The Effects of Gastroesophageal Reflux Disease on Forensic Breath Alcohol Testing

Fifteen test subjects, 10 of whom were diagnosed with gastroesophageal reflux disease (GERD), were dosed with alcohol to BACs above 0.150 g/dL. Blood and breath assays taken at 20-min intervals for 8 h after dosing demonstrated close agreement between postabsorptive BAC and BrAC values. Three subjects exhibited elevated breath alcohol concentrations up to 0.105 g/dL during the absorptive phase that were apparently due to the passage of gastric alcohol through the lower esophageal sphincter not attributable to eruction or regurgitation. The effect of gastric alcohol was not consistently proportional to the amount of unabsorbed gastric alcohol. Absorption of alcohol in the esophagus explains the nonproportionality. Breath samples contaminated by GERD-related alcohol leakage from the stomach into a breath sample were found only when there was a high concentration of alcohol in the stomach. When contaminated breath samples were encountered, they were irreproducible in magnitude.     

Proficiency Testing as a Basis for Estimating Uncertainty of Measurement: Application to Forensic Alcohol and Toxicology Quantitations

Abstract: While forensic laboratories will soon be required to estimate uncertainties of measurement for those quantitations reported to the end users of the information, the procedures for estimating this have been little discussed in the forensic literature. This article illustrates how proficiency test results provide the basis for estimating uncertainties in three instances: (i) For breath alcohol analyzers the interlaboratory precision is taken as a direct measure of uncertainty. This approach applies when the number of proficiency tests is small. (ii) For blood alcohol, the uncertainty is calculated from the differences between the laboratory’s proficiency testing results and the mean quantitations determined by the participants; this approach applies when the laboratory has participated in a large number of tests. (iii) For toxicology, either of these approaches is useful for estimating comparability between laboratories, but not for estimating absolute accuracy. It is seen that data from proficiency tests enable estimates of uncertainty that are empirical, simple, thorough, and applicable to a wide range of concentrations.     

Effects of Homeopathic Mother Tinctures on Breath Alcohol Testing

In some countries, it is illegal to drive with any detectable amount of alcohol in blood; in others, the legal limit is 0.5 g/L or lower. Recently, some defendants charged with driving under the influence of alcohol and have claimed that positive breath alcohol test results were due to the ingestion of homeopathic mother tinctures. These preparations are obtained by maceration, digestion, infusion, or decoction of herbal material in hydroalcoholic solvent. A series of tests were conducted to evaluate the alcoholic content of three homeopathic mother tinctures and their ability to produce inaccurate breath alcohol results. Nine of 30 subjects gave positive results (0.11–0.82 g/L) when tests were taken within 1 min after drinking mother tincture. All tests taken at least 15 min after the mother tincture consumption and resulted in alcohol-free readings. An observation period of 15–20 min prior to breath alcohol testing eliminates the possibility of false-positive results.     

The Accuracy of Handheld Pre‐Arrest Breath Test Instruments as a Predictor of the Evidential Breath Alcohol Test Results

Drunk driving is a serious threat to public safety. All available and appropriate tools for curbing this threat should be employed to their full extent. The handheld pre‐arrest breath test instrument (PBT) is one tool for identifying the alcohol‐impaired driver and enforcing drunk driving legislation. A set of data was evaluated (n = 1779) where the PBT instrument was employed in drunk driving arrests to develop a multivariate predictive model. When maintained and operated by trained personnel, the PBT provides a reasonable estimate of the evidential test result within the relevant forensic range (95% prediction interval:  ± 0.003 g/210 L). ROC analysis shows that a multivariate model for PBT prediction of the evidentiary alcohol concentration above versus below the legal limit of 0.08 g/210 L has excellent performance with an AUC of 0.96. These results would be of value in evidential hearings seeking to admit the PBT results in drunk driving trials.     

The Effect of Alcohol‐Based Hand Sanitizer Vapors on Evidential Breath Alcohol Test Results

This study was undertaken to determine if the application of alcohol‐based hand sanitizers (ABHSs) to the hands of a breath test operator will affect the results obtained on evidential breath alcohol instruments (EBTs). This study obtained breath samples on three different EBTs immediately after application of either gel or foam ABHS to the operator's hands. A small, but significant, number of initial analyses (13 of 130, 10%) resulted in positive breath alcohol concentrations, while 41 samples (31.5%) resulted in a status code. These status codes were caused by ethanol vapors either in the room air or their inhalation by the subject, thereby causing a mouth alcohol effect. Replicate subject samples did not yield any consecutive positive numeric results. As ABHS application can cause a transitory mouth alcohol effect via inhalation of ABHS vapors, EBT operators should forego the use of ABHS in the 15 min preceding subject testing.     

