The forensic and investigative significance of reverse paternity testing with absent maternal sample

The authors are involved in the extraction of DNA material from calcified tissues, oftentimes teeth, and analysis of such material to assist the investigative process, frequently by confirming the identity of the victim. Biologic or molecular techniques for the purposes of human identification have evolved to allow increasingly discriminating tests for use in criminal and noncriminal death investigations, as well as paternity disputes. The goal of such tests is to either include 2 samples (ie, they are from the same person, or in the case of paternity, they are from related individuals) or exclude 2 samples (ie, they are from different people or from unrelated individuals). Regardless of the system used and when data error has been eliminated, an exclusionary conclusion is irrefutable. The probability of excluding the falsely accused has steadily increased over the years as new methods are developed. Conventional ABO blood typing, for example, has a probability of exclusion (PE) of only 17%. This value increases to 53% with the inclusion of the Rh and MN systems. Additional serological markers can provide a probability of exclusion of greater than 99%. Today, the current method of choice for human identification is the polymerase chain reaction for the amplification of short tandem repeat (STR) multiplexes. This paper discusses the implications of nonpaternity in reverse paternity testing when only paternal DNA is available.     

Iatrogenic deaths following treatment for hypertrophic obstructive cardiomyopathy: case reports and an approach to the autopsy and death certification

Hypertrophic cardiomyopathy (HCM) is a disease process which results in a large, heavy heart, with hypertrophy of the interventricular septum (IVS) and left ventricle. HCM accounts for a significant number of cases of sudden cardiac death each year, most infamously in young athletes. The prevalence of the disease has increased over the past several years due to advances in clinical diagnosis and molecular genetic studies. Over this same period, new forms of treatment also have emerged. One such treatment is alcohol septal ablation (ASA). ASA is a procedure performed by a cardiologist, via cardiac catheterization, by injecting pure ethanol into selected arteries which supply the IVS, resulting in a targeted myocardial infarction. This infarct then retracts and forms a scar, decreasing the outflow obstruction and improving the patient's clinical symptoms.The authors report 2 cases of death following ASA treatment of HCM. The first, a 56-year-old male, had his ASA procedure 10 days prior to death. The second decedent, a 76-year-old female, had her procedure only 30 hours before death. These case reports are followed by a discussion about HCM, including pathology, treatments, and treatment-related pathology, before closing with a discussion about death certification in the cases presented and therapy-related deaths in general.     

You have the right not to have a hearing: an evaluation of the impact of fully advising civilly committed patients on their rights

There have long been calls for the reduction of coercion in treating civilly committed psychiatric patients. The present study assessed whether a minor procedural change intended to reduce the adversarial nature of the treatment process would have a positive impact. Results suggested that the change in procedure had a positive effect for the most direct outcome variables but results were more mixed for the indirect outcome variables. Nonetheless, overall indications were that the change of procedure affected patient outcome.     

Conceptualizing nursing research with offenders: another look at vulnerability

In this article, vulnerability is examined as it applies to the conduct of nursing research with offenders. As a group, offenders present with a multitude of acute and chronic physical and mental health care needs; they are subject to discrimination, stigmatization, and marginalization; and as such, they often experience dual, multiple, or overlapping vulnerabilities. As research participants, they are especially vulnerable to coercion, as a direct consequence of their dependency status within the correctional system. Embracing a research agenda that focuses on offenders as a vulnerable population is fraught with ambiguities not generally encountered in other settings. The ethical conduct of research with vulnerable populations reflects a contemporary research problem that requires ongoing discourse within the nursing community and the health care community at large.     

The death of managed care: a regulatory autopsy

On the heels of widespread patient protection legislation in the states, the managed care industry abandoned or greatly scaled back the core elements of gate-keeping, utilization management, and financial incentives, which are the very targets of this legislation. This article explores whether, and to what extent, the industry's abrupt change in course can be attributed to these laws. Based on extensive interviews with key informants in six representative states, the article concludes that these laws were not the primary driver of changes in managed care practices. However, patient protection laws interacted with other social and market forces, through complex forms of feedback and reinforcement, to bring about more thoroughgoing change than would have otherwise occurred.     

Obesity, courts, and the new politics of public health

Health care politics are changing. They increasingly focus not on avowedly public projects (such as building the health care infrastructure) but on regulating private behavior. Examples include tobacco, obesity, abortion, drug abuse, the right to die, and even a patient's relationship with his or her managed care organization. Regulating private behavior introduces a distinctive policy process; it alters the way we introduce (or frame) political issues and shifts many important decisions from the legislatures to the courts. In this article, we illustrate the politics of private regulation by following a dramatic case, obesity, through the political process. We describe how obesity evolved from a private matter to a political issue. We then assess how different political institutions have responded and conclude that courts will continue to take the leading role.     

