GlobalFiler Express DNA amplification kit in South Africa: Extracting the past from the present

In this study, the GlobalFiler Express amplification kit was evaluated for forensic use in 541 South African individuals belonging to the Afrikaaner, amaXhosa,1 amaZulu,1 Asian Indian and Coloured population groups. Allelic frequencies, genetic diversity parameters and forensic informative metrics were calculated for each population. A total of 301 alleles were observed ranging between 5 and 44.2 repeat units, 43 were rarely observed partial repeats and seven were novel. The combined match probability (CMP) ranged from 2.21x10 (Coloured) to 5.21x10 (AmaZulu), and the combined power of exclusion (CPE) 0.9999999978 (Afrikaaner) to 0.99999999979 (AmaZulu) respectively. No significant departures from Hardy-Weinberg equilibrium (HWE) were observed after Bonferroni correction. Strong evidence of genetic structure was detected using the coancestry coefficient? Analysis of Molecular Variance (AMOVA) and an unsupervised Bayesian clustering method (STRUCTURE). The efficiency of assignment of individuals to population groups was evaluated by applying likelihood ratios with WHICHRUN, and the individual ancestral membership probabilities inferred by STRUCTURE. Likelihood ratios performed the best in the assignment of individuals to population groups. Signs of positive selection were detected for TH01 and D13S317 and purifying/balancing selection for locus SE33. These three loci also displayed the largest informativeness for assignment (In) values. The results of this study supports the use of the GlobalFiler STR profiling kit for forensic applications in South Africa with the additional capability to predict ethnicity or continental origin of a random sample.IS

Emergency Department Opioid Prescriptions for Shoulder Dislocations 2005-2015

Introduction/Background Shoulder dislocations are frequently related to sports and outdoor activities. Many reduction techniques for simple anterior shoulder dislocations can be successfully performed in the field with simple or no analgesics. Despite this, many patients in U.S. EDs continue to be treated with opioid analgesics. To assess this, we performed an analysis of the medication administration dynamics of closed shoulder dislocations in U.S. EDs. Objective To analyze dynamics and trends in medication administration for closed shoulder dislocations in U.S. EDs Methods We analyzed shoulder dislocation ICD codes from the CDC’s 2005-2015 National Hospital Ambulatory Medical Care Survey, determined the medications prescribed, and subsequently applied appropriate statistical analyses. Results Patients with closed shoulder dislocations of any type totaled over 2 million between 2005-2015. The majority, 71.1% (95% CI 64.7-76.7, p\u3c0.0001), received opioids while in the ED, with 47.4% (95% CI 41.4-53.4, p\u3c0.0001) receiving an opioid as their first medication and 33.9% (95% CI 28.6-39.8, p\u3c0.0001) receiving opioids as a prescription at discharge. Concurrently, 38.6% (95% CI 32.8-44.8, p\u3c0.0001) of patients were administered NSAIDS in the ED, 11.4% received muscle relaxers (95% CI 8.32-15.31, p\u3c0.0001) and 3.3% (95% CI 1.6-4.66, p\u3c0.0001) received lidocaine injections. Between 2005-2015, the administration of opioids experienced a relative change overall of -10.2%, excepting hydromorphone and fentanyl, which increased 14.6% and 12.2%, respectively. Conclusions Most patients presenting to EDs with shoulder dislocations received opioids in some form. NSAIDs, muscle relaxers and lidocaine injections were comparatively underutilized. We conclude that shoulder dislocations are a significant source of opioid overprescription. Providers should feel comfortable reducing shoulder dislocation without the use of opioids