Highlights
==========


**Avalanche fatalities** 

Of the 204 deaths among avalanche victims recorded between 1984 and 2005 in Canada, three-quarters were due to asphyxia and one-quarter to trauma. Boyd and colleagues note that this pattern differs from that in Europe, where trauma is responsible for only about 5% of avalanche deaths. **See Research, page** [507](http://www.cmaj.ca/lookup/volpage/180/507?iss=5)

In a related commentary, Brugger recommends changes to the on-site care of avalanche victims to give management of trauma greater prominence. **See Commentary, page** [491](http://www.cmaj.ca/lookup/volpage/180/491?iss=5)

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/5/477/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/180/5/477/F1)

Photo by: Photos.com

**Drug-facilitated sexual assault** 

Of the victims of sexual assault in a study based in Ontario, about one-fifth were victims of drug-facilitated sexual assault. Du Mont and colleagues found that victims of drug-facilitated sexual assault were more likely than other victims to have presented to a large urban centre, to be employed, and to have consumed over-the-counter medications, street drugs or alcohol before the suspected assault. **See Research, page** [513](http://www.cmaj.ca/lookup/volpage/180/513?iss=5)

In a related commentary, Butler and Welch say that prevention efforts should include education for both men and women. **See Commentary, page** [493](http://www.cmaj.ca/lookup/volpage/180/493?iss=5)

**Diastolic heart failure** 

Diastolic heart failure is not consistently defined, and little evidence exists of effective treatments for this condition, according to a review of existing research by Tzanetos and colleagues. Clinicians should focus on treating comorbidities such as hypertension, atrial fibrillation and coronary artery disease, they say. **See Review, page** [520](http://www.cmaj.ca/lookup/volpage/180/520?iss=5)

**Return on investment in health research** 

Frank and Nason discuss 2 approaches to measure return on investment in health research. The “payback model,” which was recently adopted and modified by the Canadian Institutes of Health Research, is favoured and may help optimize future evaluations. **See Analysis, page** [528](http://www.cmaj.ca/lookup/volpage/180/528?iss=5)

**Allergic interstitial nephritis** 

A 57-year-old man presented to hospital with a 2-week history of progressive malaise, myalgia, fever, nausea, vomiting, diarrhea, polyuria and polydipsia. Acute interstitial nephritis was diagnosed. The most frequent cause of this condition is an adverse drug reaction; in this patient, the condition was likely caused by pantoprazole. **See Practice, page [535](http://www.cmaj.ca/lookup/volpage/180/535?iss=5)**

![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/5/477/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/180/5/477/F2)

**Koplik spots in early measles** 

Measles has become an uncommon cause of rash and fever since the introduction of widespread vaccination. The presence of typical Koplik spots helped make the diagnosis in this patient. **See Clinical images, page** [583](http://www.cmaj.ca/lookup/volpage/180/583?iss=5)

**Health and the budget** 

Finance Minister Jim Flaherty's 2009/10 fiscal blueprint offers nothing for health infrastructure or health human resources. **See News, page** [497](http://www.cmaj.ca/lookup/volpage/180/497?iss=5)

![Figure3](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/180/5/477/F3.medium.gif)

[Figure3](http://www.cmaj.ca/content/180/5/477/F3)

Photo by: Reuters/Blair Gable

**Earn extra money** 

The ethics of physicians earning extra monies for persuading patients to participate in clinical trials. **See News, page** [500](http://www.cmaj.ca/lookup/volpage/180/500?iss=5)