Evaluation and applicability of Alere iCup DX 14 for rapid postmortem urine drug screening at autopsy

Performing point‐of‐care urine drug screen testing at autopsy by a forensic pathologist may provide an early indication of the presence of analytes of interest during autopsy. An evaluation for the screening of 14 classes of common drugs of abuse in postmortem urine by the point‐of‐care screening device, Alere iCup DX 14, is presented. One hundred ninety postmortem urine samples were screened with the iCup occurring at autopsy by the forensic pathologist. Positive and negative results obtained from the screening kit were evaluated against confirmatory test results obtained using routine forensic toxicology analyses that employed LC‐MS/MS and GC‐MS to detect a combination of over 85 common drugs of abuse and medications. Sensitivity for each respective iCup drug class ranged from 66% (buprenorphine) to 100% (methadone, tricyclic antidepressants). Specificity for each respective iCup drug class ranged from 89% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, 3,4‐methylenedioxymethamphetamine, methadone). Positive predictive values ranged from 44% (benzodiazepines) to 100% (amphetamines, barbiturates, buprenorphine, methylenedioxymethamphetamine, methadone), while negative predictive values ranged from 96% (methamphetamine) to 100% (barbiturates, methadone, tricyclic antidepressants). A high false‐positive rate was yielded by the benzodiazepine class. The lack of fentanyl screening in the point‐of‐care device is a significant limitation considering its prolific prevalence in forensic casework. The results obtained in the study should be acknowledged when considering the use of the Alere iCup DX 14 in the context of postmortem casework to help indicate potential drug use contemporaneously with autopsy and when requiring such preliminary results prior to the release of a final forensic toxicology report.     

Coping Alone: Examining the Prospects of Adolescent Victims of Child Abuse Placed in Foster Care

The ability of a young person to cope effectively with stressful life events appears to be associated with their previous experiences and relationships. Young people in foster care who have histories of child abuse, therefore, may find they cannot cope effectively with the situation they find themselves in. This paper attempts to highlight the problems they face. A group of 21 young people were interviewed and were asked to complete the Frydenberg and Lewis Adolescent Coping Scales. Their social workers provided information on their past history both in care and prior to coming in to care. It emerged that the young people who had experienced physical and/or sexual abuse were significantly (p < 0.02) more likely to be/have been involved in problem, or Crisis, foster placements. Additionally these young people displayed less adaptive coping strategies than the young people who had not been abused. The most significant differences indicated that the victims of abuse were more likely to try and cope with stressful situations by themselves, while the other foster adolescents were significantly (p < 0.004) more likely to find support from their friends. Case studies, with reference to the teenager's own accounts, help to illustrate how a history of abuse can complicate the already difficult fostering processes, and can also affect the long-term coping abilities of the victims. The consequences of these issues are discussed.     

Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

关于完善农村养老保障制度的思考

建立和完善我国农村养老保障是关系国家长治久安的大事。在我国农村建立社会养老保障制度是一项十分复杂的系统工程,应当综合考虑我国农村社会、经济、人口、历史传统等各种因素,积极稳妥地逐步建立和完善适合我国国情的农村养老保障制度。     

对当前幼儿园保育工作问题及对策的思考

当前,幼儿园保育工作中存在着重视力度小、保育员队伍不健全、保育工作质量难以保证等诸多问题.针对这一现状,全园上下要树立起正确的保育观,通过优化管理,建设稳定、合理的保育员队伍,注重保育员的业务学习,全面提高保育工作质量,从而为幼儿的全面发展创造最佳的保育条件.     

浅论强化村级医疗卫生网络建设

村级医疗卫生网络机构是县级医疗卫生体系中的最基层网络组织,是解决农民看病难、看病贵问题的有效途径。结合玉屏自治县的调查情况,对其发展状况、存在的问题进行了详细的分析,提出了加强组织建设、加大财政投入、改善村医待遇、加强教育培训等五个方面的对策。     

A systems analysis of youth in acute and subacute therapeutic residential care

The Arkansas Department of Children and Family Services (DCFS) has reduced the use of therapeutic residential care (e.g., group homes, residential treatment centers) for youth placed in child welfare. Youth in acute or subacute congregate care for 30 or more days without Medicaid now are of particular interest. This is a longer-term psychiatric program, typically 3 to 6 months. The project team conducted a systems analysis to determine the specific characteristics and levels of need for 42 youth so that DCFS can more effectively serve these youth in the least restrictive form of treatment possible.     

The Final Frontiers of Healthcare Universalisation in Costa Rica and Panama

This article explains how Costa Rica and Panama, two Central American countries with nearly universal public healthcare programmes, have come to enjoy such broad coverage. It then describes the distinct paths each is taking towards reaching the populations still left out of healthcare coverage. Costa Rica is seeking to bring all residents under the umbrella of its ILO‐style social security plan. Panama is targeting the rural poor with a package of defined interventions aimed at maternal and child mortality. The article frames these cases within the literature on the varieties of universalism.     

论美国医疗过失案件中注意标准的确定——从历史的视角纵向分析

医疗注意义务是整个医疗过失理论的核心，而注意标准概念则是重中之重。本文从不同时期的判例着手，重点展示美国的注意义务标准的历史发展过程和总体趋势：合同还是侵权，单一程式标准还是多因素可变标准，提高病人安全还是控制医疗费用。通过分析不同时段内法理与司法实践的主要特点，本文将美国医疗注意标准的各种影响因素逐步列出，突出行业惯例和地域因素在整个体系内的辉煌与落败。如今美国的医疗注意义务标准也面临挑战，即医疗保健体系与医疗保险改革背后对医疗费用控制的政策对它产生了冲击。     

在中青年学术骨干中发展党员的工作机制研究——以Z大学G学院为例

在中青年学术骨干中发展党员,培养造就一批既有马克思主义信仰、又有现代科学文化知识的马克思主义者,是提升高校中青年学术骨干政治素养的重要举措。文章深入分析了Z大学G学院中青年学术骨干入党现状及其存在的问题,剖析与之相对的原因,探索如何改进在中青年学术骨干中发展党员的工作机制。