Evaluating the Potential for Unintentional Occupational Exposure to Fentanyl and Fentanyl Analogues Among Medicolegal Death Investigators and Autopsy Technicians

Recent increases in deaths in the United States from synthetic opioids such as fentanyl and fentanyl analogues (fentanyls) have raised concerns about possible occupational exposures to these potent agents. Medicolegal death investigators and autopsy suite staff might perform job tasks involving exposure to fentanyls. The potential for exposure to fentanyls among medicolegal death investigators and autopsy technicians at a state medical examiner's office was evaluated through review of caseload characteristics, injury and illness logs, and procedures and policies and discussions with management and employee representatives. The evaluation showed that this medical examiner's office had low potential for work-related exposure to fentanyls; its standard operating procedures and personal protective equipment requirements should reduce the potential for occupational exposure. Medicolegal death investigation agencies can develop and implement guidance to control exposures and provide workforce education and training to reduce the potential for work-related exposure to fentanyls.     

Parenting Coordination and Confidentiality: A (Not‐so) Delicate Balance

This article describes the current state and range of information protection in the growing number of states and Canadian provinces that employ parenting coordination in an effort to reduce repeat custody litigation. The predominant approach—in which what is revealed during the process is not confidential—is analyzed in terms of its compatibility with the parenting coordinator's multiple tasks of educating parents, seeking to facilitate agreements, and, if necessary, providing the court with a report, a recommended decision, or an arbitrated result. Using a case scenario with multiple parts, the article then examines such confidentiality schemes in practice by providing an action‐oriented series of questions that illustrate how much of this topic must be resolved through a parenting coordinator's exercise of discretion in the absence of rule clarity. The article then raises a number of policy questions about whether current parenting coordination confidentiality norms strike the optimal or even the correct balance on information protection and concludes by identifying several policy options that might address these questions.     

An efficient statistical procedure for interpreting DNA single locus profiling data in crime cases.

This paper describes a simplified approach to calculating the Bayesian likelihood ratio for the case where two DNA single locus profiles are to be compared. It explains how the calculation allows for band shift and also for the variation in precision with molecular weight. A simple basic theory section explains the principles of the analysis but more detailed explanations are given in an advanced theory section. Experiments on substantial data collections are described which demonstrate the robustness of the method.     

Eliminating ill-founded eliminations in handwriting comparison cases.

Document examiners sometimes eliminate writers on the basis of differences which are given too much weight. This article is an attempt to explain some conditions whereby differences in the writing of one individual are misinterpreted as significant differences, when they are actually caused by conditions which are unknown to the examiner.     

A continuous model for interpreting the positions of bands in DNA locus-specific work.

A simple but rigorous approach is offered for evaluating the evidential value of single locus DNA autoradiographs. This approach does not use a binning technique and it does not treat alleles as discrete variables. Instead, the allele distribution is considered to be continuous. The variation between two comparable bands is assessed using previously determined experimental parameters. The Bayesian treatment leads to an expression of the "quality of a match".     

Postmortem changes in the level of calcium pumping adenosine triphosphatase in rat heart sarcoplasmic reticulum

The activity of calcium pumping adenosine triphosphatase (Ca2+-ATPase) in cardiac sarcoplasmic reticulum plays a pivotal role in myocardiac contraction-relaxation. The Ca2+-ATPase activity is controlled by phosphorylation and dephosphorylation of a sarcoplasmic reticulum protein "phospholamban" in response to neurotransmitters and drugs. To clarify the role of Ca2+-ATPase in the development of cardiac rigor mortis, we examined the changes of cardiac rigidity and cardiac sarcoplasmic reticulum Ca2+-ATPase activity up to 5 h after the decapitation of rats. Fifteen minutes after decapitation, the rats showed a cardiac rigidity on left ventricles. After 30 min, rigidity was obvious over the whole heart. After 1 h, the rigidity reached a high degree which was maintained for the rest of the observation period. On the other hand, the Ca2+-ATPase activity controlled by phosphorylation and dephosphorylation of phospholamban did not change for the whole observation period (5 h). Another Ca2+-ATPase activity representing the total amount of Ca2+-ATPase in sarcoplasmic reticulum gradually decreased. The data suggest that no significant phosphorylation or dephosphorylation of phospholamban occurs for a short time, at least for 5 h, after death and that the Ca2+-ATPase tends to relax the myocardium against the development of cardiac rigor mortis.     

