Disposition of quetiapine in biological specimens from postmortem cases

Quetiapine is a new atypical antipsychotic that was approved in 1997 by the U.S. Food and Drug Administration for the treatment of schizophrenia. It possesses a high affinity for 5-HT2 receptors and a low affinity for D1 and D2 dopamine receptors. Because quetiapine has only been released recently to the U.S. market, little information exists regarding therapeutic, toxic, and lethal concentrations. This study reports the detection of quetiapine in 13 postmortem cases. Following a basic liquid-liquid extraction, quetiapine was identified and quantitated by capillary gas chromatography with nitrogen phosphorus detection. Confirmation was accomplished by full scan electron impact gas chromatography/mass spectrometry. Heart blood quetiapine concentrations ranged from 0.07 to 18.37 mg/L (N = 12, mean +/- SD = 3.42 +/- 5.67, median 0.62) and femoral blood concentrations ranged from 0.06 to 19.25 mg/L (N = 10. mean +/- SD = 3.89 +/- 6.12, median 0.81). The average heart blood/femoral blood ratio was 1.31 (range 0.55 to 2.57, N = 10). Urine, bile, and gastric contents were assayed in all cases in which they were submitted. In three cases, the cause of death was determined to be quetiapine toxicity. In these cases heart blood concentrations ranged from 0.72 to 18.37 mg/L (N = 3). These data may provide a basis for establishing levels associated with quetiapine toxicity as well as therapeutic concentrations in postmortem specimens.     

Postmortem tissue distribution of olanzapine and citalopram in a drug intoxication

A 40-year-old white male was found dead in bed in a group home for mentally ill adults. The decedent had been diagnosed a paranoid schizophrenic. An autopsy was performed at the Office of the Cuyahoga County Coroner in Cleveland, Ohio. Toxicological testing detected olanzapine and citalopram in post mortem specimens. Multiple fluids and tissues were assayed by liquid-liquid extraction followed by gas chromatography with nitrogen phosphorus detection, and qualitative confirmation by electron impact gas chromatography/mass spectrometry. Drug concentrations [olanzapine: citalopram; mg/L or mg/Kg] determined in this case are the highest reported to date involving these drugs- 1.38:3.35 heart blood, 1.11:1.65 femoral blood, 60.24:32.43 urine, 6.47:10:71 liver, and 38.36:49.16 lung, respectively. Drug concentrations in tissues were found to be the highest in lung for both drugs and lowest in the heart. Citalopram but not olanzapine was detected in bone. The cause of death was ruled acute intoxication by the combined effects of olanzapine and citalopram and the manner, accident.     

Changes in Patterns of Social Role Combinations at Ages 25–26 among Those Growing Up in England between 1996 and 2015–16: Evidence from the 1970 British Cohort and Next Steps Studies

Journal of Youth and Adolescence - Changes across education, employment, and family life over the past 20 years challenges the capacity of previously established social role combinations to...     

Digital government units: what are they,and what do they mean for digital era public management renewal?

Abstract

From 2011 onward, Digital Government Units (DGUs) have quickly emerged as a preferred solution for tackling the over-cost and under-performing digital services and lagging digital transformation agendas plaguing today’s governments. This article kickstarts a much-needed research agenda on this emerging trend, which has to date largely been ignored by public management scholars. DGUs exist at the center of the state, and adopt a shared orthodoxy, favoring agile, user-centric design, pluralistic procurement, data-driven decision making, horizontal ‘platform’ based solutions and a ‘delivery-first’ ethos. However, DGUs are differentiated in practice by their governance structures and resources, adding notable complexity to this recent machinery of government phenomenon. The article details the similarities and differences across six of the first DGUs introduced and highlights issues that researchers should address when assessing DGUs as an increasingly preferred instrument of digital era public sector renewal. This includes: their mixed record of success thus far; the risks of top-down reform efforts; external threats to DGUs’ sustainability; and accountability dilemmas accompanying digital government reforms.     

Legislating School Crisis Response: Good Policy or Just Good Politics?

Over the past decade, a growing number of schools have responded to students' safety and mental health needs following campus violence and other crises. More recently, policymakers have joined this trend, proposing legislation requiring schools to establish crisis response programs. This paper provides an overview of crisis response initiatives implemented by school districts following traumatic events, including school violence. It then examines recent state legislation and other policies, followed by a discussion of the advisability of such mandates, given the scant research and evaluation of school crisis response to date.     

Ethical Considerations in the Conduct of Electronic Surveillance Research

The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more cost-effective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights.     

The Importance of Establishing Reliability and Validity of Assessment Instruments for Mental Health Problems: an Example from Somali Children and Adolescents Living in Three Refugee Camps in Ethiopia

Assessing mental health problems cross-culturally for children exposed to war and violence presents a number of unique challenges. One of the most important issues is the lack of validated symptom measures to assess these problems. The present study sought to evaluate the psychometric properties of two measures to assess mental health problems: the Achenbach Youth Self-Report and the Child Posttraumatic Stress Disorder Symptom Scale. We conducted a validity study in three refugee camps in Eastern Ethiopia in the outskirts of Jijiga, the capital of the Somali region. A total of 147 child and caregiver pairs were assessed, and scores obtained were submitted to rigorous psychometric evaluation. Excellent internal consistency reliability was obtained for symptom measures for children and their caregivers. Validation of study instruments based on local case definitions was obtained for the caregivers but not consistently for the children. Sensitivity and specificity of study measures were generally low, indicating that these scales would not perform adequately as screening instruments. Combined test–retest and inter-rater reliability was low for all scales. This study illustrates the need for validation and testing of existing measures cross-culturally. Methodological implications for future cross-cultural research studies in low- and middle-income countries are discussed.