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Measurement of ethanol above the skin surface (supradermal) is used to monitor blood alcohol concentrations (BAC) in both legal and consumer settings. Previously, the relationship between supradermal alcohol concentration (SAC) and BAC was described using partial and ordinary differential equations (PDE model: J. Appl. Physiol. 100: 649‐55, 2006). Using a range of BAC profiles by varying absorption times and peak concentrations, the PDE model accurately predicted experimental measures of SAC. Recently, other mathematical models have relied on the PDE model. This paper proposes a new approach to modeling transdermal ethanol kinetics using a mass transfer coefficient and only ordinary differential equations (ODE model). Using a range of BAC profiles, the ODE model performed very similarly to the PDE model. The ODE model had slightly slower washout rates and slightly slower times to peak SAC and to zero SAC. Similar to the PDE model, a sensitivity analysis on the ODE model showed changes in solubility and diffusivity within the stratum corneum, stratum corneum thickness, and the volume of gas above the skin affected model performance. This new model will streamline integration into larger physiologic models, reduce computation time, and decrease the time to transform skin alcohol measurements to blood alcohol concentrations. [ABSTRACT FROM AUTHOR]

Ethanol is the most commonly encountered substance in forensic toxicology. Determining blood alcohol concentration (BAC) in autopsies accounts for the majority of work in forensic diagnosis. The most common method to assess BAC is the enzymatic oxidation method because of its low cost, easy operation, and high throughput. Still, the elevated lactate and lactate dehydrogenase (LDH) levels in postmortem blood may affect accuracy. This study uses headspace gas chromatography with a flame ionization detector (HS-GC/FID) to assess the interference of lactate and LDH levels on BAC in 110 autopsied blood samples determined by the enzymatic oxidation method. The results showed that lactate and LDH levels in postmortem blood were higher than in normal blood. There was a weak correlation between the lactate levels and BAC difference (r = 0.23, p < 0.05) and a strong correlation between LDH levels and BAC difference (r = 0.67, p < 0.001). The differentiation of BAC between the enzymatic oxidation method and HS-GC/FID was significant (p < 0.001), confirming the interference significantly. All postmortem blood samples with lactate and LDH levels higher than regular lead to a positive error in determining BAC by enzymatic oxidation method. The study results suggest that the HS-GC/FID method should be used to determine BAC in postmortem blood samples instead of the enzymatic oxidation method to avoid mistakes in forensic diagnosis. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption is one of the most important factors in a substantial number of violent deaths. The aim of our study was to investigate alcohol-related deaths in the Republic of North Macedonia in the period from 2007 to 2020, in order to study the influence of elevated blood alcohol levels in violent deaths. Five hundred sixty-four post-mortem blood samples from alcohol-related death cases—natural deaths and violent deaths (suicides, accidents, and homicides)—were analyzed, and the results were evaluated according to sex, age, and cause of death. Among 564 cases, traffic accidents were the leading cause of violent death (54.3% of the cases) followed by suicides (19.9% of the cases). In the examined post-mortem samples, BAC values ranged from 0.15–6.20 g/L. The average age was 45 ± 16 years for the male and 49 ± 19 years for the female group. The biggest proportion of high BAC values was found in the group of accidents specifically road traffic accidents and accidental intoxication as well as in the group of bolus deaths. The analysis of BAC in the cases of violent deaths in the Republic of North Macedonia confirmed that consumption of alcohol is strongly related to violent deaths. The data obtained from this study could raise caution and give aid in a national strategy for the prevention of alcohol-related violent deaths. [ABSTRACT FROM AUTHOR]

Although they comprise a relatively small subset of all traffic deaths, hit‐and‐run (HR) fatalities are both contemptible and preventable. We analyze longitudinal data from 1982 to 2008 to examine the effects of blood alcohol concentration (BAC) laws on HR traffic fatalities. Our results suggest that lower BAC limits may have an unintended consequence of increasing HR fatalities, whereas a similar effect is absent for non‐HR fatalities. Specifically, we find that the adoption of a 0.08 BAC limit is associated to an 8.3% increase in HR fatalities. This unintended effect is more pronounced in urban areas and during weekends, which are typical settings for HR incidents. [ABSTRACT FROM AUTHOR]

Alcohol consumption is a major social and forensic issue. It is often the cause of road accidents, industrial accidents, suicides and other crimes. On account of this, it is of fundamental importance in forensic toxicology to correctly quantify blood alcohol concentration (BAC). In this work, a straightforward method for the quantification of ethanol from blood samples by means of headspace gas chromatography with flame ionization detection is presented and validated. For method validation linearity, limit of detection (LOD), lower limit of quantification (LLOQ), accuracy, precision (% CV) and interference studies were carried out. All the validation conditions were satisfied according to the acceptance criteria. Proof of applicability was performed on 50 real blood samples, showing that the method was effective. [ABSTRACT FROM AUTHOR]

• Alcohol impairs perception, cognition, and action in manual driving, increasing accident risk. • Higher blood alcohol concentrations (BACs) result in more significant negative effects on driving. • More experienced drivers and drivers with more frequent alcohol consumption may be less impacted by the alcohol. • Limited studies on automated vehicles show similar impairments due to alcohol as in manual driving. • Methodological biases in reviewed studies may impact generalizability of findings. • Recommendations include in-car systems and assistive driving tech to improve road safety. Introduction : Almost a third of car accidents involve driving after alcohol consumption. Autonomous vehicles (AVs) may offer accident-prevention benefits, but at current automation levels, drivers must still perform manual driving tasks when automated systems fail. Therefore, understanding how alcohol affects driving in both manual and automated contexts offers insight into the role of future vehicle design in mediating crash risks for alcohol-impaired driving. Method: This study conducted a systematic review on alcohol effects on manual and automated (takeover) driving performance. Fifty-three articles from eight databases were analyzed, with findings structured based on the information processing model, which can be extended to the AV takeover model. Results: The literature indicates that different Blood Alcohol Concentration (BAC) levels affect driving skills essential for traffic safety at various information processing stages, such as delayed reacting time, impaired cognitive abilities, and hindered execution of driving tasks. Additionally, the driver's driving experience, drinking habits, and external driving environment play important roles in influencing driving performance. Conclusions : Future work is needed to examine the effects of alcohol on driving performance, particularly in AVs and takeover situations, and to develop driver monitoring systems. Practical applications: Findings from this review can inform future experiments, AV technology design, and the development of driver state monitoring systems. [ABSTRACT FROM AUTHOR]

In December 2022, the Ministry of Health, Labour and Welfare (MHLW) of Japan issued and implemented the guideline for evaluating the effects of psychotropic drugs on motor vehicle driving performance. This guideline recommends the use of a tiered approach to assess clinically meaningful driving impairment. It is noted that adverse events cannot be solely explained by pharmacokinetics, as the onset and duration of these events vary. Among these adverse events, those affecting alertness, such as drowsiness caused by psychotropic drugs on driving performance, are more frequently observed during initial treatment stages and dose escalation. Hence, when evaluating the effects of psychotropic drugs on driving performance, it becomes crucial to assess the persistence of clinically meaningful impairment. Therefore, the MHLW guideline, developed by the authors, emphasizes the need to assess the temporal profile of adverse events affecting driving in all clinical trials. Additionally, the guideline states that when conducting driving studies, the timing of multiple dosing should consider not only the pharmacokinetics of the investigational drug but also its tolerance. [ABSTRACT FROM AUTHOR]