The morphogenesis of electrically and heat-induced dermal changes in pig skin

In order to establish pathological evidence in dermis for distinguishing between sequelae of electrical torture and those of other superficial injuries, the skin of eleven fully anaesthetized Danish Landrace pigs have been exposed to heat and electrical energy from either 50 Hz alternating current (a.c.) or direct current (d.c.) via 12 mm large contact knobs or via a pointed 0.5 mm large electrode (only 50 Hz a.c.). The lesions have been examined from 1 to 126 days after the injury. While heat lesions exposed to energy lower than 60 joule only gave minor changes, heat lesions exposed to more than 60 joule showed changes in both collagen fibres (basophilic or eosinophilic fibres without any birefringence or coarse cross-striation in polarized light, respectively) and dermal cells (granular cytoplasm). Areas exposed to 50 Hz a.c. via 0.5 mm. electrode showed basophilic collagen fibres and in a few biopsies on day 7 calcium salts on collagen fibres. Using 12 mm large electrodes the changes were minor, but basophilic and eosinophilic collagen fibres with no birefringence or with fine/coarse cross-striation respectively were seen. Even cells with 'vesicular nuclei' were seen on day 1 and 2 after the injury. The changes in the anode area showed resemblance to that of heat lesions (basophilic collagen fibres). Eosinophilic collagen fibres with fine densely spaced cross-striation in polarized light and 'vesicular nuclei' as well as collagen fibres with calcium salts were seen in the cathode lesions. It is concluded that the dermal changes in the cathode area are specific for electrical injury from day 1 to 14. However, earlier studies have demonstrated dermal changes specific for electrical injury at day 0 and the presence of calcified collagen fibres up to 2 months after injury. The dermal changes in anode lesions were non specific and could not be differentiated from those found in heat lesions. Alternating current lesions (50 Hz) were specific from day 1 to day 7, when the pointed electrode was used, but only in a few days when the energy was transferred via the 12-mm electrodes.     

Vitamin D binding protein (Gc) subtypes by isoelectric focusing and immunoblotting

The polymorphism of the human vitamin D binding protein (Gc system) was investigated in a total of 149 sera from unrelated healthy Egyptians residing in Tanta City, Gharbiya Governorate, Nile Delta of Egypt, using isoelectric focusing (IEF) in thin-layer polyacrylamide gel followed by immunoblotting. The estimated gene frequencies were Gc1s = 0.540, Gc1f = 0.242 and Gc2 = 0.218.     

Creatine phosphokinase in serum and cerebrospinal fluid, and microscopic findings in brain and heart in hypothermic rabbits

Signs of hypothermia injury were studied in rabbits cooled to a core temperature of 30 degrees C by immersion in ice water and thereafter rewarmed to 35 degrees C. Anaesthetized control rabbits were kept normothermic (37 degrees C) for a corresponding time (4 h). Creatine phosphokinase (CPK) activity increased 24 h after hypothermia to 20-fold in serum. In cerebrospinal fluid the activity was already significantly (5-fold) increased after hypothermia and was still as high at 24 h. Smaller increase was also found in the control normothermic rabbits both in serum (10-fold) and cerebrospinal fluid (2-fold). The values had returned to the initial level after 1 week. Small haemorrhages were observed in the brain at 24 h and slight scarring was seen in the myocardium of some rabbits which had lived 4 weeks following hypothermia. The results indicate that CPK can be a useful marker in the diagnostics of hypothermia death, especially in cerebrospinal fluid, which is less affected than blood by autolysis.