The many faces of access: reasons for medically nonurgent emergency department visits

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.     

Context effects in forensic science: a review and application of the science of science to crime laboratory practice in the United States.

This article discusses the phenomenon of "context effects" by reviewing the findings and practices of a range of scientific fields, including astronomy, physics, biology, medicine, and especially the relevant research and theory from psychology. Context information, such as expectations about what one is supposed to see or conclude, has been found to have a small but relentless impact on human perception, judgment, and decision-making. The article then considers the vulnerability of forensic science practice to context effects, and concludes by suggesting that forensic science adopt practices familiar in other fields of scientific work, in particular blind or double-blind testing and also the use of evidence line-ups.     

赵尚志“主笔”《东北红星壁报》

赵尚志是东北抗日联军著名将领.曾任抗联三军军长、北满抗联总司令、抗联第二路军副总指挥.他指挥千军万马在东北大地与凶恶的日本侵略者进行艰苦卓绝的英勇斗争的光辉业绩,几乎家喻户晓,但他亲自拿起笔杆,"主笔"壁报,开展抗日宣传,却鲜为人知.     

建构东亚经济合作的新视角--中国-东盟自由贸易区的政治经济学分析

区域经济和贸易集团化是当今世界经济发展的重要趋势之一.与世界其它地区相比,东亚在区域经济一体化的进程方面明显滞后.国际政治经济学的分析方法为推动东亚经济整合提供了新的范式.中国-东盟自由贸易区的启动正是基于这种分析框架之上的有益探索.当前,在中共中央关于"发展是中国第一要务"的方针指引下,中国为推动地区经济合作提出了适合本地区经济发展特点的合作模式,这必将为中国整合地区经济,进而拉动中国经济持久增长提供新的动力.全力塑造东亚经济圈的努力正有条不紊地进行,东亚经济一体化将在艰难中曲折前进.     

Mechanisms of unexpected death in tuberous sclerosis

Tuberous sclerosis complex is a protean autosomal dominant disorder characterized by multifocal tissue lesions arising from defects in cellular migration, proliferation, and differentiation. It has an association with sudden death. In the current study, review of all cases of sudden death due to tuberous sclerosis was undertaken at the Forensic Science Centre in Adelaide, Australia from 1991 to 2001, in addition to an analysis of cases from the literature. There were two local cases where unexpected death had occurred in individuals with known tuberous sclerosis, involving a 31-year-old male (epilepsy), and a 24-year-old female (massive hemorrhage into a renal angiomyolipoma). Fatal mechanisms in cases of tuberous sclerosis may be associated with underlying cardiovascular, renal and cerebral abnormalities. Sudden death may be due to cardiac arrhythmia, epilepsy, and intra-tumoral hemorrhage with additional complications including cardiac outflow obstruction, obstructive hydrocephalus, aneurysm rupture, and spontaneous pneumothorax. An awareness of the highly variable tissue manifestations of tuberous sclerosis and the mechanisms that may be responsible for death is necessary to establish correctly the diagnosis in occult cases (possibly with molecular confirmation), and to chart accurately organ changes in individuals with established disease.     

The fingernails of Mary Sullivan: developing reliable methods for selectively isolating endogenous and exogenous DNA from evidence

The fingernails of Mary Sullivan, the last victim of the Boston Strangler, were examined to determine if any genetic information about the murderer could be obtained. The nails were extremely friable necessitating the development of new techniques for isolating and purifying DNA. DNA yields from nails were optimized by using a NaOH-based preparation technique, which was simple, efficient, and minimized handling. Methods for selectively and thoroughly removing exogenous material on nails were also developed through use of a species-specific PCR assay, wherein mitochondrial DNA from the nail could easily be differentiated from DNA of contaminating cells.     

An alternative method to screen for pepper spray residue

A method was developed to screen for pepper spray residue using instruments and methods other than those techniques commonly employed to analyze chemical residue (i.e.. gas chromatography mass spectrometry-GCMS or liquid chromatography mass spectrometry-LCMS). The method employed gas chromatography (GC), thin layer chromatography (TLC), and diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) to screen for dried pepper spray stains. Pepper sprays from nine different manufacturers were investigated. Capsaicin and dihydrocapsaicin were identified and unique IR reflectance spectra are presented. An additional five compounds were presumptively found. Results showed that a particular stain could be characterized as a pepper-based stain.