The utility of newly developed wearable biosensors for passively, noninvasively, and continuously measuring transdermal alcohol levels in the body in real time has been limited by the fact that raw transdermal alcohol data does not consistently correlate (quantitatively or temporally) with interpretable metrics of breath and blood across individuals, devices, and the environment. A novel method using a population model in the form of a random abstract hybrid system of ordinary and partial differential equations and linear quadratic tracking control in Hilbert space was developed to estimate blood or breath alcohol concentration from the biosensor-produced transdermal alcohol level signal. Using human subject data in the form of 270 drinking episodes, the method was shown to produce estimates of blood or breath alcohol concentration that are highly correlated and, thus, good predictors of breath analyzer measurements. Moreover, although the method required some advanced offline training on a laptop or on the cloud, it produced the estimated blood or breath alcohol concentration recursively online in real time, and required only computations that could be carried out on either the biosensor's built-in processor or on a portable mobile device such as a phone or tablet. [ABSTRACT FROM AUTHOR]

The analysis of blood alcohol concentration (BAC), a pivotal toxicological test, concerns acute alcohol intoxication (AAI) and driving under the influence (DUI). As such, BAC presents an organizational challenge for clinical laboratories, with unique complexities due to the need for forensic defensibility as part of the diagnostic process. Unfortunately, a significant number of scientific investigations dealing with the subject present discrepancies that make it difficult to identify optimal practices in sample collection, transportation, handling, and preparation. This review provides a systematic analysis of the preanalytical phase of BAC that aims to identify and explain the chemical, physiological, and pharmacological mechanisms underlying controllable operational factors. Nevertheless, it seeks evidence for the necessity to separate preanalytical processes for diagnostic and forensic BAC testing. In this regard, the main finding of this review is that no literature evidence supports the necessity to differentiate preanalytical procedures for AAI and DUI, except for the traceability throughout the chain of custody. In fact, adhering to correct preanalytical procedures provided by official bodies such as European federation of clinical chemistry and laboratory medicine for routine phlebotomy ensures both diagnostic accuracy and forensic defensibility of BAC. This is shown to depend on the capability of modern pre-evacuated sterile collection tubes to control major factors influencing BAC, namely non-enzymatic oxidation and microbial contamination. While certain restrictions become obsolete with such devices, as the use of sodium fluoride (NaF) for specific preservation of forensic BAC, this review reinforces the recommendation to use non-alcoholic disinfectants as a means to achieve "error-proof" procedures in challenging operational environments like the emergency department. [ABSTRACT FROM AUTHOR]

Introduction: The sex difference in alcohol use disorder (AUD) is ingrained in distinctive neurobiological responses between men and women, which necessitates further investigation for a more tailored management. Methods: Minding the findings of iron dysregulation in AUD and the sex difference in iron homeostasis in multiple physiological and pathological settings, we examined the sex difference in the association between serum ferritin and blood alcohol concentration (BAC) in intoxicated males (n = 125) and females (n = 59). We included patients with both serum ferritin tested of any value and a BAC above the level of detection during the same hospital admission period. We investigated sex difference in the relationship between BAC, serum ferritin and liver enzymes in intoxicated critically ill and noncritically ill patients. Results: We found a negative association between serum ferritin and BAC in critically ill, intoxicated females [R2 = 0.44, F(1,14) = 11.02, p = 0.005], with much attenuated serum ferritin in females compared to their male counterparts (194.5 ± 280.4 vs. 806.3 ± 3405.7 ng/L, p = 0.002). We found a positive association between serum ferritin and liver enzymes [alanine transaminase (ALT) and aspartate transferase (AST)] in critically ill intoxicated females [ALT: R2 = 0.48, F(1,10) = 9.1, p = 0.013; AST: R2 = 0.68, F(1,10) = 21.2, p = 0.001] and in noncritically ill intoxicated males [ALT: R2 = 0.1, F(1,83) = 9.4, p = 0.003; AST: R2 = 0.1, F(1,78) = 10.5, p = 0.002]. The effect of BAC on serum ferritin was not mediated by ALT [indirect effect: (B = 0.13, p = 0.1)]. We also found a significant effect of sex, anemia, intensive care unit (ICU) admission and mortality on serum ferritin. Discussion: Our results suggest that high BAC in intoxicated female patients is associated with attenuated serum ferritin levels, questioning the role of low serum ferritin in female vulnerability to alcohol. [ABSTRACT FROM AUTHOR]

The objective of this study was to summarize existing knowledge on the association between driving under the influence of alcohol and road safety outcomes and to assess factors that may explain why these estimates vary. Based on studies of the association between blood alcohol concentration (BAC) levels and crashes, we used multilevel metaregression to calculate summary effects of BAC level and analyze potential moderators of the association. Based on 60 studies and 393 effect estimates, we found that BAC level, outcome severity, use of hospital data, and geographical region contributed to heterogeneity in results. The effect of BAC on crash and injury risk and culpability is stronger at higher BAC levels and for more serious outcomes. The relationship between BAC level and outcome is approximately exponential. The relationship is stronger in studies from Nordic countries than in studies from other countries, possibly because of the relatively low level of drunk driving in these countries. Studies based on hospital data and studies using non-crash-involved control groups find smaller effects on average. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) treatments, including medications, are increasingly offered via telehealth. Objective: This study characterizes 90-day treatment retention and changes in objectively measured blood alcohol concentration (BAC) in a large cohort receiving AUD telehealth. Methods: Patients received AUD treatment through Ria, a virtual (telehealth) program offering AUD treatment that is tailored to patient goals (e.g. abstinence or controlled drinking). Patients were encouraged to complete breathalyzer readings twice daily for measurement-based care. We characterized rates of 90-day treatment retention (i.e. completing a BAC reading or medical/coaching encounter on the 90th day or later) and used growth curve analyses to model changes in daily estimated peak BAC over 90 days. Results: Of 4121 patients (51.5% women), 50.1% had 90-day treatment retention (n = 2066, 52.2% women). Most patients received prescriptions for AUD medications (84.6%) and completed encounters with medical providers (86.7%) and coaches (86.1%). Patients with 90-day retention provided 184,817 BAC readings in the first 90 days. Growth curve analyses revealed significant reductions in daily estimated peak BAC (p <.001) from a mean of 0.092 (day 1) to 0.038 (day 90). Similar magnitudes of BAC reduction were observed for men and women and for patients with abstinence and controlled drinking goals. Conclusion: Telehealth appears to be a viable approach to delivering AUD treatments in a manner that promotes drinking reductions. Telehealth approaches can yield reductions in objectively measured BAC, including for some patient subgroups that have historically faced greater stigma in AUD treatment settings, such as women and people with non-abstinence drinking goals. [ABSTRACT FROM AUTHOR]

