Verapamil toxicity: an unusual case report and review of the literature

Verapamil blocks the rapid influx of calcium into the cardiac myocytes of the cardiac conduction system and smooth muscle of the vasculature, resulting in decreased myocardial contractility, prolonged conduction time, and vascular relaxation. A sustained-release form, verapamil SR (or ER), is available that contains higher levels of medication and requires only once-daily dosing. The majority of reported fatal cases of verapamil toxicity are due to massive, intentional overdoses. Herein, we present an unusual case of fatal verapamil SR toxicity in a 57-year-old female that resulted from accidental overdose of only 3 tablets (720 mg), as witnessed by the decedent's daughter. In spite of the low dose ingested, the postmortem cardiac blood verapamil level was clearly toxic (6000 ng/mL, or 6 mg/L). Her preexisting medical conditions included hypercholesterolemia, hypertension, iron deficiency anemia, diabetes mellitus, and associated mild chronic renal failure. Complicating factors, which likely include the decedent's preexisting renal and cardiac disease, and a review of the available literature will be discussed.     

Acute deaths in nonpregnant adults due to invasive streptococcal infections

Streptococcal organisms, part of the normal human bacterial flora, occasionally become infectious pathogens responsible for a wide array of clinical syndromes, ranging from mild pharyngitis to death. Notably, infections due to group A and group B beta-hemolytic strains are well known for causing invasive disease leading to death. These deaths, while often suspected clinically, occasionally are not diagnosed until autopsy. We present 3 rapid deaths, with very different presentations, due to streptococcal infection. Two decedents experienced sudden deaths due to pneumonia and severe meningoencephalitis caused by group B beta-hemolytic streptococcal infection, a common cause of neonatal meningitis but only rarely reported in nonpregnant adults. The final case involves a 69-year-old male who presented to the emergency room with a complaint of shoulder pain but over the next several hours developed signs of necrotizing fasciitis, became septic, and died. While antemortem cultures were negative, owing to antibiotic administration, postmortem cultures of bone and deep soft tissue were positive for group A beta-hemolytic Streptococcus sp. Acute and sudden deaths due to infectious etiology represent an uncommon yet well-documented occurrence. The importance of appropriate postmortem cultures in these situations and a review of the literature will be discussed.     

Healthy Families America effectiveness: a comprehensive review of outcomes

This paper reviews 33 evaluations of Healthy Families America sites, with emphasis on 15 studies that include a control or comparison group. Outcome domains include child health and development, maternal life course, parenting, and child maltreatment. Parenting outcomes (e.g., parenting attitudes) show the most consistent positive impacts. Mixed results in other domains indicate the need for in-depth research to identify factors associated with better outcomes. Several factors that may contribute to differences in outcomes are discussed, including site implementation and quality, differences in family risk levels, and recent augmentations to program design. The paper also highlights two large-scale evaluations, one community-wide (Hampton, Virginia) and one statewide (Indiana), to illustrate exemplary evaluation approaches found in HFA research. Overall, HFA's continuing evolution has been positively impacted by researcher-practitioner partnerships.     

Negotiating Liberty: The Use of Political Opportunities and Civil Society by Barbary State Captives and Guantánamo Bay Detainees

This article contrasts two distinct sets of prisoners who were held by foreign governments: sailors from the United States held captive in Algiers in the late‐eighteenth century and British citizens detained in Guantánamo Bay in the early‐twenty‐first century. The article uses social movement theory to examine and compare the campaigns orchestrated by these men and their supporters, and the role of those campaigns in securing their freedom. It demonstrates the utility of social movement theory in comparing cases of foreign detention that transcend centuries, regions and communication technologies. We find that successful campaigns on behalf of citizens held captive abroad, and the timeline of those successes, are contingent on the exploitation of domestic political opportunities and an external event to trigger government action on behalf of the captives.     

Early onset offending and later violent and gun outcomes in a contemporary youth cohort

Currently there is great concern regarding the high homicide rate and persistent weapon carrying among urban youth. Criminal career research has offered criminology an opportunity to understand offending as a process that has a beginning, middle, and end. Using that framework, the current study examined a contemporary cohort of arrestees and estimated the extent to which age of first arrest predicts future violent and gun offending. Net of demographic and offending variables, the results indicated that early onset was a significant predictor of serious violent offenses and weapon involvement. Theoretical and policy implications of these findings are discussed.     

STATEWIDE INITIATIVES TO ENCOURAGE ALTERNATIVE DISPUTE RESOLUTION AND ENHANCE COLLABORATIVE APPROACHES TO RESOLVING FAMILY ISSUES

Over the past 27 years, since the concept of the multidoor courthouse was first introduced, methods for resolving family issues have increasingly focused on less adversarial and more collaborative approaches. Infrastructures have developed in a variety of ways in different states to initiate, support, and promote these approaches, and pilot projects have provided an invaluable avenue for testing and implementing changes. This article will describe some of the current statewide initiatives to develop infrastructure and implement change through creative pilot projects and will propose strategies to sustain these changes.     

Are counter-terrorism strategies effective? The results of the Campbell systematic review on counter-terrorism evaluation research

The events of September 11th have led to massive increases in personal, commercial, and governmental expenditures on anti-terrorism strategies, as well as a proliferation of programs designed to fight terrorism. These increases in spending and program development have focused attention on the most significant and central policy question related to these interventions: Are these programs effective? To explore this question, this study reports the results of a Campbell Collaboration systematic review on evaluation research of counter-terrorism strategies. Not only did we discover an almost complete absence of evaluation research on counter-terrorism interventions, but from those evaluations that we could find, it appears that some interventions either did not achieve the outcomes sought or sometimes increased the likelihood of terrorism occurring. The findings dramatically emphasize the need for government leaders, policy makers, researchers, and funding agencies to support both outcome evaluations of these programs as well as efforts to develop an infrastructure to foster counter-terrorism evaluation research.