Aortic dissection after ingestion of "ecstasy" (MDMA)

The authors report a case of aortic dissection and cardiac tamponade in a 29-year-old man after ingestion of ecstasy (methylenedioxymethamphetamine, MDMA) at a "rave" party. There was no history of hypertension, myxoid heart disease, or other risk factors for aortic dissection in the deceased, although a minor degree of cystic medial necrosis was noted on histologic examination of the aorta. Autopsy toxicology revealed low residual levels of MDMA in the blood about 48 hours after ingestion of the drug. This case report describes a probable association between MDMA ingestion and aortic dissection in a previously well young adult. The likely mechanisms are discussed, and the difficulties in diagnosing this complication are highlighted.     

Lawyers' Questioning: The Effect of Confusing Questions on Witness Confidence and Accuracy

The present study investigated the effect on witness confidence and accuracy of confusing questions often used by attorneys in court. Participants viewed a videotaped film and were individually questioned about the incident 1 week later. Half the participants were asked questions using six categories of confusing questions (negatives, double negatives, leading, multiple questions, complex syntax, and complex vocabulary); the remaining half were asked for the same information using simply phrased equivalents. Confusing questions reduced participant-witnesses' accuracy and suppressed confidence–accuracy relationships compared with the condition where simplified alternatives were asked. Witness performance was impaired by the fact that mock-witnesses rarely asked for a confusing question to be explained or qualified their answers. This experiment demonstrates the importance of ensuring that lawyers ask witnesses simple, clear, questions.     

Expanded School Mental Health: Challenges and Opportunities in an Emerging Field

Reviews the need for and development of expanded school mental health (ESMH) programs, which provide a continuum of mental health promotion and intervention through school–community partnerships. Since ESMH is a relatively new, but increasingly prominent field, countless issues are being addressed in practice and research and in efforts to bridge practice and research. We review particular content and context dimensions of ESMH in need of development including quality assessment and improvement, empirically supported practice, improving assessment and outcome evaluation, involving educators in the work, understanding school environments, and tailoring programs through qualitative research. Summaries of articles that amplify these themes are provided.     

Evaluation of a Psychoeducational Program to Help Adolescents Cope

Over 20% of a sample of 706 young adolescents identified themselves as experiencing difficulties and being in need of specific help in coping. A psychoeducational Program Helping Adolescents Cope was offered to 112 of those. This was adapted, with permission, from the Coping with Stress Course, devised by Albano et al. (1997). Participants progress was monitored and evaluated using qualitative and quantitative measures. The psychoeducational Program was found to be significantly effective in reducing participants depression scores, in reducing their reliance on unproductive means of coping and overall in helping them cope. This article presents the methodology used, key results and discusses the implications of this work for professionals working with adolescents in the area of prevention and coping.Claire Hayes is a clinical and educational psychologist who has recently moved from her post of lecturer in the National University of Ireland Maynooth to develop the Break through Anxiety service as a private practitioner. She received her PhD in Education/Psychology from Dublin City University, Ireland. Her major research interests are in how psychological theories, such as cognitive behavioural theory, can be taught as a means of prevention and copingMark Morgan is Head of Education in St. Patricks College, Drumcondra, Dublin 9, which is part of Dublin City University. He received his PhD in social psychology from the London School of Economics. His research has mainly been in the area of literacy, educational disadvantage and substance use, particularly the evaluation of prevention programmes.     

The detection and enhancement of latent fingermarks using infrared chemical imaging

The use of a new technique, Fourier transform infrared (FTIR) chemical imaging, has been demonstrated for the enhancement of latent fingermarks on a number of surfaces. Images of untreated fingermarks on glass backgrounds with excellent ridge detail were acquired using infrared chemical imaging. High quality fingermarks on glass backgrounds were also developed using ethyl cyanoacrylate (super glue) fuming and subsequent infrared chemical imaging. This new method allows the collection of images from backgrounds that traditionally pose problems for current fingermark detection methods. The background may, for example, be highly colored, have a complex pattern, or possess other pattern or image characteristics that make it difficult to separate fingermark ridges using traditional optical or luminescent visualization. One background that has proven to be a challenging surface for the development of latent fingermarks is the Australian polymer banknote. To demonstrate the power and applicability of infrared chemical imaging, fingermarks fumed with ethyl cyanoacrylate were successfully imaged from Australian polymer banknotes.     

The death of managed care: a regulatory autopsy

On the heels of widespread patient protection legislation in the states, the managed care industry abandoned or greatly scaled back the core elements of gate-keeping, utilization management, and financial incentives, which are the very targets of this legislation. This article explores whether, and to what extent, the industry's abrupt change in course can be attributed to these laws. Based on extensive interviews with key informants in six representative states, the article concludes that these laws were not the primary driver of changes in managed care practices. However, patient protection laws interacted with other social and market forces, through complex forms of feedback and reinforcement, to bring about more thoroughgoing change than would have otherwise occurred.