The Frye hearing in Florida: an attempt to exclude scientific evidence.

State Supreme Courts require a minimum threshold of reliability and acceptance in the scientific community for all medical and similar evidence to be admitted at trial. In Florida and some other states, the courts adhere to what is known as the Frye standard, whereas in most states and in Federal Courts, it is the so-called Daubert standard. The jurisdiction of the present case is Hillsborough County (Tampa), Florida. Forensic pathologists seldom, if ever, are requested to participate in such hearings, unlike their toxicological and basic science colleagues who are more involved in research methodology and technical procedures. The burden is on the proponent of the evidence to prove the general acceptance of both the underlying scientific principle of the test and procedures used to apply that principle to the facts of the case at hand. The trial judge has the sole discretion to determine this question and general acceptance must be established by a preponderance of the evidence. The authors describe in detail a hearing in a case in which they were all involved. One author (WQS) had researched and documented the original scientific methodology in the literature. The situation involved a car and tractor trailer crash with the two occupants of the car dying of multiple trauma, whereas the truck driver was not injured. Autopsy of the auto driver revealed multiple injuries with exsanguination, and only vitreous humor and liver tissue, but not blood, were tested for ethyl alcohol. The estate of the driver of the automobile brought suit against the owner of the trucking company for wrongful death. The plaintiff requested a Frye hearing to question the reliability of testing other body specimens to translate to probable blood alcohol level. The testimony, submitted documents, and eventual decision by the judge are discussed.

Forces required to initiate sliding in second-generation intramedullary nails.

Second-generation intramedullary nails, which allow the fixation screw that is placed in the femoral head to slide distally and thus allow compression of the fracture of the femoral neck, have become a popular option for the treatment of ipsilateral fractures of the femoral neck and shaft. However, the sliding characteristics of the screw within the barrel of the nail or the side-plate have not been assessed biomechanically, to our knowledge. The goal of the current study was to investigate the forces required to initiate sliding of the proximal screw in intramedullary devices and to compare these forces with those required to initiate sliding of hip screws. The loading configuration simulated the typical angle of 135 degrees between the intramedullary nail and the proximal screw. The forces required to initiate sliding of the proximal screw, with the screw extended fifty-one, seventy-six, eighty-six, and 102 millimeters beyond the proximal end of the barrel, were measured for three different types of second-generation intramedullary nails (Recon, ZMS, and Gamma), a sliding compression hip screw, and an intramedullary hip screw, and these forces were then compared. With each amount of extension of the screw, the hip screws required lower forces to initiate sliding than did the second-generation intramedullary devices. Of the second-generation devices, the Gamma nail required the highest forces to initiate sliding; the Recon and ZMS nails required 20 to 40 percent lower forces compared with the Gamma nail. None of the devices jammed in any of the loading configurations that were tested. When the extension of the screw was increased, higher forces were required to initiate sliding.

Use of social indicators in assessment of local community alcohol and other drug dependence treatment needs within Chicago.

The State Systems Development Program of the US Center for Substance Abuse Treatment supports needs assessment studies conducted through state authorities. This article reports results of a social indicator study funded through this program of alcohol and other drug dependence (AODD) treatment needs specific to communities in Chicago, Illinois. Purposes of study analyses were: identify theoretical factors underlying a large set of social indicators, determine degree to which resultant factor scale scores predict community resident admissions to publicly-funded AODD treatment, and explore usefulness of factor scale scores in grouping communities into planning regions. Cautions and limitations in interpretation of results are discussed.

Serum cytokine levels in patients with Alzheimer's disease.

Alzheimer's disease (AD) has been proposed to be an inflammatory disorder. In a recent study, markedly elevated levels of the anti-inflammatory cytokine transforming growth factor beta (TGF-beta) in the serum and cerebrospinal fluid of patients with advanced AD suggested a potential predictive value of this cytokine in patients with AD. In the present prospective study, we tested the hypothesis that the levels of TGF-beta in serum would be increased in patients with AD and could thereby serve as a diagnostic marker. We found that serum TGF-beta levels but not proinflammatory cytokine levels were significantly (P < 0.05) elevated in patients with AD (n = 22) in comparison with the levels in their healthy spousal controls. Also, serum TGF-beta levels were positively correlated (r = 0.45; P < 0.05) with disease severity. Nevertheless, the elevation in serum TGF-beta levels in patients with Ad was modest, and considerable overlap with the control values suggests that the diagnostic usefulness of this cytokine for AD is limited.

