range 33-39 pg/mg, depending on the segment.     

Fentanyl concentrations in 23 postmortem cases from the hennepin county medical examiner's office

The purpose of this study was to compare blood fentanyl concentrations in fentanyl-related deaths with fentanyl concentrations found incidentally at autopsy, as well as with fentanyl concentrations found in hospitalized patients receiving fentanyl. Between the years 1997 to 2005, 23 fentanyl-positive postmortem cases were identified. Nineteen of 23 (82.6%) cases were deemed to be drug overdoses. Fentanyl alone was responsible for 8 of the 19 (42.1%) overdose deaths. Mean and median fentanyl concentrations were 36 (SD 38) microg/L and 22 microg/L, respectively, range 5-120 microg/L. Seven of the cases were accidental, one undetermined. The remaining 11 of the 19 (57.9%) cases were mixed drug overdoses. Fentanyl concentrations in these cases were 31 (SD 46) microg/L, range 5-152 microg/L. All of the mixed drug overdoses were determined to be accidental. Four cases where fentanyl was considered an incidental postmortem finding were determined to be natural deaths. In hospitalized inpatients (n = 11) receiving fentanyl 2 of the patients receiving fentanyl for chronic pain for more than 3 months had concentrations of 8.5 microg/L and 9.9 microg/L. The other nine inpatient concentrations were less than 4 microg/L. In conclusion, blood fentanyl concentrations found in cases where fentanyl alone was determined to be the cause of death were similar to cases where fentanyl was part of a mixed drug overdose. There was also considerable overlap between fentanyl concentrations in fentanyl-related overdose deaths compared to hospitalized patients being treated for chronic pain. Fentanyl concentrations in postmortem cases must be interpreted in the context of the deceased's past medical history and autopsy findings.     

The recovery of illicit drugs from oral fluid sampling devices

Testing for drugs in oral fluid is a convenient procedure for determining recent drug use. A number of issues are still to be resolved and this paper investigates the effects of storage systems on drug stability and recovery using three different collection devices supplied by Cozart, Immunalysis and Microgenics (third party). Drugs were analysed using a range of immunoassay systems followed by MS confirmation and quantitation. The reproducibility of the weight of specimen collected was excellent (CV<10%) for the three collection devices tested. Of the three systems studied, only the Cozart product gave acceptable recovery of THC from drug-spiked oral fluid. A combination of Cozart, Immunalysis and Diagnostix immunoassays with the Cozart collection system gave the most sensitive and discriminating screening assays for the drugs studied, namely THC, benzodiazepines, methamphetamine and morphine. Storage at either 5 degrees C or room temperature had no significant effect on drug recoveries.     

System intervention problems in child sexual abuse investigations: the mothers' perspectives

On learning that her child was sexually abused, a mother must interact with professionals charged with the implementation of investigations, treatment, and legal remedies. This qualitative study, based on data from three focus groups (n = 19) and open-ended survey questions (n = 40), documents mothers' experiences with these professionals. Mothers report a lack of support from many professionals including receiving poor services, being criticized, insensitivity to their concerns, and being accused of false allegations and state that they have difficulty seeing the "system" as a positive future resource. Mothers reported appreciation for helpful professionals, whom they most often identified as therapists. Determining which mothers are reporting system problems and the effect of negative maternal-system interactions on mother and child outcomes are recommended as follow-up research.     

Workers with Disabilities Between Legal Changes and Persisting Exclusion: How Contradictory Rights Shape Legal Mobilization

It has become commonplace within disability sociolegal scholarship to argue that, in the last 30 years, a new legal and policy approach to disability has emerged, leading to a paradigm shift from a social protection framework to an antidiscrimination model. Some authors have stressed, however, that the new model has not fully replaced the older social protection approach. Yet little is still known about how the coexistence of these different models impacts on the everyday experience of disability in the workplace and on potential legal mobilization. Based on interviews with workers with disabilities who mobilized the law to obtain reasonable accommodation in Belgium combined with an analysis of evolving Belgian legal schemes relating to disability, this article explores how interactions between social, labor, and antidiscrimination rights shape legal mobilization of persons with disabilities in the workplace. We find that individual's initial self‐identification as workers or persons with disabilities influences how they frame their claim and the kind of legal norms they refer to in a first stage but that both their identification and their rights consciousness evolve and change through the course of legal mobilization as they interact with various professionals and navigate between the different concepts and rights available in current law.     

The Accuracy and Applicability of 3D Modeling and Printing Blunt Force Cranial Injuries

The purpose of this study was to determine the factors affecting the accuracy of 3D models and 3D prints of cranial blunt force trauma, to evaluate the applicability and limitations of modeling such injuries. Three types of cranial blunt force lesions were documented (hinge, depressed, and comminuted) using three forms of surface scanning (laser, structured light scanner, and photogrammetry) at two different quality settings (standard and high). 3D printed models of the lesions were produced using two different materials (a gypsum‐like composite powder called VisiJet^® PXL and an acrylic engineered composite plastic called VisiJet^® M3 in crystal colour). The results of these analyzes indicate the prints in this study exhibit some statistically significant differences from the actual bone lesions, but details of the lesions can be reproduced to within 2 mm accuracy.     

Characterization of the Products Formed by the Reaction of Trichlorocyanuric Acid with 2-Propanol

Abstract:  We report a recent investigation into the death of a cat that was initially thought to involve intentionally burning the animal via the use of an ignitable liquid. The exposure of the animal to flame was ruled out. Instead, forensic investigation revealed the intentional mixing together of a common outdoor swimming pool chlorinator, trichlorocyanuric acid (TCCA), and 2-propanol (aka, isopropyl alcohol or rubbing alcohol). The reaction of these two chemicals resulted in the formation of cyanuric acid residue, hydrochloric acid, and the evolution of a significant volume of chlorine gas. Further α-chlorination side reactions also occurred between 2-propanol and TCCA to produce a variety of chlorinated 2-propanone species that were detected on the submitted evidence. The identification of the products of both the main reaction and the side reactions allowed the authors to determine what chemicals were originally mixed together by the culprit.     

The Role of Cognitive Distortion in the Relationship Between Abuse,Assault, and Non-Suicidal Self-Injury

The purpose of this study was to examine the relationship between childhood abuse, assault, cognitive distortion, and non-suicidal self-injury (NSSI) in a clinical adolescent sample. The sample included one hundred eighty-five psychiatrically hospitalized adolescents and their parents. Adolescent participants were predominantly female (71.4%), Caucasian (84%), and of non-Hispanic ethnicity (9.2%). Participants completed a diagnostic interview and self-report measures to assess youth history of abuse and assault, cognitive errors, negative self-views, and recent NSSI. No relationship was found between childhood abuse and NSSI. However, a history of assault was associated with NSSI among youth who reported higher cognitive errors and more negative self-views, even after controlling for gender and internalizing disorders. These results suggest that existing affect regulation models of NSSI may be enhanced by incorporating the role of cognitive distortion. Clinically, results also suggest that assessing adolescent victims of assault for cognitive errors and negative self-views, and helping them restructure these cognitive distortions when present, may reduce the likelihood of NSSI.