Fatality involving complications of bupivacaine toxicity and hypersensitivity reaction

This case represents unusual findings of elevated bupivacaine and tryptase concentrations following local anesthetic, bupivacaine, administered as a scalene nerve block for elective rotator cuff repair surgery. Following bupivacaine injection, the patient exhibited almost immediate seizure activity, bradycardia, and cardiac arrest. Resuscitative efforts including cardiopulmonary bypass restored a cardiac rhythm. However, the clinical medical status of the patient progressively declined and he died 7 h following administration of the local anesthetic. Autopsy revealed several abnormalities of the heart including cardiomegaly, myocardial bridging, and lipomatous hypertrophy of the intraatrial septum, which may have contributed to bradycardia and arrhythmia. Postmortem toxicology results revealed elevated bupivacaine and tryptase concentrations. Elevated postmortem bupivacaine concentrations 7 h following administration and abrupt onset of seizures indicate unintentional intravascular injection instead of nerve and tissue infiltration. An elevated postmortem tryptase concentration points to the possibility of a hypersensitivity reaction to bupivacaine.     

Matching consequences to behavior: implications of failing to distinguish between noncompliance and nonresponsivity

Neither punitive nor therapeutic approaches alone are effective at addressing the dual public health and public safety concerns associated with managing criminal behavior perpetrated by people who have psychiatric and substance use disorders. The optimal solution may instead require the integration of both criminal justice supervision and treatment. Using problem-solving courts (PSCs) as a model, we focus on one dimension of this integrated approach, distinguishing between behavior that stems from willful noncompliance with supervision and behavior that results from nonresponsivity to treatment. First, we discuss the public health and public safety consequences of using singular approaches to address the criminal behavior of this population. We then present lessons learned from PSCs that distinguish between noncompliant and nonresponsive behaviors in making treatment and supervision decisions. Finally, we consider how the concepts of nonresponsivity and noncompliance may be extended, via policy, to probation and parole settings as well as mental health and substance abuse treatment services outside the criminal justice setting in order to enhance public health and safety.     

A supervisor like me: Race,representation, and the satisfaction and turnover decisions of public sector employees

Studies of race representation in public organizations illustrate the importance of bureaucrat race in determining client‐level outcomes. Building “upward” from this research, this study examines how supervisor race impacts outcomes for street‐level bureaucrats using data from a nationally representative sample of public schools. Employing multiple estimation methods, we find that, consistent with the predictions of representation theory, teachers report higher job satisfaction and turn over less often when supervised by an own‐race principal. We also find that race congruence impacts the tangible and intangible organizational benefits teachers receive, and, moreover, that race congruence impacts white and African American employees differently. Most troubling, we find evidence that black teachers earn substantially less in supplemental pay when they work for a white principal, even when compared to white teachers in the same school. © 2011 by the Association for Public Policy Analysis and Management.     

Visual detection of trace nitroaromatic explosive residue using photoluminescent metallole-containing polymers

The detection of trace explosives is important for forensic, military, and homeland security applications. Detection of widely used nitroaromatic explosives (trinitrotoluene [TNT], 2,4-dinitrotoluene [DNT], picric acid [PA]) was carried out using photoluminescent metallole-containing polymers. The method of detection is through the quenching of fluorescence of thin films of the polymer, prepared by spray coating organic solutions of the polymer, by the explosive analyte. Visual quenching of luminescence (lambda(em) approximately 400-510 nm) in the presence of the explosive is seen immediately upon illumination with near-UV light (lambda(ex)=360 nm). Detection limits were observed to be as low as 5 ng for TNT, 20 ng for DNT, and 5 ng for PA. In addition, experiments with normal production line explosives and their components show that this technology is also able to detect composition B, Pyrodex, and nitromethane. This method offers a convenient and sensitive method of detection of trace nitroaromatic explosive residue.     

Review article: Realising realism's role in us policy towards Europe

Adam Bronstone, European Union ‐ United States Security Relations. Transatlantic Tensions and the Theory of International Relations. Basingstoke: Macmillan, 1997. Pp.viii + 282, biblio., index. £45. ISBN 0–333–69136–9.

Robert L. Hutchings, American Diplomacy and the End of the Cold War. An Insider's Account of US Policy in Europe, 1989–1992. Baltimore: Johns Hopkins University Press, 1997. Pp.xx + 456, illus., biblio., index. £33. ISBN 0–8018–5620–5.

Thomas Risse‐Kappen, Cooperation Among Democracies. The European Influence on US Foreign Policy. Princeton: Princeton University Press 1995. Pp.x + 250, biblio., index. £30.50. ISBN 0–6910–3644–6.     

Birds of a Feather Fight Together: Status-Enhancing Violence,Social Distance and the Emergence of Homogenous Gangs

Objectives

This study proposes a theoretical framework for understanding two empirical findings from gang research: (1) gangs are generally racially homogenous, even in heterogeneous environments, and (2) gang violence tends to be intra-racial. We draw from the extensive literature on street gangs as well as from research on group formation and status-enhancing behavior to develop a theoretical model of gang formation.

Methods

Using game theory, we model the simultaneous decisions of individuals to commit status-enhancing acts of violence and to seek protection by joining a gang. We then conduct computer simulations to examine the resulting patterns of violence and gang composition.

Results

We demonstrate that as long as some social distance exists between racial groups in a community, gang violence will be intra-racial and gangs will be homogenous. We find that our results are robust to a number of simple variations of the model and allow us to generate several hypotheses about the nature of gang formation and patterns of violence.

Conclusions

When violence is motivated by socially constructed rewards, socially closer targets are likely to yield greater rewards. In such a system, individuals must reduce their likelihood of victimization by entering a social contract of non-violence (i.e. gang membership) with individuals who might view them as status-enhancing targets (i.e. socially close individuals). The result is that gangs are made up of socially close individuals interested in attacking other socially close individuals. Therefore, gangs tend to be racially homogenous and violence is overwhelmingly intra-racial.

     

Social Network Position of Gang Members in Schools: Implications for Recruitment and Gang Prevention

Schools are venues in which gang and non-gang involved youth converge. It is therefore a likely venue for gang recruitment. The extent to which this occurs depends upon the ability of gang members to connect with non-gang members. In this study, we compare the social network positions of high social status gang members who are well integrated into school networks with low status members who are not. Using network data from the Add Health study (n = 1,822), we find that not only are high status gang members strongly embedded within school networks, but that this status is driven by their ability to connect with non-gang members rather than other gang members (indicated by the high number of friendship nominations they receive from non-gang members). These gang members are potentially in optimal positions to influence others to join gangs. The implications of these results for school-based gang prevention programs are discussed.