Results of a prospective randomized trial for treatment of severely brain-injured patients with hyperbaric oxygen.

The authors enrolled 168 patients with closed-head trauma into a prospective trial to evaluate the effect of hyperbaric oxygen in the treatment of brain injury. Patients were included if they had a total Glasgow Coma Scale (GCS) score of 9 or less for at least 6 hours. After the GCS score was established and consent obtained, the patient was randomly assigned, stratified by GCS score and age, to either a treatment or a control group. Hyperbaric oxygen was administered to the treatment group in a monoplace chamber every 8 hours for 1 hour at 1.5 atm absolute; this treatment course continued for 2 weeks or until the patient was either brain dead or awake. An average of 21 treatments per patient was given. Outcome was assessed by blinded independent examiners. The entire group of 168 patients was followed for 12 months, with two patients lost to follow-up study. The mortality rate was 17% for the 84 hyperbaric oxygen-treated patients and 32% for the 82 control patients (chi-squared test, 1 df, p = 0.037). Among the 80 patients with an initial GCS score of 4, 5, or 6, the mortality rate was 17% for the hyperbaric oxygen-treated group and 42% for the controls (chi-squared test, 1 df, p = 0.04). Analysis of the 87 patients with peak intracranial pressures (ICP) greater than 20 mm Hg revealed a 21% mortality rate for the hyperbaric oxygen-treated patients, as opposed to 48% for the control group (chi-squared test, 1 df, p = 0.02). Myringotomy to reduce pain during hyperbaric oxygen treatment helped to reduce ICP. Analysis of the outcome of survivors reveals that hyperbaric oxygen treatment did not increase the number of patients in the favorable outcome categories (good recovery and moderate disability). The possibility that a different hyperbaric oxygen treatment paradigm or the addition of other agents, such as a 21-aminosteroid, may improve quality of survival is being explored.

The needs of deaf substance abusers in Illinois.

A summary is presented of available information regarding the special characteristics and needs of hearing-impaired alcoholics and drug addicts. The various obstacles to this population receiving treatment are seen to be made even more formidable by apparent minimal adherence in the chemical dependency field to the legal mandate that agencies and institutions that receive federal funding must provide services that are accessible to disabled persons. The Illinois Task Force on Substance Abuse Among the Hearing Impaired was established to examine the needs of this population in Illinois. The results of a needs assessment conducted by the Task Force are summarized. The conclusion is reached that the minimal accessibility of hearing-impaired individuals to substance abuse treatment reported in the literature extends to Illinois as well. The concerns of agencies in attempting to meet the needs of this population are cited. Specific recommendations are made to changes in programming intended to improve the level of substance abuse services accessible to hearing-impaired individuals.

Statistical power in nursing research.

A power analysis was performed on 62 articles that were published in Nursing Research and Research in Nursing and Health during 1989. The analysis revealed that when effects were small, the mean power of the statistical tests being performed to test research hypotheses was .26, indicating a very high risk of committing a Type II error. When effects were moderate, the mean power increased to .71, which is still below the conventionally acceptable power of .80. Only when a study involved large effects was the power adequate (mean of .95). Of the 583 power estimates calculated, 53% were for small effects. These analyses indicate that a substantial number of published nursing studies, and presumably even more of unpublished studies, have insufficient power to detect real effects, primarily because the samples used are too small.

Use of case vignettes in suicide risk assessment.

Thirty-three brief case histories of suicidal patients were given to 19 experienced crisis workers for 7-point ratings of short- and long-term suicide risk. The ratings revealed considerable variability, raising questions about the reliability of such global assessments of suicidality. The most consistently rated cases were selected to operationally define "mild," "moderate," and "high" risk. Thus, each level was "anchored" by several vignettes. It was hoped that these anchor points would lead to more uniform future ratings among crisis workers. The correlation between short- and long-term risk ranged from near zero for some vignettes to as high as .82 (median = .46), demonstrating the need to rate both separately. Long-term risk was more difficult to rate, as demonstrated by a larger number of cases judged to be unrateable because of "insufficient information" (94 vs. 53 rater-case combinations). When the anchor vignettes were provided as a guide to the same sample of crisis workers, their ratings of suicide risk, as expected, showed significantly improved consistency.

Stability of initial fixation of the tibial component in cementless total knee arthroplasty.

