Breath alcohol concentration determined with a new analyzer using free exhalation predicts almost precisely the arterial blood alcohol concentration

A new breath alcohol (ethanol) analyzer has been developed, which allows free exhalation, standardizes measured exhaled alcohol concentration to fully saturated water vapor at a body temperature of 37 degrees C (43.95 mg/L) and includes a built-in self-calibration system. We evaluated the performance of this instrument by comparing standardized alcohol concentration in freely expired breath (BrAC) with arterial (ABAC) and venous (VBAC) blood alcohol concentrations in fifteen healthy volunteers who drank 0.6 g of alcohol per kg body weight. The precision (coefficient of variation, CV) of the analyzer based on in vivo duplicate measurements in all phases of the alcohol metabolism was 1.7%. The ABAC/BrAC ratio was 2251+/-46 (mean+/-S.D.) in the post-absorptive phase and the mean bias between ABAC and BrAC x 2251 was 0.0035 g/L with 95% limits of agreement of 0.033 and -0.026. The ABAC and BrAC x 2251 were highly correlated (r=0.998, p<0.001) and the regression relationship was ABAC = 0.00045 + 1.0069 x (BrAC x 2251) indicating excellent agreement and no fixed or proportional bias. In the absorption phase, ABAC exceeded BrAC x 2251 by at most 0.04+/-0.03 g/L when tests were made at 10 min post-dosing (p<0.05). The VBAC/BrAC ratio never stabilized and varied continuously between 1834 and 3259. There was a proportional bias between VBAC and BrAC x 2251 (ABAC) in the post-absorptive phase (p<0.001). The pharmacokinetic analysis of the elimination rates of alcohol and times to zero BAC confirmed that BrAC x 2251 and ABAC agreed very well with each other, but not with VBAC (p<0.001). We conclude that this new breath analyzer using free exhalation has a high precision for in vivo testing. The BrAC reflects very accurately ABAC in the post-absorption phase and substantially well in the absorption phase and thereby reflects the concentration of alcohol reaching the brain. Our findings highlight the magnitude of arterio-venous differences in alcohol concentration and support the use of breath alcohol analyzers as a stand-alone test for medical and legal purposes.     

Donor conception legislation in Victoria, Australia: the "Time to Tell" campaign, donor-linking and implications for clinical practice

The State of Victoria in Australia was one of the first jurisdictions in the world to introduce legislation regulating donor conception. Under the Infertility (Medical Procedures) Act 1984 (Vic), donor-conceived people, aged 18 years and over, parents of children under 18 years, and donors gained the right to apply for the release of identifying information about each other recorded in a Central Register. As a result, of this and subsequent legislation, services providing donor treatment were obliged to change clinical practice relating to recruitment of donors, counselling of donors and recipients and recordkeeping. Since this legislation was introduced in 1988, over 5,000 donor-conceived children have been born and in 2006 the first 100 of these children reached the age of 18. The Victorian Infertility Treatment Authority (ITA) conducted a public education campaign to provide information and support to people affected by the legislation. This article describes clinical practice changes prompted by legislation, the 'Time to Tell" campaign and the service model developed for linking parties on the donor registers. The Victorian experience demonstrates that laws allowing the parties involved in donor conception access to information about each other must be accompanied by changes to clinical practice, public education about the implications of the laws, and services to meet the needs of those seeking information relating to donor conception and those contacted as a result.     

Geoengineering: neither economical,nor ethical—a risk–reward nexus analysis of carbon dioxide removal

This article addresses a central debate in combatting climate change: whether we should focus on reducing CO₂ emissions or on removing the emitted CO₂ from the atmosphere. We favor the former by arguing against the economic viability of the carbon dioxide removal (CDR) branch of geoengineering. This is of course not a question of either or, but we argue that the perception of CDR as a viable option reduces the willingness to reduce CO₂ emissions. Using the recently developed approach of risk–reward nexus (RRN) in the economics of innovation, we question the economic viability of CDR. The main argument is simple: if one uses the new framework of RRN in evaluating the innovations involved in the CDR branch of geoengineering, not only does one include more areas of risk but also one has to consider a broader base for distributing the rewards. Consequently, from RRN’s point of view, it would be less likely to find investing in CDR economically viable for the investor firms. Although the core argument of the paper concerns the economics of CDR, in a final section the paper tries to show that the economic argument has also ethical implications against relying on CDR.     

A follow-up study of sex offenders treated by Thames Valley Sex Offender Groupwork Programme, 1995–1999

The following paper is a reconviction study of 183 sex offenders treated by the Thames Valley Project between 1995 and 1999. Some demographic details are provided about the sample. Subjects were monitored for a mean of 3.9 years. A total of 10 subjects (5.4% of total) were reconvicted for a further sexual offence. A further 19 men (10.3%) either had allegations made against them or committed a behaviour that may have involved or been the preparation for further sexual offending, defined here as “recidivism”. Details about post-treatment behaviour were drawn from three sources: two national police databases which indicated any formal sexual reconviction and the files kept on each sex offender registered with Thames Valley Project (TVSOGP), a multi-funded community-based sex offender treatment programme. The pre-treatment re-conviction risk status of each man was calculated using part one of the Risk Matrix 2000 algorithm (static factors). Risk levels were compared for those where reconviction, re-offending or recidivism was identified and those where it was not and a correlation was found in the predicted direction although this was not statistically significant. The advantages and limitations of this kind of follow-up study are discussed, together with some recommendations for future research.     

Legal Professionalism and International Criminal Proceedings

In criminal practice before international tribunals, the boundariesbetween lack of professionalism (serious misconduct) by prosecutionand taking an erroneous position on the law (procedural error)are particularly blurred, if only because the backgrounds andexpectations of all persons involved in the proceedings areprofoundly different and the playing field is still insufficientlydefined. This is illustrated by the Furundija case brought beforean International Criminal Tribunal for the former Yugoslavia(ICTY) Trial Chamber in 1998. In that case the Chamber heldthat the prosecution, by failing to disclose a document to thedefence, had both engaged in serious misconduct and made a seriousprocedural error. Instead, the Lord Advocate and the Crown Agentof Scotland, later consulted by the ICTY Prosecutor, concludedthat there had only been an error of judgment. National caselaw, for instance that of Canadian courts, makes it clear thata good faith decision not to disclose a document, made in theexercise of professional judgment on a difficult and novel issue,may constitute an error of judgment, but certainly does notamount to misconduct.     

Feelings of Safety In The Presence Of the Police,Security Guards,and Police Volunteers

Uniformed presence is commonly thought to create feelings of safety in people. However, do differently uniformed people contribute to an equal amount of safety and are there situation-dependent differences? The present study examined the association between various types of uniformed presence and people’s feelings of safety through a questionnaire among 352 respondents (18–86 years) (49.1 % women). The questionnaire contained pictures of situations perceived as relatively safe and unsafe with or without uniformed presence. The respondents estimated how safe they thought they would feel in these situations with no uniformed presence, two police officers, six police officers, a police vehicle, two security guards, or two police volunteers. Results showed that uniformed presence did not increase feelings of safety in a situation perceived as relatively safe, making patrol unnecessary. In situations perceived as relatively unsafe however, all types of uniformed presence increased feelings of safety. Foot patrolling police contributed to the greatest increase in feelings of safety. Security guards and police volunteers created similar amounts of feelings of safety making police volunteers a cost-effective alternative. All types of foot patrol were better than vehicle patrol, making non-police groups an alternative to vehicle patrol. Some situational, gender, and age differences were found.