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Sharma AN Nelson LS Hoffman RS 《The American journal of forensic medicine and pathology》2004,25(2):156-158
The neurologic manifestations of thallium poisoning include a severely painful ascending peripheral neuropathy, autonomic dysfunction, cranial nerve abnormalities, and a toxic encephalopathy. Although thallium has a short half-life, these neurologic manifestations commonly progress, even as the blood concentration of thallium decreases. This suggests either that thallium persists in neuronal tissues or that it initiates an injury cascade that takes time to fully manifest. As the latter mechanism is consistent with many toxin exposures, the concept of a central nervous system reservoir for thallium is often discounted. A recent case provided a unique opportunity to evaluate this possibility. A 48-year-old man was acutely and chronically thallium poisoned by his common-law wife. During his initial exposures, only gastrointestinal symptoms manifested. Following an acute ingestion, hospitalization was required. Over 3 days, his symptoms rapidly progressed from a severely painful neuropathy to slurred speech, ptosis, confusion, coma, respiratory insufficiency, and death. Because of considerations of alternative diagnoses, 2 lumbar punctures were performed, one on admission and another on the day of his death. Serum thallium concentrations obtained from stored blood samples were paired with spinal fluid concentrations from the same days. On day 1, serum and spinal fluid concentrations were 8700 mu/L and 1200 mu/L, respectively. On day 3, although the serum concentration had fallen to 7200 mu/L, the spinal fluid concentration had increased to 2100 mu/L. This case provides evidence to support the hypothesis that thallium distributes into the central nervous system more slowly than the blood compartment, and this may in part account for the progression of neurologic findings in the setting of decreasing serum concentrations. 相似文献
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Investigating why people use the hospital emergency department (ED) for visits considered medically nonurgent can enhance our understanding of people's expectations of health care services, of their conceptions of prudent lay judgment, and of difficulties in negotiating the logistics of primary care services. This study identified reasons for such ED use from users' perspectives in both pediatric and adult visits. Respondents were asked to explain what brought them to the ED and to define an emergency. The study was conducted in two northeastern U.S. hospital EDs. The analysis drew on a convenience sample of 408 (331 pediatric, 77 adult users) face-to-face interviews that employed both open- and closed-ended questions. Findings indicate most patients had medical insurance and a regular place of care and most arrived by car or taxi. Twelve main themes emerged under three main categories: conceptions of needs, appropriateness, and preference for the ED. The findings indicate that various reasons for ED use may be construed as access issues. These include beliefs regarding limited availability of after-hour consultation services and of timely appointments at one's primary care site. Drawing on the findings, a typology that distinguishes between groups of users according to their preference for the ED, a level of congruence between their own reason and their definition of an emergency was developed. The typology suggests that people's concerns that influence their decision to come to the ED cannot be solved simply by expanding primary care services or by educational interventions. Its application yields recommendations for services and interventions. 相似文献
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In August 2002, the Court of Appeals of the state of Victoria, Australia, reduced the non-parole portion of a man's prison sentence from two years to 18 months because imprisonment would be a greater burden on someone with HIV than on a healthy person. 相似文献
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Baker AM Johnson DG Levisky JA Hearn WL Moore KA Levine B Nelson SJ 《Journal of forensic sciences》2003,48(2):425-428
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. 相似文献
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Larry J. Nelson Laura M. Padilla-Walker Sarah Badger Carolyn McNamara Barry Jason S. Carroll Stephanie D. Madsen 《Journal of youth and adolescence》2008,37(5):605-615
Many studies have documented the ways in which shyness can be a barrier to personal well-being and social adjustment throughout
childhood and adolescence; however, less is known regarding shyness in emerging adulthood. Shyness as experienced during emerging
adulthood may continue to be a risk factor for successful development. The purpose of this study was to compare shy emerging
adults with their non-shy peers in (a) internalizing behaviors, (b) externalizing behaviors, and (c) close relationships.
Participants included 813 undergraduate students (500 women, 313 men) from a number of locations across the United States.
Results showed that relatively shy emerging adults, both men and women, had more internalizing problems (e.g., anxious, depressed,
low self-perceptions in multiple domains), engaged in fewer externalizing behaviors (e.g., less frequent drinking), and experienced
poorer relationship quality with parents, best friends, and romantic partners than did their non-shy peers.
Larry J. Nelson is an Associate Professor in the School of Family Life at Brigham Young University. He received his Ph.D. in 2000 from the University of Maryland, College Park. His major research interests are in social and self development during early childhood and emerging adulthood. Laura M. Padilla-Walker is an Assistant Professor in the School of Family Life at Brigham Young University. She received her Ph.D. in 2005 from the University of Nebraska—Lincoln. Her major research interests center on the parent-adolescent relationship as it relates to adolescents’ moral and prosocial behaviors and internalization of values. Sarah Badger received her Ph.D. in 2005 from Brigham Young University. Her major research interests are marriage formation and development as well as emerging adulthood and marriage readiness. Carolyn McNamara Barry is an Assistant Professor of Psychology at Loyola College in Maryland. She received her Ph.D. in 2001 from the University of Maryland, College Park. Her major research interests are in social and self development during adolescence and emerging adulthood. Jason S. Carroll is an Associate Professor in the School of Family Life at Brigham Young University. He received his Ph.D. in 2001 from the University of Minnesota. His major research interests are in marriage formation and development as well as emerging adulthood and marriage readiness. Stephanie D. Madsen is an Associate Professor of Psychology at McDaniel College. She received her Ph.D. in 2001 from the Institute of Child Development, University of Minnesota. She is particularly interested in how relationships with significant others impact child and adolescent development. 相似文献
Larry J. NelsonEmail: |
Larry J. Nelson is an Associate Professor in the School of Family Life at Brigham Young University. He received his Ph.D. in 2000 from the University of Maryland, College Park. His major research interests are in social and self development during early childhood and emerging adulthood. Laura M. Padilla-Walker is an Assistant Professor in the School of Family Life at Brigham Young University. She received her Ph.D. in 2005 from the University of Nebraska—Lincoln. Her major research interests center on the parent-adolescent relationship as it relates to adolescents’ moral and prosocial behaviors and internalization of values. Sarah Badger received her Ph.D. in 2005 from Brigham Young University. Her major research interests are marriage formation and development as well as emerging adulthood and marriage readiness. Carolyn McNamara Barry is an Assistant Professor of Psychology at Loyola College in Maryland. She received her Ph.D. in 2001 from the University of Maryland, College Park. Her major research interests are in social and self development during adolescence and emerging adulthood. Jason S. Carroll is an Associate Professor in the School of Family Life at Brigham Young University. He received his Ph.D. in 2001 from the University of Minnesota. His major research interests are in marriage formation and development as well as emerging adulthood and marriage readiness. Stephanie D. Madsen is an Associate Professor of Psychology at McDaniel College. She received her Ph.D. in 2001 from the Institute of Child Development, University of Minnesota. She is particularly interested in how relationships with significant others impact child and adolescent development. 相似文献
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