This experiment supplements the study, "Statistical comparisons of blood alcohol samples from 6‐ml and 10‐ml grey‐top tubes". The initial study analyzed fortified samples for blood alcohol concentration (BAC) using two sizes of gray‐top tubes: a 10‐ml tube containing a nominal 1% sodium fluoride (NaF), a preservative, and a 6‐ml tube containing 0.25% NaF, using the variables of time, storage temperature, fill volume, and concentration. From that study, paired t‐tests determined no difference in BAC from data sets of the two tube sizes, however, Analysis of Variance, or ANOVA, testing determined the two tube sizes yielded different results at 0.08 g/100 ml. To investigate this potential disparity, this study fortified new samples at 0.08 g/100 and focused on two variables: fill volume and storage duration, while increasing the sample population (to n = 8). For this study, the two tube types yielded equivalent concentrations under the majority of conditions studied. Differences between the two tube types were found using paired t‐test for the high‐volume samples on Days 7 and 30; ANOVA yielded the same results but also determined one additional statistical difference for the Day 30 low‐volume samples. However, the differences observed between tube sizes fall within standard deviation ranges established for the analytical method precision profile, indicating statistical differences are not analytically significant. Further studies are needed to investigate the comparability of the tubes under real‐world conditions, under which oxygen and/or additives are not added during sample preparation steps or by usage of blood bank products. [ABSTRACT FROM AUTHOR]

Background: Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists). Methods: The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables. Results: Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08). Conclusion: Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit. [ABSTRACT FROM AUTHOR]

Race/ethnicity has been strongly associated with substance use testing but little is known about this association in injured patients. We sought to identify trends and associations between race/ethnicity and urine toxicology (UTox) or Blood Alcohol Concentration (BAC) testing in a diverse population after trauma. We conducted a retrospective cross-sectional study of adult trauma patients admitted to a single Level-1 trauma center from 2012 to 2019. The prevalence of substance use testing was evaluated over time and analyzed using a multivariable logistic regression, with a subgroup analysis to evaluate the interaction of English language proficiency with race/ethnicity in the association of substance use testing. A total of 15,556 patients (40% White, 13% Black, 24% Latinx, 20% Asian, and 3% Native or Unknown) were included. BAC testing was done in 63.2% of all patients and UTox testing was done in 39.2%. The prevalence of substance use testing increased over time across all racial/ethnic groups. After adjustment, Latinx patients had higher odds of receiving a BAC test and Black patients had higher odds of receiving a UTox test (P < 0.001 and P < 0.001, respectively) compared to White patients. Asian patients had decreased odds of undergoing a UTox or BAC test compared to White patients (P < 0.001 and P < 0.001, respectively). Patients with English proficiency had higher odds of undergoing substance use testing compared to those with limited English proficiency (P < 0.001). Despite an increase in substance use testing over time, inequitable testing remained among racial/ethnic minorities. More work is needed to combat racial/ethnic disparities in substance use testing. [ABSTRACT FROM AUTHOR]

Transdermal alcohol biosensors that do not require active participation of the subject and yield near continuous measurements have the potential to significantly enhance the data collection abilities of alcohol researchers and clinicians who currently rely exclusively on breathalyzers and drinking diaries. Making these devices accessible and practical requires that transdermal alcohol concentration (TAC) be accurately and consistently transformable into the well-accepted measures of intoxication, blood alcohol concentration/breath alcohol concentration (BrAC). A novel approach to estimating BrAC from TAC based on covariate-dependent physics-informed hidden Markov models (HMMs) with two emissions is developed. The hidden Markov chain serves as a forward full-body alcohol model with BrAC and TAC, the two emissions, assumed to be described by a bivariate normal which depends on the hidden Markovian states and person-level and session-level covariates via built-in regression models. An innovative extension of hidden Markov modeling is developed wherein the HMM framework is regularized by a first-principles PDE model to yield a hybrid that combines prior knowledge of the physics of transdermal ethanol transport with data-based learning. Training, or inverse filtering, is effected via the Baumâ€"Welch algorithm and 256 sets of BrAC and TAC signals and covariate measurements collected in the laboratory. Forward filtering of TAC to obtain estimated BrAC is achieved via a new physics-informed regularized Viterbi algorithm which determines the most likely path through the hidden Markov chain using TAC alone. The Markovian states are decoded and used to yield estimates of BrAC and to quantify the uncertainty in the estimates. Numerical studies are presented and discussed. Overall good agreement between BrAC data and estimates was observed with a median relative peak error of 22% and a median relative area under the curve error of 25% on the test set. We also demonstrate that the physics-informed Viterbi algorithm eliminates non-physical artifacts in the BrAC estimates. [ABSTRACT FROM AUTHOR]

Driving under the influence of alcohol is one of the greatest dangers to the safety of road users not only in Germany, but across the rest of the world. An essential indicator for both punitive and corrective measures as well as for the prediction of recidivism is the blood alcohol concentration (BAC). This paper examines the relationships between BAC of first-time offenders, former drinking history, traffic related alcohol problem (TRAP), and the outcome of a medical-psychological assessment. The concept of TRAP combines syndromes from Alcohol Use Disorders (AUD) and a non-clinical delinquency category (drink and drive issue without AUD). It is in use for diagnostics among "hard core" alcohol-impaired offenders according to a diagnostic model which is applied in Germany and accepted by the legislator. The present study (N = 505) showed that a BAC of 0.11% upwards must be considered as a risk parameter for the identification of drivers with non-normative, and therefore traffic safety impairing drinking patterns. The importance of BAC as a risk indicator for road safety is underlined by significant correlations between BAC with drinking history and TRAP, but its prognostic value is poor, since BAC was unrelated to the outcome of the medical-psychological assessment. It could be demonstrated that TRAP severity increases with higher age, higher BAC, greater number of drinking days, higher occasion-related drinking amounts, and non-social drinking motivation (against stress and tension). Practical consequences are drawn regarding preconditions for re-issuing a driving licence. [ABSTRACT FROM AUTHOR]

