End-of-life decisions and demented patients. What to do if the patient's current and past wishes are in conflict with each other?

In this article different approaches are distinguished in order to solve the question of what has to be done if a demented patient behaves in a manner which is found to be inconsistent with his previously expressed wishes. Positions vary, from implementing the advance directive to not implementing the advance directive. The article defends a compromise position by holding that the exact circumstances of each case should be weighed against each other to determine the outcome and to provide an answer to the research question.     

Extreme versus quotidian: addressing temporal dichotomies in Philippine disaster management

Brief narratives of two recent events in Luzon island—a flashflood in Angeles City and an eruption of Mayon volcano—underscore the disparity between natural hazards as amplifiers of everyday hardship for many Filipinos and the Philippine disaster management system's orientation towards extreme‐event response. Three major factors contribute to this dichotomy. First, population dynamics combined with the lack of access to resources compels poor Filipinos to live and work in hazardous areas, discounting risk from extreme natural events to focus on daily needs. Second, the institutional setting of the country's disaster management within the military establishment makes it difficult, though not impossible, to focus and address the underlying causes of vulnerability. Third, existing modes of funding disaster expenditures are all biased towards immediate response rather than long‐term risk‐reduction. The implications of these findings to disaster management and research in the Philippines are identified. Copyright © 2008 John Wiley & Sons, Ltd.     

Planned complex suicide: an unusual case

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.     

From population- to subject-based limits of T/E ratio to detect testosterone abuse in elite sports

In elite sports, indirect testing of testosterone abuse is mainly based on the testosterone over epitestosterone (T/E) ratio. Since this marker is characterized by a small ratio of intra- to inter-individual variation, it is surprising that current anti-doping strategy uses a screening test based on a population-based limit. From a database of more than 15,000 steroid profiles obtained from routine controls, the collection of steroids profiles of 11 elite athletes followed during 2 years, and a longitudinal study involving 17 amateur athletes, 8 of which were orally administrated testosterone undecanoate pills, we selected 12 case studies to represent the possible scenarios to which the anti-doping laboratories are confronted. Various detection strategies at the disposal of the laboratories are employed and discussed, including isotope ratio mass spectrometry (IRMS) analysis and a Bayesian interpretation of the T/E-time profile. The weak sensitivity versus specificity relation of a population-based limit for the T/E ratio is outlined. As a result, we propose a Bayesian screening test whose T/E threshold progressively evolves from a population basis to a subject basis as the number of individual test results increases. We found that this screening test heightens drastically the capacity to detect testosterone abuse, at no additional financial and administrative expenses for anti-doping authorities.     

Colchicine poisoning: case report of two suicides

Colchicine overdose is uncommon but potentially life threatening because of the high toxicity of the drug. Poisoning by colchicine may occur following ingestion of medication used in acute attacks of gout and inflammatory diseases. We describe two cases involving suicide by the ingestion of medications marketed in France. In case 1, only heart blood was taken after body external examination. In case 2 an autopsy was performed and heart blood, urine, gastric contents and bile were taken for toxicological analysis. Colchicine was assayed in biological specimens by an HPLC-DAD method, after extraction by dichloromethane at pH 8, adding prazepam as internal standard (IS). Analyses were performed on a Symetry C-8 column. Mobile phase was a gradient of acetonitrile/pH 3.8 phosphate buffer. Colchicine is eluted at 13.1 min and the method is linear for blood, urine and bile over the range 4-1000 ng/mL. LOQ is 4 ng/mL. The concentrations of colchicine detected are: case 1: heart blood 13 ng/mL; case 2: heart blood 66 ng/mL, urine 500 ng/mL, gastric content 12 ng/mL, bile 5632 ng/mL. Our findings are in the range of lethal concentrations previously described, but there is no correlation with the amount of ingested drug. Even after massive overdose, it could be impossible to detect colchicine in blood, and as there is a widespread enterohepatic recirculation before excretion in bile and feces, bile is the target sample to analyse. We conclude in both cases that the cause of death was suicide with colchicine. It appears very important to perform an autopsy in order to obtain bile, urine, heart blood and femoral blood.     

Surface Curvature of Pelvic Joints from Three Laser Scanners: Separating Anatomy from Measurement Error

Recent studies have reported that quantifying symphyseal and auricular surface curvature changes on 3D models acquired by laser scanners has a potential for age estimation. However, no tests have been carried out to evaluate the repeatability of the results between different laser scanners. 3D models of the two pelvic joints were generated using three laser scanners (Custom, Faro, and Minolta). The surface curvature, the surface area, and the distance between co‐registered meshes were investigated. Close results were found for surface areas (differences between 0.3% and 2.4%) and for distance deviations (average <20 μm, SD <200 μm). The curvature values were found to be systematically biased between different laser scanners, but still showing similar trends with increasing phases/scores. Applying a smoothing factor to the 3D models, it was possible to separate anatomy from the measurement error of each instrument, so that similar curvature values could be obtained (p < 0.05) independent of the specific laser scanner.     

Off-Label Prescribing by Psychiatrists: What is the Practitioner's Liability?

In psychiatry, the molecules available and the dosages recommended when a drug receives marketing authorization are not always adequate to treat patients with major behavioral disturbances. Off-label prescribing is frequent in this context, with regard to the indications and the dosages given as well as to the drug combinations used. However, if complications or death occur, the practitioner's liability may be engaged. The authors report three deaths attributed to off-label prescribing in psychiatry and which led to charges against the physicians. They review the precautions to be taken when prescribing in such conditions (no other possible treatment, existence of sound scientific evidence, consent obtained from the patient, or their legal representatives except in cases of force majeure) and the physician's liability if adverse events occur that could be attributed to off-label prescribing.     

Single-metal deposition (SMD) as a latent fingermark enhancement technique: an alternative to multimetal deposition (MMD)

This paper proposes an alternative solution to multimetal deposition (MMD) for the development of latent fingermarks on non-porous and porous surfaces. MMD offers a good sensitivity, however it is very time-consuming and requires many reagents to be carried out. Single-metal deposition (SMD) replaces the silver enhancement of the gold colloids by a gold enhancement procedure. This reduces the number of baths by one as well as the number of reagents and their cost, utilizes reagents with a longer shelf life, and most importantly reduces the labor-intensity of the procedure. It offers quasi-identical results to MMD and thus makes a very attractive alternative.     

欧盟关于知识产权执法的建议

在中国、印度等发展中国家为达到《与贸易有关的知识产权的协议》(TRIPS)规定的知识产权保护标准而努力的时候,欧美等发达国家提出了知识产权保护的更高的标准。此种动向,值得我国业内人士关注。2003年,欧洲委员会提出的欧盟关于加强知识产权执法的建议,其中就提出了一些超TRIPS(TRIPS-Plus)的条款。在一次国际研讨会上,欧洲委员会贸易司主管官员Christophe De Vroey先生介绍了这项新建议以及欧盟有关知识产权保护的一些最新进展。应我们之约,Vroey先生特将讲话稿作了修改,以符合本刊发表的要求。在此,我们对Christophe De Vroey先生的帮助表示感谢。