The link between recurrent maltreatment and offending behaviour

This article considers recurrent maltreatment and offending behaviour. The sample was 60 males and 19 females (11 to 18 years) resident within a secure institution in England and considered a risk to themselves and/or others. Overall, 20.8% had not experienced maltreatment, 6.5% had experienced a single incident, 11.7% were repeat victims (same perpetrator), 6.5% were revictimised (different perpetrators), and more than half (54.5%) had suffered both repeat and revictimisation. Of those who had committed a violent and/or sexual crime, 74% had experienced some form of revictimisation, compared to 33% of those who committed nonviolent offences. Those young people most likely to have committed violent and/or sexual crimes were those who had been victims of recurrent extrafamilial maltreatment (many of whom had also experienced recurrent intrafamilial maltreatment). Thus, in this sample, revictimisation was associated with serious crimes. However, these findings are preliminary, and prospective research with a larger sample is needed.     

Sudden unexpected death due to a previously undiagnosed plasma cell dyscrasia

The plasma cell dyscrasias are a diverse group of disorders characterized by the production of a clonal paraprotein. Sudden death is a recognized complication of the plasma cell dyscrasias, most commonly in individuals with cardiac involvement by amyloidosis. However, the current forensic literature has no reported cases in which sudden death resulted from complications of a plasma cell dyscrasia that was first diagnosed by postmortem histologic examination. We present the case of a woman whose sudden and unexpected death resulted from a seizure. Postmortem examination revealed no evidence of trauma or a grossly identifiable natural disease process that would have accounted for her death. However, microscopic and immunohistologic studies revealed a previously undiagnosed plasma cell dyscrasia, the clonality of which was determined by immunohistochemical studies for immunoglobulin light chains, that was not associated with amyloid deposition. This case elucidates a previously unrecognized cause of sudden unexpected death and illustrates the importance of microscopic studies in selected cases examined in medical examiner/coroner offices.     

Investigation of Postmortem Absorption and Redistribution After the Application of a Fentanyl Patch

Fentanyl deaths have increased with availability of transdermal patches. Interpretation of postmortem fentanyl levels may be complicated by postmortem redistribution and absorption of fentanyl from a patch. We applied an unused 100‐μg/h fentanyl patch onto the lower abdomen of a decedent with no premortem fentanyl exposure. Ocular fluid, blood, and urine were collected prior to placement, and the decedent was refrigerated for 23 h. Prior to the autopsy, urine, subcutaneous tissue under the patch, and samples from the same anatomic sites were obtained. We observed no fentanyl in any postpatch placement samples (LOD: 0.1 ng/mL for blood and vitreous fluid, 1.0 ng/mL urine, 2.0 ng/g for tissues). Although we observed no postmortem absorption of fentanyl, this was only a single case; therefore, we recommend that patches be removed after receipt of a cadaver before initiation of an autopsy, with the location of removed patch documented.     

Does Spatial Variation in Heterogeneity Matter? Assessing the Adoption Patterns of Business Improvement Districts

Because they supplement the municipal provision of local public goods, Business Improvement Districts (BIDs) provide an opportunity to examine the space, scope, and determinants of the provision of local public goods. A BID is formed when a group of merchants or commercial property owners in a neighborhood vote in favor of package of self‐assessments and local public goods to be funded with those assessments. These districts solve a collective action problem in the provision of public goods because once a majority has voted in favor, participation is compulsory for all merchants or commercial property owners in the neighborhood. I use a unique dataset on adoption patterns of BIDs in California to test two main claims suggested by the theoretical literature: first, that businesses respond to individual heterogeneity that determines the quality of local public goods, and second, that the type of heterogeneity—overall or spatial—matters. In contrast to the literature on residents, this study finds at best a weak correlation between a city's adoption of a BID and heterogeneity. In addition, despite the theoretical preference for spatial over overall heterogeneity, BIDs are not more likely to be adopted by spatially heterogeneous cities.     

Stalking,harassment and aggressive/intrusive behaviours towards general practitioners: (2) associated factors,motivation, mental illness and effects on GPs

Seventy per cent of general practitioners (GPs) were found in an earlier study to have been subject to aggressive/intrusive behaviours by patients, with nearly 20% stalked and 20% harassed. Using the same sample, an exploration was undertaken of patterns of behaviour, patient characteristics, including mental illness and motivation, GP characteristics, and effects upon them of aggression/intrusion. There were significant differences in patterns of behaviour between stalking and harassment. Nearly half the patients involved were suspected to be mentally ill, including 54.5% of stalking cases. Stalking was significantly associated with intimacy-seeking motivation, and harassment with resentful motivation. No significant associations emerged between sex of patients or GPs and aggressive/intrusive behaviours. Measures of GP time-at-risk were associated with higher prevalence of individual behaviours. GPs’ responses to aggressive/intrusive behaviours included increasing security and changing routines, with small minorities afraid to go out or be at home alone, and a proportion experiencing adverse effects on personal relationships.