Difficulties in forensic medical evaluation of some forms of craniocerebral injury

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.     

Plasma,oral fluid and sweat wipe ecstasy concentrations in controlled and real life conditions

In a double-blind placebo controlled study on psychomotor skills important for car driving (Study 1), a 75 mg dose of +/- 3,4-methylenedioxymethamphetamine (MDMA) was administered orally to 12 healthy volunteers who were known to be recreational MDMA-users. Toxicokinetic data were gathered by analysis of blood, urine, oral fluid and sweat wipes collected during the first 5h after administration. Resultant plasma concentrations varied from 21 to 295 ng/ml, with an average peak concentration of 178 ng/ml observed between 2 and 4h after administration. MDA concentrations never exceeded 20 ng/ml. Corresponding MDMA concentrations in oral fluid, as measured with a specific LC-MS/MS method (which required only 50 microl of oral fluid), generally exceeded those in plasma and peaked at an average concentration of 1215 ng/ml. A substantial intra- and inter-subject variability was observed with this matrix, and values ranged from 50 to 6982 ng/ml MDMA. Somewhat surprisingly, even 4-5h after ingestion, the MDMA levels in sweat only averaged 25 ng/wipe. In addition to this controlled study, data were collected from 19 MDMA-users who participated in a driving simulator study (Study 2), comparing sober non-drug conditions with MDMA-only and multiple drug use conditions. In this particular study, urine samples were used for general drug screening and oral fluid was collected as an alternative to blood sampling. Analysis of oral fluid samples by LC-MS/MS revealed an average MDMA/MDEA concentration of 1121 ng/ml in the MDMA-only condition, with large inter-subject variability. This was also the case in the multiple drug condition, where generally, significantly higher concentrations of MDMA, MDEA and/or amphetamine were detected in the oral fluid samples. Urine screening revealed the presence of combinations such as MDMA, MDEA, amph, cannabis, cocaine, LSD and psilocine in the multiple-drug condition.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Assessing the Impact of Bureaucracy Bashing by Electoral Campaigns

The literature on the implications of electoral "bureaucracy bashing" for public management is thin. This is partly because of the difficulty of defining basic terms and measuring results in meaningful ways. Using focus group data, this article explores how senior federal managers perceive campaign bureaucracy bashing and assess its consequences. The participants perceive that candidate-based bashing affects federal management on two levels: one emotional, the other programmatic. The emotional impact is pronounced, producing frustration and hostility from senior managers toward political candidates, political appointees, and the media. Senior managers report that bashing adversely affects policy implementation through low morale, poor recruitment, and training and by fostering an environment of distrust toward bureaucracy. Grounded in a diverse literature relating to public administration, the presidency, campaigns and elections, and political communication, this inquiry finds that senior managers confirm many of the speculations these works raise about how bashing affects public employees and public policy.     

Government's response to Hurricane Katrina: A public choice analysis

We use public choice theory to explain the failure of FEMA and other governmental agencies to carry out effective disaster relief in the wake of Hurricane Katrina. The areas in which we focus are: (1) the tragedy of the anti-commons resulting from layered bureaucracy, (2) a type-two error policy bias causing over cautiousness in decision making, (3) the political manipulation of disaster declarations and relief aid to win votes, (4) the problem of acquiring timely and accurate preference revelations, (5) glory seeking by government officials, and (6) the shortsightedness effect causing a bias in governmental decision making.     

Locke on the Moral Basis of International Relations

This article aims to focus analysis of Locke's theory of international relations away from the familiar discourse of sovereignty and natural law and toward a different discourse involving self-government and international society. It argues that Locke's conception of international society balanced interrelated, overlapping, and even competing claims about sovereignty and natural law in a normative framework in which the right of self-government replaced the principle of sovereignty as the moral basis of international relations. Thus, for Locke the norms deduced from the law of nature govern the international state of nature even as independent societies remain the primary executors of the law of nature in international society. The article concludes by considering how Locke's reflections on international relations may contribute to our understanding of contemporary debates about sovereignty, the use of force, and the ethics of intervention.     

State Poverty Rates: Do the New Welfare Policies Make a Difference?

This article uses four models to identify the best predictors of state poverty levels and changes in state poverty rates since the implementation of welfare reform. The policy decisions based on the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) by the states are tested along with more traditional variables identified in the literature. Using several measures of state poverty, the analysis finds that those states with the lowest poverty rates are those with the healthiest economies, and the most generous state spending on Temporary Assistance for Needy Families (TANF). States with the highest percentage of their TANF rolls made up of black citizens tend to have the highest rates of poverty. Initial poverty rates are found to be important in that states with higher initial poverty levels are capable of generating a larger reduction in poverty than states with lower initial rates. With the exception of limited evidence on sanctions, none of the PRWORA–based policies were found to have any effect on poverty rates.