Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

Buprenorphine is considered to have little respiratory side effects at therapeutic doses and the partial agonistic properties should produce a "ceiling effect" for respiratory depression at higher doses. Still, there are several reports on buprenorphine related deaths. Most deaths involve drug users and the co-administration of other CNS depressant drugs as well as reduced tolerance have been suggested to be risk factors. The primary aims were to investigate if lack of tolerance and/or co-ingestion of other psychotropic drugs are significant risk factors in buprenorphine fatalities. From July 2005 to September 2009, all autopsy cases where buprenorphine or norbuprenorphine had been detected in femoral blood and where analysis of buprenorphine had been performed in urine were selected. Results from the postmortem examination and toxicology were compiled. Postmortem toxicology was performed using the routine methodology at the laboratory. In total, 97 subjects were included in the study. These were divided into four groups; Intoxication with buprenorphine (N=41), Possible intoxication with buprenorphine (N=24), Control cases where buprenorphine was not the cause of death (N=14), and Unclear (N=18). The metabolite to parent compound ratios in both blood and urine in the Intoxication group were significantly different from those in the Control and Unclear groups. An extensive poly-drug use was seen in all groups with several additional opioids in the Possible group (54%) and in the Unclear group (78%) and hypnotics or sedatives in more than 75% of the Intoxication, Possible, and Unclear cases. Illicit drugs were present in all groups but not to a great extent with amphetamine and tetrahydrocannabinol as the main findings. Interestingly, 4 cases in the Intoxication group presented with no other significant drugs in blood other than buprenorphine. We conclude that a lethal concentration of buprenorphine in blood cannot be defined. Instead the analysis of blood as well as urine can be an important tool to show that the drug was taken shortly before death and to rule out a continuous use of buprenorphine supporting the notion that abstinence is an important risk factor. The presence of alprazolam in more than 40% of the Intoxications and the presence of hypnotics and sedatives in 75% of the Intoxications suggests that these drugs interact with buprenorphine producing toxic effects that buprenorphine alone would not have produced. Still, in 10% of the Intoxications no other drugs were found indicating that under certain circumstances buprenorphine alone may produce respiratory depression resulting in death.     

Sudden cardiac death in young adults: environmental risk factors and genetic aspects of premature atherosclerosis

Familial hypercholesterolemia (FH) is a genetic disorder that may lead to premature coronary heart disease (CHD) and sudden cardiac death (SCD). Mutations in the LDLR or APOB genes cause FH. We have screened the LDLR and the ligand-binding region of APOB genes in 52 cases of SCD. Deceased patients were younger than 40 years of age and were suspected of having FH. The LDLR and APOB genes were examined via PCR, high-resolution melting, and DNA sequencing. Therein, it was observed that 7.7% of the screened patients exhibited a rare sequence variant in the LDLR gene, with 5.7% suspected of being pathogenic mutations. Lipid profiles and genetic testing for FH could be considered when autopsy reveals significant atherosclerosis of the coronary arteries in young adults. First-degree family members are advised to seek medical advice and testing to determine their own risks of atherosclerosis to prevent premature CHD and SCD.     

Islamic State Nasheeds As Messaging Tools

Although jihadi nasheeds play an important role in the Islamic State's propaganda, there is scant literature on the topic. This article is an exploratory study on seventeen Islamic State nasheeds released between December 2013 and March 2015. The main argument is that Islamic State nasheeds are effective messaging tools because they focus on a limited number of themes that have broad appeal among Muslims. The nasheeds differ from other Islamic State propaganda in their almost exclusive focus on war and fighting, rather than on the softer sides of life in the Islamic State.     

Civil society and political protest in India—The case of Coca-Cola in Kerala

The Indian economic and political systems have recently opened up for increased foreign investments, which has resulted also in new forms of popular resistance. This article analyzes the campaign launched against the Coca-Cola-Company in Plachimada, Kerala, India, which in 2004 resulted in the closure of its bottling factory after accusations of water depletion and pollution. The analysis in the article is based on the theoretical concept “political opportunity” and concludes that the decision to close the plant was the result of an efficiently run popular campaign based on a tightly knit group of local activists, held together by a tribal identity. Vital for the success was also the help the group attracted by national and international civil society support groups and media, as well as the link between both media and civil society towards the political parties and the state.     

Counterproliferation Bargaining with the United States: China and the Spread of Nuclear Weapons

This article analyzes China’s use of issue-linkage strategies in its approach to nuclear proliferation. It highlights that China has used its ties to nuclear proliferators as a bargaining chip vis-a-vis the United States. The United States is dependent on Chinese cooperation to secure nonproliferation objectives such as a non-nuclear Iran, and China has used this dependency to extract side-payments for its cooperation. Moreover, Beijing has used non-cooperation on nuclear proliferation as retaliation when the US has hurt its interests in unrelated policy areas, such as through arms sales to Taiwan. In contrast with past studies, the article claims that China’s approach to nonproliferation remains partly transactional to this day.     

Do voters learn? Evidence that voters respond accurately to changes in political parties’ policy positions

A premise of the mass–elite linkage at the heart of representative democracy is that voters notice changes in political parties’ policy positions and update their party perceptions accordingly. However, recent studies question the ability of voters accurately to perceive changes in parties’ positions. The study advances this literature with a two-wave panel survey design that measured voters’ perception of party positions before and after a major policy shift by parties in the government coalition in Denmark 2011–2013. Two key findings extend previous work. First, voters do indeed pay attention to parties when they visibly change policy position. Second, voters update their perceptions of the party positions much more accurately than would have been expected if they merely relied on a ‘coalition heuristic’ as a rule-of-thumb. These findings imply that under some conditions voters are better able to make meaningful political choices than previous work suggests.     

Did the Egalitarian Reforms of the Swedish Educational System Equalise Levels of Democratic Citizenship?

In the mid‐1990s an extensive reform of the Swedish educational system was initiated in order to create a ‘school for everyone’ intended to function like a ‘social equaliser’. The new unified gymnasium initiated longer educational programmes with an extended curriculum of social science courses. This article examines whether the well documented gap in levels of democratic citizenship indicators between students in theoretical and vocational gymnasium study programmes persisted after this massive reform. Given the vast amount of empirical research that has shown that education promotes democratic citizenship, the reform could be expected to result in a decreased civic gap. However, contrary to the conventional wisdom in research on the impact of education, little evidence is found linking the initiation of longer educational programmes with more social science courses to an increase in the levels of the examined dimensions of democratic citizenship. The egalitarian reform of the Swedish gymnasium, which provided more civic education, did not produce hypothesised positive effects on any of the dimensions under study (i.e., political participation, political knowledge and political attentiveness). Rather, results support the pre‐adult socialisation models since the gap between citizens from theoretical and vocational gymnasium study programmes remained after the unification of the educational system.