The diagnosis of drowning is one of the most difficult in forensic pathology and previously we proposed criteria for a positive tissue analysis according to the qualitative and quantitative diatom investigations. In the positive cases, we studied the reliability of determining the site of drowning by comparing the diatom taxa found in the lung samples with those of the water samples or in the absence of these samples with the results of the water diatom monitoring programme set up in our region. In this study, we present two series of cases, the first is one of 20 corpses who died from accidental or suicidal drowning with known drowning site, and the second of 20 corpses for which the drowning site was unknown. The results showed that a concordance of the abundance of the diatom taxa in tissues compared to the site of drowning and their distribution relative to one another was 65% in the group where the site of drowning was known and 35% in the other group. The concordance of the individual distribution in the lungs of water diatom taxa may be an interesting method to guide the investigations for determining the site of drowning. The two limiting factors are the concentration of diatoms in the lungs and the development of a river monitoring programme in the district of the study.

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Alford's theory of structural interests in health care has been used as a heuristic device both in the USA and the UK. Despite concerns about its heuristic power it provides a lucid analytical framework and is helpful in exposing the structural interests that underpin political processes in health systems. To date its application in the UK has been primarily in relation to an NHS dominated by health authorities and hospital providers. Recent reforms in the UK have created a new context dominated by primary care organizations. In this paper we identify the key players in English primary care groups as they relate to Alford's structural interest groups: the professional monopolizers, corporate rationalizers and community. The paper outlines the context of the involvement of the key groups and then analyses the relationships between them. In doing so it raises concerns about the structure and purpose of primary care groups and the probability that key tensions between general practitioners who adopt a corporate rationalizer role and those who retain a professional monopolizer role will be damaging to the progress and development of PCGs. Our analysis also highlights the continuing weakness of the community as an interest group despite the emphasis on involving patients and the public. Importantly, we would suggest that the professional monopolizers among GPs will retain a powerful voice, countering the new corporate rationalizers and continuing to claim that they represent the community's interests. Analysing Structural Interests in Primary Care GroupsAlford's () theory of structural interests in health care, which was originally deployed to explain local reform processes in the city of New York, has also been applied to the NHS (Ham ; Allsop ; Harrison et al. ; Wistow ; North ). There have been misgivings about its heuristic power (Harrison et al. ; North ) but it may be helpful in focusing attention on embedded interests underpinning political processes within the © Blackwell Publishers Ltd.  health services and in providing a lucid framework for analysis. Alford's three groups-the professional monopolizers, the corporate rationalizers and the community-reflecting in turn dominant, challenging and repressed interests in health care, have provided a succinct representation of the key stakeholders, visible or not, in health care politics. Structural interest theory has, however, been primarily applied in the UK to the hospital sector where reforms in the s were principally targeted. Recent reforms in the NHS in England have delegated responsibility for service development to local primary care groups (PCGs) and primary care trusts (PCTs). There is the prospect of more pluralistic decision making, derived not only from the constituent membership of the board but also from the expectation that PCG/Ts will solicit local views on services. However, decisions will be also be framed by budgetary pressures, NHS priorities and increasingly by national guidelines on treatment and se...

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