Acute fatal acetaminophen overdose without liver necrosis

Two unusual cases of suicidal overdose of acetaminophen (paracetamol) without the usual extensive centrilobular necrosis of the liver are reported. Both cases were subjected to comprehensive drug screening by immunoassay, and a combination of gas chromatography with mass spectrometry, nitrogen detection, and electron capture detection. Acetaminophen was detected in both cases. No other drugs were detected in case #1, and only a small amount of olanzapine (<0.1 mg/L) was detected in case #2. No anatomical cause of death was identified in either case. If untreated, the normal outcome of a large acetaminophen overdose would be massive hepatic necrosis with delayed death and low blood and tissue acetaminophen concentrations. In contrast, particularly high postmortem acetaminophen concentrations were measured in both our cases with little hepatic tissue damage. For case #1, femoral blood acetaminophen 1280 mg/L, vitreous 878 mg/L, and liver 729 mg/kg; in case #2, cardiac blood 1220 mg/L, vitreous 779 mg/L, liver 3260 mg/kg, and gastric 11,500 mg/500 g. Acetaminophen was measured using high performance liquid chromatography with UV detection (254 nm) using 3-hydroxyacetanilide as the internal standard. The very high concentrations of acetaminophen is these cases but relatively little hepatic damage suggests an alternative, possibly cardiac, mechanism of death.     

Factors influencing the contamination of UK banknotes with drugs of abuse

Bank of England banknotes sampled from different locations in the UK have been analysed for the presence of cocaine, diamorphine (DAM), Delta(9)-tetrahydrocannabinol (THC) and 3,4-methylenedioxymethamphetamine (MDMA). A database of the contamination detected is routinely used as a benchmark against which the contamination detected on seized banknotes can be compared. Evidence presented at court details how banknotes seized from a suspect may differ from banknotes in general circulation in terms of their contamination with controlled drugs. A question arising from such evidence is whether seized banknotes could have become contaminated through being in circulation in drug "hot spots". In order to address this issue, a Plackett-Burman experimental design was used to investigate the influence of source location and other factors on banknote contamination with drugs of abuse. Banknotes were drawn from banks in eight regions throughout the UK. Each location could be described by a unique combination of the factors under investigation, namely whether the location was rural or urban, in the North or South of the UK, and whether it was a port of entry. The socio-economic class and the proportion of drug offenders in the area and the denomination of the banknotes were also considered as potentially influential factors. Indices were calculated to describe the degree to which samples were contaminated with different drugs, and normal probability plots were used to identify the factors that could account for the contamination observed. Whilst some factors were more influential than others, it was shown that, at the 95% confidence level, none of the proposed factors were significant influences on the contamination. Cocaine contamination on banknotes has been shown to follow a log-normal distribution. It was, therefore, possible to calculate F- and t-statistics to compare the cocaine contamination on the entire sample set with that detected on a second sample set consisting of banknotes all drawn from a single bank branch. It was shown that both inter-bank samples and intra-bank samples had similar variance and similar contamination levels at the 95% confidence level. This suggests that there are no significant regional trends in the contamination of banknotes with drugs of abuse across the UK.     

Pilgrimage to wellness: an exploratory report of rural African American clergy perceptions of church health promotion capacity

Churches serve vital roles in African American communities, where disease burden is disproportionately greater and healthcare access is more limited. Although church leadership often must approve programs and activities conducted within churches, little is known about their perception of churches as health promotion organizations, or the impact of church-based health promotion on their own health. This exploratory study assessed perceptions of church capacity to promote health among 27 rural, African American clergy leaders and report the relationship between their own health and that of their congregation. Results indicate a perceived need to increase the capacity of their churches to promote health. Most common were conducting health programs, displaying health information, kitchen committee working with the health ministry, partnerships outside of the church, and funding. Findings lay the foundation for the development of future studies of key factors associated with organizational change and health promotion in these rural church settings.     

Asphyxial deaths from the recreational use of nitrous oxide.

The recreational use of nitrous oxide is widespread. Nitrous oxide for recreational use is usually obtained from anesthesia tanks or whipped-cream machine chargers or cans. Twenty previously described deaths associated with recreational nitrous-oxide use describe anesthesia tanks and whipped-cream machine dispensors as a source. Five deaths associated with nitrous oxide use are presented; two involving whipped-cream cannisters as the source, two involving anesthesia tanks, and one involving a racing fuel tank as a source of nitrous oxide. Autopsy findings in our cases were subtle or negative, but usually suggestive of asphyxia. Through a laboratory simulation, we have confirmed that nitrous oxide displaces oxygen in a closed space, which probably leads to asphyxia. A review of the literature, neuropharmacology, and pathophysiology of nitrous oxide use is also presented.     

The Importance of Family and School Domains in Adolescent Deviance: African American and Caucasian Youth

Previous work has documented the similar importance of developmental domains in accounting for adolescent deviance in different racial/ethnic groups (e.g., Vazsonyi A. T., and Flannery, D. J., 1997, J. Early Adolesc. 17(3): 271–293). The current investigation is a replication and extension of this line of work. It examined the importance of the family (closeness, monitoring, and conflict) and school (grades, homework time, educational aspirations, and commitment) domains on a sample of adolescent (mean age = 16.4 years) African American and Caucasian youth (N = 809). The following important findings were made: (a) developmental processes including family and school domain variables and deviance were very similar for African American and Caucasian youth; (b) both developmental domains revealed independent predictive relationships with a number of different measures of adolescent deviance in both groups; and (c) the 2 domains uniquely accounted for 25% and 37% of the variance explained respectively in African American and Caucasian adolescent total deviance.