Radiographic demonstration of esophageal and tracheal fistulas at autopsy using a contrasting medium that vulcanizes at room temperature

Esophageal and tracheal fistulas, which occur in 0.05% of medicolegal autopsies, were demonstrated in three cases by a postmortem radiographic technique using silicone rubber/lead oxide as a contrasting medium that vulcanizes at room temperature. In one 83-year-old male, a tracheoesophageal fistula was detected, which had developed after surgical repair of an esophageal rupture caused by a flexible fiberoptic endoscope. In a second case, carcinoma of the esophagus in a 78-year-old male had eroded the trachea and arcus of the aorta creating a fatal tracheoesophagoaortic fistula. In a third case, 55-year-old female developed a tracheobrachicephalic artery fistula as a result of an infiltrating cystic adenocarcinoma of the trachea, resulting in a fatal hemorrhage into the trachea. The results of this study indicate that diagnostic radiologic methods using a vulcanized contrasting medium are useful in supplementing normal dissection in autopsy cases with suspected fistulas of the esophagus or trachea.     

Beyond 'Do No Harm': The Challenge of Constructing Ethical Relationships in Refugee Research

This paper highlights some of the central ethical challengesinvolved in undertaking social science research with refugeesin conflict and crisis situations. It focuses on two main setsof challenges: first, the difficulties of constructing an ethicalconsent process and obtaining genuinely informed consent; andsecond, taking fully into account and responding to refugeeparticipants' capacities for autonomy. The authors also discussthe challenges involved in applying the central normative principlesgoverning ethics review processes—the principles of beneficence,integrity, respect for persons, autonomy and justice—tothe context of refugee research. It is argued that researchersshould seek ways to move beyond harm minimization as a standardfor ethical research and recognize an obligation to design andconduct research projects that aim to bring about reciprocalbenefits for refugee participants and/or communities. Some ofthe methodological issues raised by this analysis are discussedin the conclusion.     

Christianity and punitive mentalities: A qualitative study

According to David Garland (1990) scholars should be concerned about the cultural foundations of punishment in modern western society, such as religion. To this end, Garland conceptualizes punitive mentalities and sensibilities that provide the cultural support for structural systems ofpunishment. Punitive mentalities are ways of thinking about punishment, whereas punitive sensibilities are ways of feeling about punishment. Garlandsuggests that religious traditions are an important source of punitive mentalities and sensibilities. This research is an empirical analysis ofpunitive mentalities and their cultural roots, using qualitative research.Research questions focus on the following: Are there distinctively punitivementalities? How do punitive mentalities influence the desire for officialpunishment? Data from a previous study (Cook, 1998a) are analyzed here to explore terrains of punitive mentalities within the contexts of Christianity.Findings identify four distinct categories: anti-punitive, non-punitive,retributive and vengeful mentalities where Christian (non)belief systemsare important cornerstones. Respondents in each group have specific desires regarding the state's use of punishments, especially the ``death penalty''.     

Has PPS increased Medicare expenditures on physicians?

We use data from 1983 and 1985 on the volume of Medicare physician services to analyze whether Medicare's Prospective Payment System (PPS), which resulted in a significant decline in hospital spending, led to a partially offsetting increase in real expenditures for physician services. We also analyze the effect of increases in assignment rates, increasing incomes of the elderly, and other factors on real expenditures during this period. Our main conclusion is that PPS has at most a small positive effect on real physician expenditures. Because people spent less time in the hospital, Medicare physician spending declined; but because of incentives to shift radiology and other services out of the hospital, some of this decline was offset. We also conclude that the sharp increase in Medicare assignment rates over this period, along with the rising incomes of the elderly during this period, contributed to the observed growth.     

A modification of the microplate method for reverse ABO typing of bloodstains and additional validation studies

The results of additional validation studies of a sensitive microplate hemagglutination assay for ABO reverse grouping of bloodstains are presented. The results of the validation study demonstrate the reliability of the microplate assay for use in routine serological casework. Based on these studies, the microplate assay has now replaced the Lattes crust test for ABO reverse grouping of bloodstains in the FBI Laboratory.     

Acidic and neutral drugs screen in blood with quantitation using microbore high-performance liquid chromatography–diode array detection and capillary gas chromatography–flame ionization detection

Blood previously acidified with aqueous saturated ammonium chloride solution was extracted with ethyl acetate. The dried extract was subjected to acetonitrile–hexane partition. The acetonitrile portion was analysed for the presence of acidic and neutral drugs by HPLC–DAD (200 mm×2.1 mm I.D. microbore ODS-Hypersil column) and GC–FID (25 m narrow-bore×0.25 mm I.D. HP-5 column with 0.33 μm film thickness). The protocol was found to be suitable for both clinical toxicology (including emergency toxicology) and postmortem toxicology. At least 66 drugs of interest were unequivocally identified by RRTs (HPLC) and UV spectra (DAD) match while another 12 were unequivocally identified by double RRTs match (HPLC and GC). Quantitation was facilitated by incorporating calibration blood standards in each assay batch. The five drugs most commonly encountered in clinical blood specimens (1150 cases) were: paracetamol (47.4% of the cases); chlormezanone (6.6%), theophylline (1.74%), naproxen (1.65%) and mefenamic acid (1.56%). The following drugs were detected in toxicologically significant quantities in postmortem blood specimens (245 cases): phenobarbitone (1.22% of the cases), naproxen (0.82%), chlormezanone (0.82%), theophylline (0.82%), carbamazepine (0.41%) and paracetamol (0.41%).