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.     

The China model of Korean reunification

Like Germany's reunification, essentially the annexation of East Germany by West Germany, Korean reunification looms as most likely, ultimately and largely entailing South Korea's annexation of North Korea. The awesome cost borne by West Germany for reunification has been instructive to South Korea, particularly in recognition that the material and ideological gaps between North and South Korea are far greater than those which existed between East and West Germany. A possible solution to the negative implications of cataclysmic reunificationmay rest in gradual reunification of the Koreas, with an interim industrialization of North Korea by South Korea, based on the model of the economic development zones in southeastern China; hence, the “China Model”. In such a scenario the investors in North Korea's gradual industrialization would be (primarily) the huge conglomerate South Korean corporations chaebol which seek cheaper labor pools abroad. Investment by such corporations, in cooperation with the South Korean government, and possibly supplemented by western and Japanese capital investment, would presumably raise levels of productivity and the standard of living in the economically and agriculturally ravished North. The North-South gaps would thus be gradually reduced as would the financial and other burdens South Korea would otherwise have to bear for cataclysmic reunification.     

The admiralty and the Anglo-German Naval agreement of 18 June 1935

This essay offers a reappraisal of the Royal Navy's decisive role in the making of the Anglo-German Naval Agreement. It argues that the Admiralty's response to Hitler's offer of a fixed naval tonnage ratio was more rational and more complex than previous accounts would suggest. The premise here is that the only way to grasp Admiralty policy is to reconstruct the coherent set of financial, industrial, technical, diplomatic and strategic imperatives that shaped it. This approach reveals that the agreement represented the shrewd use of naval armaments diplomacy to achieve a long-term strategic goal. Far from being a blunder, concluding the agreement was a prudent measure consistent with an elaborate Admiralty programme that aimed to adjust the international naval order to advance Britain's prospects as the world's leading seapower.     

Adolescents view their mental health

A new 40-item behavioral checklist, the Adolescent Life Assessment Checklist (ALAC), was devised to be used with patient and nonpatient samples. A comparable form obtains information from a parent or guardian. Responses of 356 adolescents from three sources were analyzed for differences attributable to race, sex, age, sample source, and their interactions. A factor analysis was carried out on the average within-race-sex-source subgroup correlation matrix, resulting in seven meaningful and six usable oblique factors. Subscales were developed and corrections were computed to remove estimated differences due to race, sex, and age. Corrected scales significantly differentiate the three samples.This study was supported in part by MCHS Grant No. MC-R-390201, the Adolescent Clinic Foundation, and USPHSMH Fellowship Grant No. 0597921.Received her Ph.D. in psychology from Washington University, St. Louis; received a Foundations Fund for Research in Psychiatry interdisciplinary research-teaching grant, 1959–1965. Current research interests include test development, evaluation, and personality research.Received her M.D. from Medical College of Georgia at Augusta; her medical internship was at Michael Reese Hospital, Chicago, Illinois. Current research interests include stress, coping, and adaptation in children and adolescents.She is a licensed psychologist with the State of Ohio, with an M.A. from the University of Cincinnati. Current research interests include verbal behavior, psychotherapeutic efficacy, and dream research.Received his M.D. from College of Medicine, University of Cincinnati; his medical internship was with Boston City Hospital, and he is the founder of the Adolescent Clinic, Cincinnati General Hospital. Current research interests include growth and development and medical/social problems at adolescence.     

Assessing policy capacity in Canada's public services: Perspectives of deputy and assistant deputy ministers

Abstract: The state of policy capacity within Canada's various levels of government has for some time been the subject of discussion both within the public services themselves and among the academic research community. Drawing on the results of a 2006 survey of deputy and assistant deputy ministers working in Canada's federal, ten provincial and three territorial governments, this article presents assessments made by the most senior leadership. The survey results show that ninety per cent of deputy ministers and assistant deputy ministers agree that policy capacity has changed but that the change is not uni‐directional. Both improvements and decline in policy capacity were observed, although assessments of decline were somewhat more pronounced. Moreover, improvements in policy capacity were found to be associated with a reduced focus on direct service delivery, a greater concern with long‐term planning, and the presence of a political leadership interested in innovation. Conversely, declining policy capacity was found to be linked to centralization of power, the loss of institutional memory, and “churning” within the ranks of the executive leadership. Additionally, level of government was also observed to be linked with change in policy capacity, with provincial deputies reflecting more negatively on policy capacity decline in their government than deputies at other levels.     

Implementing Change in an Urban School District: A Case Study of the Reorganization of the Little Rock School District

In July 2005, the Little Rock, Arkansas, school district implemented a new policy to reorganize its management structure in order to create a more efficient bureaucracy. Using Richard Matland’s ambiguity‐conflict model of policy implementation, the authors examine the implementation of this school reorganization policy. Interviews and surveys were conducted with the superintendent and his executive assistants, school principals, teachers, and staff. In line with Matland’s model, the findings suggest that successful implementation is directly related to the policy characteristics of ambiguity and conflict. However, the authors point to the importance of recognizing particular characteristics for different groups of stakeholders within the policy implementation process. Discrepancies among groups of policy actors in the degree of policy ambiguity and policy conflict lead to strikingly different implementation strategies.