Prevention science,drug abuse prevention,and Life Skills Training: Comments on the state of the science

There has been tremendous growth in the field of prevention science over the past two decades. The defining features of contemporary prevention science are high quality empirical research using rigorous and well-established scientific methods, careful hyphothesis testing, and the systematic accumulation of knowledge. One area where substantial progress has been made is in our understanding of the etiology and prevention of tobacoo, alcohol, and illicit drug abuse. In this paper, we review the growth in prevention as a scientific enterprise, discuss advances in drug abuse prevention research, and review the effectiveness of one approach to the problem of adolescent drug abuse, the Life Skills Traning (LST) program, and the methodological strengths of the LST evaluation research. In addition, we provide a response to criticism regarding two types of data analysis in evaluation research, and show that these analyses can help address a number of important research questions with implications for theory and practice. First, the analysis of high fidelity subsamples can address research questions about the importance of program implementation fidelity; and second, composite measures of concurrent tobacco, alcohol, and marijuana use (i.e., polydrug use) are useful in testing research questions about program effects on more serious levels of drug involvement. With an increasing number of ramdomized controlled trials underway, the field of prevention science is contributing to a new generation of evidence-based approaches and policies that, if widely utilized, offer the potential of reducing the mortality and morbidity associated with a number of major health and social problems.     

Too big to fail,too powerful to jail? On the absence of criminal prosecutions after the 2008 financial meltdown

Various explanations have been offered regarding the causes of the current global economic crisis that was spawned by the collapse of mortgage-based securities in the U.S. that were sold world-wide and that contained "toxic assets" comprised of subprime loans. There is ample evidence that such loans were originated through fraud. Firms recorded huge profits, and executives were awarded large bonuses even though some had led their companies into bankruptcy and plunged both the U.S. and global economies into the greatest recession since the Great Depression. This paper assesses the reasons why there have been no major prosecutions to date, and compares the U.S. government's response to that in the savings and loan crisis. It analyzes the influence of large financial institutions on lawmaking, regulation, and the allocation of enforcement resources, the continued general lack of understanding of financial fraud including control fraud, and problems related to the higher status and power of potential defendants.     

Systemic Dissemination of Injected Foreign Material

A 32‐year‐old woman collapsed following an intravenous injection of material that included crushed pharmaceutical tablets. Resuscitation was attempted but was unsuccessful. She had an extensive past medical history of complications resulting from intravenous drug use. Death was due to mixed drug toxicity. The major findings at autopsy included a 10 mm deep skin sinus over the right femoral vein that was used as an injection site. Polarizable foreign material was present at the injection site and also within the lungs with a granulomatous reaction. Of note, a probe‐patent foramen ovale had permitted paradoxical embolization of this material into the systemic circulation with lodgement within the liver, portal lymph nodes, myocardium, spleen, kidneys, and pancreas. This case highlights the importance of checking for any intracardiac shunts, which may be quite small, and systemic dissemination of foreign material to multiple organs in intravenous drug users who present for medicolegal assessment.     

The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins: a 10-year autopsy study

Death due to hemorrhage from ruptured peripheral varicose veins is an uncommon event. A review of the files of Forensic Science SA (FSSA) in Adelaide, South Australia, was undertaken over a 10-year period from January 1996 to December 2005 for such cases. A total of 8 cases were found out of a total of 10,686, representing <0.01% of autopsy cases. The male to female ratio was 1:3, with an age range of 58-84 years (mean = 78 years). The victims were all located at their home addresses, where they had been alone at the time of their deaths. Scene investigations revealed considerable blood loss, with pooling around the victims' bodies, and also in other parts of the house, particularly the bathroom/toilet areas. Four ulcers were of an acute perforative type and 2 were of a chronic ulcerative type. In 2 cases, bleeding followed trauma. Toxicologic evaluation was performed in only 3 of the cases, revealing blood alcohol levels of 0.06% and 0.14% in 2 cases, respectively. A further victim had been prescribed anticoagulant drugs for an unrelated condition. Additional findings of significance were ischemic heart disease in 3 cases and deep venous thrombosis of the calf veins on the side of the fatal hemorrhage in another case (with no evidence of pulmonary thromboembolism). One victim had acute gastric erosions, suggesting that hypothermia following collapse played a role in the terminal event. Autopsy evaluation of such cases should include careful layer dissection of the area of hemorrhage to confirm the presence of the ruptured varix and to enable directed histologic sampling.