The doctor will e-mail you now: physicians' use of telemedicine to treat patients over the Internet

This article examines the problems currently associated with the practice of telemedicine and suggests that the best solution for this particular field of medicine is a national standard of care. This article also suggests that the Food and Drug Administration's (FDA) current functions are easily expandable to the telemedicine context; therefore, the agency should regulate the implementation of such a standard in the telemedicine field. This article proposes that the FDA use medical practice guidelines in developing the applicable standard. Other agencies, such as the American Medical Association (AMA) and other website alliances, could also aid the FDA in implementing this standard because of their experience in setting such guidelines for the traditional medical context. Finally, this article suggests that in implementing the national standard of care, the FDA should increase the standard of care that telephysicians, as compared to traditional physicians, owe their patients because of the risks associated with treating patients in the absence of hands-on consultations. By implementing a national standard of care, problems currently associated with telemedicine will be resolved, and physicians and patients will have more confidence in telemedicine.     

Y-chromosome STR haplotypes in two population samples: Azores Islands and Central Portugal

The Y-chromosome haplotypes defined by nine STRs (DYS19, DYS385, DYS389I, DYS389II, DYS390, DYS391, DYS392 and DYS393) were studied in 207 unrelated individuals from Central Portugal and 63 from Azores Islands. The most common haplotype in Central Portugal was shared by 3.4% of the males, while 160 haplotypes were unique. In Azores Islands the most common haplotype was shared by 6.4% of the males, while 40 haplotypes were unique. The values of haplotype diversity were 0.993 for Central Portugal and 0.976 for Azores Islands.     

The use of bloodhounds in determining the impact of genetics and the environment on the expression of human odortype

Bloodhounds are used to trail fleeing felons and missing persons. In order to start a trail, the dog must be presented with a person's scent. There are many hypotheses on what a bloodhound smells while trailing. The present study attempts to identify whether human scent is genetic, and if it is influenced by one's environment. Bloodhounds trained in human scent discrimination were used to differentiate between monozygotic twins, related and nonrelated persons, living together and apart. The first test required the dogs to run blind trails after being presented with the scent of one person in the pair, while the opposite person was hidden. The second test allowed the dogs to trail one person in the pair after both people were hidden. Results appear to demonstrate that bloodhounds rely heavily on genetic cues when differentiating between people. Environmental cues do not appear to significantly aid the bloodhound in scent discrimination.     

Adolescent and young adult suicide: a 10-year retrospective review of Kentucky Medical Examiner cases

The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.     

Correlation of Delta9-tetrahydrocannabinol concentrations determined by LC-MS-MS in oral fluid and plasma from impaired drivers and evaluation of the on-site Dräger DrugTest

Oral fluid (collected with the Intercept((R)) device) and plasma samples were obtained from 139 individuals suspected of driving under the influence of drugs and analyzed for Delta(9)-tetrahydrocannabinol (THC), the major psychoactive constituent of cannabis, using a validated quantitative LC-MS-MS method. The first aim of the study was to investigate the correlation between the analytical data obtained in the plasma and oral fluid samples, to evaluate the use of oral fluid as a 'predictor' of actual cannabis influence. The results of the study indicated a good accuracy when comparing THC detection in oral fluid and plasma (84.9-95.7% depending on the cut-off used for plasma analysis). ROC curve analysis was subsequently used to determine the optimal cut-off value for THC in oral fluid with plasma as reference sample, in order to 'predict' a positive plasma result for THC. When using the LOQ of the method for plasma (0.5 ng/mL), the optimal cut-off was 1.2 ng/mL THC in oral fluid (sensitivity, 94.7%; specificity, 92.0%). When using the legal cut-off in Belgium for driving under the influence in plasma (2 ng/mL), an optimal cut-off value of 5.2 ng/mL THC in oral fluid (sensitivity, 91.6%; specificity, 88.6%) was observed. In the second part of the study, the performance of the on-site Dr?ger DrugTest for the screening of THC in oral fluid during roadside controls was assessed by comparison with the corresponding LC-MS-MS results in plasma and oral fluid. Since the accuracy was always less than 66%, we do not recommend this Dr?ger DrugTest system for the on-site screening of THC in oral fluid.     