This study measured the vertical displacement of three kinds of cementless tibial components [Porous Coated Anatomical (PCA), Tricon, and Whiteside], under eccentric loading up to 2,225 N. Displacement between the tibial tray and the proximal tibia was measured with linear variable differential transformers at the anterior and posterior side when anteriorly or posteriorly loaded, and at the medial and lateral side when medially or laterally loaded. The general pattern of motion was sinking at the loaded side and lift-off at the opposite side. Lift-off opposite the loaded side was fairly small for all components at all measurement sites. Among the three components, the Whiteside showed the smallest displacements. The Tricon (when anteriorly or posteriorly loaded), and the PCA (when medially or laterally loaded) showed sinking at the loaded side. Anterior screw fixation of the PCA was not effective in preventing anterior lift-off. The tilting motion of the tibial components observed in this study implies instability of the initial fixation, which could possibly compromise bony ingrowth. Furthermore, this tilting could cause uneven distribution of load, and potentially result in fracture of the underlying bone.

Health care cost containment measures and mortality in Hennepin County's Medicaid elderly and all elderly.

In Minnesota, several health care cost containment measures occurred about the time Medicare's Prospective Payment System (PPS) was implemented. These included a moratorium on additional nursing home beds, preadmission screening of nursing home applicants, and rapid growth in HMO (health maintenance organization) enrollment by Medicare recipients. Hospital days per elderly Medicaid recipient decreased by 38 percent for those in nursing homes and by 35 percent for those not in nursing homes from 1982 to 1984. By 1986, hospital days per recipient had decreased 53 and 55 percent, respectively, from the 1982 level. Age-adjusted mortality rates for elderly Medicaid nursing home residents for the period 1977 through 1986 showed an increasing trend after 1982. Estimated age-adjusted mortality rates for the entire County population, which had decreased steadily from 1970 to 1982, rose significantly above the projected rate in 1984, 1985, 1986, and 1987. We conclude that, coincident with the institution of the PPS and other health care cost containment measures, use of hospital care has fallen for all elderly Medicaid recipients, age-adjusted mortality rates among those in nursing homes have increased, and the mortality rate trend for the total Hennepin County elderly population has stopped declining.

Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing.

The rotational stability of fractures of the radius and ulna treated with Rush pins and/or fracture bracing was studied in six fresh cadaver forearms. Forearm rotation and fracture site motion (rotation) were measured as functions of applied forearm torque and rotation (pronation-supination). Values were obtained from the forearm: (1) intact and with both bones fractured; (2) without fixation; (3) with a fracture brace; (4) with Rush pins; and (5) with a combination of Rush pins and a fracture brace. A brace was ineffectual in reducing fracture site motion when the wrist was rotated to specified angles compared to fracture site motion for the forearm with no fixation treatment rotated to the same angles. When loading to specific torque levels, however, the brace reduced fracture site motion to one-half the motion with no fixation treatment. Under both loading conditions, Rush pin fixation significantly and markedly reduced the fracture site motion (to approximately one-eighth of the motion with no fixation treatment), whereas a brace in conjunction with Rush pins did not significantly further reduce the fracture site motion. The radius showed more motion at fracture site than the ulna.

Reduction in cement-bone interface shear strength between primary and revision arthroplasty.

This study quantified changes in the cement-bone interface shear strength between primary and first- and second-revision arthroplasties as a function of mechanical interlock between the cement and bone. There were 128 segments obtained from four pairs of fresh human femora that were prepared sequentially as for primary and first and second revisions, taking care to maintain original canal morphology. Cement was pressurized into the cavity of the anatomic specimens, and the maximum interface shear strength between the cement plug and the bone was experimentally determined for each revision. First-revision interface shear strength was reduced to 20.6% of primary strength, and second revision strength to 6.8% of primary strength.

Radiographic changes in bone dimensions in asymptomatic cemented total hip arthroplasties. Results of nine to thirteen-year follow-up.

On twenty-six cemented total hip replacements that had been followed for an average of 10.4 years (range, nine to thirteen years), a retrospective radiographic study was done to assess dimensional changes in the cross section of the bone in a group of asymptomatic patients. Cortical dimensions were measured on radiographs and were normalized using a radiographic distortion factor that was derived from the width and length of the prosthesis. The data were then analyzed using a least-squares method. Analyses were performed for the men, for the women, and for the combined group. The results for all three groups showed a significant decrease in cortical thickness as well as widening of the medullary canal, but no periosteal expansion.

