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Acute Lung Injury Following Blood Transfusion: Expanding the Definition

November 21, 2018October 12, 2017 by admin

Abstract and Introduction

Abstract

Objective: Acute lung injury (ALI) is a well known complication following the transfusion of blood products and is commonly referred to as transfusion-related acute lung injury (TRALI). The objectives of this review are to summarize current knowledge of TRALI with an emphasis on issues pertinent to the intensivist and to define the newly recognized Delayed TRALI syndrome.

Data synthesis: The classic TRALI syndrome is an uncommon condition characterized by the abrupt onset of respiratory failure within hours of the transfusion of a blood product. It is usually caused by anti-leukocyte antibodies, resolves rapidly, and has a low mortality. A single unit of packed cells or blood component product is usually implicated in initiating this syndrome. It has, however, recently been recognized that the transfusion of blood products in critically ill or injured patients increases the risk (odds ratio 2.13; 95% confidence interval 1.75-2.52)...

The Plethysmograph: A Review of Recent Literature James G. Barker and Robert J. Howell

November 21, 2018October 13, 2017 by admin

The penile plethysmograph is an individually applied physiological test, that measures the flow of blood to and from the genital area. Over the past 20 years the plethysmograph has evolved into a sophisticated computerized instrument capable of measuring slight changes in the circumference of the penis. Despite the sophistication of the current equipment technology, a question remains whether the information emitted is a valid and reliable means of assessing sexual preference. Much research has accompanied the evolution of the seismography. Generally, the plethysmograph is recognized as the best objective measure of male sexual arousal because blood flow into the penis is the only measure of sexual arousal that doesn't seem to be influenced by other factors. The objectiveability to measure penile arousal has helped the plethysmograph evolve into one of the important tests in the assessment and treatment of male sex offenders.

Ideally,

y-Hydroxybutyrate Concentrations in Pre- and Postmortem Blood and Urine

November 21, 2018October 13, 2017 by admin

To the Editor:

With γ-hydroxybutyrate (GHB) becoming popular as a drug of abuse in the US and elsewhere (1), we are receiving increasing requests for the analytical determination of GHB in blood or urine in criminal investigations, especially in sexual assault cases. In a recent report of a fatal poisoning with GHB, the victim had a postmortem blood GHB concentration of 27 mg/L (2), and another three GHB-related fatalities were reported with postmortem blood GHB concentrations of 52–121 mg/L (3).

As a part of a validation study before instituting a GC-MS method described by others (4), we tested for GHB presence in a series of forensic specimens submitted routinely to us by law enforcement agencies and medical examiner offices in cases not known to be GHB-related. No GHB was detected (detection limit, 1 mg/L) in the blood or urine of living persons or in postmortem urine, but very substantial concentrations,...

Please Don’t Say Anything: Partner Notification and the Patient-Physician Relationship

November 21, 2018October 13, 2017 by admin

Commentary by Ronald Epstein, MD, James C. Thomas, PhD, MPH, and Gregory W. Rutecki, MD

On Dr. Singh's recommendation, one of her patients, Mr. Henry Roland, consented to be tested for HIV and had a positive test result, which he feared but suspected. Mr. Roland has a longtime girlfriend, Lisa, whom he sometimes mentions to Dr. Singh. When talking to Mr. Roland about his positive test result, Dr. Singh brought up the topic of notifying Mr. Roland's past and present partners so they could be tested themselves. Mr. Roland refused to agree to tell Lisa, or even allow Dr. Singh to notify the health department so they could call her to suggest that she be tested.

"If she's positive, she'll know it was me. Please don't say anything or she'll know I gave it to her."

Mr. Roland told Dr. Singh that he intended to continue having sexual relations with Lisa,...

Affective Neuroscience Of Pleasure: Reward In Humans And Animals

November 21, 2018October 13, 2017 by admin

Abstract

Introduction Pleasure and reward are generated by brain circuits that are largely shared between humans and other animals.

Discussion Here, we survey some fundamental topics regarding pleasure mechanisms and explicitly compare humans and animals.

Conclusion Topics surveyed include liking, wanting, and learning components of reward; brain coding versus brain causing of reward; subjective pleasure versus objective hedonic reactions; roles of orbitofrontal cortex and related cortex regions; subcortical hedonic hotspots for pleasure generation; reappraisals of dopamine and pleasure-electrode controversies; and the relation of pleasure to happiness.

Introduction Affective neuroscience has emerged as an exciting discipline in recent years (Berridge 2003a; Damasio 2004; Davidson et al. 2003; Davidson and Sutton 1995; Feldman Barrett and Wager 2006; Kringelbach 2005, 2008; LeDoux and Phelps 2000; Leknes and Tracey 2008; Panksepp 1991; 1998; Rolls 2005). Many important insights have been gained into brain mechanisms of affect, motivation, and emotion through studies of both animals and humans....