Evaluation of the Analytical Performance of a Fuel Cell Breath Alcohol Testing Instrument: A Seven‐Year Comprehensive Study

Abstract: Between 2003 and 2009, 54,255 breath test sequences were performed on 129 AlcoSensor IV–XL evidential instruments in Orange County, CA. The overall mean breath alcohol concentration and standard deviation from these tests was 0.141 ± 0.051 g/210 L. Of these test sequences, 38,580 successfully resulted in two valid breath alcohol results, with 97.5% of these results agreeing within ±0.020 g/210 L of each other and 86.3% within ±0.010 g/210 L. The mean absolute difference between duplicate tests was 0.006 g/210 L with a median of 0.004 g/210 L. Of the 2.5% of duplicate test results that did not agree within ±0.020 g/210 L, 95% of these had a breath alcohol concentration of 0.10 g/210 L or greater and 77% had an alcohol concentration of 0.15 g/210 L or greater. The data indicate that the AlcoSensor IV–XL can measure a breath sample for alcohol concentration with adequate precision even amid the effects of biological variations.     

Paradigm Shift for the Alcohol Breath Test

Abstract: The alcohol breath test (ABT) has been used for quantification of ethyl alcohol in individuals suspected of driving under the influence for more than 50 years. In this time, there has been little change in the concepts underlying this single breath test. The old model, which assumes that end‐exhaled breath alcohol concentration is closely related to alveolar air alcohol concentration, is no longer acceptable. This paper reviews experimental research and mathematical modeling which has evaluated the pulmonary exchange processes for ethyl alcohol. Studies have shown that alcohol exchanges dynamically with the airway tissue both during inspiration and expiration. The airway tissue interaction makes it impossible to deliver air with alveolar alcohol concentration to the mouth. It is concluded that the ABT is dependent on physiological factors that need to be assessed for accurate testing.     

Variability in the Blood/Breath Alcohol Ratio and Implications for Evidentiary Purposes

The breath analyzer is an indispensable tool for identifying alcohol levels among drivers. While numerous studies have shown high correlations between blood and breath alcohol concentrations, most are limited by the study design. This study seeks to assess this relationship by minimizing potential measurement bias, document time from alcohol consumption to testing, and adjusting for potential confounders. A blinded study was performed using conditions closely resembling those in the field. The Draeger 7110 MKIII IL breath analyzer was used to assess breath alcohol concentrations (BrAC). Participants were 61 healthy volunteers aged 21–37 years with body mass index ≤30 and no history of alcoholism. A total of 242 valid blood/breath tests were performed in four test sets. The study results showed a high correlation coefficient between BrAC and blood alcohol concentration (BAC) levels (r = 0.983) with high sensitivity (97%) and specificity (93%). This strong association between the breath analyzer and BAC persisted even after adjustment for various stages of alcohol absorption. These results illustrate the high diagnostic sensitivity of the breath analyzer in field‐tested conditions.     

Results of a proposed breath alcohol proficiency test program

Although proficiency test programs have long been used in both clinical and forensic laboratories, they have not found uniform application in forensic breath alcohol programs. An initial effort to develop a proficiency test program appropriate to forensic breath alcohol analysis is described herein. A total of 11 jurisdictions participated in which 27 modern instruments were evaluated. Five wet bath simulator solutions with ethanol vapor concentrations ranging from 0.0254 to 0.2659 g/210 L were sent to participating programs, instructing them to perform n = 10 measurements on each solution using the same instrument. Four of the solutions contained ethanol only and one contained ethanol mixed with acetone. The systematic errors for all instruments ranged from -11.3% to +11.4% while the coefficient of variations ranged from zero to 6.1%. A components-of-variance analysis revealed at least 79% of the total variance as being due to the between-instrument component for all concentrations. Improving proficiency test program development should consider: (1) clear protocol instructions, (2) frequency of proficiency testing, (3) use lower concentrations for determining limits-of-detection and -quantitation, etc. Despite the lack of a biological component, proficiency test participation should enhance the credibility of forensic breath test programs.     