Background: Injuries account for a major proportion of global morbidity and mortality related to alcohol use. Information on the prevalence of alcohol-related injury in rural Sri Lanka is limited. The aims of this study were to determine the burden of alcohol-related injury in a hospital-based sample in rural Sri Lanka and explore factors associated with an increased risk of alcohol-related injury.Methods: Involvement of alcohol in injury amongst in-patients was assessed in three hospitals in the North Central Province of Sri Lanka over 6 months. Adult (≥ 18 years) patients were eligible. Patients were assessed for: injury characteristics, current alcohol use (in the past year) using the Alcohol Use Disorder Identification Test (AUDIT), and acute intoxication. Patients with a blood alcohol concentration (BAC) reading equivalent of 10 mg/dL (2.17 mmol/L) were considered as having an alcohol-related injury. Binary logistic regression was used to explore association between alcohol-related injury and demographic and injury characteristics.Results: A total of 883 injured patients were eligible and consented to the study. No alcohol use was reported by 487 (55.2%) of patients (35.6% of men, 95.2% of women). Prevalence of alcohol-related injuries was 14.8% overall and 32.8% among current alcohol users. Almost all patients with an alcohol-related injury were male (122/123; 99.2%); 24 (18.8%) of these patients scored positive for possible alcohol dependence. Patients with an alcohol-related injury had significantly higher AUDIT scores (median = 15 vs 6, p < 0.001), were significantly more likely to be aged 26-40 (OR 2.29, 95% CI:1.11, 4.72) or 41-55 years (OR 2.76, 95% CI: 1.29, 5.90) (compared to 18-25 years), to have a transport-related injury (OR 5.14, 95% CI: 2.30, 11.49) (compared to animal/plant sting/bite), and have intentional injuries (OR 3.47, 95% CI: 1.01, 11.87).Conclusions: One in three injuries among people who drank alcohol in this sample were alcohol-related. In addition, problematic alcohol use was higher among those with alcohol-related injury. Further work is needed to explore whether this prevalence of alcohol-related injury is reflected in other rural settings in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder is a chronic disorder with a high likelihood of relapse. The consistent monitoring of blood alcohol concentration through breathalyzers is critical to identifying relapse or misuse. Smartphone apps as a replacement of or in conjunction with breathalyzers have shown limited effectiveness. Yet, there has been little research that has effectively utilized wireless or Wi-Fi--enabled breathalyzers that can accurately, securely, and reliably measure blood alcohol concentration. Objective: The purpose of this study is to evaluate the impact of a wireless blood alcohol concentration device in collaboration with long-term treatment on dropout rates, psychological distress, treatment motivation, quality of life, and need for higher levels of follow-up care for patients with alcohol use disorder. Methods: The randomized clinical trial will include two arms, access to the wireless breathalyzer versus no access to the breathalyzer, while both groups have access to treatment. Evaluation will last 3 months with a 6-week follow-up, during which each participant will be interviewed at admission, 1 month in, 2 months in, 3 months in, and follow-up. Individuals will be recruited online through a secure telehealth meeting invitation. Outcomes will focus on the impact of the wireless breathalyzer within the alcohol use disorder population, and the combined effect on psychological distress, treatment motivation, and quality of life. In addition, we intend to investigate the impact of the breathalyzer on dropout rates and participants'need for higher levels of follow-up care and treatment. Results: The recruitment of this study started in July 2020 and will run until 2022. Conclusions: This information will be important to develop cost-effective treatments for alcohol dependence. Ongoing monitoring allows treatment providers to take an individualized disease management approach and facilitates timely intervention by the treatment provider. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the prevalence of drinking and driving on roadways in urban areas and highways in Cameroon, and to determine the associations between drinking and driving and socio-demographic factors.Methods: A cross-sectional study of motor vehicle drivers was performed on Fridays, Saturdays, and Sundays between May and September 2020 with three driver groups: (1) random motor vehicle drivers (including riders) on major highways, (2) drivers recruited at car stations in Yaoundé, and (3) at fuel stations in Douala. Alcohol was measured using breathalyzers, and a questionnaire collected socio-demographic data.Results: In total, 2402 motor vehicle drivers were asked to participate in the study and 1701 (70.8%) gave informed consent. The vast majority (98.6%) were men. Drivers aged 30-39 years constituted the largest age group on highways and in Yaoundé, whereas 18-29 years was the largest age group in Douala. The highest prevalence of alcohol was observed among drivers in Yaoundé, which included mainly clandestine taxi car drivers and motorcycle taxi riders, where about 30% had blood alcohol concentrations (BAC) above the legal limit of 0.08%. The proportion with BACs above the legal limit was about 6% among the drivers in Douala, which included mainly motorcycle taxi riders, and about 4% among drivers on highways.Conclusions: The findings indicate that drinking and driving is a major traffic safety problem on Cameroonian public roads, especially among motorcycle taxi riders and clandestine taxi drivers in towns, which represent the major mass transportation means in the country. Drinking and driving education and legislation should be better developed and enforced in order to reduce the number road traffic crashes. [ABSTRACT FROM AUTHOR]

This paper focuses on the analysis of the system of equations that describes the blood alcohol concentration (BAC) involving two linked absorption processes, first in the stomach and then in the blood. Each process was modeled with conformable and Caputo derivatives; thus, in this way, the BAC was simulated via four different derivative combinations. In the analysis, the dimensional homogeneity of the equations was maintained. The efficiency (with respect to the classical integer order model) of the obtained solutions was estimated by fitting them to experimental data. The Caputo-conformable combination leads to the highest efficiency followed by the conformable-conformable combination. [ABSTRACT FROM AUTHOR]

Historically, blood alcohol concentration (BAC) studies utilized a 1% concentration of the preservative sodium fluoride (NaF), leaving an information gap supporting usage of lower concentrations of NaF to preserve ethanol. As many forensic laboratories utilize Becton, Dickinson and Company 6‐mL gray‐top tubes (0.25% NaF), statistical comparisons were conducted to determine whether significant differences exist between BAC values obtained from 6‐mL tubes versus 10‐mL tubes (1% NaF). Whole blood was spiked at three concentrations, (0.04, 0.08, and 0.15 g/100 mL) and aliquoted into tubes at "low," "medium," and "high" fill volumes. Tubes were split into refrigerated or ambient storage and analyzed after 1, 3, 5, 7, and 30 days, using headspace gas chromatography. Each 6‐mL and 10‐mL tube pair, prepared, stored, and analyzed under identical conditions, was compared by t‐test (95% confidence level). For refrigerated tubes, 32 of 45‐tube pairs did not reject the null hypothesis (that 6‐mL and 10‐mL tubes yield equivalent BACs), and 31 of 45 ambient stored tube pairs did not reject the null hypothesis. Analysis of variance (ANOVA) found no significant differences between 6‐mL and 10‐mL gray‐top tubes for 0.04 and 0.15 g/100 mL concentrations over 30 days; significant differences were observed for 0.08 g/100 mL concentration tubes, which warrants further study. Paired t‐tests of grouped samples found no significant differences between 6‐mL and 10‐mL tubes at any concentration. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to estimate the number of crash deaths specifically attributable to alcohol-impaired driving, with a focus on various strategies for introducing vehicle-based solutions. If alcohol detection systems are standard in all new vehicles, how many lives could be saved in the near term, and how long will it take to essentially eliminate alcohol-impaired driving? Alternatively, if such systems are offered as an option, how many lives could be saved?Methods: Fatal crashes in the United States during 2015-2018 were classified by the highest driver blood alcohol concentration (BAC) and the corresponding age category of that driver. Based on the estimates of relative risk (RR) for a given driver group, eliminating alcohol in the driver's blood should lower risk by the attributable proportion, 1 - 1/RR. Multiplying this quantity by the number of deaths for the driver group yielded the estimated number of lives potentially saved if the BACs were reduced to zero.Results: Systems that restrict drivers with any BAC could prevent nearly 12,000 deaths per year, while systems that restrict BAC to less than 0.08 g/dL could prevent more than 9,000 deaths. Within 3 years of a mandate for vehicle-based alcohol detection systems, it is expected that the annual lives saved would be between 1,000 and 1,300. Within 6 years, it would be between 2,000 and 2,600 lives saved per year, and within 12 years it would be between 4,600 and 5,900 lives saved per year. A system required only for those convicted of alcohol-impaired driving could save between 800 and 1,000 lives per year. A system available only to fleets of vehicles could save between 300 and 500 lives per year.Conclusions: Vehicle-based interventions will not immediately solve the problem of alcohol-impaired driving, but they are an important component of the overall strategy. Even if required as standard equipment in all new vehicles, it will take 12 years before there are enough to reach more than half of their potential. If vehicle-based interventions are instead voluntary or introduced as options, then progress toward a solution will be much slower. [ABSTRACT FROM AUTHOR]

