Altered states: state health privacy laws and the impact of the Federal Health Privacy Rule

Although the Federal Health Privacy Rule has evened out some of the inconsistencies between states' health privacy laws, gaps in protection still remain. Furthermore, the Federal Rule contains some lax standards for the disclosure of health information. State laws can play a vital role in filling these gaps and strengthening the protections afforded health information. By enacting legislation that has higher privacy-protective standards than the Federal Health Privacy Rule, states can play three important roles. First, because they can directly regulate entities that are beyond HHS's mandate, states can afford their citizens a broader degree of privacy protection than the Federal Health Privacy Rule. Second, by having state health privacy laws, states can enforce privacy protections at the local level. Finally, action by the states can positively influence health privacy policies at the federal level by raising the standard as to what constitutes sufficient privacy protection. High privacy protections imposed by states may serve as the standard for comprehensive federal legislation, if and when Congress reconsiders the issue. So far, states' reactions to the Federal Privacy Rule have been mixed. Only time will tell whether states will assume the mantle of leadership on health privacy or relinquish their role as the primary protectors of health information.     

The Downstream Benefits of Experimentation

The debate about the cost-effectiveness of randomized fieldexperimentation ignores one of the most important potentialuses of experimental data. This article defines and illustrates"downstream" experimental analysis—that is, analysis ofthe indirect effects of experimental interventions. We arguethat downstream analysis may be as valuable as conventionalanalysis, perhaps even more so in the case of laboratory experimentation.     

Fatal outcome of poisoning with the benzodiazepines flunitrazepam and diazepam

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.     

Mandibular ramus height as an indicator of human infant age

There were two goals to be achieved from the analysis of 53 skeletonized infants from the Southwest Collection at the National Museum of Natural History. The first objective was to determine whether this infant sample could be aged based on a mandibular measurement. The second was to determine which dimension of the mandible, if any, most accurately predicts infant age within a six-month range. Seven osteometric measurements were applied to each mandible. Statistical analysis determined that the individuals in the Smithsonian's Southwest Collection that were under two-years-old could be accurately aged to within six months. Out of these seven measurements the most accurate age-at-death estimates were generated based on the maximum height of the mandibular ramus. This finding can potentially aid investigators in determining the age-at-death of infants.     

An improved method for post-PCR purification for mtDNA sequence analysis

Mitochondrial DNA (mtDNA) analysis of forensic samples typically is performed when the quantity and quality of DNA are insufficient for nuclear DNA analysis or when maternal relatives may be the only reference source. Many of the steps required in the analytical process are both lengthy and labor intensive. Therefore, improvements in the process that reduce labor without compromising the quality of the data are desirable. The current procedure requires purification of the amplicons by centrifugal filtration after PCR and prior to cycle sequencing. Because this method requires several manipulations to perform, alternate cleanup procedures were investigated. These include the use of 1) Qiagen QlAquick PCR Purification columns, 2) Concert Rapid PCR Purification columns, and 3) ExoSAP-IT reagent. When the yield of purified amplicons, quality of the sequence profile, and ease of assay were evaluated, the use of ExoSAP-IT reagent for post-amplification purification was chosen to replace the filtration method.     

PMS,psychosis and culpability: sound or misguided defense?

Premenstrual Syndrome (PMS) is believed to affect up to 90% of women of reproductive age. A small subset of women have been identified who actually experience psychotic symptoms in the premenstrual phase of their cycles. Not surprisingly, PMS has made it into the courts where it has been offered as a defense for criminal acts. The defense has generally fared poorly in the United States, although it has been successfully used as a factor in supporting diminished capacity in Great Britain. The following paper sets out to review the medical literature on premenstrual syndrome with a particular focus on premenstrual psychosis. Available literature from both medical and legal sources is then utilized to investigate instances in which premenstrual psychosis has been invoked as a defense in the courts.     

Role of alcohol in heroin overdose

The relationship between ethanol and risk of heroin overdosage was studied. Statistical processing of the results of forensic chemical analysis (460 expert evaluations) carried out in Chelyabinsk Regional Bureau of Forensic Medical Expert Evaluations in 2000 was carried out. The results of morphine and ethanol measurements in the blood and urine from corpses where deaths ensued from narcotic or ethanol poisoning, were analyzed. The concentrations of morphine in the blood and urine were measured on a gaseous chromatographer with mass-selective detector (Hewlett Packard HP 6890/HP-5972). Methods for measuring urinary and blood morphine are described. The results of statistical analysis demonstrated relationships between the age and ethanol concentrations in the blood and urine; blood ethanol and total urinary and blood morphine concentrations; blood concentration of free morphine and presence of 6-monoacetylmorphine in the blood. The authors conclude that the presence of ethanol in the blood together with morphine drastically augments the risk of rapid death from respiration arrest. It can also lead to a relatively high risk of overdosage in experienced narcomaniacs using heroin and ethanol.     

Analysis of ionic ratios in myocardial tissue and their relation to cardiac damage

The authors evaluated the usefulness of the postmortem biochemical analysis of ionic ratios in different parts of the heart and their relation to cardiac damage caused by chest trauma, as observed by anatomopathologic study. Fifty-nine 59 cases were studied, selected from routine necropsies, and samples were taken from different sites of cardiac tissue. The cause of death was trauma in 40 cases and nontraumatic causes in 19 cases. The object of this study was to analyze the levels of Na+, K+, Ca+2, Mg+2, and Zn+2 in different zones of the heart, and the relationship between intracellular and extracellular ion ratios and the different causes of death and any anatomopathologic alterations observed. The biochemical tests revealed a possible relation between the ionic values and cause of death. Alterations in cell membrane permeability and corresponding modification of the ionic ratios were produced earlier than histologic alterations, which need longer to establish themselves whether or not they follow a traumatic process.     

A new improved method for extraction of DNA from teeth for the analysis of hypervariable loci

A new method for better recovery of DNA suitable for amplification of hypervariable loci from fragments of teeth, consisting of two steps-scraping and aspiration, and extensive decalcification-is reported. Higher yields of high molecular weight DNA were obtained from the root, pulp, and crown of all kinds of 120 teeth, irrespective of gender, age, and source of teeth. HLA DQA1, 5 poly markers (LDLR, GYPA, HBGG, D7S8, and Gc), and other 12 short tandem repeat loci (HPRTB, F13B, LPL, D13S317, D7S820, D5S818, D21S11, D18S51, FGA, D8S1179, D3S1358, and vWA) could be successfully amplified and typed from recovered DNA.     

Understanding Children's Use of Secrecy in the Context of Eyewitness Reports

To investigate socioemotional influences on children's eyewitness accuracy, we examined children's reports for activities they were motivated to conceal. Forty-eight 3–6-year-old children participated in a standardized play session with their mothers. Half of the children were told by an experimenter not to play with certain toys, but did so at the urging of their mothers, who told their children to keep the play activities secret. The remaining children were not restricted from playing with the toys, nor told by their mothers to keep the play activities secret. Later, all children were interviewed about the activities with free narrative and detailed questions. Half were given an interview that consisted of highly suggestive questions; half were given an interview consisting of specific, less suggestive questions. Results indicated that older children who were instructed to keep events secret withheld more information than did older children not told to keep events secret. Younger children's reports were not significantly affected by the secret manipulation. There were no significant effects associated with interview type. We discuss implications for understanding the development of children's knowledge and use of secrecy, and applications of the research to issues that arise when child witnesses give reports in legal contexts.