Medicolegal Assessment Of Blood Transfusion Errors–an Interdisciplinary Challenge.

November 21, 2018October 13, 2017 by admin

Abstract

Given a current total incidence of erroneously administered blood transfusions of 1:12,000-1:36,000 (AB0 incompatible 1:38,000), the percentage of lethal outcomes ranges between 2 and 5%; i.e. the sole fact of an erroneous transfusion does not mandatorily result in a causal connection with lethal outcome, which can give rise to problems in the medicolegal assessment. We report on the conception and results of a novel interdisciplinary approach to assess the lethal significance of blood transfusion errors. Besides autopsy, histological investigation and immunohistochemical detection of AB0 incompatible foreign red blood cells in autopsy specimens, transfusion medicine investigations offer the opportunity to assess several immunohaematologic features. We assessed the immunohaematologic gel card ("microcolumn") technique for suitability in the forensic assessment of an AB0 incompatible transfusion incident in a septic patient, who had had no history of previous blood transfusions, with lethal outcome. After such an erroneous transfusion had been simulated in vitro, pre-transfusion...

A History On The Use Of Blood Transfusions In Cycling

November 21, 2018October 13, 2017 by admin

The recent revelations by the Dutch newspaper De Volksrant concerning the PDM team's doping regime at the 1988 Tour de France raise more questions than they answer, particularly with regard to the use of blood transfusions in 1980s cycling. Here we consider what is known about the use of transfusions in general and some of the questions these latest PDM revelations raise in relation to the history of blood doping in cycling.

Part I

What is known about the use of blood transfusions in sport, particularly in cycling? Most people will be able to tell you that the Finnish middle-distance runner Lasse Virén is said to have made use of transfusions when winning at the Munich and Montreal Olympics in 1972 and 1976. Most people will also be able to tell you that Francesco Moser broke Eddy Merckx's Hour Record in 1984 with the help of blood transfusions....

Multiple Homicide Offenders Arbitrary Cut-Off Points and Selection Bias

November 21, 2018October 13, 2017 by admin

On Christmas Eve in 2008, an unemployed aerospace engineer dressed as Santa Claus entered his ex-wife’s parents’ home in Covina, California and proceeded to shoot indiscriminately at the 25 or so partygoers inside. He then planned to light the house on fire using a homemade blowtorch, but an unexpected explosion foiled his detailed plans and ultimately quashed his plot to escape. The house, now engulfed in flames, burned to the ground and hid the gruesome fates of those inside. Nine people, including the man’s ex-wife and her parents, died as a result of the gunfire and/or fire. The badly burned offender retreated to his brother’s house some 30 miles away and decided the odds were against him ending his own life with a single gunshot to the head.According to police, Bruce Pardo had no prior criminal record or history of violence. To those who knew... nicest guy” who “always had a smile.”

Religious Affiliations and Homicide: Historical Results from the Rural South

November 21, 2018October 13, 2017 by admin

Abstract

Durkheim had argued that Protestantism decreased homicidal tendencies while Catholicism tended to increase it. However, other writers have maintained that fundamental Protestantism may increase the tendency toward homicide. This study examines the question by relating religious affiliation data by race obtained from a 1916 Census Department study to homicidal rates in the rural South for 1920, and finds that both Protestant and Catholic affiliations for whites are related to less homicide, while for blacks religious affiliation is unrelated to the homicide rate. For the case of the South, these results tend to refute Durkheim's position that Catholicism increases the tendency toward homicide.

Psychiatric Characteristics of Homicide Defendants

November 21, 2018October 13, 2017 by admin

Abstract

Objective The authors examined the rate of mental disorders in an unselected sample of homicide defendants in a U.S. jurisdiction, seeking to identify psychiatric factors associated with offense characteristics and court outcomes.

Method Defendants charged with homicide in a U.S. urban county between 2001 and 2005 received a psychiatric evaluation after arrest. Demographic, historical, and psychiatric variables as well as offense characteristics and legal outcomes were described. Bivariate analyses examined differences by age group and by race, and logistic models examined predictors of multiple victims, firearm use, guilty plea, and guilty verdict.

Results Fifty-eight percent of the sample had at least one axis I or II diagnosis, most often a substance use disorder (47%). Axis I or II diagnoses were more common (78%) among defendants over age 40. Although 37% of the sample had prior psychiatric treatment, only 8%...