Death due to acute alcohol poisoning lacks specific anatomical characteristics, compared with other deaths due to drug poisoning. We report three forensic cases of death from acute alcohol poisoning due to inhibition of the respiratory centre and eventual asphyxia. Blood alcohol concentrations in the three fatalities were 5.28, 3.33 and 3.78 mg/mL, respectively. Lethal doses and blood alcohol concentrations showed differences between individuals. Detailed auxiliary tests besides autopsy were undertaken. These cases show that forensic scientists should exclude other causes of death, combine the autopsy with auxiliary tests, and then make an appraisal. [ABSTRACT FROM AUTHOR]

Aims: Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. Methods: The Queensland Suicide Register in 2004–2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. Results: BAC information was available for 6744 suicides, 92% of all cases in 2004–2015. The final model showed that independent factors distinguishing BAC+ from BAC− were: age group 25–44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. Conclusions: Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment. [ABSTRACT FROM AUTHOR]

Background: In June 2013, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 to 0.03 mg/mL in Taiwan. Thus, this study aimed to assess the epidemiological changes in terms of drinking among drivers in southern Taiwan before and after the law was imposed. Methods: Only patients who had undergone the BAC test at the emergency room were included in the study. The patients during the study period before (n = 2735) and after (n = 2413) the implementation of the law were selected for comparison. Drunk patients were defined as those who had a BAC ≥ 0.005 and were considered as driving under the influence (DUI) of alcohol. Meanwhile, driving while intoxicated (DWI) was defined as a BAC ≥ 0.05, which was the level adopted in the new law. Results: Since the BAC limit lowered to 0.03, the number of DUI patients significantly decreased from 340 (12.4%) to 171 (7.1%), and that of DWI patients significantly reduced from 273 (10.0%) to 146 (6.1%) based on the alcohol test. In addition, after the implementation of the law, the number of associated injuries did not significantly decrease from that before the law was implemented in patients involved in alcohol-related crashes. Conclusion: After lowering the legal BAC limit from 0.05 to 0.03, responsiveness to the change in law was observed among the studied population. However, such responsiveness may not be observed in some citizens who may need special interventions to help reduce their behavior of drinking and driving. [ABSTRACT FROM AUTHOR]

Background: Motorcyclists who drink and drive are at a higher risk of death and disability than other types of drivers. The purpose of this study was to query a national trauma database to evaluate the impact of elevated blood alcohol concentration (BAC) on outcomes in patients who sustained injury following a motorcycle crash.Methods: The National Trauma Data Bank (NTDB) data was accessed from 2012 to 2014. Patients ≥ 18 years of age who sustained a traumatic injury following a motorcycle accident with a confirmed blood alcohol test at the time of arrival to the hospital were included. Other variables examined were: sex, race, injury severity score (ISS), and initial Glasgow Coma Scale motor score (GCSMOT), systolic blood pressure (SBP, mm Hg), SBP <90, and comorbidities. Patients with a blood alcohol concentration (BAC) at or beyond the legal limit (0.08 g/dL) comprised the "alcohol positive" group, while those with a BAC confirmed negative comprised the "alcohol negative" group. The patients who tested BAC < 0.08 g/dl were excluded from the analysis. The primary outcome of the study was in-hospital mortality. Univariate followed by propensity matched analysis was performed. All p-values were 2 sided and p-values < 0.05 were considered statistically significant.Results: Of 113,843 patients involved in motorcycle crash, 67,183 patients underwent BAC testing. The majority (68.52%) tested negative, 21.14% tested positive above the legal limit and remaining 10.34% tested with a BAC <0.08 g/dl . A total of 29,922 patients, satisfied the inclusion criteria for final analysis. After propensity score matching, there was 100% improvement on standardized mean difference on matching variables (age, sex, race).However, differences continued between the groups on, SBP < 90, ISS and GCSMOT. The hospital mortality rates were 3.1% vs 3.9% (P < 0.001) between alcohol negative and the alcohol positive groups, respectively. The odds ratio of mortality in alcohol positive group was 1.27 (95% CI: 1.07, 1.53) and the absolute risk difference in hospital mortality was 0.008 (CI: 0.002, 0.014).Conclusion: Patients who tested with a BAC above the legal limit sustained a higher injury severity score and higher in-hospital mortality compared to patients who tested negative. [ABSTRACT FROM AUTHOR]

Addition of ethanol in human serum albumin decelerates the protein dynamic process upon temperature jump. [Display omitted] • Addition of ethanol in human serum albumin decelerates the protein dynamics. • The effect of alcohol is weakened at slightly hyperthermic temperatures. • Understanding the role of alcohol in perturbing HSA at the molecular level. The addition of ethanol at concentrations ≤ 1.0 vol% in human serum albumin (HSA) at the physiological concentration (ca. 47 mg L−1) does not influence the secondary structure but decelerates the protein dynamic process of HSA upon thermal stimulus probed by fluorescent temperature jump technique. The biological implication may be that inebriated persons are less sensitive to environmental stimuli because their HSA molecules may act more slowly when interacting with chemicals in the blood. This result provides an alternative perspective on the role of alcohol in perturbing the biological function of HSA at the molecular level. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to examine the impact of blood alcohol concentration (BAC) on the occurrence of pneumonia and sepsis among traumatic injury victims.Methods: Retrospective study data were retrieved from the 2007-2010 National Trauma Data Bank and included all patients ≥14 years of age, with a "blunt" or "penetrating" injury, who were taken to a level 1 or level 2 trauma center, had complete systolic blood pressure and heart rate records, and had a confirmed blood alcohol test at the time of hospital arrival. Patients' characteristics and outcome information were compared between two groups (those with a BAC above the legal limit [>0.08 g/dL] and those with a negative BAC result), followed by propensity score matching and a follow-up paired analysis.Results: Of 279,460 patients, 92,960 tested positive for alcohol with a BAC above the legal limit. There were clear demographic differences between the groups (p < 0.001). Therefore, propensity score matching was performed to better balance the groups and the resulting standardized mean differences of less than 10% indicated successful matching. When comparing the occurrence of both pneumonia and sepsis between the matched pairs, there was a statistically significantly higher rate of pneumonia in the alcohol positive patients, 8.0% vs. 7.3%, (p = 0.03), but no significant clinical difference. Additionally, no significant difference was observed for the rate of sepsis across the groups (p = 0.62).Conclusion: Patients who tested positive for alcohol following a traumatic injury showed a statistically higher incidence of pneumonia, but there was no clinically significant difference. Additionally, there was no significant difference identified in the incidence of sepsis between the BAC groups. [ABSTRACT FROM AUTHOR]

