Fentanyl concentrations in 23 postmortem cases from the hennepin county medical examiner's office

The purpose of this study was to compare blood fentanyl concentrations in fentanyl-related deaths with fentanyl concentrations found incidentally at autopsy, as well as with fentanyl concentrations found in hospitalized patients receiving fentanyl. Between the years 1997 to 2005, 23 fentanyl-positive postmortem cases were identified. Nineteen of 23 (82.6%) cases were deemed to be drug overdoses. Fentanyl alone was responsible for 8 of the 19 (42.1%) overdose deaths. Mean and median fentanyl concentrations were 36 (SD 38) microg/L and 22 microg/L, respectively, range 5-120 microg/L. Seven of the cases were accidental, one undetermined. The remaining 11 of the 19 (57.9%) cases were mixed drug overdoses. Fentanyl concentrations in these cases were 31 (SD 46) microg/L, range 5-152 microg/L. All of the mixed drug overdoses were determined to be accidental. Four cases where fentanyl was considered an incidental postmortem finding were determined to be natural deaths. In hospitalized inpatients (n = 11) receiving fentanyl 2 of the patients receiving fentanyl for chronic pain for more than 3 months had concentrations of 8.5 microg/L and 9.9 microg/L. The other nine inpatient concentrations were less than 4 microg/L. In conclusion, blood fentanyl concentrations found in cases where fentanyl alone was determined to be the cause of death were similar to cases where fentanyl was part of a mixed drug overdose. There was also considerable overlap between fentanyl concentrations in fentanyl-related overdose deaths compared to hospitalized patients being treated for chronic pain. Fentanyl concentrations in postmortem cases must be interpreted in the context of the deceased's past medical history and autopsy findings.     

Crisis (hostage) negotiators weigh in: the skills,behaviors, and qualities that characterize an expert crisis negotiator

This research identified what skills, behaviors, and qualities experienced crisis (hostage) negotiators believe enhance or harm their success during negotiation. 188 negotiators from various countries (primarily United States) voluntarily completed an online survey in which they listed the aforementioned characteristics and reported on various aspects of their own background and behaviors. Open-response questions were coded and quantitative methods revealed what qualities were listed most frequently by negotiators. Active listening, displays of empathy, effective communication, and remaining calm and collected appear at the top of their to-do lists. Conversely, being confrontational, arguing, yelling, and interrupting were reported as behaviors to be avoided. Most negotiators attend trainings multiple times a year and read on the topic of crisis negotiation. About half follow a model during negotiations, typically the FBI’s Behavioral Change Stairway Model. Findings are discussed with relevance to future research directions and improvement of negotiator trainings.     

Sibling Incest: A Model for Group Practice with Adult Female Victims of Brother–Sister Incest

Working with groups of people who have been sexually abused introduces mutual experiential themes into the process that can be beneficial and meaningful. This paper discusses brother–sister incestuous sexual abuse with implications for group work. Literature and research is reviewed concerning sexual abuse, incest, family relationships, and theories that aid in explaining incest. Themes covered include: effects of incest, coping methods, blaming, and family of the victim. Common themes are explored and implications for group work are suggested on the basis of length, detail, structure, content, and pre-group contact.