Asking Routinely About Intimate Partner Violence in a Child and Adolescent Psychiatric Clinic: A Qualitative Study

Among children visiting child and adolescent psychiatric clinics (CAP), the prevalence of exposure to intimate partner violence (IPV) is reported to be approximately 25 %. The extent to which CAP clinicians are aware of this violence, however, is unclear. Some researchers recommend asking about IPV at intake, both to raise disclosure rates and to ensure adequate treatment. Many clinicians are reluctant to do so as a matter of routine when there is no indication of occurrence of IPV in the family. When we interviewed 14 clinicians about their experiences using a standard questionnaire about IPV, three themes emerged: (a) constraint (the questions hinder the development of good relationships with patients), (b) uncertainty (upon reflection, screening is acknowledged as important, but somewhat deficient), and (c) utility (the questionnaire provides a useful framework). Our findings indicate that clinicians’ negative feelings and ambivalence make the implementation of routinely asking about IPV a long process.     

Hypothermia Secondary to Glioblastoma Multiforme? Autopsy Findings in Two Cases

Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia‐related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes.     

Caffeine fatalities--four case reports

Four cases of fatal intoxications with caffeine are described. Caffeine is widely available in beverages and in different OTC-products, in many of them in combinations with other drugs like ephedrine. Caffeine is not as harmless as one might believe. An overdose of caffeine alone, intentional or not, might be deadly. It seems to be warranted to include caffeine in the drug-screening of forensic autopsy cases. It is not motivated from a medical point of view to sell pure caffeine over the counter.     

The emergence of self-managing schools in South Africa: Devolution of authority or disguised centralism?

This paper considers the devolution of authority to public school governing bodies (SGBs) in the context of self-managing schools. It examines the nature of the powers, functions and duties assigned to them in legislation and asks whether the manner in which South African legislation provides for the devolution of authority and power represents authentic devolution of power, or whether it can be characterised as centralisation in disguise. The question is answered by examining, against the backdrop of general and education-specific legal provisions, two examples of functions of SGBs, namely those to determine language and admission policies.     

Bureaucracies,Neoliberal Ideas,and Tax Reform in New Zealand and Ireland

Why did New Zealand adopt one of the most neoliberal tax systems in the world, whereas Ireland pursued a heterodox tax policy of low rates, deep deductions, and distortionary tax incentives? The diverging tax policy trajectories of these two small liberal market economies since 1980 are not well accounted for by conventional ideational, partisan, or political‐institutional explanations. The article argues that the varying degree of neoliberal reform is better understood as the result of differences in the institutionalization of economic knowledge within the state. Distinct administrative institutions in New Zealand and Ireland gave rise to profound differences in the identities, expertise, economic ideas, and policy advice approach of tax policy bureaucrats, which had a major impact on tax policymaking in the two countries.     

The effectiveness of the FCB grid as a tool for writing superior advertising strategy

ABSTRACT

This article, as far as could be determined, is a first attempt at measuring the effectiveness of advertising strategy. It is demonstrated by illustrating how the FCB grid (quadrant and sextant versions) can be used by undergraduate advertising students to write superior advertising strategies when compared with a textbook formula. Strategies written according to three different methods were analysed and evaluated to demonstrate that when the FCB grid is used to write advertising strategies, it results in superior advertising strategies.     

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

Buprenorphine is considered to have little respiratory side effects at therapeutic doses and the partial agonistic properties should produce a "ceiling effect" for respiratory depression at higher doses. Still, there are several reports on buprenorphine related deaths. Most deaths involve drug users and the co-administration of other CNS depressant drugs as well as reduced tolerance have been suggested to be risk factors. The primary aims were to investigate if lack of tolerance and/or co-ingestion of other psychotropic drugs are significant risk factors in buprenorphine fatalities. From July 2005 to September 2009, all autopsy cases where buprenorphine or norbuprenorphine had been detected in femoral blood and where analysis of buprenorphine had been performed in urine were selected. Results from the postmortem examination and toxicology were compiled. Postmortem toxicology was performed using the routine methodology at the laboratory. In total, 97 subjects were included in the study. These were divided into four groups; Intoxication with buprenorphine (N=41), Possible intoxication with buprenorphine (N=24), Control cases where buprenorphine was not the cause of death (N=14), and Unclear (N=18). The metabolite to parent compound ratios in both blood and urine in the Intoxication group were significantly different from those in the Control and Unclear groups. An extensive poly-drug use was seen in all groups with several additional opioids in the Possible group (54%) and in the Unclear group (78%) and hypnotics or sedatives in more than 75% of the Intoxication, Possible, and Unclear cases. Illicit drugs were present in all groups but not to a great extent with amphetamine and tetrahydrocannabinol as the main findings. Interestingly, 4 cases in the Intoxication group presented with no other significant drugs in blood other than buprenorphine. We conclude that a lethal concentration of buprenorphine in blood cannot be defined. Instead the analysis of blood as well as urine can be an important tool to show that the drug was taken shortly before death and to rule out a continuous use of buprenorphine supporting the notion that abstinence is an important risk factor. The presence of alprazolam in more than 40% of the Intoxications and the presence of hypnotics and sedatives in 75% of the Intoxications suggests that these drugs interact with buprenorphine producing toxic effects that buprenorphine alone would not have produced. Still, in 10% of the Intoxications no other drugs were found indicating that under certain circumstances buprenorphine alone may produce respiratory depression resulting in death.