Postmortem Computed Tomography in Firearm Homicides: A Retrospective Case Series,

Postmortem computed tomography (PMCT) is integrated into the evaluation of decedents in several American medical examiner offices and medicolegal death investigative centers in many other countries. We retrospectively investigated the value of PMCT in a series of firearm homicide cases from a statewide centralized medical examiner’s office that occurred during 2016. Autopsies were performed or supervised by board-certified forensic pathologists who reviewed the PMCT scans prior to autopsy. PMCT scans were re-evaluated by a forensic radiologist blinded to the autopsy findings and scored by body region (head–neck, thoracoabdominal, and extremities). Injury discrepancies were scored using a modified Goldman classification and analyzed with McNemar’s test. We included 60 males and 20 females (median age 31 years, range 3–73). Based on PMCT, 56 (79.1%) cases had injuries relevant to the cause of death in a single body region (24 head–neck region, 32 thoracoabdominal region). Out of these 56 cases, 9 had a missed major diagnosis by PMCT outside that region, including 6 extremity injuries visible during standard external examination. Yet all had evident lethal firearm injury. We showed that PMCT identifies major firearm injuries in homicide victims and excludes injuries related to the cause of death in other regions when a single body region is injured. Although PMCT has a known limited sensitivity for soft tissue and vascular pathology, it can be combined with external examination to potentially reduce or focus dissections in some of these cases depending on the circumstances and medicolegal needs.     

High performance liquid chromatographic determination of alcohols with reference to body distribution of methanol

A method has been developed on reverse phase high performance liquid chromatography for simultaneous determination of methyl, ethyl and isopropyl alcohols under refractive index detection using pure water as the mobile phase. A good separation has been achieved between these alcohols. Detector response was linear with a detection limit of 5 mg/100 ml. Recovery studies were performed by adding known amounts of methyl and ethyl alcohols to blood, lung and liver within the range 80–90%. The reproducibility of the results was always >90%. The quantitative distribution of methyl alcohol in postmortem body tissues and fluids has been reported in three cases of poisoning.     

The Impact of Prenatal Exposure to Power Plant Emissions on Birth Weight: Evidence from a Pennsylvania Power Plant Located Upwind of New Jersey

To examine the infant health impact of prenatal exposure to power plant emissions, we draw scientific evidence on the impacted region downwind of a large polluter, a coal‐fired power plant located on the border of two states and proven to be the sole contributor to the violation of air quality standards of the impacted region. Our results show that among all live singleton births that occurred during 1990 through 2006, those born to mothers living as far as 20 to 30 miles away downwind from the power plant (which is also an affluent region) during pregnancy are at greater risks of low birth weight (LBW) and very low birth weight (VLBW): the likelihoods of LBW and VLBW could increase approximately by 6.50 and 17.12 percent, respectively. In light of the continual efforts of The U.S. Environmental Protection Agency in reducing cross‐state air pollution caused by transboundary power plant emissions, our study is aimed at broadening the scope of cross‐border pollution impact analysis by taking into account adverse infant health effects of upwind polluters, which can impose disproportionate burdens of health risks on downwind states due to air pollutants transported by wind.     

Factors that Influence Mental Health Stigma Among 8th Grade Adolescents

Unmet mental health need is a significant problem for adolescents. Although stigma is identified as a major barrier to the use of mental health services among youth, there is limited research on this topic. In-depth interviews (n=57) among a sample of 8th grade students in a suburban, mid-Atlantic community portray adolescent mental health attitudes and how these views are shaped. Satisfactory personal experiences with mental health services as well as accurate mental health knowledge contribute to positive mental health attitudes among teens. The anticipation of negative responses towards mental health care-seeking from family members, peers, and school staff are key factors in teens’ comfort and willingness to address mental health concerns. The research provides critical information on the factors that contribute to the development of stigma and emphasizes the need to address stigma in youth mental health education, programs, and treatment plans. Authors are affiliated with the Johns Hopkins Bloomberg School of Public Health, Department of Population and Family Health Sciences. Dr. Chandra has a background in adolescent health, and is particularly interested in improving the accessibility and appropriateness of youth mental health services and involving young people in the translation of research into practice. Dr. Minkovitz is interested in improving preventive service delivery, enhancing quality of care, and understanding maternal factors that influence children’s receipt of health care     