Measurement of Uncertainty for Aqueous Ethanol Wet‐Bath Simulator Solutions Used with Evidential Breath Testing Instruments

Aqueous ethanol wet‐bath simulator solutions are used to perform calibration adjustments, calibration checks, proficiency testing, and inspection of breath alcohol instruments. The Toxicology Bureau of the New Mexico Department of Health has conducted a study to estimate a measurement of uncertainty for the preparation and testing of these wet‐bath simulator solutions. The measurand is identified as the mass concentration of ethanol (g/100 mL) determined through dual capillary column headspace gas chromatography with flame ionization detector analysis. Three groups were used in the estimation of the aqueous ethanol wet‐bath simulator solutions uncertainty: GC calibration adjustment, GC analytical, and certified reference material. The standard uncertainties for these uncertainty sources were combined using the method of root‐sum‐squares to give u_c = 0.8598%. The combined standard uncertainty was expanded to U = 1.7% to reflect a confidence level of 95% using a coverage factor of 2. This estimation applies to all aqueous ethanol wet‐bath simulator solution concentrations produced by this laboratory.     

The rate of dissipation of mouth alcohol in alcohol positive subjects

Seven subjects participated in a two-part study to evaluate mouth alcohol dissipation in alcohol positive subjects. In part one, subjects rinsed their mouths with a vodka solution and were breath tested after 1, 2, 3, 4, and 5 min intervals. On average, breath alcohol concentration (BrAC) decreased 20.4% (range 3.2-47.9%) between 1 and 2 min after rinsing. In part two of the study, multiple breath tests were administered after rinsing once with the vodka solution. The BrAC decreased more than 0.020 g/210 L between the first and second tests for all subjects (average 0.095 g/210 L, range 0.021-0.162 g/210 L). The average time for subjects to reach their unbiased BrAC was 9.35 min (range 4-13 min) after rinsing. This study reaffirms the need for duplicate breath testing and confirms that the minimum of a 15-min observation period is sufficient for mouth alcohol to dissipate in alcohol positive subjects.     

Alcohol ingestion and age of death in hanging suicides

Retrospective review of 100 consecutive, nondecomposed cases of suicide because of hanging was conducted at Forensic Science SA, Australia. Alcohol was detected in 38 cases (38%). The percentage of victims who had ingested alcohol significantly decreased with age (r(2)=0.81), with alcohol detected in 57.1% of those aged ≤24 years, compared to 28.5% of those aged between 55 and 64 years, and 0% of those aged ≥65 years. A similar linear relationship between alcohol ingestion and age was found for cases with blood alcohol levels >0.05 g/100 mL (r(2)=0.73). The mean ages of those with detectable alcohol (35.2 years) levels >0.05 g/100 mL (35.1 years) and levels >0.1 g/100 mL (37.2 years) were all significantly less than in those with no detectable alcohol (44.4 years) (p<0.005, <0.005, <0.05 respectively). A clear relationship between alcohol ingestion and younger age was shown in hanging suicides.     

采血管中添加剂对血样中乙醇含量的影响

目的：探讨不同种类采血管对血样中乙醇含量检测结果的影响。方法分别用7种一次性真空采血管[无抗凝剂管、促凝剂管、分离胶-促凝剂管、枸橼酸钠（1∶4）管、枸橼酸钠（1∶9）管、柠檬酸钠（9∶1）管、EDTA-K2管]采集10名志愿者饮酒后2 h血液,用顶空气相色谱法检测血样中乙醇含量。结果相同血样用不同的采血管,其乙醇含量检测结果不同,依次为分离胶-促凝剂管〉促凝剂管〉无抗凝剂管〉EDTA-K2管〉枸橼酸钠（1∶9）管〉枸橼酸钠（1∶4）管,柠檬酸钠（9∶1）管与枸橼酸钠（1∶9）管检测结果基本一致。结论采集涉嫌酒后驾驶的驾驶员血样,应选用一次性真空采血管,首选EDTA-K2管。     

Unnatural and Violent Death in Cases with High Blood Alcohol Concentration— Autopsy Study

The use of alcohol increases the risk of dying from unnatural or violent causes. The presented study explored the distribution of age, gender, cause, and circumstances of death in persons who died in an unnatural and violent manner, with a blood alcohol concentration (BAC) higher than 0.3 g/dL, and where the cause of death was not alcohol intoxication. We defined the control (0 < BAC < 0.3 g/dL) and study (BAC ≥ 0.3 g/dL) groups, as in subjects with these concentrations, there is a significant risk of gross intoxication, stupor, and death. The subjects from the study group were older, with no difference in gender distribution. Traffic accidents were the most common fatal event in both groups, followed by suicides. Other accidents (choking on food and exposure to fire) were more frequent in the study group. Compared to the control group, subjects from the study group were older persons whose deaths were mainly accidental.     