Objective: Road traffic injury (RTI) is one of the most significant public health problems in Thailand, especially during New Year and Songkran (Thai traditional New Year) holidays, which have the highest traffic density during the entire year. Drunk driving was reported to be one of the leading causes of RTI in Thailand. This study aimed to investigate the prevalence of patients with high blood alcohol concentration (BAC) and the association of BAC and specific organ injury during New Year and Songkran (Thai traditional New Year) holidays.Methods: A cross-sectional study was performed to analyze the database from the Thai Governmental Road Safety Evaluation Project. Patient data on RTIs were collected from 26 main provincial hospitals during the New Year Festival 2003 and 2004 and Songkran Festival in 2003. Patient characteristics, type of organ injured, and BAC levels were mainly analyzed.Results: During those long holidays, 2,642 RTI patients were identified, among whom 1,341 patients had high BAC levels. High BAC levels were associated with motorcycle users, male sex, middle age, teenagers, being riders or drivers, and not using protective devices. Moreover, high BAC levels were associated with brain injury.Conclusion: Excessive alcohol consumption and RTIs occurred on New Year and Songkran Festival in Thailand. Legislation should be strictly used during these long holidays to control driving under the influence of alcohol, particularly among motorcyclists. [ABSTRACT FROM AUTHOR]

Although the benefits of sauna bathing have been demonstrated in epidemiological studies, sauna deaths have been reported. The aim of this study was to determine the demographic and forensic characteristics associated with different blood alcohol concentrations (BACs) in sauna deaths in Korea. In this retrospective analysis, data were collected from a nationwide pool in Korea between January 2008 and December 2015 to determine the role of alcohol intoxication in sauna deaths based on the subjects’ BAC and to evaluate the demographic and forensic characteristics associated with different BACs. One hundred and three deaths were classified into 2 groups: the non-intoxication (NI) group (BAC,<0.08%; n = 27) and the intoxication (I) group (BAC,≥0.08%; n = 76). Demographic and forensic characteristics were compared between the groups using a multinomial logistic regression analysis. The proportions of decedents who were male (odds ratio: 17.4, 95.0% confidence interval: 3.8-79.8) and in a prone position at the scene of death (odds ratio: 11.3, 95.0% confidence interval: 2.1-60.1) were significantly higher (P < 0.001 and P < 0.05, retrospectively) in the I group than in the NI group. However, no significant differences were observed with respect to obesity, coronary artery narrowing, and liver pathology. Sauna deaths exhibited different characteristics according to BACs detected at autopsy. The differences in sauna deaths between the I and NI groups may have implications for the targeted prevention of sauna deaths associated with alcohol consumption. [ABSTRACT FROM AUTHOR]

Background In recent years, there has been increasing attention to “lower BAC” drinking drivers, typically those whose blood alcohol content (BAC) is under the legal limits defined in criminal law. In 2009, legislation was enacted in Ontario, Canada that enabled police to issue roadside license suspensions to individuals caught driving with BAC between 0.05% and 0.08%, known as the “warn range”. Multiple warn range (MWR) offenders are required to attend the Back on Track (BOT) remedial measures program. This study aimed to provide: (1) a preliminary characterization of MWR drivers charged under warn range legislation; and (2) an initial assessment of outcomes associated with BOT participation among MWR offenders. Methods A subsample of 727 MWR offenders was drawn from program records, and compared to samples of 3597 first-time Criminal Code (CC) offenders (those caught driving with a BAC of 0.08% or higher) and 359 second-time CC offenders. To provide an initial assessment of outcomes associated with BOT participation, another subsample consisted of 394 MWR participants from whom pre- and post-workshop questionnaires were collected and successfully matched using probabilistic matching processes. Results Similarities in demographic profile and driving history between MWR and first-time CC participants were apparent. MWR offenders scored higher on risk of problem drinking and drink-driving recidivism than either of the CC offender groups. Second-time CC offenders scored higher on these measures than first-time CC offenders. Following BOT participation, MWR participants demonstrated positive change including improved knowledge of and intentions to avoid drink-driving. Conclusions MWR offenders share a similar demographic profile to that of first-time CC offenders and they report significantly higher risk of problem drinking and recidivism. MWR offenders may include high-functioning problem drinkers who are likely to continue drink-driving and who may escalate to a CC drink-driving offense. Like CC offenders, MWR offenders benefited from BOT participation. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Breathalyser estimate of blood alcohol concentration (BAC) is widely used as an objective intoxication measure, but is not always practical in nightlife contexts. This study uses in situ data collected in nightlife environments to explore how four measures of intoxication are related so as to inform the development of a more practical and reliable method of differentiating intoxication for people working in the night-time economy.Design and Methods: Nightlife patron interviews were conducted in five Australian cities. Participants completed demographic questions and were asked about current session (past 12 h) alcohol use, and four different measures of intoxication were assessed: BAC, participant's self-reported intoxication (0-10), interviewer rating of the participant's intoxication (0-10) and interviewer-rated number of the participants' of physical signs of intoxication.Results: A total of 7028 patrons were surveyed and n = 5273 included in analysis. Mean age was 23.9 years (SD = 6.36); 61.5% were male. There was a significant difference in occurrence of all observable intoxication symptoms across differing levels of BAC (P < 0.001). All visible symptoms became more common as intoxication increased, except for talking very quickly/talkative and giggly symptoms. As BAC levels increase, the extent of the disagreement between self-rated and interviewer-rated intoxication measures widens. Exhibiting four or more visible intoxication symptoms emerged as a reliable method for observers to identify intoxicated patrons.Discussion and Conclusions: As BAC increases, people become worse at estimating their own intoxication, but sober observers remain relatively accurate. Findings provide support for efforts to strengthen and enforce responsible service of alcohol. [ABSTRACT FROM AUTHOR]