Carbon monoxide-related deaths in a metropolitan county in the USA: an 11-year study

Carbon monoxide (CO) poisoning as a cause of death is well documented in industrialized countries. The objective of this study was to compare demographic data in deaths due to accidents (in fires) and suicides in the same population between 1988 and 1998. Furthermore, the potential effect of a community wide education effort regarding safety in the home was assessed. Postmortem reports were reviewed for all deaths examined at the Office of the Cuyahoga County Coroner in Cleveland, OH, USA. During the study period, there were 209 accidental deaths due to fires in the home (6.5% of all accidents in the home) and 182 CO deaths by suicide (9.8% of all suicides). Demographic characteristics of the two groups differed: while males represented the majority of cases in both groups (55% of accidents, 70% suicides), race specific death rates were higher for whites than blacks (18/100,000 white, 3/100,000 black) in suicides compared with 29/100,000 deaths for blacks and 11/100,000 for whites in accidental cases. Fire deaths were prevalent in the young (0-9 years) and old (>60) whereas in the suicide group the age specific death rate was highest for those over 70 years. The majority of fire deaths occurred in the city of Cleveland but suicides were prevalent in the suburbs. More fire deaths occurred in December than any other month whereas more suicides occurred in April. In 1992, there was a community wide effort to provide free smoke detectors to residents in Cleveland. In 1992, there were 4.2/100,000 fire deaths in the city. This decreased to 0.6/100,000 in 1996, increased to 1.2/100,000 in 1997 followed by a decrease to 0.8/100,000 in 1998. This suggested that the program may have aided in decreasing these types of deaths. Deaths due to fires in the suburbs were <1/100,000 throughout the study period.     

Isolation of Delta9-THCA-A from hemp and analytical aspects concerning the determination of Delta9-THC in cannabis products

A simple procedure based on a common silica gel column chromatography for the isolation of Delta9-tetrahydrocannabinolic acid A (Delta9-THCA-A) from hemp in a multi-milligram scale is presented. Further, the decarboxylation reaction of Delta9-THCA-A to the toxicologically active Delta9-tetrahydrocannabinol (Delta9-THC) at different analytical and under-smoking conditions is investigated. Maximal conversion in an optimised analytical equipment yields about 70% Delta9-THC. In the simulation of the smoking process, only about 30 % of the spiked substance could be recovered as Delta9-THC.     

The effect of the ageing of crime scene objects on the results of scent identification line-ups using trained dogs

In a scent identification line-up, a trained dog matches the scent trace left by a perpetrator at the crime scene to the odour of a suspect in a line-up of different odours. The procedures are strictly defined and the results are routinely used by the police and as evidence in court in a number of European countries. This paper describes the effect of ageing of the odour trace collected at the crime scene on the performance of the dogs in recognising the perpetrator in a line-up. The results show that whilst the dogs perform faultlessly in matching odours collected on the same day, the results drop to a lower level and become more variable in the period studied (2 weeks to 6 months). However, the results do not show a systematic decrease in performance. A possible explanation is the development of a steady state in the glass jars containing the perpetrator odour trace after initial differential evaporation of components of the residue or break down of unsaturated components into saturated ones. Prevention of this initial change may prevent the drop in performance observed in this study, thus increasing the reliability of these scent identifications.     

Ilium growth study: applicability in sex and age diagnosis

The use of coxal elements for age and sex diagnosis from the skeleton is the primary and most widespread way of bringing us closer to the identity of dead individuals in archaeological and certain forensic scenarios. Diagnosis in sub-adults, especially in fetus and infant age, is not clear; and further studies are needed. This work presents the analysis of the growth of six variables in the ilium, from birth to 97 years of age, in order to evaluate its significance and its capacity for age and sex determination during and after growth. The materials used were 327 specimens from four documented Western European collections. Growth curves were calculated for the three classical variables of the ilium (width, length and index) and three new variables of the acetabulum area (horizontal and vertical diameter of the ilium acetabular surface and the ilium acetabular index). None of the curves showed a lineal growth, except those of the horizontal diameter of the ilium acetabular surface for the male series. The ilium width has the most complicated growth and it is explained by a four-degree polynomial. All the variables studied can be useful for adult sex discrimination with the exception of the ilium width and ilium acetabular index. Furthermore, the most useful variables for subadult and adult age estimation in archaeological samples, as well as in forensic samples, are the absolute measurements (ilium length and width, horizontal and vertical diameter of the ilium acetabular surface); however, the ilium width is the best variable, as this can be applied to all growth ages using both sexual series together up to 20 years of age.