Hazards of mattresses, beds and bedding in deaths of infants

Of 52 infants who had died suddenly and were referred to autopsy, nine had lain on adult water beds for the first time; five had died as a result of accidents; two had died on water beds; two were in beds with widely spaced slats; and one had died as a result of strangulation. Three deaths were due to overlying. Three other infants had been placed on sheepskin rugs for the first time and were found dead shortly thereafter. These infants ranged in age from 2 to 9 months, except for a severely mentally retarded nine-year-old with spastic paraplegia. We believe that a general warning should be issued concerning water beds and that soft bedding should not be used for infants. Infants should not be placed unattended or left to sleep on water beds; only beds recommended for infants should be used. Overlying of a young infant is most likely to occur on a water bed, or if the parent is obese or has consumed alcohol.     

Environmental Security and New Middle Powers: The Case of South Korea

This article considers the role of new middle powers in the climate change debate. We focus on the issue of “green growth.” We argue that new middle powers such as South Korea are increasingly proactive in promoting this green growth agenda and, as a result, challenging conventional realist and liberal approaches and expectations to new middle powers. This diplomacy is aiming to bridge states, great and small, by leading to strategic breakthroughs in the current climate change negotiation deadlock. The article discusses South Korea’s green growth initiative and identifies how this initiative affects South Korea’s middle power role in the global environmental debate with respect to its inclusion in the Environment Integrity Group and its initiative the Global Green Growth Institute (GGGI).     

Horses or unicorns: can paying for performance make quality competition routine?

The competitive benefits of pay-for-performance (P4P) financial incentives are widely assumed. These incentives can affect health care through several mechanisms, however, not all of which involve competition. This insight has three implications. First, federal antitrust enforcement should continue to scrutinize P4P arrangements. Second, government needs to play a larger role in P4P than through antitrust oversight. Third, widespread enthusiasm for a particular health policy reform does not relieve policy makers of the obligation to understand its theoretical basis.     

Potency Trends of Δ9‐THC and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008*

Abstract: The University of Mississippi has a contract with the National Institute on Drug Abuse (NIDA) to carry out a variety of research activities dealing with cannabis, including the Potency Monitoring (PM) program, which provides analytical potency data on cannabis preparations confiscated in the United States. This report provides data on 46,211 samples seized and analyzed by gas chromatography‐flame ionization detection (GC‐FID) during 1993–2008. The data showed an upward trend in the mean Δ⁹‐tetrahydrocannabinol (Δ⁹‐THC) content of all confiscated cannabis preparations, which increased from 3.4% in 1993 to 8.8% in 2008. Hashish potencies did not increase consistently during this period; however, the mean yearly potency varied from 2.5–9.2% (1993–2003) to 12.0–29.3% (2004–2008). Hash oil potencies also varied considerably during this period (16.8 ± 16.3%). The increase in cannabis preparation potency is mainly due to the increase in the potency of nondomestic versus domestic samples.     

Understanding the Role of Participation in Public Service Delivery: Evidences from Rural West Bengal,India

The present study, using household level data of East Midnapore district of West Bengal, India, examines the role of people’s participation in public service delivery. It considers four dimensions of participation namely attending meetings, raising voice, lodging complaints, and making contributions. The study confirms the role of participation in public service delivery. Apart from participation, households’ socioeconomic and political positions also exert significant impacts. There is, however, likelihood of “elite capture” and “clientelism” in the delivery of public services. Effective service delivery presupposes that while attending meetings, people must raise their voice and make contributions.