Alcohol operant self-administration paradigms are critical tools for studying the neural circuits implicated in both alcohol-seeking and consummatory behaviors and for understanding the neural basis underlying alcohol-use disorders. In this study, we investigate the predictive value of two operant models of oral alcohol self-administration in mice, one in which alcohol is delivered into a cup following nose-poke responses with no accurate measurement of consumed alcohol solution, and another paradigm that provides access to alcohol via a sipper tube following lever presses and where lick rate and consumed alcohol volume can be measured. The goal was to identify a paradigm where operant behaviors such as lever presses and nose pokes, as well as other tracked behavior such as licks and head entries, can be used to reliably predict blood alcohol concentration (BAC). All mice were first exposed to alcohol in the home cage using the "drinking in the dark" (DID) procedure for 3 weeks and then were trained in alcohol self-administration using either of the operant paradigms for several weeks. Even without sucrose fading or food pre-training, mice acquired alcohol self-administration with both paradigms. However, neither lever press nor nose-poke rates were good predictors of alcohol intake or BAC. Only the lick rate and consumed alcohol were consistently and significantly correlated with BAC. Using this paradigm that accurately measures alcohol intake, unsupervised cluster analysis revealed three groups of mice: high-drinking (43%), low-drinking (37%), and non-drinking mice (20%). High-drinking mice showed faster acquisition of operant responding and achieved higher BACs than low-drinking mice. Lick rate and volume consumed varied with the alcohol concentration made available only for high- and low-drinking mice, but not for non-drinking mice. In addition, high- and low-drinking mice showed similar patterns during extinction and significant cue-induced reinstatement of seeking. Only high-drinking mice showed insensitivity to quinine adulteration, indicating a willingness to drink alcohol despite pairing with aversive stimuli. Thus, this study shows that relying on active presses is not an accurate determination of drinking behavior in mice. Only paradigms that allow for accurate measurements of consumed alcohol and/or lick rate are valid models of operant alcohol self-administration, where compulsive-like drinking could be accurately determined based on changes in alcohol intake when paired with bitter-tasting stimuli. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed whether college student (1) protective behavioral strategy (PBS) use differed between those who reached legal intoxication during their most recent drinking episode compared to those who did not reach the legal blood alcohol concentration (BAC) threshold, and (2) frequency of PBS use could explain the variance associated with BAC during the most recent drinking episode, above and beyond one's sex, age, and involvement in the Greek system.Design: Secondary data analysis of the American College of Health Association's National College Health Assessment.Setting: Forty-four distinct campuses were included.Participants: A total of 21479 college students were included.Measures: BAC and PBS were measured.Analysis: The data were analyzed by conducting both independent samples t-tests and a multiple regression model. Effect sizes are reported.Results: Participants who reached legal intoxication used PBS less frequently ( P < .001; d = 0.80). Frequency of PBS use had the strongest unique contribution to the regression model (β = -.315, P < .001), such that participants with higher BAC reported less frequent use of PBS.Conclusion: Interventions should seek to develop strategies that encourage college student use of PBS prior to, and during, drinking episodes. More frequent use of PBS can reduce intoxication as well as occurrence of alcohol-associated consequences. [ABSTRACT FROM AUTHOR]

Hangover due to alcohol consumption causes social and physical problems. There is a growing interest in edible insects worldwide. We have previously published a new technology to make hard mature silkworm, Bombyx mori , into edible form, steamed and freeze-dried mature silkworm larval powder (SMSP). In this study, AIN-76 or SMSP (0.1 and 1 g/kg rat body weight) containing diets in SD rats were pretreated for 2 weeks, and ethanol (3 g/kg rat body weight) was administered as an oral gavage and sacrificed after 3 hours. As a result, blood alcohol and aldehyde levels were significantly decreased in SMSP fed rats. In addition, liver injury markers, alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were significantly decreased in SMSP group compared to ethanol group. TNF-a, an inflammatory cytokine, and malondialdehyde (MDA), an oxidative stress marker, also showed a dosedependent decrease in the group receiving SMSP. Conclusively, consumption of SMSP not only reduced hangover induced by ethanol, but also decreased liver damage, oxidative stress, and inflammatory response. [ABSTRACT FROM AUTHOR]

Objective: Drink driving is widely recognized as a major road safety problem. In Australia, health promotion messages encourage monitoring the number of standard drinks consumed prior to driving. This pilot research aimed to investigate commuting behavior and blood alcohol concentration (BAC) of diners, including intended drivers, at Sunshine Coast restaurants.Methods: Five hundred and forty-four diners (n = 260 males) consented to participate in a brief interview and to use a breathalyzer device to measure their BAC.Results: Forty percent of participants advised they don't drink and drive (34% of males, 45% of females; 67.25% of <17-20 years, 30.5% of 50-59 years), and of the remaining participants, 75% advised they count the number of their drinks (69% of males, 84% of females; 32% of <17-20 years, 82% of 50-59 years), while 10% of participants monitored their BAC by how they were feeling (12% of males, 6% of females). Thirty-seven percent of participants said it was easy/very easy to estimate their BAC (41% of males; 33% of females; 21% of <17-20 years, 43% of 50-59 years). The actual BAC was less than expected for 56% of participants, with one-third underestimating BAC and some intended drivers having an actual BAC in excess of the 0.05 limit.Conclusions: Given the proportion of diners who reported they count the number of drinks, or use feelings as a way to gauge BAC, coupled with the considerable proportion who underestimated their BAC, a safer public health message is to avoid driving if you intend to drink. In addition, targeted intervention for experienced drivers (and, arguably, drinkers) appears warranted, as every participant aged less than 21 years who stated he or she would drive home indeed had a zero BAC. Interestingly every female driver who stated she would be driving home also had a legal BAC, suggesting gender-specific intervention. [ABSTRACT FROM AUTHOR]

Background: The public health costs associated with alcohol-related traffic crashes are a continuing problem for society. One harm reduction strategy has been to employ per se limits for blood alcohol concentrations (BACs) at which drivers can legally operate motor vehicles. This limit is currently 0.08% in all 50 US states. Recently, the National Transportation Safety Board proposed lowering the legal limit to 0.05% (NTSB, 2013). While research has well-validated the ability of alcohol to impair driving performance and heighten crash-risk at these BACs, relatively little is known about the degree to which alcohol might increase drivers' risk-taking.Methods: Risk-taking was examined in 20 healthy adults who were each tested in a driving simulator following placebo and two doses of alcohol calculated to yield peak BACs of 0.08% and 0.05%, the respective current and proposed BAC limits. The drive test emphasized risk-taking by placing participants in a multiple-lane, high-traffic environment. The primary measure was how close drivers maneuvered relative to other vehicles on the road (i.e., time-to-collision, TTC).Results: Alcohol increased risk-taking by decreasing drivers' TTC at the 0.08% target BAC relative to placebo. Moreover, risk-taking at the 0.05% target was less than risk-taking at 0.08% target BAC.Conclusions: These findings provide evidence that reducing the legal BAC limit in the USA to 0.05% would decrease risk-taking among drivers. A clearer understanding of the dose-response relationship between various aspects of driving behaviors, such as drivers' accepted level of risk while driving, is an important step to improving traffic safety. [ABSTRACT FROM AUTHOR]

Background: There is a growing trend of preloading with alcohol before entering entertainment districts. It is claimed that this occurs to save money and that preloading may be a good indicator of harmful drinking and risk taking behaviours more generally. No study has collected data from a large sample as the participants entered entertainment districts and measured blood alcohol concentration (BAC) levels and self-reported drinking and risk taking behaviours in a systematic way.Methods: In this research, police and academics worked together to gauge the breadth and depth of preloading behaviours. In all, 3039 people completed a questionnaire and were breathalysed as they entered entertainment districts in Queensland, Australia. Of those, 2751 represented people from Brisbane and this data, collected every Thursday night to Sunday morning during the warm months, was analysed.Results: More than 79% of people reported to preload and 71% returned a BAC greater than zero, both with little difference between the genders. Of preloaders, the mean BAC was 0.071, with 'to socialise with friends' being the primary reason given for preloading. Increasing preloading BAC was related to increasing risk taking and antisocial behaviours, as well as alcohol abuse and dependence. Older people entering entertainment districts had more accurate estimates of their BAC, yet 20% of our sample did not understand how the BAC system worked. Conducting the research was associated with a higher access rate to police and a lower arrest rate in the areas of data collection in comparison to the same nights 1year earlier.Conclusion: Preloading is widespread and involves moderate to heavy drinking in the Australian population visiting entertainment districts. Any interventions to curb drinking behaviours and reduce violence in night time entertainment districts need to involve approaches aimed at cultural phenomena, such as preloading behaviours. [ABSTRACT FROM AUTHOR]

