Forensic issues in cases of Diogenes syndrome

Diogenes syndrome is a syndrome described in the clinical literature in elderly individuals characterized by social isolation and extreme squalor. A number of typical features are found in the forensic evaluation of these deaths as the cases usually initiate medicolegal investigations due to the circumstances and the lack of recorded medical histories. Examinations of the death scenes are often difficult as victim's houses are in a state of disrepair, with filth and clutter, and pet dogs may resent the intrusion of strangers. Bodies are often filthy, with parasitic infestations, and are often putrefied due to the social isolation of the deceased and the delay in the finding of the corpse. Bodies may be traumatized from postmortem animal depredation by rodents or pets (eg, cats, dogs), and injuries such as bruises and lacerations may be present from falls associated with terminal illnesses or alcoholism. Blood or putrefactive fluids may be spread throughout the house by pets. Treatable medical conditions are often present in advanced stages, and features of hypothermia may be found. Attending police may suspect robbery due to disarray of the house and homicide due to apparent "bleeding" around the body from purging of putrefactive fluids, injuries from falls, or postmortem animal activity and "blood stains" throughout the house from antemortem injuries and/or fluid spread by animals. Finally, the identification of the deceased may be compromised by decay and/or postmortem animal activity. Thus, in addition to having typical clinical manifestations, such individuals appear to form a distinct subset of forensic cases having characteristic death scene and autopsy features and presenting particular difficulties in postmortem evaluations.     

Regulating Supply Chains to Improve Health and Safety

The fragmentation of previously integrated systems of productionand service delivery has been an important feature of organisationalrestructuring over the last three decades. This article highlightsthe adverse implications of this development for the healthand safety of workers, examines the extent to which currentBritish health and safety law provides an adequate frameworkfor addressing these outcomes and explores whether its capacityto do so could be enhanced through the introduction of new statutoryprovisions on the regulation of supply chains. It concludesthat, in terms of both structure and operation, the presentframework of law is problematic. It further argues that recentinternational initiatives show that it is feasible to developsuch statutory provisions and that existing evidence suggeststhat provisions of this type could usefully be introduced inrespect of a number of areas of activity where the implicationsof the externalisation of production and service delivery seemparticularly problematic.     

Beschwerdelegitimation vor den Verwaltungsgerichten

Ohne Zusammenfassung     

Verfassungsreform: Zusatzargument Gemeinschaftsrecht?

Das Programm der derzeitigen Bundesregierung sieht eine Reform der Gerichtsbarkeit öffentlichen Rechts vor, derzufolge (neben der Einrichtung von Verwaltungsgerichten in den Ländern und eines Verwaltungsgerichtes erster Instanz auf Bundesebene) nach einer Entscheidung des VwGH auch noch der VfGH angerufen werden kann. Der folgende Beitrag befasst sich mit den Konsequenzen einer solchen Konstruktion für den Vollzug von Gemeinschaftsrecht.     

Intensive case management as a jail diversion program for people with a serious mental illness: a review of the literature

This article reviews the research on intensive case management (ICM) programs as a jail diversion intervention for people with a serious mental illness (SMI). The review includes two types of ICM programs: (a) general ICM programs that included an assessment of arrests and incarceration rates for people with an SMI and (b) ICM programs specifically implemented as a component of a jail diversion intervention for people with an SMI. Results indicate that general ICM programs (19) rarely led to reductions in jail or arrest rates over time, and these rates were similar to those found in standard mental health services. General ICM programs that included an integrated addiction treatment component (8) had mixed results but a trend toward reductions in rates of arrests and incarceration over time for individuals with an SMI and a co-occurring substance use disorder. Results were mixed for jail diversion interventions with an ICM program, but most ICM programs (8) led to significant reductions in arrests and incarcerations over time. Specific elements of effective ICM jail diversion programs are discussed.     

Female recidivists speak about their experience in drug court while engaging in appreciative inquiry

Eleven female drug-court participants looked at current and past experiences to assess their program and envision future program innovations. From these women's perspective, the strongest component of drug court was being surrounded by staff dedicated to their progress and recovery. Graduated supervision and accurate drug testing were appreciated rather than resented when the participants were not humiliated and were treated with respect. Wraparound services, resources, and referral; treatment facilities that accepted children; and individualized treatment plans and therapy with offenders who are ex-addicts, and preferably females, allowed for greater involvement and active participation in recovery. Progressing through three phases, acquiring skills, a job, and visitation rights to see their children or regaining custody, increased these women's sense of self-efficacy perception and confidence in their ability to lead a drug-free, meaningful life. Findings show the importance of qualitative criteria in evaluating drug-court participants' progress and the process of recovery.     

Jazz and substance abuse: road to creative genius or pathway to premature death

Jazz music and jazz musicians have often been linked for better or worse to the world of addictive substances. Many talented jazz musicians either had their careers sidetracked or prematurely ended due to their addiction to drugs and/or alcohol. The rigors of nightly performances, travel, and for many musicians a disapproving society exacted a toll that impacted the creativity of many artists of the genre. The fact that drug and alcohol use had a significant impact on the performance levels of numerous jazz musicians in the 1940's and 1950's has been much discussed, but more study of that impact is warranted. While recent research has provided new information regarding this challenging topic, there is still much to learn. Indeed, a number of questions for inquiry may be posed. Among those questions are the following: Was the work of these jazz artists truly inspired? Would their creative output have been enhanced had they not been addicted to substances? What was the impact of the addictive substances on their ability to function as creative artists and is there evidence to refute or verify that impact? Are there identifiable traits in certain artists that allowed them to be creative in spite of their addictions? This examination presents an evaluation of the evidence of the link between creativity and substance abuse especially as it relates to selected jazz artists during this time period and how they remained creative and actually prospered in their careers in spite of addictions to controlled substances.     

Seven years until electronic health records: the negative effects of the new Stark exceptions and anti-kickback safe harbors

Last year's introduction of an exception to the Stark Regulations and a new Anti-Kickback safe harbor allows donors (mainly hospitals) to assist recipients (mainly physicians) with the establishment of electronic health records systems. This Article analyses the new regulations and makes the case that, among other negative effects, they will create an undesirable shift in physician referrals in the short term.     

Death on a sauna stove

A 67-year-old woman noticed a strange smell from the cellar of her house. When she followed the smell, she found her 64-year-old husband with the face and upper part of his body lying on the stove of the private sauna. He was dead when the emergency doctor arrived. The autopsy revealed upper gastrointestinal bleeding from mucosal lesions in the esophagus with an agonal fall on the sauna stove as the cause of death. In addition, there were signs of chronic alcohol and drug abuse.