Forensic aspects of maxillofacial radiology

Radiology has been used extensively in conventional dental identification, anatomically based identification and identification using maxillofacial skeletal landmarks such as the frontal sinus. Examples of these are well documented in the literature. The purpose of this paper was to revisit the methods where radiographic methods may be used to determine identity using the teeth, the root structures and the frontal sinuses. Additionally suggestions are offered for management of radiography in mass disasters and cases where age determination is required. Computer assisted tomography can be used in the assessment of the degree of fit of a weapon to a wound in cases of blunt force skull injury and plane films can assist in depicting the pattern of post mortem skull fractures. Micro-computed tomography has been used in matching weapons to wounds in sharp-force injury cases. The radiologist's role in cases of civil litigation and fraud is discussed and case examples are given. There are gaps in the science where radiological methods are used. The author offers several suggestions for possible research projects to close some of these gaps.     

The Parent Opinion Questionnaire and Child Vignettes for Use with Abusive Parents: Assessment of Psychometric Properties

Psychometric properties of the Parent Opinion Questionnaire (POQ) and the Child Vignettes (CV) were examined. Participants included 78 abusive and 77 comparison mothers and fathers. Scores on the POQ were very low, and there were no differences between abusive and comparison parents on any of the six rationally-derived scales of the POQ or the full scale. Results of factor analysis and assessment of internal consistency did not support the six scales. Full scale scores were associated with parental psychopathology, parenting stress, self-reported discipline practices, and IQ, but were unrelated to observed parenting behavior. On the CV, abusive parents indicated more negative attributions and harsher intended punishment for children's aversive behavior than did comparison parents. Negative attribution ratings and intended punishment ratings on the CV were related to parental psychopathology and parenting stress; scores on intended punishment were related to parents’ perceptions of their children's adjustment, self-reported disciplinary practices, and observed negative parenting behavior.     

Alprazolam-related deaths in Palm Beach County

Alprazolam is a commonly prescribed benzodiazepine. The abuse of benzodiazepines is most frequently seen in conjunction with the abuse of other drugs. Only rare fatalities have been attributed to alprazolam alone. We undertook a retrospective review of cases investigated by the Palm Beach County Medical Examiner's Office in which postmortem toxicologic studies indicated the presence of alprazolam, to further study the pattern of alprazolam abuse. Our review consisted of 178 cases, including 87 in which death was attributed to combined drug toxicity, 2 to alprazolam toxicity alone, 44 to trauma, 12 to natural causes, and 33 to another drug or drugs. Cocaine and methadone were the most common cointoxicants in the cases of combined drug toxicity, while heroin was less frequently detected. There was considerable overlap in the postmortem blood alprazolam concentrations among the groups. The overlapping ranges of concentrations of alprazolam detected indicate that it may be difficult to define a lethal alprazolam range, and that it may not be possible to determine the actual role of alprazolam as a causal factor in cases of combined drug toxicity. This study confirms that alprazolam alone is rarely a cause of death, and that alprazolam abuse usually occurs within a polydrug use pattern. The high incidence of cocaine as a cointoxicant has not been previously reported.     

Challenges and Outcomes at the Ninth Session of the Conference of the Parties to the United Nations Framework Convention on Climate Change

From 1 to 12 December 2003, the Ninth Session of the Conference of the Parties to the United Nations Framework Convention took place in Milan, Italy. This conference continued the laborious effort of developing an international climate regime by preparing for the Kyoto Protocol’s entry into force. Some two dozen decisions were adopted on a wide range of options for responding to climate change. This paper assesses the progress achieved at the conference on a number of issues. Among these were operational details for implementing forestry projects under the Convention’s Clean Development Mechanism, and guidelines for reporting on greenhouse gas emissions and removals from agriculture, forestry and land-use change. Parties also decided on rules with respect to two funds, the Special Climate Change Fund and the Least Developed Country Fund. With respect to developing countries, Parties continued discussions on rules for building response capacity in light of the expected adverse effects of climate change and transferring environmentally sound technology. They also discussed how to incorporate scientific advice from the Third Assessment Report of the Intergovernmental Panel on Climate Change into the negotiations. Although Russia did not ratify the Kyoto Protocol prior to the conference, Milan demonstrated momentum and interest among Parties to support the climate regime. Nevertheless, it is doubtful whether the detailed discussions were able to contribute to preparing for the long term. To this end, this paper concludes that more discussion and leadership is required to bridge the North/South gap if a post-2012 climate regime is to stand.