Ochronosis Presenting as Methemoglobinemia

Ochronosis is the blue‐gray discoloration of collagen‐containing tissues due to homogentisic acid (HGA) deposition, secondary to endogenous alkaptonuria or exogenous enzyme inhibition. In renal disease, accumulation of HGA in serum can cause methemoglobinemia. A 60‐year‐old woman with renal disease and anemia presented with 3 days of weakness and months of gray skin discoloration. Her hemoglobin was 8.1g/dl with 24.5% methemoglobin. Despite treatment with methylene blue, exchange transfusion, and continuous renal replacement therapy, the patient died. Autopsy revealed gray discoloration and ochronotic pigment in the ribs and cartilage. Based on these findings, the patient was diagnosed with ochronosis, suggestive of alkaptonuria, complicated by methemoglobinemia. The differential diagnosis for blue‐gray skin discoloration includes argyria, methemoglobinemia, and ochronosis. This patient's clinical and autopsy findings suggested alkaptonuria complicated by methemoglobinemia due to progressive renal dysfunction. Development of methemoglobinemia in the setting of chronic skin discoloration and renal failure should prompt consideration of alkaptonuria.     

“Racial Threat”, Partisan Climate, and Direct Democracy: Contextual Effects in Three California Initiatives

Does context—racial, economic, fiscal, and political—affect whites’ votes on racially-related ballot propositions? We examine non-Hispanic whites’ voting behavior on three California ballot initiatives: Propositions 187, 209, and 227. Unlike previous analyses that lacked individual-level data and were therefore limited to ecological inference, we combine individual-level data from exit polls with county-level contextual variables in a hierarchical linear model. Racial/ethnic context affected whites’ votes only on Proposition 187, economic context had no influence on vote choice, and the effect of fiscal context was limited to Proposition 227. However, across the propositions, whites’ decisions were shaped by their political context. Thus, we do not find support for the “racial threat” hypothesis across all racially-charged issues.     

Fatality from diphenhydramine monointoxication: a case report and review of the infant, pediatric, and adult literature

As an antihistamine, diphenhydramine (DPH) is well known for its use in allergy treatment. Since its introduction in 1946, it has been marketed under various trade names, the most popular being Benadryl. Three years after its introduction, the first fatality due to DPH toxicity was reported in 1949.To better understand the incidence of fatalities due to DPH monointoxication, we reviewed deaths that were reported from 2 data sources: (1) the English-language literature using PubMed, from 1946 through 2003; and (2) the Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System (ARAAPCCTESS), from 1983 through 2002. The results were then tabulated using age, gender, clinicopathologic findings, and toxicology results.Combined results from both data sets show the following mean (and range) for age and DPH levels: Adult, 35.6 years (18-84) and 19.53 mg/L (0.087-48.5); pediatric, 8.6 years (1.25-17) and 7.4 mg/L (1.3-13.7); infant, 31 weeks (6 weeks-11 months) and 1.53 mg/L (1.1-2.2), respectively.Most deaths were certified as accident or suicide; however, 6 infant homicides were reported. The most common symptoms for all cases were cardiac dysrhythmias, seizure activity, and/or sympathetic pupil responses. The most common autopsy finding was pulmonary congestion.     

Legitimating Racial Discrimination: Emotions, Not Beliefs, Best Predict Discrimination in a Meta-Analysis

Investigations of racial bias have emphasized stereotypes and other beliefs as central explanatory mechanisms and as legitimating discrimination. In recent theory and research, emotional prejudices have emerged as another, more direct predictor of discrimination. A new comprehensive meta-analysis of 57 racial attitude-discrimination studies finds a moderate relationship between overall attitudes and discrimination. Emotional prejudices are twices as closely related to racial discrimination as stereotypes and beliefs are. Moreover, emotional prejudices are closely related to both observed and self-reported discrimination, whereas stereotypes and beliefs are related only to self-reported discrimination. Implications for justifying discrimination are discussed.

