Cerebrospinal fluid analysis in fatal thallium poisoning: evidence for delayed distribution into the central nervous system

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.     

Prothrombin G20210A mutation and sudden death

The authors present a case of sudden death in a previously healthy 36-year-old male. At autopsy there were bilateral pulmonary thromboemboli and right ventricular dilatation. Histologic findings in the lungs included recanalized, old thrombi and evidence of pulmonary hypertension. Genetic analysis for hereditary risk factors was heterozygous positive for the prothrombin G20210A mutation. Implications of this finding, its history and the diagnostic technique shall be discussed. The authors recommend that all cases of deep venous thromboses and pulmonary thromboemboli lacking known risk factors be evaluated for newly described genetic variations associated with an increased risk for venous thrombosis.     

FINEX: a Probabilistic Expert System for forensic identification

A series of recent papers have shown how to formulate complex problems of forensic DNA identification inference, such as occur in disputed paternity or criminal identification cases, in terms of Probabilistic Expert Systems (PESs). However, at the present time, general purpose PES software is not particularly well suited to the repetitive tasks of: specifying an appropriate set of marker networks for a specific problem; for editing the many local conditional probability tables; and combining evidence from several genetic markers to evaluate likelihoods. Here, I describe a user-friendly prototype software tool called FINEX developed both to automate such tasks and also to evaluate likelihoods of interest. Ease of use is achieved by a graphical specification language that enables a user to quickly specify a range of forensic DNA problems. I describe the algorithms by which FINEX converts the user input in the graphical specification language and data on observed markers to the Bayesian networks used in PES.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

New regionalism(s) in the global political economy. Conceptual understanding in historical perspective

  This paper places the contemporary study of regionalism in historical context. It argues that the study of regionalism has occurred in two waves. The first gathered pace as a sub-field of International Relations from the late 1950s and the second emerged in the context of the globalisation of the late 1980s and the 1990s. RID="*" ID="*" This paper, originally presented as a lecture to the Asia Europe Foundation University, 7^th Summer School, Barcelona: November 11, 2002, represents an abbreviated and revised version of Shaun Breslin and Richard Higgott (2000) Studying Regions: Learning from the Old Constructing the New, New Political Economy 5 (3): 333–352. Permission of the Editors of New Political Economy to publish in this form is gratefully acknowledged. The support of the Economic and Social Research Council in the writing of this paper is also gratefully acknowledged.     

Predicting mouth width from inter-canine width--a 75% rule

It has been suggested that inter-canine width plus 57% of the cumulative distance between the lateral aspect of the canines and the pupil centers can be used to estimate mouth width. Evidence also suggests that the distance between the medial irises approximates actual mouth width fairly well. However, these soft tissue prediction guidelines are limited because they rely on accurate medio-lateral positioning of the pupils within the orbits, for which no systematic empirical evidence appears to exist at this stage. It would, therefore, be more appropriate to use only known hard tissue landmarks in mouth width prediction. This study reports the results of using inter-canine width as a percentage of mouth width for its prediction. This method seems favorable in comparison to the other guidelines because it is as accurate, uses known hard tissue landmarks, and does not rely on assumptions concerning pupil location. Estimating mouth width by using the canines alone, therefore, seems the best guideline to use in facial approximation techniques, at least given knowledge existing at this stage.     

The forensic analysis of thermal transfer printing

Thermal transfer printing refers to printing processes that utilize heat to produce an image by either physical or chemical means or by a combination of both. As the technology has improved and the supplies have become less expensive, the use of thermal printing in the personal and business markets has increased significantly. Specifically, dye diffusion thermal transfer and thermal mass transfer have become predominant in the production of counterfeit credit cards, drivers' licenses, and other types of documents produced on plastic media. Chemical analysis by means of thin layer chromatography (TLC) has proven to be useful in characterizing various types of inks (e.g., writing and inkjet inks). In this study, the authors examined 81 different samples that included a total of 54 printer samples (43 photographic prints on paper and eleven plastic card samples) and 27 printer ribbons. A new TLC method was developed and tested utilizing a solvent system (80% n-hexane, 3% methyl ethyl ketone, and 17% ethyl acetate) that is capable of producing excellent resolution.     

Polydrug fatality involving metaxalone

A 29-year old female with a history of depression was found dead in a hotel room. The death scene investigation found empty pill bottles and an empty liter bottle of wine. Metaxalone, a centrally acting muscle relaxant, along with citalopram, ethanol, and chlorpheniramine were identified in the postmortem samples and quantitated by gas chromatography-mass spectrometry. The concentration of metaxalone in femoral vein blood was 39 mg/L. The heart blood concentration was 54 mg/L. Femoral vein blood concentrations of citalopram and chlorpheniramine were 0.77 mg/L and 0.04 mg/L, respectively. Ethanol levels were 0.13 g/dL in vitreous and 0.08 g/dL in heart blood. Other tissue samples were also analyzed. The authors consider the metaxalone concentrations toxic and potentially fatal. The citalopram concentrations were lower than those reported in fatal cases for this drug alone. Death was ascribed to polydrug abuse/overdose with metaxalone a major contributor. This represents the first reported case to our knowledge in which a metaxalone overdose significantly contributed to death.     

The fraction of disability caused at work

Disability has high societal and personal costs. Various disparate federal and state programs attempt to address the economic and social needs of people with disabilities. Presumably workplace injuries and accidents are an important source of disability. Yet separate public policies and research literatures have evolved for these two social problems--disability and workplace injuries--despite their relatedness. This article seeks to document the overlap between these two phenomena in estimating the proportion of the disabled population whose disability was caused by workplace injury, accident, or illness using the Health and Retirement Study of 1992. The results point toward the need for initiatives to reduce disability that focus on work-related causes, which are a common pathway to disability, and that may result in substantial savings in federal programs.