Cerebrospinal fluid analysis in fatal thallium poisoning: evidence for delayed distribution into the central nervous system

The neurologic manifestations of thallium poisoning include a severely painful ascending peripheral neuropathy, autonomic dysfunction, cranial nerve abnormalities, and a toxic encephalopathy. Although thallium has a short half-life, these neurologic manifestations commonly progress, even as the blood concentration of thallium decreases. This suggests either that thallium persists in neuronal tissues or that it initiates an injury cascade that takes time to fully manifest. As the latter mechanism is consistent with many toxin exposures, the concept of a central nervous system reservoir for thallium is often discounted. A recent case provided a unique opportunity to evaluate this possibility. A 48-year-old man was acutely and chronically thallium poisoned by his common-law wife. During his initial exposures, only gastrointestinal symptoms manifested. Following an acute ingestion, hospitalization was required. Over 3 days, his symptoms rapidly progressed from a severely painful neuropathy to slurred speech, ptosis, confusion, coma, respiratory insufficiency, and death. Because of considerations of alternative diagnoses, 2 lumbar punctures were performed, one on admission and another on the day of his death. Serum thallium concentrations obtained from stored blood samples were paired with spinal fluid concentrations from the same days. On day 1, serum and spinal fluid concentrations were 8700 mu/L and 1200 mu/L, respectively. On day 3, although the serum concentration had fallen to 7200 mu/L, the spinal fluid concentration had increased to 2100 mu/L. This case provides evidence to support the hypothesis that thallium distributes into the central nervous system more slowly than the blood compartment, and this may in part account for the progression of neurologic findings in the setting of decreasing serum concentrations.     

Unmanaged care: towards moral fairness in health care coverage

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.     

Coronal cleft vertebra initially suspected as an abusive fracture in an infant

A case of a four-month-old male infant is described who was found unresponsive at home and brought to the emergency room. He lived for four days. During his hospital admission he was diagnosed by radiography with a fracture of the third lumbar vertebra that was presumed abusive in nature. Autopsy examination failed to confirm a fracture. However, a defect in the development of the vertebral bodies was discovered. He was diagnosed with possible failure of the notochord to regress, a condition with no significant sequelae. The cause of death was certified as sudden infant death syndrome after full investigation, and all autopsy studies were negative.     

Die Koordination von Raumplanung und Verkehrspolitik in urbanen Räumen der Schweiz: Determinanten der politischen Geographie,der politischen Kultur oder der institutionellen Struktur?

Der Beitrag befasst sich mit den exogenen Bestimmungsfaktoren der Koordination raumwirksamer Politiken anhand der vier Agglomerationen von Basel, Bern, Lausanne und Genf. Ein Vergleich von entsprechenden Outcomes zeigt markante Unterschiede zwischen den vier Städten. Nach einer kurzen Kritik der Binnenorientierung gängiger Governance-Ansätze werden die drei exogenen Erklärungsansätze der politischen Geographie, des Institutionalismus und der politischen Kultur in vier Thesen beschrieben. Deren Exploration weist die Wichtigkeit von Kontextvariablen bei der Untersuchung von Ressourcen-Regimen aus. So ist eine Abhängigkeit der inhaltlichen Koordination von soziokulturellen, geographischen und historischen Faktoren auszumachen. Dagegen ist der Zusammenhang mit der Einschätzung der institutionalisierten Koordination nicht eindeutig, was die Vermutung nahelegt, dass im Falle der prozeduralen Koordination die endogenen Faktoren stärkere Erklärungskraft besitzen und die Regime Analysis mithin das geeignetere Mittel zu ihrer Untersuchung darstellt.     

Arsenic speciation of two specimens of Napoleon's hair

Since 1960, it has been demonstrated by various analytical procedures that high concentrations of arsenic were present in Napoleon's hair. Various authors, indicating that the detected arsenic levels are a consequence of external contamination, have challenged the results of these examinations. We have tested two strands of hair, referenced as Noverraz and Grand Maréchal Bertrand. Samples were incubated 6 h in water at 90 °C, and arsenic speciation was carried out by HPLC–ICP/MS. The residue was injected on a cation-exchange PRP-X200 column that allows the detection of arsenobetaine and on an anion-exchange PRP-X100 column to test for the mineral forms. In these conditions, the inorganic species As(III), As(V) and their metabolites (DMA and MMA) were separated. Analysis of hair samples highlighted massive amounts of total arsenic (42.1 and 37.4 ng/mg). Arsenical species found in the two samples of analyzed hair are distributed in the following: As(III) 31.1 and 44.7%; As(V) 66.3 and 53.2%; DMA 0.42 and 0.15%. Traces of MMA were detected, and 2% of the species could not be identified. These results prove that more than 97% of the arsenic found in the hair of Napoleon is in inorganic form, which is consistent with a chronic intoxication to arsenic.     

Stressors, coping resources and strategies, and police stress in South Korea

The present article extends prior research to identify the predictors of police stress from work place problems, the resources available through social support, different strategies for coping with stress, and conditions unique to policing in South Korea. The unique conditions are perceived public perception of police and attitudes towards women working outside of the home. Seven hundred officers were asked to participate in the research, and 686 did participate (96 percent response rate). Almost half of the variance in stress could be explained. Reports of being ridiculed and “set up” in dangerous situations, and to a lesser extent, lack of support from superiors and perceived disrespect from the public, were salient predictors of stress. Coping strategies did not moderate the associations between stressors and stress. Findings were interpreted in relation to collectivist culture and possible points of intervention.