The Substitution Approach To Intergovernmental Relations: The Case Of OSHA

Federal legislation of the last two decades has substantiallyreduced state autonomy in dealing with many regulatory issues.Participation in the implementation of these federal programsmay, however, enable states to exert some leverage over policyoutcomes. Variations in state leverage no doubt exist from oneintergovernmental grant program to the next. Substitution authoritymay be one variable accounting for this variation. Under a substitutionapproach, a federal agency cannot only sever the flow of fundsto a grantee; it can also step in and operate a program if statesfail to meet expectations or choose not to participate. Thisarticle generates more basic propositions about the substitutionapproach by analyzing its implementation under the OccupationalSafety and Health Act of 1970. The article examines the roleplayed by substitution authority in motivating the OccupationalSafety and Health Administration (OSHA) to adopt an aggressiveposture toward the states. The article then assesses whetherOSHA's aggressiveness prompted state grantees to exert considerableeffort on behalf of program goals. Finally, the implicationsof current reform proposals, which call for a sorting out offunctions between the states and the federal government, receiveattention.     

Systems analysis and emergency command and control systems for municipalities and law enforcement

This article is designed to provide insight into methodologies that can be used to assess alternative emergency command and control systems for municipalities and law enforcement. Some potential pitfalls and errors are highlighted.     

Mechanism of formation of spinal injuries

It was stipulated that in medicolegal examination of deaths due to mechanical trauma accompanied by vertebral column separation it is necessary to investigate the surface of separation, which as a rule passes along the verge of the osseous and cartilagnous locking laminae. At the initial stage of avulsion a fragment of osseous lamina of the adjacent vertebral corpus remains fixed to cartilaginous lamina. Taking into account the localization of this fragment one may judge upon the direction of spine flexure.     

Intimate partner violence research in the health care setting: what are appropriate and feasible methodological standards?

The past 20 years of research has exposed the profound cost of intimate partner violence (IPV) in health care problems and health care dollars for victims and bystanders. As a result, professional organizations encourage clinicians to identify IPV victims and to refer them to community resources. To date there is little evidence to show the value of these efforts, and many completed studies are criticized for methodological weaknesses. IPV studies are challenging to design, and the double-blind randomized controlled trial may be an impossible standard. To move forward, funders and study committees are encouraged to reassess the standards for IPV research methodologies.     

Clinical and forensic examinations of glycemic marker 1,5-anhydroglucitol by means of high performance liquid chromatography tandem mass spectrometry

Postmortem diagnosis of diabetes and a diabetic coma can be difficult because of the lack of characteristic morphological findings. 1,5-Anhydroglucitol (1,5-AG), the 1-deoxy form of glucose, competes with glucose for reabsorption in the kidneys. Therefore, diabetics with a permanent hyperglycemia show significantly lower serum concentrations of 1,5-AG than non-diabetics. A liquid chromatography-mass spectrometric method for the determination of 1,5-AG in serum and postmortem blood was developed and validated according to international guidelines. Linearity was given between 1μg/ml and 50μg/ml. Recovery rates ranged between 70.8% and 89.8%, the limit of quantification of the procedure was 0.20μg/ml, limit of quantification was 0.55μg/ml. Serum of 199 diabetics and 116 non-diabetics and femoral blood of 31 diabetic and 27 non-diabetic deceased was measured. Average concentrations were significantly (p<0.001) higher in non-diabetics compared to diabetics ante and postmortem. Seven of the diabetics may have died because of a hyperglycemic coma indicated by a sum formula of Traub>450mg/dl. 1,5-AG average concentrations in these deceased were not significantly different to diabetics which did not die because of a diabetic coma. Concentrations of 1,5-AG give a hint for not well controlled diabetes antemortem and postmortem and can be assumed as an additional and alternative information postmortem to the measurement of HbA1c or fructosamine.     

Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases

Tolperisone (Mydocalm) is a centrally acting muscle relaxant with few sedative side effects that is used for the treatment of chronic pain conditions. We describe three cases of suicidal tolperisone poisoning in three healthy young subjects in the years 2006, 2008 and 2009. In all cases, macroscopic and microscopic autopsy findings did not reveal the cause of death. Systematic toxicological analysis (STA) including immunological tests, screening for volatile substances and blood, urine and gastric content screening by GC-MS and HPLC-DAD demonstrated the presence of tolperisone in all cases. In addition to tolperisone, only the analgesics paracetamol (acetaminophen), ibuprofen and naproxen could be detected. The blood ethanol concentrations were all lower than 0.10 g/kg. Tolperisone was extracted by liquid-liquid extraction using n-chlorobutane as the extraction solvent. The quantification was performed by GC-NPD analysis of blood, urine and gastric content. Tolperisone concentrations of 7.0 mg/l, 14 mg/l and 19 mg/l were found in the blood of the deceased. In the absence of other autopsy findings, the deaths in these three cases were finally explained as a result of lethal tolperisone ingestion. To the best of our knowledge, these three cases are the first reported cases of suicidal tolperisone poisonings.