Utilizing the urinary 5-HTOL/5-HIAA ratio to determine ethanol origin in civil aviation accident victims

Specimens from fatal aviation accident victims are submitted to the FAA Civil Aerospace Medical Institute for toxicological analysis. During toxicological evaluations, ethanol analysis is performed on all cases. Care must be taken when interpreting a positive ethanol result due to the potential for postmortem ethanol formation. Several indicators of postmortem ethanol formation exist; however, none are completely reliable. The consumption of ethanol has been shown to alter the concentration of two major serotonin metabolites, 5-hydroxytryptophol (5-HTOL) and 5-hydroxyindole-3-acetic acid (5-HIAA). While the 5-HTOL/5-HIAA ratio is normally very low, previous studies using living subjects have demonstrated that the urinary 5-HTOL/5-HIAA ratio is significantly elevated for 11-19 h after acute ethanol ingestion. Recently, our laboratory developed and validated an analytical method for the simultaneous determination of both 5-HTOL and 5-HIAA in forensic urine samples using a simple liquid/liquid extraction and LC/MS/MS and LC/MS/MS/MS. In this previous work a 15 pmol/nmol serotonin metabolite ratio cutoff was established in postmortem urine, below which it could be conclusively determined that no recent antemortem ethanol consumption had occurred. In the current study this newly validated analytical method was applied to five ethanol-positive aviation fatalities where the origin of the ethanol present could not previously be conclusively determined. In four of the five cases examined the detected ethanol was demonstrated to be present due to postmortem microbial formation, and not consumption, even though some indication of ethanol consumption may have been present.     

When silence threatens safety: lessons from the first Canberra Hospital neurosurgical inquiry

Despite widespread institutional and professional support, the recommendations of the Bristol Royal Infirmary Inquiry may be insufficient to reduce patient risk from impaired senior medical practitioners. Using the First Inquiry into Neurosurgical Services at the Canberra Hospital as a case study, this article argues that the Bristol-type recommendations--which emphasise reformulation of clinical governance structures, including early reporting of "sentinel events" and compulsory clinical audits--will be ineffective without a reformed institutional ethos that encourages open transparency and respect for those committed to such processes. Such reformulation may need to commence in medical education and involve new strategies including the use of portable digital technology to facilitate self-assessment of performance and immediate reporting of adverse incidents.     

To leave or to stay?: Battered women's concern for vulnerable pets

Consistent with previous research, almost half of a sample of 41 pet-owning battered women reported that their partners had threatened or actually harmed their pets, and over a fourth reported that concern for their pets had affected their decisions about leaving or staying with the batterer. Differences between rural and urban women were not significant, although higher proportions of rural than urban women reported that their partners had threatened or harmed their pets and that concern for their pets had affected their decisions. For the sample as a whole, logistic regression analyses showed that women whose pets had been threatened or harmed were significantly more likely to report that concern for their pets had affected their decisions about leaving or staying. The findings suggest that service providers should inquire about battered women's concern for their pets and should include arrangements for animals in safety planning.     

Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Career-marriage orientations in college youth: An analysis of perceived personal consequences and normative pressures

The present research was designed to examine factors associated with career and marriage orientations in male and female college students. The first phase of the research identified qualitatively different factors associated with variations in life structure. Respondents completed an open-ended questionnaire which elicited the perceived consequences and normative pressures concerning three life structure alternatives: (a) emphasizing career, (b) emphasizing marriage, and (c) placing equal emphasis on career and mariage. A set of 24 concerns was identified, and sex differences on several of these dimensions were noted. In general, the data were consistent with previous analyses of value structures in adults. The second phase of the research used a quantitative approach to examine the three life structure alternatives. Males and females did not differ in the relative emphasis they intended to give to career and marriage. However, sex differences in the perceived consequences of the life structure alternatives were noted.This research was conducted while the first author was a National Research Service Award (NIMH) trainee, Grant No. 1 T32 MH14593. A modified version of this paper was presented at the 87th Annual Convention of the American Psychological Association, New York, september 1979.Current research interest is psychosocial development during the adult years.Received Ph.D. from the University of Illinois, 1976. Current research interest is attitude theory and measurement.