The blood alcohol concentration (BAC) is the most frequent determination in a Forensic Toxicology Laboratory. Despite its apparent simplicity, the results interpretation can be complex and always have relevant social and legal implications, particularly in postmortem analysis. In the present report we describe the case of a 55-year-old male with an apparent natural death by myocardial infarction, whose initial BAC was 0.18g/L but, in repeated determinations prompted by discrepancies observed in the first two, it rapidly increased to 0.85g/L three days later, leading to the suspicion of in vitro ethanol production. A microbiological examination of the sample revealed the presence of the bacteria Escherichia coli and Enterococcus faecalis, and yeast Candida parapsilosis, known for their involvement in ethanol production. Although this is a case report and it is not meant to be generalizable, we discuss an existing large body of scientific literature showing the difficulties, limitations and some relevant medico-legal questions regarding BAC determinations in postmortem samples and their interpretation, particularly in the context of plausible in vitro ethanol production. The key conclusion is that evaluating a postmortem BAC is a complex and multifactorial process that always deserves a thorough analysis and a careful interpretation. [ABSTRACT FROM AUTHOR]

Objective The magnitude of acute tolerance is a strong predictor of the development of longer-term chronic tolerance and plays a decisive role in risky decisions (e.g., driving after drinking). Therefore, it is important to identify factors that increase the magnitude of this adaptive process. This study explored whether acute tolerance magnitude varied as a function of the overall rate of increase in breath alcohol concentration (BrAC). Methods Twenty-nine young adult social drinkers ( M age = 22.55, SD = 3.10; 62.1% women) consumed a moderate dose of alcohol (men: 0.86 g/kg, women: 0.75 g/kg) in a controlled laboratory setting. Subjective intoxication was assessed at matched BrACs (~0.060 g/dl) on each limb of the BrAC curve. Results Hierarchical regression results indicated that faster overall increases in BrAC on the ascending limb were associated with greater acute tolerance for subjective intoxication ratings ( p < .01, R2 = .29). Conclusions These results present some of the first evidence that faster increases in BrAC may be associated with greater acute tolerance, as indicated by greater reduction in subjective intoxication across the limbs of the BrAC curve. This greater reduction may, in turn, promote heavier drinking and/or engagement in behaviors for which one is unfit (e.g., driving after drinking). [ABSTRACT FROM AUTHOR]

• Alcohol-naïve Wistar rats licked small amounts of 66% alcohol. • Alcohol intake increased peripheral open field activity and blood concentration. • c-Fos expression increased in nucleus accumbens shell and insular cortex. • Tasting 66% alcohol occurred in food restricted and nonrestricted rats. • Central area activity correlated positively with licking for 66% alcohol. Whereas rodents generally reject high alcohol concentrations, access to 66% alcohol can reinforce operant licking in a progressive ratio situation. Three experiments were conducted to identify a potential mechanism underlying this effect. In Experiment 1, food-restricted male and female Wistar rats received access to either 66% alcohol or water in their home cage for one hour over four sessions. Consumption of alcohol and water was similar, showing that rats neither preferred nor rejected 66% alcohol. Peripheral (but not central) activity in an open field (OF) was higher after access to 66% alcohol than water, a result inconsistent with motor impairment. Blood alcohol concentration was higher after 66% alcohol than water and was positively correlated with fluid displacement and peripheral distance in the OF. c-Fos immunoreactivity after exposure to 66% alcohol vs. water showed increased activation in the nucleus accumbens shell, anterior cingulate cortex, and insular cortex. In Experiment 2, whether access to food was restricted (to an 81–84% of the ad libitum weight) or free (ad libitum), female Wistar rats licked at similar frequency from a sipper tube delivering 66% alcohol. This result is inconsistent with an account based on the caloric content of 66% alcohol. In Experiment 3, food-restricted male and female Wistar rats exhibited a positive correlation between activity in the central area of an OF (an index of sensation/novelty seeking) and licking for 66% alcohol. These results are consistent with the hypothesis that the reinforcing value of 66% alcohol is related to sensation/novelty seeking. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study is to establish the point at which a high blood alcohol concentration (BAC) in patients admitted to a hospital's emergency department (ED) after an automobile accident can increase the severity of the injury and influence the survival and death rates. Materials and Methods: Our study is a prospective performed on patients >18 years of age admitted to the ED for in-car road accidents (ICRA) between September 15, 2011 and September 14, 201214-09-2012. Information such as demographic features, trauma score systems, BACs, hospital charges, discharge, hospitalization, and death of the patients was recorded. Results: The BACs of 52 out of a total of 324 patients were determined to be above normal limits (50 mg/dL). The clinical condition of patients with a BAC above normal limits was relatively worse (42.9%) than those with a BAC within normal limits (p<0.05).The BAC was above normal limits for 30.0% of the hospitalized patients, for 50% of surgical patients, and for 45.5% of deceased patients. Conclusion: This study determined that there is a relationship between a high BAC and injury severity for patients admitted to the ED for ICRA and that a high BAC negatively affects the survival rate and increases the death rate in emergency medicine. [ABSTRACT FROM AUTHOR]

Blood alcohol concentration is the most frequent analytical determination carried out in forensic toxicology laboratories worldwide. It is usually required to assess if an offence has been committed by comparing blood alcohol levels with specified legal limits, which can vary widely among countries. Due to possible serious legal consequences associated with non-compliant alcohol levels, measurement uncertainty should be carefully evaluated, along with other metrological aspects which can influence the final result. The whole procedure can be time-consuming and error-generating in routine practice, increasing the risks for unreliable assessments. A software application named Ethanol WorkBook (EtWB) was developed at the author's laboratory by using Visual Basic for Application language and MS Excel(®), with the aim of providing help to forensic analysts involved in blood alcohol determinations. The program can (i) calculate measurement uncertainties and decision limits with different methodologies; (ii) assess compliance to specification limits with a guard-band approach; (iii) manage quality control (QC) data and create control charts for QC samples; (iv) create control maps from real cases data archives; (v) provide laboratory reports with graphical outputs for elaborated data and (vi) create comprehensive searchable case archives. A typical example of drink driving case is presented and discussed to illustrate the importance of a metrological approach for reliable compliance assessment and to demonstrate software application in routine practice. The tool is made freely available to the scientific community at request. [ABSTRACT FROM AUTHOR]