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301.
Presley L Lehrer M Seiter W Hahn D Rowland B Smith M Kardos KW Fritch D Salamone S Niedbala RS Cone EJ 《Forensic science international》2003,133(1-2):22-25
Identification of 6-acetylmorphine, a specific metabolite of heroin, is considered to be definitive evidence of heroin use. Although 6-acetylmorphine has been identified in oral fluid following controlled heroin administration, no prevalence data is available for oral fluid specimens collected in the workplace. We evaluated the prevalence of positive test results for 6-acetylmorphine in 77,218 oral fluid specimens collected over a 10-month period (January-October 2001) from private workplace testing programs. Specimens were analyzed by Intercept immunoassay (cutoff concentration=30 ng/ml) and confirmed by GC-MS-MS (cutoff concentrations=30 ng/ml for morphine and codeine, and 3 ng/ml for 6-acetylmorphine). Only morphine-positive oral fluid specimens were tested by GC-MS-MS for 6-acetylmorphine. A total of 48 confirmed positive morphine results were identified. An additional 107 specimens were confirmed for codeine only. Of the 48 morphine-positive specimens, 32 (66.7%) specimens were positive for 6-acetylmorphine. Mean concentrations (+/-S.E.M.) of morphine, 6-acetylmorphine and codeine in the 32 specimens were 755+/-201, 416+/-168 and 196+/-36 ng/ml, respectively. Concentrations of 6-acetylmorphine in oral fluid ranged from 3 to 4095 ng/ml. The mean ratio (+/-S.E.M.) of 6-acetylmorphine/morphine was 0.33+/-0.06. It is suggested that, based on controlled dose studies of heroin administration, ratios >1 of 6-acetylmorphine/morphine in oral fluid are consistent with heroin use within the last hour before specimen collection. The confirmation of 6-acetylmorphine in 66.7% of morphine-positive oral fluid specimens indicates that oral fluid testing for opioids may offer advantages over urine in workplace drug testing programs and in testing drugged drivers for recent heroin use. 相似文献
302.
This article describes the quality improvement intervention of a managed behavioral healthcare company to improve the quality of suicide risk assessments by its panel of providers. At-risk cases are identified by the patient's self-reported high frequency of suicidal ideation on a standardized outcome measure. Clinicians also assess severity of suicidal ideation based on clinical interviews. The clinician's assessment is identified as probably erroneous if the patient report indicates a high frequency of suicidal ideation and the clinicians assessment of suicidal ideation is none. The article describes the methods used to encourage clinicians to utilize information from the patient self-report measure as part of the clinical assessment. Probable suicidal ideation assessment errors were subsequently reduced by 29% over a 1-year period of administration. 相似文献
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304.
This paper draws upon data from the Pittsburgh site of the MacArthur Foundation's Risk Assessment Study, a large-scale study of violence risk among persons discharged from psychiatric hospitals, to examine the effect of the neighborhood context on risk of violence. This paper has two purposes: (1) to assess the extent to which the inclusion of neighborhood characteristics enhances violence prediction models—models that traditionally only include individual-level characteristics; and (2) to assess the consistency of individual level risk factors across different neighborhood contexts. Results indicate that neighborhood poverty has an impact over and above the effects of individual characteristics in identifying cases with violence. These findings support efforts to include neighborhood context in the assessment and management of violence risk among discharged psychiatric patients. 相似文献
305.
Objective:To characterize injury frequency, injury patterns, and health care seeking behavior in women with intimate partners enrolled in batterer intervention programs. Methods: A standardized telephone interview was conducted on a sample of women with male partners enrolled in batterer intervention programs in four U.S. cities. Information on prior injuries and the utilization of health care services was sought. Results: Four hundred and eighty eight of the 648 women (75.3%) reported a history of prior injury as a result of abuse. Contusions were the most common injury. Of the women reporting contusions, 233 (51.4%) reported contusions as their only injuries. Another 220 women (48.6%) reported other injuries in addition to contusions. In the majority of cases (63.2%) the contusions were to multiple body parts. When the contusion involved only one anatomical region, it was mostly to the face. A total of 192 of the 488 injured women (39.3%) reported ever seeking medical care for injuries caused by their intimate partner. Twenty-three women (4.7% of the injured cohort or 3.5% of the total cohort) reported having ever been hospitalized for injuries sustained from abuse. 相似文献
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307.
Stakeholder coordination is a prominent theme in current development discourse. Experience with decentralization and community water management in northern Ghana highlights the complexities of coordinating stakeholders at the local level. In this case, roles and responsibilities must be clarified between legislated sub‐district structures on the one hand, and civic water groups on the other. This is especially important with regard to resolving which party should collect revenues and manage assets and expenditures in the water sector. The key mechanism for addressing these issues is the District Assembly, which is empowered under the decentralization law to coordinate stakeholders, both ‘horizontally’, across social actors, and ‘vertically’, between the national and sub‐district levels. While such local‐level dynamics are indeed complex and challenging, they are at the same time probably more amenable to at least medium‐term resolution than stakeholder competition issues at the national level. Copyright © 2002 John Wiley & Sons, Ltd. 相似文献
308.
This article examines the role of party activists in the partisan evolution of the abortion issue. Previous research indicates that party elites—specifically members of Congress—and partisans in the mass public have become more differentiated in their abortion attitudes during the last several decades with Democrats becoming more pro-choice and Republicans becoming increasingly pro-life. The missing piece of the picture is the behavior of party activists. Accordingly, this research examines the changes in the abortion attitudes of two groups of party activists during the last three decades: campaign activists and national convention delegates. From 1972 to 1980 there were no significant differences in the abortion attitudes of Republican and Democratic campaign activists, and the mean positions of the two parties' national convention delegates did not differ greatly. However, since 1984 there has been a growing differentiation in the abortion positions of both groups of party activists. Now Democratic activists are consistently pro-choice while Republican activists are equally pro-life. This evidence indicates that the differentiation on the abortion issue that has only recently emerged among partisans in the mass public was predated by an earlier and much more dramatic polarization that had already developed among party activists and elites, thus supporting a model of issue evolution introduced by Carmines and Stimson in their study of racial issues. We also find that citizens' abortion attitudes have become increasingly correlated with party voting not just in presidential elections but also in House, Senate, and gubernatorial contests during this period as well as being more closely related to political ideology. All of this evidence points to the growing extent to which abortion has become a partisan issue in American politics and the key role that party activists have played in this process. 相似文献
309.
Many studies suggest that personal ideology accounts for much more of congressional voting behavior than does attention to the desires of the electorate. There are two main explanations given for this seemingly robust conclusion: 1) poor measures of constituency preferences compared to those for ideology or behavior, and 2) representatives “shirk” on an inattentive electorate. We argue that existing studies have been biased against the “interest” explanation by ignoring the structure of American Congressional elections, in particular the party primary process. Correcting for the party primary effect, we show, within the context of abortion politics, that constituency interests possess greater explanatory power than previous models would suggest. 相似文献
310.