Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

Which government officials leak unauthorized information to the press in Washington?

Every modern president of the United States has been bedeviled by unauthorized leaks of government information to the press. Who is responsible for such leaks? Presidents of the United States have accused civil servants of attempting to undermine them. However, journalists have suggested that the presidents' own political appointees leak more. Using interviews conducted in 2013 with both presidential political appointees and civil servants who worked in public affairs for the U.S. Treasury Department during the administrations of Presidents Barack Obama and George W. Bush, as well as interviews with reporters with whom the Treasury officials interacted frequently, this case study finds that political appointees and civil servants leak unauthorized information that does not serve the president's interests to the press with roughly the same frequency. The findings shed light on behavior that is typically shrouded in secrecy and call into question the effort by modern U.S. presidents to gain greater control of the federal government by hiring record numbers of political appointees. Copyright © 2015 John Wiley & Sons, Ltd.     

Deserving Shelter: Conditional Access to Accommodation for Rejected Asylum Seekers in Austria,the Netherlands,and Sweden

Abstract

Limitations in access to welfare services for noncitizens of a host country are structured through conditional entitlements, which require benefit claimants to meet certain conditions to access welfare services. This article explores the conditions and regulations determining access to state-organized accommodation facilities for non-removed rejected asylum seekers in Austria, the Netherlands, and Sweden and the way in which these conditions are implemented. Based on qualitative interviews with stakeholders and analysis of policy documents, I argue that qualities of deservingness, such as vulnerability and performance, determine noncitizens’ access to state-provided accommodation, which strengthens the logic of migration control.     

The Nature of Law and Potential Coercion

This paper argues for a novel understanding of the relationship between law and coercion. It firstly refutes Kenneth Himma’s claim that the authorisation of coercive enforcement mechanisms is a conceptually necessary feature of law. It then claims that the best way to understand the law is as coercion‐apt. The “coercion‐aptness” of law is clarified, in part, by appealing to an essential distinction between law and morality: Whereas it can be reasonable for the law to appeal to coercive means in order to motivate compliance, it seems decidedly unreasonable for morality to do so.     

Measuring the boundaries of America's permanent campaign

This research measures the boundaries of the “permanent campaign” practiced by spokespeople for the United States government. Scholars have accused modern White House communications staff of conducting a permanent campaign by prioritizing presidential public opinion ratings over good governance. However, researchers have not previously measured whether this campaign is conducted exclusively from the White House, or if government agencies are also involved—dramatically increasing the potential scale and scope of the campaign. The researcher conducted a rare set of interviews with public affairs officers who worked for the Treasury Department during the administrations of Presidents Obama and George W. Bush to find out whether they utilize public opinion ratings in their work and whether they attempt to play to the emotions, rather than the reason, of the American people. This study finds that the Treasury is not conducting a permanent campaign. The results demonstrate that the campaign is not practiced in a cabinet agency critical to presidential political fortunes and reelection prospects, suggesting that it is likely confined to the White House.     

Microscopical discrimination of human head hairs sharing a mitochondrial haplogroup

In forensic analyses, determining the level of consensus among examiners for hair comparison conclusions and ancestry identifications is important for assessing the scientific validity of microscopical hair examinations. Here, we present data from an interlaboratory study on the accuracy of microscopical hair comparisons among a subset of experienced hair examiners currently analyzing hair in forensic laboratories across the United States. We examined how well microscopical analysis of hair can reliably be used to differentiate hair samples, many of which were macroscopically similar. Using cut hair samples, many sharing similar macroscopic and microscopic features, collected from individuals who share the same mitochondrial haplogroup as an indication of genetic relatedness, we tested multiple aspects that could impact hair comparisons. This research tested the extent to which morphological features related to ancestry and hair length influence conclusions. Microscopical hair examinations yielded accurate assessments of inclusion/exclusion relative to the reference samples among 85% of the pairwise comparisons. We found shorter hairs had reduced levels of accuracy and hairs from populations examiners were not familiar with may have impacted their ability to resolve features. The reliability of ancestry determinations is not yet clear, but we found indications that the existing categories are only somewhat related to current ethnic and genetic variation. Our results provide support for the continued utility of microscopical comparison of hairs within forensic laboratories and to advocate for a combined analytical approach using both microscopical analysis and mtDNA data on all forensic analyses of hair.     

Saliva identification in forensic samples by automated microextraction and intact mass analysis of statherin

The enzyme α-amylase has long been a commonly targeted protein in serological tests for saliva. While being especially abundant in saliva, α-amylase is detectable in vaginal secretions, sweat, fecal matter, breast milk and other matrices. As a result, assays for α-amylase only provide a presumptive indication of saliva. The availability of mass spectrometry-based tools for the detection of less abundant, but more specific, protein targets (e.g., human statherin) has enabled the development of high confidence assays for human saliva. Sample throughput, however, has traditionally been low due to multi-step workflows for protein extraction, quantitation, enzymatic digestion, solid phase cleanup, and nano-/capillary-based chromatography. Here, we present two novel “direct” single-stage extraction strategies for sample preparation. These feature immunoaffinity purification and reversed-phase solid-phase microextraction in conjunction with intact mass analysis of human statherin for saliva identification. Mass analysis was performed on the Thermo Scientific Q-Exactive™ Orbitrap mass spectrometer with a 10-min analytical run time. Data analysis was performed using Byos^® from Protein Metrics. Two sample sets were analyzed with a population of 20 individuals to evaluate detection reliability. A series of casework-type samples were then assayed to evaluate performance in an authentic forensic context. Statherin was confidently identified in 92% and 71% of samples extracted using the immunoaffinity purification and solid phase microextraction approaches, respectively. Overall, immunoaffinity purification outperformed the solid phase microextraction, especially with complex mixtures. In toto, robotic extraction and intact mass spectrometry enable the reliable identification of trace human saliva in a variety of sample types.