Fentanyl-related deaths: demographics, circumstances, and toxicology of 112 cases

Since 1979, the potent narcotic analgesic fentanyl and its analogs have been synthesized in clandestine laboratories and sold as heroin substitutes. At least 112 overdose deaths have been associated with their use. In this study, toxicology data, autopsy findings, and coroners' investigative reports were reviewed in order to construct a profile of the typical fentanyl overdose victim and to identify any factors that might heighten the risk of death from fentanyl use. The "typical" fentanyl overdose victim was 32.5 +/- 6.7 years of age (range, 19 to 57 years), male (78%, compared with 22% female), and Caucasian (50%, compared with 29% Hispanic, 20% Black, and 0.9% Asian). With the exception of his or her age, the typical fentanyl overdose victim is quite similar to the typical heroin user. Nearly all the deaths (94%) occurred in California, yet within the state they were widely distributed throughout 17 counties and 44 cities. Pulmonary edema and congestion and needle puncture sites were consistent postmortem findings. No preexisting medical conditions were identified as possible risk factors. Although most of the fentanyl victims had a prior history of intravenous drug use, morphine or codeine were not commonly found, which suggests that the victims had little or no opiate tolerance. Ethanol was present in 38% of the cases and is thought to be a significant risk factor. Mean fentanyl concentrations in the body fluids were quite low: 3.0 +/- 3.1 ng/mL (0.3 +/- 0.31 micrograms/dL) in blood and 3.9 +/- 4.3 ng/mL (0.39 +/- 0.43 micrograms/dL) in urine, measured by radioimmunoassay. Although the potency of the analogs and the purity of street samples varies considerably, it is probably the general availability of the drug rather than the potency of a particular analog that determines the incidence of overdose deaths.     

Between Euroscepticism and Eurosupport: The Attitudes of Urban and Rural Populations in Poland 2000–2008

Three main factors explain public support for EU membership: utilitarian expectations, the role of values and ideas, and class partisanship. In the Polish case, public opinion polls and issues more specific to Poland, such as the role of the Catholic Church, populist political parties and profound Euroscepticism among farmers, suggest that although these theoretical explanations overlap, each of them has a different explanatory value. The economic approach remains the best predictor of support for EU membership, and whereas values and identity are closely linked to and dependent upon economic expectations, the impact of national politics appears largely decoupled from Polish Euroscepticism.     

Parallel universes: Canadian and U.S. public administration study

Abstract: In this article, the discipline/profession of Canadian public administration is compared to its American counterpart. As parallel universes of inquiry and application, both have evolved from administration to management to governance. In spite of this and other similarities, possibilities for greater collaboration and cross‐fertilization have been overlooked and impeded by what the author calls an American attitude of “benign neglect.” The Canadian study of public administration reciprocates with self‐sufficiency and an enviable coherence in spite of similar divisions in the two countries between political science/policy and generic management approaches. To confirm the neglect, the author conducted a mini‐survey of Canadian content in the journal Public Administration Review and in papers presented at U.S. conferences and – for contrast – of American content in the journal Canadian Public Administration and at Canadian conferences. Modest proposals for rectifying the evident parallel but separate trajectories are suggested through greater interaction that would enrich both study and practice. Exploring some of the overlooked successes in Canadian administration would be useful for students of public administration in the U.S. Sommaire : Le présent article établit une comparaison entre la discipline/la profession de l'administration publique canadienne et son homologue aux États‐Unis. En tant qu'univers parallèles d'enquêtes et d'application, les deux ont évolué, passant de l'administration au management, puis à la gouvernance. Malgré cela et d'autres similarités, les possibilités d'une plus grande collaboration et d'enrichissement mutuel ont été ignorées et empêchées par une attitude américaine qualifiée par l'auteur de «négligence bienveillante ». L'étude canadienne de l'administration publique a réagi par l'autosuffisance et une cohérence enviable malgré des divisions similaires dans les deux pays entre les approches de sciences politiques et de gestion générique. Pour confirmer cette négligence, l'auteur a entrepris un mini sondage sur le contenu canadien dans la revue Public Administration Review et lors de conférences américaines et, par contraste, sur le contenu américain dans Administration publique du Canada et lors de conférences canadiennes. De modestes propositions sont faites pour rectifier les trajectoires évidentes, parallèles, et cependant distinctes, suggérant une plus grande interaction qui enrichirait à la fois la théorie et la pratique. Il serait utile pour les étudiants américains en administration publique d'examiner en profondeur certains des succès ignorés de l'administration canadienne.     

LESSENING THE STING OF ASFA: THE REHABILITATION‐RELAPSE DILEMMA BROUGHT ABOUT BY DRUG ADDICTION AND TERMINATION OF PARENTAL RIGHTS

Congress passed the Adoption and Safe Families Act of 1997 (ASFA) as a response to children waiting in foster homes for years without permanent placement. In addressing the problem of permanency, however, Congress set a strict limit on how long a child could be in foster care (15 out of the most recent 22 months) before a state must either commence a proceeding to terminate parental rights or else lose valuable federal funding. Due to health care funding schemes and quality of treatment, this requirement, in particular, negatively impacts parents currently in drug rehabilitation whose parental rights may be permanently terminated before a realistic chance to recover is permitted. Although ASFA requires that states make “reasonable efforts” to keep families united, it does not define “reasonable efforts,” leaving parental rights and family unity subject to a chaotic interpretation of this requirement from state to state. “Reasonable efforts” should be interpreted to take into account current drug addiction and recovery research and drug court programs should be used to facilitate this goal. Research has shown that focusing on adequate treatment saves states money and improves the lives of children and their families, reducing the need for reliance on termination of parental rights.     

Investigations of complaints and quality of health care

Malpractice law is frequently justified by the claim that it improves health care services but this belief remains untested. Using a multiple case study in 16 remote rural areas in New Zealand, this study examined the effects of formal quasi-judicial investigations on the quality of health care services. The study found that the fragile local health systems were damaged by the quasi-judicial investigations of the medical disciplinary body and became less efficient and less user-friendly. A few doctors left rural practice and were difficult to replace. The remaining health workers responded to the investigations in a negative manner, losing confidence, enthusiasm and motivation for work; they performed in a less efficient manner, working more slowly, setting up barriers to access, ordering more tests and referring more to secondary care. Complainants also appeared to have been disadvantaged as a consequence of having complained.     

Luminescent visualization of latent fingerprints by direct reaction with a lanthanide shift reagent.

The utilization of the lanthanide shift reagent tris (6,6,7,7,8,8,8-heptafluoro-2,2-dimethyl-3,5-octanedionato) europium (III) [Eu(fod)3] as a simple one-step reagent for the luminescent visualization of latent fingerprints has been investigated. UV excitation of Eu(fod)3-treated prints, achieved by using a hand-held UV lamp or a Polilight, results in an orange emission at 614 nm. Time-resolved imaging is not required for visualization. Visualization of latent fingerprints on paper under the conditions used, although good, was found to be inferior to that obtained by standard DFO (1,8-diazafluoren-9-one) treatment, whereas visualization of prints obtained on aluminum drink cans and galvanized iron proved superior to that obtained by Superglue/panacryl treatment. Eu(fod)3 treatment can also be used first without compromising subsequent ninhydrin or DFO treatment, making it a 'nothing-to-lose" reagent.