Detection of ethyl glucuronide in blood spotted on different surfaces

This study aims to show that sensitive detection of ethyl glucuronide in dried blood spotted onto various surfaces after a period of 24h is feasible. At present, there is insufficient information how tightly ethyl glucuronide (EtG) binds to various materials and how easily it can be eluted. 4ml aliquots of blood samples obtained from seven volunteers after consumption of alcoholic beverages were applied to six different surfaces. After drying and a 24h-storage at 20±2°C the samples were re-dissolved in water, and EtG was subsequently analyzed by a LC-MS Paul-type ion trap. A comparison was made between dried and corresponding fluid samples. EtG was detectable in all subjects' samples following consumption of alcohol. EtG was also detectable after a storage time of four weeks at 4°C in whole blood that had been preserved with EDTA. EtG was detectable in all samples dried on different surfaces and its concentration remained relatively constant irrespective of the particular condition of the material. Detection of EtG in blood spots from the scene may indicate recent alcohol consumption in cases where collection of blood remained undone or could not be performed.     

Carbon monoxide concentrations in the 2009 Victorian Bushfire disaster victims

Blood was available for the estimation of carboxyhemoglobin saturation (COHb) in 30 of the 173 persons who died in the Victorian bushfires in February 2009. The ages of these 30 deaths ranged from 3 to 80 years and there were 8 females. 13 cases (43%) were considered negative (less than 5% COHb), 12 (40%) were between 5 and 40% COHb, 2 (6.7%) between 40 and 50% and 3 (10%) were greater than 50% COHb. There were 6 persons either found within a building or a car and the COHb in these cases ranged up to 69% (mean 50%). There were 5 cases where the location was unable to be determined as either indoor or outdoor due to the extensive nature of the fire. The remaining 19 deceased persons were all located outside in the open and the concentration of COHb in these cases ranged up to 30% (mean 19%). Hydrogen cyanide was only detected in two deceased persons at concentrations of 0.5 and 2.7 mg/L, respectively. 13 deceased were found to have soot in the airways following necropsy but this did not correlate with the COHb levels.     

Breaking up is hard to do: the economic impact of provisional funding contingent upon evidence development

Funding contingent upon evidence development (FED) has recently been the subject of some considerable debate in the literature but relatively little has been made of its economic impact. We argue that FED has the potential to shorten the lag between innovation and access but may also (i) crowd-out more valuable interventions in situations in which there is a fixed dedicated budget; or (ii) lead to a de facto increase in the funding threshold and increased expenditure growth in situations in which the programme budget is open-ended. Although FED would typically entail periodic review of provisional or interim listings, it may prove difficult to withdraw funding even at cost/QALY ratios well in excess of current listing thresholds. Further consideration of the design and implementation of FED processes is therefore required to ensure that its introduction yields net benefits over existing processes.     

Associations Between Caregiver Support, Bullying, and Depressive Symptomatology Among Sexual Minority and Heterosexual Girls: Results from the 2008 Boston Youth Survey

Although sexual minority (SM) youth are at an increased risk for being bullied and experiencing depression, it is unclear how caregiver support is interrelated with those variables. Therefore, we sought to assess: (a) the prevalence of nonphysical bullying, depressive symptomatology, and caregiver support among heterosexual and SM girls, (b) the association between caregiver support and bullying in both groups, and (c) whether sexual orientation moderates the interactive effect of caregiver support and bullying on depressive symptoms. Data come from a survey of students in 22 Boston public high schools; 99 of the 832 girls in the analytic sample were SM. We used chi-square statistics to examine group differences, and multiple regression to estimate the association between the caregiver support, sexual orientation, being bullied, and depressive symptomatology. SM girls reported similar levels of caregiver support as heterosexual girls, but reported higher levels of depressive symptomatology. They were also more likely to report nonphysical bullying. Tests for interactions were not statistically significant, suggesting that bullying, caregiver support, and sexual orientation are independently associated with depressive symptomatology.     

谈新疆少数民族吸食大麻人员焦虑心理的自我矫正

新疆消费大麻具有悠久的历史。由于大麻对各类疾病的治疗有明显的疗效,且吸食麻烟易戒断,因此,尽管不少人认识到吸食大麻成瘾会罹患精神疾病,但大麻还是在新疆少数民族百姓生活中使用较频繁。近几年来发现吸食大麻的少数民族人群中出现焦虑症状较突出,他们会经常无缘无故的、没有明确对象和内容的焦急、紧张、恐惧和不安,经常感觉到威胁即将来临,但又说不出究竟存在何种威胁或危险。中外研究成果表明吸食大麻易导致精神异常。对此类人群自身应采取增强自信、自我刺激、自我放松、自我脱敏、自我催眠、自我放松等自救措施,以通过自我矫正改变因吸食大麻而形成的焦虑心理。     

Rib fractures in infants due to cardiopulmonary resuscitation efforts

Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.     

Legal medicine and the medical establishment

Formal medical discipline-based regulation and professional support for legal medicine practitioners have been a long time coming. While informal associations and societies of like-minded doctors and dentists have existed for some time, they have not had the sort of "establishment credibility" that is required to influence policy-makers and drive formal processes for professional training and regulation in this area. The recent creation of formal medical College status for medico-legal specialists within the medical establishment is described and the advantages discussed. The creation of formal career pathways, organised training structures and policy advisory systems in legal medicine for government has the potential to support recruitment to this difficult and challenging area of medical practice. This can only be of benefit to the legal profession who rely on these medical practitioners in so many areas. The standards setting, recertification, revalidation and accreditation activities of a formal Royal Medical College are likely to have significant influence on the work of health and legal policy regulators at a time of considerable change.