Psychotropic Drugs And Homicide: A Prospective Cohort Study From Finland

November 21, 2018October 13, 2017 by admin

After a high-profile homicide case, there is often discussion in the media on whether or not the killing was caused or facilitated by a psychotropic medication. Antidepressants have especially been blamed by non-scientific organizations for a large number of senseless acts of violence, e.g., 13 school shootings in the last decade in the U.S. and Finland [1]. In September 2014, there were more than 139,000 hits from Google for the search terms “antidepressant, homicide”, and more than 1,050,000 hits for the terms “antidepressant, violence”. It is likely that such massive publicity in the lay media has already led a number of patients and physicians to abstain from antidepressant treatment, due to the perceived fear of pharmacologically induced violence.

What is the scientific evidence for an association between psychotropic drugs and homicidal behavior? Most of the available studies are case reports that only suggest a coincidental link between violence or homicide and antidepressants...

Column One : Murder Or Natural Causes? : Four Years After Crystal Spencer’s Death, Her Case Remains A Mystery. Following The Trail Leads To Rumors, Theories And Mishandled Evidence.

November 21, 2018January 3, 2018 by admin

The death of Crystal Spencer has evolved into a bizarre mystery--a tangled web of rumors and botched evidence, lawsuits and personal obsession.

Nearly four years ago, the 29-year-old topless dancer was found dead in her disheveled Burbank apartment. She was half-nude, her body decomposed beyond recognition. Her telephone was off the hook.

Whether she was murdered, or merely died of a sudden illness, is a lingering question. Authorities labeled the cause of death "undetermined," leaving angry, tormented loved ones to cling to theories: Spencer was killed by the Japanese mafia. Spencer was an FBI informant murdered by strip-club hoodlums. Spencer was strangled by a ruthless suitor.

The case has taken on a "Twilight Zone" quality, as if fate intended some sleight of hand. On the night of her death, the couple downstairs heard what they later described as muffled shrieks and screams, the apparent cries of someone "being tortured." But they never called police...

Structural Factors And Black Interracial Homicide: A New Examination Of The Causal Process

November 21, 2018July 5, 2017 by admin

Abstract

This study evaluates the assumption that deprivation among African Americans and racial inequality lead to black interracial homicide due to racial conflict and antagonism. Using refined race-adjusted Supplemental Homicide Report data, Uniform Crime Report data and census data, we test an alternative hypothesis that draws on the macrostructural opportunity theory to assess and more accurately specify the relationship between structural characteristics and black interracial homicide. We find that first, the relationship between economic factors and black interracial homicide can be explained in large part by high rates of financially motivated crime such as robbery, and second, that economic factors are associated with financially motivated but not expressive black interracial killings. Analyses of black intraracial killings are performed for comparison purposes. Collectively, the findings suggest that conflict-based explanations rooted in racial antagonism and frustration aggression may be premature....

Homicide And Allied Inquiries: In Whose Best Interests?

November 20, 2018October 13, 2017 by admin

Abstract

Over a decade ago the present author presented some comments on homicide inquiries in this journal. Since then there have been a number of important developments, including the increase in the number of such inquiries and changes in their constitution and functions. A somewhat neglected area has been soliciting the views of those who chair such inquiries. The present contribution endeavours to remedy this deficiency.

Relational Distance and Homicide: The Role of the Stranger

November 20, 2018October 13, 2017 by admin

I. INTRODUCTION

When the actions of one individual cause the death of another, a homicide has occurred. While that initial statement is simple, homicide is a multi-faceted act involving numerous possible causes and circumstances. As Nettler suggests, there are many routes that lead to culpable killing.' Given the diverse nature of the acts described as homicide, it is little wonder that theoretical writing on the subject as a whole has been spartan. The first step in explaining any phenomenon is adequate classification of the groups of acts sought to be understood.3 In the case of homicide, a number of strategies have been tried in classifying those acts that result in death. Some authors have concentrated on causes of homicide, including psychological imbalance (mental illness, psychiatric disorders), motivations (political, religious, sexual, self-defense, conflict) and methods (poison, shooting, beating). By far the most common tactic has been to study the...

What’s the ROI on Cold Case Investigations?

November 20, 2018October 13, 2017 by admin

The field of forensics has grown by leaps and bounds over the past several years, so much so that decades-old crime cases can sometimes be solved with DNA testing and other modern technology. In an effort to increase case clearance rates (and catch bad guys long gone) police departments have slowly opened more ‘cold case’ units over the last 20 years; a phenomenon that has been documented and dramatized on TV.

In a new RAND paper, researchers Robert C. Davis, Carl Jensen, and Karin E. Kitchens set out to measure the effectiveness of cold case units by posing a simple question, though one that’s rarely asked of police work: What’s the return on investment? They write:

[D]espite the increasing number of cold-case units and the expenditure of significant resources to fund them, we know virtually nothing about the return on this investment. Does it make sense...