Evaluating the Efficiency of Primer Extension Capture as a Method to Enrich DNA Extractions,

In this study, we sought to document the efficiency of primer extension capture (PEC) as a method to enrich DNA eluates of targeted DNA molecules and remove nontarget molecules from pools containing both. Efficiency of the method was estimated by comparing number of “copies in” to “copies out” by quantitative polymerase chain reaction. PEC retention of DNA targets ranging 109‐288 base pairs (bps) in length was 15.88–2.14% (i.e., loss of 84.12–97.86% of target molecules). Experimental modifications of the PEC method resulted in no significant improvements. However, the benefit of PEC was revealed in its ability to remove most nontarget DNA molecules (99.99%). We also discovered that many (56.69%) of the target molecules are “lost” prior to their immobilization on the streptavidin‐coated beads. These estimates of methodological efficiency are directly comparable to previous ones observed following “fishing” for DNA, an alternative method for DNA enrichment.     

A Lockean Theory of Territory

In this article I defend a straightforward application of Lockean property arguments to territorial rights. The article is divided into three parts. In the first part I explain the difference between two rights to land: property rights and territorial rights. In the second part I explain why an individualistic account of a Lockean theory of territory cannot be used to theorise about territorial rights. In the third part I defend a collectivist version of Lockean theory of territory. I argue that it is possible to apply directly Lockean principles regarding land use to territorial rights. I punctuate my defence with examples where Lockean principles are intuitively helpful in resolving conflicts over territorial rights.     

NECESSARY MEASURES AND LOGISTICS TO MAXIMIZE THE SAFETY OF VICTIMS OF DOMESTIC VIOLENCE ATTENDING PARENT EDUCATION PROGRAMS

This article suggests measures that should be taken to ensure, as much as possible, the safety of victims of domestic violence. Because victims and perpetrators of domestic violence will inevitably be attendees at parent education programs, such programs must be sensitive to the safety concerns of these victims. Only when victims of domestic violence are safe will their children be safe and able to benefit from what their parents learn at these education programs. This article concludes that, by weaving common-sense logistical, administrative, and curricular recommendations into the fabric of every parent education program, the safety of victims and children will be prioritized as it must be, while all attendees still receive the maximum benefit from these valuable programs.     

Preliminary Observations on the Ability of Hyperspectral Imaging to Provide Detection and Visualization of Bloodstain Patterns on Black Fabrics

Abstract: The analysis of bloodstain patterns can assist investigators in understanding the circumstances surrounding a violent crime. Bloodstains are routinely subjected to pattern analysis, which is inherently dependent upon the ability of the examiner to locate and visualize bloodstain patterns on items of evidence. Often, the ability to properly visualize bloodstain patterns is challenging, especially when the stain patterns occur on dark and/or patterned substrates. In this study, preliminary research was performed to better understand how near‐infrared reflectance hyperspectral imaging (HSI) could be used to observe bloodstain patterns on commonly encountered black fabrics. The ability of HSI to visualize latent bloodstains on several commonly encountered substrates is demonstrated. The images acquired through HSI are of sufficient quality to allow for differentiation between stains produced from an impact mechanism or a transfer mechanism. This study also serves as a proof of concept in the differentiation of multiple staining materials. Because of its ability to generate spectral data, the data provide a preliminary separation of stains where more than one type of stain existed.     

Integrating the Accreditation Council for Graduate Medical Education general competencies into forensic pathology fellowship training

Since July 2004, forensic pathology fellowships have been required to provide training in 6 general competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. In anticipation of this movement, beginning in 2002 the Office of the Medical Investigator (OMI) of the state of New Mexico began incorporating specific training in the general competencies into the fellowship program. Our experience has shown that the additional instruction and evaluation have proven to be valuable in preparing fellows for a successful forensic pathology career, did not detract from the more traditional aspects of forensic pathology training, and in many instances improved our training and assessment procedures.     

Pills,potions, and purgatives: women and abortion methods in Ireland, 1900–1950

This article examines women's efforts to induce miscarriage in Ireland (the Irish Free State, Éire, and the Republic) from 1900 to 1950. It demonstrates that, when possible, Irish women avoided surgical procedures, preferring instead to consume pills, potions, and purgatives to cause abortion. Irish women viewed emmenagogues and abortifacients as more natural than surgery and in keeping with women's traditions; these substances, they understood, had been used for centuries to restore menstruation and return the female body to normalcy and health. Overall, it was control—control over the methods of abortion and control over what they put into their own bodies, as well as autonomy when it came to managing their own reproductive health—that mattered most to Irish women seeking to terminate unwanted pregnancies. Irish women's abortion efforts expose their resolve to manage their reproductive lives and thus remind us how they sometimes rejected the dictates of the conservative twentieth-century state-Church consensus, bypassing legislation and negotiating religious cultural norms.