A Review of Alcohol‐Impaired Driving: The Role of Blood Alcohol Concentration and Complexity of the Driving Task

The operation of a motor vehicle requires the integrity of sensory, motor, and intellectual faculties. Impairment of these faculties following the consumption of alcohol has been studied extensively through laboratory, closed‐course and on‐road driving, and epidemiological studies. The scientific literature was reviewed critically, with a focus on low‐to‐moderate blood alcohol concentrations (BAC ≤ 0.100%), to identify the most reliable determinants of alcohol‐impaired driving. Variables such as age, gender, driving skill, and tolerance were shown to have limited impact on impairment. It was concluded the most relevant variables are BAC and complexity of the driving task. The scientific literature provides a high degree of confidence to support the conclusion that a BAC of 0.050% impairs faculties required in the operation of a motor vehicle. Whether impairment is apparent depends upon the complexity of the driving task, which applies to both study design and actual driving.     

Deaths in Unlicensed Alcohol Rehabilitation Facilities,

Non‐English‐speaking people do not always seek medical care through established institutions. This paper reports a series of deaths in unlicensed alcohol rehabilitation facilities serving Spanish‐speaking men. These facilities are informal groups of alcohol abusing men who live together. New members receive various treatments, including administration of ethanol or isopropanol, restraint, and seclusion. We reviewed 42 deaths in unlicensed alcohol rehabilitation facilities in Los Angeles County during the years 2003–2014. Data gathered included age, length of time spent in the facility, blood alcohol and drugs at autopsy, and cause and manner of death. Causes of death included acute alcohol poisoning, alcohol withdrawal, and a variety of other causes. Three cases were considered homicides from restraint asphyxia. The Department of Medical Examiner‐Coroner has worked with the police, district attorney, and State Department of Health Services to try to prevent additional deaths in unlicensed alcohol rehabilitation facilities. Nevertheless, prevention has been difficult.     

Fourier-transformed infrared breath testing after ingestion of technical alcohol

The study aim was to evaluate the feasibility of a Fourier-transformed infrared (FT-IR) analyzer for out-of-laboratory use by screening the exhalations of inebriated individuals, and to determine analysis quality using common breath components and solvents. Each of the 35 inebriated participants gave an acceptable sample. Because of the metabolism of 2-propanol, the subjects exhaled high concentrations of acetone in addition to ethanol. Other volatile ingredients of technical ethanol products (methyl ethyl ketone, methyl isobutyl ketone, and 2-propanol) were also detected. The lower limits of quantification for the analyzed components ranged from 1.7 to 12 microg/L in simulated breath samples. The bias was +/-2% for ethanol and -11% for methanol. Within-day and between-day coefficients of variation were <1% for ethanol and <4% for methanol. The bias of ethanol and methanol analyses due to coexisting solvents ranged from -0.8 to +2.2% and from -5.6 to +2.9%, respectively. The FT-IR method proved suitable for use outside the laboratory and fulfilled the quality criteria for analysis of solvents in breath.     

Death in sauna

Bathing in sauna is common in Finland, where there are approximately 2 million saunas among the population of 5.2 million. In this paper, deaths occurring while in a sauna in 1990-2002 in Finland were studied by analyzing police and forensic autopsy reports, death certificates, and toxicological results. The annual rate of death occurring while in a sauna was less than 2 per 100,000 inhabitants. Close to half (51%) of the cases were determined to be natural deaths and exposure to heat was the cause of death in 25%. Overall, 50% of all cases were under the influence of alcohol. The main conclusion is that death in the sauna is a rare event even in Finland where the frequency of sauna bathing is high. The role of alcohol as a risk factor has grown. The prevention of these deaths should focus on less drinking of alcohol and avoid leaving a drunken bather alone in the sauna.     

Quantifying Uncertainty in Estimations of the Total Weight of Drugs in Groups of Complex Matrices

In case practice at forensic drug departments, multiple items from one seizure are sometimes sent in with the question: what is the total amount of drugs in the seizure? This may be complicated especially if impregnated material is involved such as clothes or rubber. Measurement uncertainty is typically stable on drug percentages, not weights, and subsampling may take place. It is recognized more and more that determination and reporting of uncertainty on estimators are an essential part of obtaining scientifically sound results in the forensic field. Methodology is described to quantify uncertainty on estimations of the total drug weight in groups of complex matrices, given simple statistical models, along a subdivision of five types of cases. Given each of these types, case examples are given where uncertainty is quantified in estimations of drug weights, by means of confidence intervals. The described models are statistically sound and relatively easy to implement.