Suicide in children and adolescents: a 10-year retrospective review

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.     

Mitochondrial DNA error prophylaxis: assessing the causes of errors in the GEP'02-03 proficiency testing trial

A qualitative and quantitative analytical method was developed and validated for the determination of 49 licit and illicit drugs in oral fluid. Small oral fluid samples, volume 1mL, were collected from volunteers using a modified Omni-Sal device and the analytes were extracted from an oral fluid/buffer mixture using a single Bond Elut Certify solid phase extraction cartridge. Liquid chromatography-tandem mass spectrometry (LC-MS-MS) and gas chromatography-repetitive full scan mass spectrometry (GC-MS) were used in parallel to analyze the extracts for the targeted drugs. Extracts were analyzed by GC-MS in their underivatized form and as their pentafluoropropionyl derivatives. Deuterated internal standards were used for quantification of drugs of abuse by LC-MS-MS to minimize matrix effects. Methadone-d(9) and tumoxetine were used as the internal standards for quantification of non-derivatized and derivatized analytes respectively by GC-MS. Linearity was demonstrated over the range 5-200 ng/mL and limits of detection were less than 4 ng/mL for each drug analyzed. The method demonstrated acceptable recoveries for most of the analytes and good intra- and inter-day precision. Acquisition of data by repetitive full scan GC-MS allows the addition of further analytes to the target menu.     

Extra Effort During Memory Retrieval May Be Associated with Increases in Eyewitness Confidence

When testifying in court, witnesses are motivated to try as hard as possible to give an accurate account. This study tested the proposition that extra effort by eyewitnesses during a memory test can lead to higher confidence ratings without any accompanying changes in accuracy. Participant-witnesses answered multiple-choice questions about a classroom visitor who had spoken 5 days earlier. In the high-motivation condition participants could earn prizes based on their memory test performance; in the low-motivation condition there were no special incentives. Although the motivation manipulation did not affect mean witness confidence, the confidence–accuracy and effort–accuracy correlations were substantially smaller in the high-motivation condition than in the low-motivation condition. Furthermore, the confidence ratings for those participants who reported expending high levels of effort in both motivation conditions were significantly higher than the confidence ratings for the low-effort participants, despite the fact that response accuracy did not differ as a function of reported effort. These findings have important implications for understanding how pressures to perform well in the courtroom can affect eyewitness confidence.     

Employers: passive purchasers or provocateurs?

This article addresses the potential role of business leadership in diverse efforts to reform health care financing: exploring managers efforts to alter health care markets in their role as large purchasers of health insurance, their potential contributions to future national policy proposals, and their involvement with community-level activities to control local health costs and quality. I argue that managers' leadership in market restructuring and community health initiatives will be difficult to reproduce in the realm of major national health policy initiatives due to constraints related to ideas, interests, and organization.     

Government Hedging: Motivation, Implementation, and Evaluation

This article examines option hedging strategies that enable politicians to manage budgetary risk. While the theoretical risk management arguments are general, the simulation analysis considers the example of oil revenue risk in Texas, and estimates the costs and benefits of an option hedging program. To evaluate government option hedging strategies, the study develops a hedge quotient measure that compares the future value of realized revenues plus net option proceeds to the future value of expected revenue. The average hedge quotient is found to be lower for the option hedging strategy than for the unhedged position, illustrating the cost of an option hedging program. Nevertheless, option hedging effectively manages extreme downside risk and stops large budget deficits from occurring. Politicians may also like option hedging because it preserves the potential of realizing budget surpluses.     

Scenes from a mall: Retail training and the social exclusion of low-skilled workers

In this article we examine how post-industrial Britain and Denmark undertake vocational training for low-skilled retail workers. Specifically, we evaluate whether leaders in training skilled industrial workers are also doing the best job with low-skilled service workers. While Danish retail is increasingly becoming a haven for low-skilled workers, British workers are gaining in skills levels with the transition to services even in the retail sector. While some suggest that social democratic countries have sacrificed the political interests of low-skilled workers in order to protect core manufacturing workers, we find no evidence of this. Rather, the high expectations of vocational training in Denmark have forged barriers to the easy admission of low-skilled service workers, while the British system provides more entry points for vocational training at different levels. The structures of coordination that had narrowed the gap between white-collar and blue-collar manufacturing workers during the industrial age are creating new cleavages in the post-industrial economy.