The predictive value of history and scene investigation for toxicology results in a medical examiner population

Medical examiner offices vary in the extent to which they pursue postmortem toxicology. Our office routinely tests decedents for ethanol and drugs of abuse, and we decided to evaluate the usefulness of our practice. We reviewed 1180 medical examiner cases examined in 2002-2003. History and scene investigation indicated that alcohol or drugs of abuse were likely to be detected in 369 cases, yet toxicology testing revealed an intoxicating substance in 589 cases, a prevalence of 50%. Screening for toxicology testing based on investigative findings had a sensitivity of 0.47, a specificity of 0.84, and a positive predictive value of 0.74. Moreover, even in the 811 cases where initial investigation did not suggest substance abuse, toxicology testing revealed at least 1 substance that was pertinent to the subsequent investigation in one third of the cases (260), and the intoxicating substance was sufficiently important to merit inclusion as a cause of death or contributing factor in nearly half of those cases (113). We conclude that investigation alone is ineffective at predicting the presence of intoxicating substances within decedents.     

Measuring the intercondylar shelf angle using radiographs: intra- and inter-observer error tests of reliability

This study presents a test of intra- and inter-observer measurement error rates of the intercondylar shelf angle of the distal femur, as measured on lateral radiographs. This measurement is the central element of a method to determine racial affiliation from the distal femur. Four observers independently radiographed a set of 33 complete and partial femora from collections housed at the Joint POW/MIA Accounting Command, Central Identification Laboratory. Each observer then measured the intercondylar shelf angles in each radiograph, following the original method's guidelines. A supplementary inter-observer error test was conducted by four additional observers on one set of radiographs. Statistically significant differences were found for both intra- and inter-observer error based on the results of Student's t-tests, paired samples t-tests, and ANOVA analyses. The results of this study indicate that further experimentation should be undertaken in order to develop refined measurement techniques that may help improve standardization and reduce the observer error rates.     

Methyl 3-[3',4'-(methylenedioxy)phenyl]-2-methyl glycidate: an ecstasy precursor seized in Sydney, Australia

Five 44 gallon drums labeled as glycidyl methacrylate were seized by the Australian Customs Service and the Australian Federal Police at Port Botany, Sydney, Australia, in December 2004. Each drum contained a white, semisolid substance that was initially suspected to be 3,4-methylenedioxymethylamphetamine (MDMA). Gas chromatography-mass spectroscopy (GC/MS) analysis demonstrated that the material was neither glycidyl methacrylate nor MDMA. Because intelligence sources employed by federal agents indicated that this material was in some way connected to MDMA production, suspicion fell on the various MDMA precursor chemicals. Using a number of techniques including proton nuclear magnetic resonance spectroscopy ((1)H NMR), carbon nuclear magnetic resonance spectroscopy ((13)C NMR), GC/MS, infrared spectroscopy, and total synthesis, the unknown substance was eventually identified as methyl 3-[3',4'(methylenedioxy)phenyl]-2-methyl glycidate. The substance was also subjected to a published hydrolysis and decarboxylation procedure and gave a high yield of the MDMA precursor chemical, 3,4-methylenedioxyphenyl-2-propanone, thereby establishing this material as a "precursor to a precursor."     

Barricaded Captive Situations in Schools: Mitigation and Response

Although not common occurrences, schools are occasionally the site of barricaded captive events. To date little research has examined these acts of school violence. The purpose of this article is to describe 19 school barricaded captive events that occurred between February, 1998 and September, 2007 in the United States. Data were analyzed by examination of news reports of each incident, and include the following variables: Incident location (state, community), school level and size, time of day of the event, location of the event within the school, age and sex of the subjects, information about the captives, presence of school resource officers, student screening mechanisms, behavioral changes of the subjects, the subject’s expected outcomes, injuries or fatalities, demands and deadlines, captive escapes and releases, weapons, incident resolution, tactical team response, and negotiations. Results pertain to incident demographics, prevention/mitigation, and response.     

Rationales and mechanisms for revitalizing US manufacturing R&;D strategies

The race to economic superiority is increasingly occurring on a global scale. Competitors from different countries are employing new types of growth strategies in attempts to win that race. The United States cannot, therefore, continue to rely on outdated economic growth strategies, which include an inability to understand the complexity of the typical industrial technology and the synergies among tiers in high-tech supply chains. In this context, a detailed rationale is provided for maintaining a viable domestic technology-based manufacturing capability. In the United States, the still dominant neoclassical economic philosophy is at best ambivalent on the issue of whether a technology-based economy should attempt to remain competitive in manufacturing or let this sector continue to offshore in response to trends in comparative advantage, as revealed through shifts in relative prices. The paper argues that the neoclassical view is inaccurate and that a new innovation model is required to guide economic growth policy. Specifically, the paper provides (1) a rationale for why an advanced economy such as the United States needs a manufacturing sector; (2) examples of the process of deterioration of competitive positions for individual industries and, more important, entire high-tech supply chains; (3) an explanation of the inadequacy of current economic models for rationalizing needed new policy strategies; and (4) a new economic framework for determining both policy mechanisms and targets for those mechanisms, with emphasis on the systems nature of modern technologies and the consequent requirement for public–private innovation ecosystems to develop and deliver these technologies. Several targets are suggested for major policy mechanisms.     

