Trends and pattern of drug abuse deaths in Maryland teenagers

The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19.5%) by both narcotics and cocaine, four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p<0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin/morphine and methadone, and was confined to teenagers residing in the suburban and rural areas.     

Bystander reaction to women fighting: developing a theory of intervention

This article explores accounts of bystanders to female-on-female public violence. Group interviews with participants in the night-time economy are carried out. Whereas men tend to respond to the discussion topic of female-on-female violence with laughter, this laughter reveals ambivalence and discomfort as much as amusement. Men seem to negotiate the tension between the expectation that they should intervene in emergencies and a catalogue of costs that attend intervention. Female bystanders appear to have a different set of concerns. They talk about feelings of shame at the interpersonal and the group level. Women cite the public spectacle, and the opportunity for men to demean or sexualize women, as reasons for intervention. The article concludes with some recommendations about the importance of exploring female violence in its own terms, beginning with a series of identified moral and social dilemmas incurred within possible third-party intervention.     

Informed consent in the electroconvulsive treatment of geriatric patients.

The past 15 years have been marked by an increasingly stringent regulatory atmosphere regarding the administration of ECT, leading to delays in treatment and declines in usage. Regulatory changes requiring judicial intervention in clinical decisions are driven by the notion that only the courts can provide adequate due process protections when legal rights and clinical need conflict. We retrospectively reviewed the documentation of the informed consent process for 62 geriatric patients receiving ECT to assess the degree to which clinicians conformed to the spirit of the informed consent doctrine in a state that allows significant clinical discretion in decisions to administer ECT to patients lacking decisional capacity. In the eight cases in which the patient's decisional capacity was questioned, we found appropriate documentation of the patient's failure to comprehend his condition or the proposed treatment, evidence of a high degree of family involvement in decision making, and extensive use of outside consultants to document decisional incapacity and the need for treatment. Evidence of family participation in decision making was present for a high percentage of cases in which decisional capacity was unquestioned. Our review demonstrated high compliance with the procedural safeguards contained in the state regulation and with the spirit of the informed consent doctrine.     

The Impact of Electoral Reform on the Public Service: The New Zealand Case

October 1996 marked the beginning of a new era in New Zealand politics, with the advent of a system of proportional representation based on the German model. This article explores the impact of electoral reform on the public service. First, it summarises the extensive public sector reforms during the mid-to-late 1980s and considers the preparations undertaken by the public service for proportional representation. Second, it outlines the concerns and expectations about the likely consequences of the new electoral system on the bureaucracy. Third, against this background, the article examines the extent to which the public service has been affected by electoral reform. It is argued that despite some notable changes to the political environment within which officials operate, the overall impact of proportional representation on the public service to date has been modest. The analysis presented here is based on a series of interviews conducted during 1997 with ministers, senior public servants, ministerial advisers and parliamentary officials, along with a range of secondary sources.     

Evaluation of the Abbott TDx-radiative energy attenuation (REA) ethanol assay in a study of 1105 forensic whole blood specimens

In a preliminary study to determine the applicability of the Abbott radiative energy attenuation (REA) method for the quantification of ethanol in whole blood specimens it was concluded that a larger number of samples was required to evaluate the method, particularly for use in forensic toxicology applications. In this study, 573 blood specimens from suspected driving while intoxicated individuals (DWI blood) and 532 postmortem blood specimens (PM blood) were analyzed by the REA method and a headspace gas chromatographic method (GC) currently used in this laboratory. "Negative" specimens (less than 10 mg/dL by GC) and "positive" specimens (greater than or equal to 10 mg/dL by GC) in each category were analyzed. Linear regression analysis comparing the REA values with the GC values was performed for each type of blood specimen. The equation obtained for DWI blood specimens was REA = 0.943 GC + 1.54; the equation for PM blood specimens was REA = 0.980 GC + 2.76. The correlation coefficient for each group was greater than 0.99. The data suggested that a limit of detection of 10 mg/dL could be applied for DWI blood specimens, while 20 mg/dL would be recommended as the limit of detection for PM blood specimens.