A structure for organizational learning

The Journal of Technology Transfer - Japanese manufacturers have demonstrated for the past 20 years that continuous learning within their organizations has been, and continues to be, fundamental to...     

Emergence of fentanyl-related deaths in Travis County,Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022

The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit “Xanax” (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.     

Medium‐Chain Acyl‐CoA Dehydrogenase Deficiency in Adulthood: A Potential Diagnosis in a Patient with Mental Status Changes Suspected of Drug Toxicity

Medium‐chain acyl‐CoA dehydrogenase (MCAD) deficiency is a rare but important component of the differential diagnosis for adults with a history of premortem mental status changes and the postmortem finding of hepatic steatosis. This case report describes a 30‐year‐old white man who, following a period of nausea and vomiting, was admitted to the hospital with sudden mental status deterioration followed rapidly by clinical deterioration and death. Treating physicians in this case suspected acute illicit drug toxicity with synthetic cathinones based on social history. Clinicians and medical examiners should be aware that the presentation, signs, and symptoms described may indicate an underlying inborn error of metabolism such as MCAD deficiency and take action accordingly.     

Assessing the Effects of Medical Marijuana Laws on Marijuana Use: The Devil is in the Details

This paper sheds light on previous inconsistencies identified in the literature regarding the relationship between medical marijuana laws (MMLs) and recreational marijuana use by closely examining the importance of policy dimensions (registration requirements, home cultivation, dispensaries) and the timing of when particular policy dimensions are enacted. Using data from our own legal analysis of state MMLs, we evaluate which features are associated with adult and youth recreational and heavy use by linking these policy variables to data from the Treatment Episode Data Set (TEDS) and National Longitudinal Survey of Youth (NLSY97). We employ differences‐in‐differences techniques, controlling for state and year fixed effects, allowing us to exploit within‐state policy changes. We find that while simple dichotomous indicators of MML laws are not positively associated with marijuana use or abuse, such measures hide the positive influence legal dispensaries have on adult and youth use, particularly heavy use. Sensitivity analyses that help address issues of policy endogeneity and actual implementation of dispensaries support our main conclusion that not all MML laws are the same. Dimensions of these policies, in particular legal protection of dispensaries, can lead to greater recreational marijuana use and abuse among adults and those under the legal age of 21 relative to MMLs without this supply source.     

Living in the Shadow of Violence: Local Civil–Military Engagement during Anti-Communist Insurgency Operations in the Philippines

Abstract

The Philippine approach to the anti-communist insurgency after 1986 has featured peace talks with the rebels, amnesty and livelihood packages, and strengthened security forces. While the military has remained central to the counterinsurgency campaign, the government has also institutionalized police involvement in conducting operations and requested input from local civilian authorities in paramilitary recruitment and human rights monitoring. Legal restrictions against human rights violations by soldiers were also established. The experience of 20 frontline communities in central Philippines reflects these changes. Local civil-military interaction has moved from confrontation to consultation and accommodation. However, tension remains because the military and civilian leaders disagree on the gravity of the insurgent threat.     

US voter registration reform

Voter registration in the United States changed after the 2000 election with a requirement that states adopt statewide voter registries. However, these registries vary in design in practice, with some states having state managed “top–down” registries and other states having more decentralized “bottom–up” registries. I compare the effect of moving to a top–down registry with the adoption of Election Day registration – where voters can register to vote the day of the election – on voters saying that they are not registered because of election management problems or not voting because of a voter registration issue. EDR had a pronounced effect on reducing voter registration problems but the adoption of new voter registries had minimal effect on the same problems.     

Book reviews

Ephraim Maisel, The Foreign Office and Foreign Policy 1991–1926 (Brighton: Sussex Academic Press 1994), £35. ISBN 1–898723–04–4.

Timothy P. Maga, The World of Jimmy Carter: U.S. Foreign Policy 1977–1981 (West Haven, CT: University of New Haven Press, 1994). 189 pp. ISBN 0–936385–23–0.

Michael Leifer, Dictionary of the Modern Politics of South‐East Asia (London and New York: Routledge, 1995), xii + 271pp. £45. ISBN 0–415–04219–4.

Christopher C. Harmon and David Tucker (eds.), Statecraft and Power: Essays in Honor of Harold W. Rood (Lanham and London: University Press of America with the National Institute for Public Policy, 1994), 284pp ISBN 0–8191–8718–6.