The Progressive Ratcheting of Environmental Laws: Impact on Public Management

One of the problem-making tendencies in environmental policymaking has been an incremental approach to regulation and control. Either because the full dimensions of an environmental problem are not perceived or because political resistance compels step-by-step action, environmental controls tend to be applied progressively, beginning with nominal, largely ineffectual, retroactive declarations. Failing to meet objectives, laws are toughened and extended year by year until the severty of sanctions begins to defeat their intended effects. The fractionized state of environmental law, focusing on specific problems of pollution and subject to changes in interpretation, makes observance and enforcement difficult. The National Environmental Policy Act of 1969 could have facilitated the unification of environmental policy; unfortunately presidents and congresses have not chosen to use it for this purpose. Meanwhile, because environmental protection per se is relatively new to public law and policy and has few roots in the common law, private citizens aggrieved by political obstruction of their expectations have appealed to the courts for relief and compensation. Conservative courts have granted this relief under the "taking" clause of the Constitution. Extraordinary measures in constitutional law may be necessary to resolve an impasse in public policy resulting from conflict between public interests and private rights as interpreted by the judiciary.     

Nursing culpability: a proposal for change in nursing regulation

Nurses make mistakes. They work in a complex environment which can sometimes be a contributory factor to a mistake being made. At present, Nurses' Boards in Australia have no mandate to investigate the circumstances in which a mistake is made. Their jurisdiction is limited to investigation of the individual nurse. This article sets out the argument for change in nursing legislation to allow for a broadening of the role of Nurses' Boards. It argues that an extension of their jurisdiction explicitly to allow them to investigate inadequacies in the health system would be a constructive development.     

Oxycodone intoxication in an infant: accidental or intentional exposure?

A case is presented of a 10 month old male who went into cardiac arrest at a local store. The infant subsequently expired and was autopsied at the Office of the Chief Medical Examiner, State of Maryland. The only remarkable finding was the detection of oxycodone in the postmortem specimens; the blood and liver oxycodone concentrations were 0.6 mg/L and 1.6 mg/kg, respectively. Oxycodone was identified and quantitated by gas chromatography-nitrogen-phosphorus detection and confirmed by full scan electron ionization gas chromatography-mass spectrometry. The medical examiner ruled that the cause of death was oxycodone intoxication, and the manner of death was homicide. The key toxicologic question in this case was whether or not it was reasonable for the infant to be exposed to oxycodone exclusively through breast milk or through an alternate source. It was concluded that, at best, there were serious concerns about the likelihood of drug exposure through consumption of breast milk.     

Interest groups and state Medicaid drug programs

A simultaneous equations model is estimated to analyze the interaction between state Medicaid pharmaceutical drug reimbursement rates, drug recipients per capita, and expenditures per drug recipient. Interest groups are shown to have a strong positive impact on pharmacy reimbursement rates, which, in turn, have an impact on pharmacy participation rates and drug utilization and expenditure patterns. Finally, a strong inverse relationship exists between expenditures per recipient and program size. The results verify the existence of substantial variation in state Medicaid programs and point to potentially growing disparities as a result of current policies.     

Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Deposition of 7-aminoflunitrazepam and flunitrazepam in hair after a single dose of Rohypnol

In recent years, there has been a notable increase in the number of reports on drug-facilitated sexual assault. Benzodiazepines are the most common so-called "date-rape" drugs, with flunitrazepam (Rohypnol) being one of the most frequently mentioned. The aim of this study was to determine whether flunitrazepam and its major metabolite 7-aminoflunitrazepam could be detected in hair collected from ten healthy volunteers after receiving a single 2 mg dose of Rohypnol using solid phase extraction and NCI-GC-MS. Such data would be of great importance to law enforcement agencies trying to determine the best time interval for hair collection from a victim of drug-facilitated sexual assault in order to reveal drug use. Ten healthy volunteers (eight women and two men, 21 to 49 years old) participated in the study. The following hair samples were collected from each volunteer: one before flunitrazepam administration, and 1, 3, 5, 14, 21, and 28 days after. In five volunteers, 7-aminoflunitrazepam was detected 24 h after flunitrazepam administration and remained in hair throughout the entire 28-day study period (0.6-8.0 pg/mg). In two cases, 7-aminoflunitrazepam appeared in hair 21 days after drug intake (0.5-2.7 pg/mg), and in two subjects 14 days later (0.5-5.4 pg/mg). In one volunteer, 7-aminoflunitrazepam was detected on day 14 and 21 but concentrations were below the quantitation limit. Flunitrazepam was detected in some samples but all concentrations were below the quantitation limit (0.5-2.3 pg/mg).     

Parent-adolescent separation: The role of parental divorce

Previous research has identified Emotional Separation and Personal Control as two sets of home leaving indicators that are associated, respectively with relatively troubled and relatively untroubled parent-adolescent separation. As expected, among late adolescent males, parental divorce was highly related to endorsement of Emotional Separation as an important composite indicator of having left home. For females, being a firstborn was associated with endorsing Personal Control as an important composite indicator of home-leaving. Findings were interpreted as supporting previous research which has indicated that males experience more adjustment problems after parental divorce than females.Received Ph.D. from Michigan State University. Current research interests are parent-adolescent separation and perceptions of loneliness.Received Ph.D. from Michigan State University. Current research interests are adolescent-parent separation and evaluation research.     

Feminists and femininity: A case-study of WSPU propaganda and local response at a Scottish by-election

This article examines the attitudes towards femininity expressed by the WSPU speakers at the 1907 Aberdeen by-election and the response these attitudes elicited from Aberdonians. Although the evidence suggests that a majority of the local population accepted the WSPU's demand for votes (for tax-paying women only) on the grounds of equality, the WSPU felt a need to emphasize the expediency of its proposal. In order to argue that such an extension of the franchise would benefit all women WSPU speakers emphasized the priority of sex over all other social divisions but deliberately accepted the specific differences assumed in popular concepts of ‘femininity’ rather than drawing attention to the male ideology and social institutions in which such definitions originated. Some of the imputed feminine attributes which led Aberdeen men and women of all classes to accept the popular stereotype of domestic woman are examined, as are the difficulties the WSPU encountered because its campaigning activities clashed with its own concept of woman, a difficulty shared by other women's association in Aberdeen.