Unexpected Serotonin Syndrome,Epileptic Seizures,and Cerebral Edema Following 2,5‐dimethoxy‐4‐bromophenethylamine Ingestion

4‐bromo‐2,5‐dimethoxyphenethylamine (2C‐B) is a designer drug. In Europe, 2C‐B is easily obtained and used for recreational purposes. It is known for its stimulating effects similar to those of 3,4‐methylenedioxymethamphetamine, although in higher doses it has more hallucinogenic effects. Here, we report a case of 2C‐B ingestion, confirmed by liquid chromatography‐tandem mass spectrometry, in an 18‐year‐old man. The neurological consequences were severe, including the development of serotonin syndrome and severe brain edema. Supportive therapy resulted in a stable condition, although, after several months, the patient still suffered from severe neurological impairment due to the drug‐induced toxicity. This case showed that 2C‐B could not be identified with the drugs of abuse screening routinely used in Dutch hospitals. The use of 2C‐B carries many risks, with potentially profound neurological damage, that both consumers and healthcare physicians are unaware of.     

The Proliferation of Renewable Energy Systems will Continue Irrespective of Federal Support

James Richard Perry's U.S. Department of Energy recently released a staff report on electricity markets and reliability which, among other things, discussed concerns regarding the reliability of renewable energy system. Notably, however, the purported issues regarding renewable energy systems should be more accurately described as issues resulting from our aging electrical infrastructure, which is currently based on the 100-year old Edisonian peaker plant model. Accordingly, this article briefly reviews the environmental benefits of renewables, highlights new and exciting renewable technologies developed to overcome issues related to antiquated distribution networks, and discusses why the market for renewable energy systems will continue to flourish—regardless of U.S. Federal support.     

Relative Advantages of Person- and Variable-Based Approaches for Predicting Problem Behaviors from Kindergarten Assessments

Kindergarten teacher ratings of physical aggression, hyperactivity,inattention, anxiety, and prosocial behavior were used to predictself-reported delinquency, peer-rated social withdrawal, and schoolplacement in preadolescence (ages 10 to 12 years) in a large longitudinalsample of boys from low socio-economic neighborhoods. Two analyticstrategies were used: person-oriented and variable-oriented approaches. Inthe person approach, eight clusters, based on the kindergarten behaviors,were used to predict delinquency, social withdrawal, and schoolplacement. In the variable approach, the kindergarten behaviors were used asdimensions in logistic regressions. Family adversity was used as the firstpredictor in both approaches; it significantly predicted all the outcomes inpreadolescence. The results obtained using the two approaches were partly inaccordance. In both sets of results, kindergarten teacher-ratedexternalizing behavior problems were most related to later self-reporteddelinquency, and internalizing problems to peer-rated socialwithdrawal. However, the person approach showed that all patterns ofkindergarten behavior problems increased the risk for placement out of anage-appropriate regular classroom, while only inattention and lack ofprosocial behavior were the significant dimensional predictors of thisnegative outcome according to the variable approach. Also, the personapproach showed that the Multiproblem kindergarten boys had the highestpercentage of comorbidity of preadolescent problems. The ROC curvesindicated that prediction of delinquency, social withdrawal, and schoolplacement were equally accurate using the cluster and variableapproaches. Advantages and limits of both approaches are discussed withreference to their usefulness for clinicians.     

Modifying children's court care plans to acknowledge poverty and disadvantage

This think piece suggests that Children's Court Care Plans should include a new section that documents poverty and social disadvantage, especially of Aboriginal and Torres Strait Islander families, when they are under investigation for child abuse and neglect. New South Wales in Australia is used as the exemplar state, but this suggestion may find an echo elsewhere.

Points for practitioners

• As a general proposition social and economic circumstances should be considered in addition to parental dysfunction in child protection proceedings in Children's court.
• Care Plans prepared for hearings in the NSW Children's Court, often developed in response to serious harm report investigations, currently do not contain information about parents' poverty and social disadvantage and hence decontextualise family living circumstances.
• Consistent with international evidence, Care Plans should require information about parents' socioeconomic situation, including social disadvantage of residential neighbourhood, status and cost of household tenancy, and household income.
• Taking account of social and economic circumstances has the potential to generate savings in out-of-home care that can be re-allocated to support services to reduce poverty and social disadvantage and thereby reduce the need for removal of children from parental care.

     

Issue opacity and sustainability standard effectiveness

Many voluntary sustainability standards govern opaque environmental and social issues, which are difficult to understand and address. Extant studies show mixed evidence around the effectiveness of such standards. We develop a theoretical framework that relates different degrees and types of opacity to standard effectiveness. Systemic opacity results from issues embedded in complex, diverse, and dynamic settings, whereas behavioral opacity stems from human challenges in interpreting and acting upon focal issues. Rigid sustainability standards, oriented toward compliance, are effective for addressing issues that are transparent or enshrouded by behavioral opacity, but are counterproductive for issues with systemic opacity. The trade-off between rigidity and flexibility leads to optimal effectiveness when standards governing systemically and behaviorally opaque issues are moderately rigid. Our ideas are illustrated with two leading sustainability standards in the fisheries and real estate sectors, which effectively address transparent issues but show limited success when facing opacity. We conclude that unpacking issue opacity is instrumental in designing and implementing more effective sustainability standards.