Extended high frequency hearing sensitivity. A normative threshold study in musicians.

Sixty members of the Minnesota Orchestra (aged 24 to 64 years) and 30 nonmusicians (aged 20 to 69 years) were evaluated for hearing sensitivity within the conventional audiometric range (0.25 to 8 kHz) and within the extended high frequency audiometric range (9 to 20 kHz). Threshold data were evaluated by age, sex, and musician-nonmusician categories for the respective frequencies, and data were compared to other studies. Musician hearing appeared no poorer than nonmusician hearing, suggesting no major hearing loss from musicians exposure to orchestral noise. Hearing acuity of the two groups was similar to some normal groups reported in the world literature but appeared poorer in comparison to some normal groups defined by a very restrictive definition of normal hearing. Issues relating to the definition of normal hearing are explored. A mathematical model descriptive of the extended high tone hearing sensitivity for musicians and non-musicians evaluated was calculated. The formula is presented from which typical age-specific extended high frequency thresholds may be calculated for the 90 subjects evaluated.

Evidence of the construct validity and potential application of a multivariate approach to alcoholism diagnosis.

To investigate the construct validity of a proposed 10-factor alcoholism diagnostic profile, a principal components analysis was performed on the responses of 1,535 alcoholic inpatients to a questionnaire designed to assess functioning in a number of life areas. A total of 16 components, explaining 50% of the total variance, were retained for rotation and interpretation. On this basis it is recommended that consideration be given to additional factor areas in the proposed profile. It is suggested that factor profiles from the proposed model might be of use in formulating predictions regarding treatment completion. To evaluate the likelihood of this suggestion, a stepwise discriminant analysis was performed using scale scores for the 16 components and the additional variable of age in an attempt to differentiate between treatment completers and premature discharges in the sample. The discriminant function which resulted contained 12 of the 17 variables available and served to correctly identify 62.5% of the premature discharges. Cautions are expressed regarding generalizations from the results of both analyses. It is concluded that evidence was obtained for both the construct validity of the factors in the proposed model and of the potential clinical use of the resultant profiles. Although substantial research and development is required, the proposed model seems to offer numerous advantages over the diagnostic approaches currently available.

Epidemiology, mortality and morbidity in multiple trauma patients.

Three hundred, twenty-nine multiple trauma patients with skeletal injuries admitted to Hennepin County Medical Center, Minneapolis were analyzed for mortality and morbidity based on injury severity score (ISS) and timing of fracture stabilization. Fifty-three deaths (16%) occurred with 38% dying during the first six hours. Survival prospects with injury severity score over 40 were bleak. Age, sex, mechanism of injury, and time of occurrence of injury was also tabulated. Two hundred, twenty-nine patients with 474 long bone fractures were analyzed based on timing of fracture stabilization: immediate stabilization within 24 hours; delayed primary stabilization over 24 hours to one week; secondary osteosynthesis more than one week; non-operative treatment. Respiratory distress syndromes occurred in 6%, 2.4%, 9%, and 12%; mortality rate of 3%, 0%, 6.4%, and 26% for treatment groups A, B, C, and D respectively. However, it must be noted that treatment group B with lower ARDS and mortality rate had no type III open fractures and lower injury severity score.

Effects of instrument type and orchestral position on hearing sensitivity for 0.25 to 20 kHz in the orchestral musician.

Minnesota Orchestra members (42 males, 18 females) aged 24 to 64 years, all asymptomatic for hearing problems or ear disease, were evaluated with a hearing history questionnaire, otolaryngologic examination, and pure tone audiometry for the conventional (0.25 to 8 kHz) and extended high frequency (9 to 20 kHz) ranges. Hearing sensitivity was examined with respect to musician instrument type, years of playing, and orchestral stage position. Type of instrument played and position on the orchestral stage had no significant correlation with hearing loss.

The use of the Staggered Spondaic Word and the competing environmental sounds tests in the evaluation of central auditory function of learning disabled children.

Children aged 6 to 12 years with intelligence and pure-tone hearing within the normal range (91 functioning academically within the middle 50% and having uneventful hearing health histories and 76 demonstrating learning disabilities) were evaluated with dichotic central auditory listening tasks. Auditory response patterns were established and analyzed for normal and learning disability-specific performance. Children with learning disability-specific performance. Children with learning disabilities performed more poorly than "normal" peers on verbal and nonverbal listening tasks, suggesting learning disabled children may be identified by auditory performance on dichotic listening skills.