Analysis of buprenorphine in urine specimens.

The simultaneous determination of buprenorphine (Temgesic) and its major metabolite, N-desalkylbuprenorphine, in urine samples has been studied. By using reversed-phase high-performance liquid chromatography (HPLC) with electrochemical detection, therapeutic concentrations of unconjugated buprenorphine down to 0.2 ng/mL, and 0.15 ng/mL for the metabolite, can be detected in urine samples. This method has been applied to a variety of urine samples from drug users. The possible analytical interference from several other regulated drugs has been studied. The results were also compared with those obtained from a commercial radioimmunoassay (RIA) test. This test is only capable of detecting buprenorphine concentrations higher than 1 ng/mL.     

The ‘new’ policy approach to housing: A review of the literature

A new convention of ‘self-help housing’ has become established over the past 20 years. However, a close examination of the literature shows that this approach is not widely implemented, but remains largely at the level of showcase projects; moreover the lowest income groups are usually not the principal beneficiaries of sites-and-service schemes. The literature gives evidence of powerful political, administrative and economic interests against the large-scale legal delivery of sites-and-services, and in favour of the continued dependence of the poor on illegal access.     

Race and sentencing: A meta-analysis of conflicting empirical research results

This paper employs meta-analytic methodology to evaluate the research results of a number of separate race and sentencing studies in the context of three competing theoretical frameworks (the differential involvement, direct-impact, and interactionist perspectives), and the empirical evidence supporting each. The data indicate that although the effect size of race on sentencing is not statistically significant at this level of aggregation, its relationship to sentencing is significantly conditioned by the measurement techniques employed by researchers. Specifically, this study shows that certain methods of classifying racial groups may mask the true effect of race on sentencing decisions. The implications of this finding for future research are discussed.     

Emerging problems for staff associated with the release of potentially dangerous forensic patients

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.     

Pseudo-gunpowder stippling caused by fragmentation of a plated bullet

In this report we present a case of pseudo-gunpowder stippling caused by fragmentation of a plated bullet. Investigation of the incident revealed absence of an interposed target, no evidence of ricochet, and a normally functioning, undamaged weapon. Electroplated ("plated" or "coated") bullets are relatively uncommon. They look similar to jacketed bullets in that the lead core is covered by a copper-colored jacketlike material. However, the copper-colored plating material is thinner than the typical jacket material. In certain instances, the plating may strip away from the lead core during transit through the barrel of the weapon and can produce injuries that mimic gunpowder stippling. Forensic pathologists are advised to be aware of this phenomenon. Misinterpretation of such wounds could result in improper classification of range of fire or improper conclusions about the presence or absence of an interposed target or ricochet.     

Flow cytometric evaluation of postmortem pulp DNA degradation

During postmortem autolysis, cellular organelles and nuclear DNA break down into their constituent parts. DNA flow cytometric analysis was applied to study the denaturation of splenic cell DNA as a possible method for postmortem interval determination. DNA denaturation continued for 72 hours at a constant rate, with no intact DNA peaks thereafter. The value of using dental pulp tissue for flow cytometric determination of postmortem interval was investigated. The pulps of 57 routinely removed impacted third molars from patients 15 to 30 years of age were obtained. Pulp tissue was removed at 24, 48, 72, 96, 120, and 144 hours postextraction. Debris (degraded DNA) was defined as all signals left of the standardized mean 2n peak and expressed as a percentage of the total number of signals. In contrast to the splenic cell DNA, dental pulp tissue exhibited minimal DNA degradation by 144 hours postextraction, and no constant relation was found between time and DNA degradation during this time. In this study, pulp tissue was found to be unreliable to determine the early postmortem interval but might be of greater value in the later stages.     

The relationship between mandated community treatment and perceived barriers to care in persons with severe mental illness

OBJECTIVE: In recent decades debate has intensified over both the ethics and effectiveness of mandated mental health treatment for persons residing in the community. Perceived barriers to care among persons subjected to mandated community treatment, and the possibility that fear of involuntary treatment may actually create or strengthen such barriers rather than dissolve them, are key issues relevant to this debate but have been little studied. This article explores the link between receipt of mandated (or "leveraged") community treatment and reasons for avoiding or delaying treatment reported by persons with severe mental illness. It also examines the potential moderating effect of social support on the association between mandated treatment experiences and barriers attributable to fear of involuntary commitment or forced treatment. METHOD: Data are presented from a survey of 1011 persons with psychiatric disorders being treated in public-sector mental health service systems in five U.S. cities. Logistic and negative binomial regression analyses were used to examine the association between mandated community treatment and perceptions of barriers to care, controlling for demographic and clinical characteristics. RESULTS: Across sites, 32.4% to 46.3% of respondents reported barriers attributed to fear of forced treatment. Whereas 63.7% to 76.1% reported at least one non-mandate-related barrier to care; the mean number of non-mandated barriers to care ranged from 1.6 to 2.3 (range 0-7). Between 44.1% and 59.0% of participants had experienced at least one type of leveraged treatment. Persons experiencing multiple forms of mandated treatment were more likely to report barriers to care in comparison to those not reporting mandated treatment. Findings also indicated that social support moderates the relationship between multiple leverages (three or four forms) and mandate-related barriers to care. CONCLUSIONS: Perceived barriers to care associated with mandated treatment experience have the potential to adversely affect both treatment adherence and therapeutic alliance. Awareness of potential barriers to care and how they interact with patients' perceived social support may lead to improved outcomes associated with mandated treatment.