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity

Obesity can involve any organ system and compromise the overall health of an individual, including premature death. Despite the increased risk of death associated with being obese, obesity itself is infrequently indicated on the death certificate. We performed an audit of our records to identify how often “obesity” was listed on the death certificate to determine how our practices affected national mortality data collection regarding obesity‐related mortality. During the span of nearly 25 years, 0.2% of deaths were attributed to or contributed by obesity. Over the course of 5 years, 96% of selected natural deaths were likely underreported as being associated with obesity. We present an algorithm for certifiers to use to determine whether obesity should be listed on the death certificate and guidelines for certifying cases in which this is appropriate. Use of this algorithm will improve vital statistics concerning the role of obesity in causing or contributing to death.     

The Centrality of Theory in Modern Day Crime Prevention: Developments,Challenges, and Opportunities

Theory matters in crime prevention. Indeed, but this is hardly the full story. Crime prevention is oftentimes viewed as atheoretical—not grounded in the etiology of crime and offending. Reasons abound for this view, and the recent interest in an evidence-based approach to policy-making has been at the forefront. This article reviews the role that theory plays in modern day crime prevention, with a special focus on the three main crime prevention strategies: developmental, community, and situational. The review identifies a number of key challenges and opportunities for making theory more central to crime prevention. It suggests that the classification system employed in situational crime prevention has allowed for a more explicit connection between sound theory and prevention techniques, and may provide important lessons for developmental and community crime prevention.     

Mighty Morphin’ age progression: how artist,age range,and morphing influences the similarity of forensic age progressions to target individuals

When children go missing, authorities sometimes release age progressed images that are intended to approximate the person's current appearance. The current studies measured the influence of the range between the time when the child went missing and the age portrayed in the age progression on the similarity between the progressions and current images of the targets. Experiment 1 examined whole face images and Experiment 2 examined internal features only. Eight artists were recruited to produce progressions at three age ranges. Also included were averaged (morphed) images made of progressions of the same individual at a given range by different artists. Progressions across shorter ranges produced images more similar than those across longer ranges, and target comparisons yielded higher similarity ratings than foil comparisons. Although there was much variability among artists, the morphed images performed better than the average rating given to all age progressions.     

Return to Work for Healthcare Professionals with Substance Use Disorders: Clinical, Legal, and Ethical Challenges

Occupational health providers (OHPs) and other clinicians who assess readiness to work have a difficult task in assessing return to work for healthcare professionals (HCPs) with substance use disorders (SUDs). About 10 to 15 % of HCPs will misuse drugs or alcohol at some time in their career, yet they are often reluctant to seek help. This paper reviews the clinical challenges of assessing SUDs in HCPs, including risk factors, prognosis, and limited evidence base for work restrictions. Furthermore, ethical and legal challenges throughout the return to work process are reviewed for stakeholders such as HCPs with SUDs, OHPs, other providers, employers, and the public at large. Suggestions are made for stakeholders, particularly for OHPs and other providers, who are navigating this complex environment.     

Early Intervention with Compensated Lower Back-Injured Workers at Risk for Work Disability: Fixed versus Flexible Approach

Low back pain (LBP), a leading cause of disability, has been linked with profound economic, personal, and social costs (Hills 2006; World Health Organization 2003). This significant effect propels research in identifying modifiable risk factors that protract LBP; these factors can be targeted in early intervention (EI) (Pransky, Journal of Occupational & Environmental Medicine, 49(3):249–251, 2007; Schultz et al., Journal of Occupational Rehabilitation, 17:327–352, 2007, Journal of Occupational Rehabilitation, 18(2), 140–151, 2008; White et al. 2013). This randomized controlled study evaluated the effectiveness of two approaches, fixed versus flexible, in delivering proactive, interdisciplinary EI with 63 workers within a workers' compensation interdisciplinary case management setting (i.e., WorkSafeBC, Canada). Off-work 4 to 10 weeks post-back injury, the workers were also at risk of protracted work disability (N?=?24 at high risk; N?=?39 at moderate risk). Fixed, protocol-driven, interdisciplinary, multimodal, clinical, occupational, and case management-based EI was compared with a flexible, individual need-driven EI with the same modalities as the fixed approach. Results showed a significant narrowing of the outcome gap between the two interventions. High-risk injured workers tended to benefit more from a fixed, protocol-driven approach, as shown in the pilot study (Schultz et al. Journal of Occupational Rehabilitation, 18(2), 140–151, 2008). The results indicated that moderate-risk workers benefitted from a more flexible, need-based, individual, and low-intensity approach as compared with a fixed approach. The flexible approach for moderate-risk workers was also less costly and consumed fewer rehabilitation and health care resources. Recommendations for future research and practice included larger sample sizes, controllability of research interventions, risk for disability-EI matching, and conditions under which a flexible delivery of multimodal EI is more efficacious than a fixed approach, and vice versa.