Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

Omissions relevant to the contextual domains of technology transfer models

Ideographic representations (schematic drawings) are useful for analyzing and communicating complex ideas. They constitute simplified versions of the way multiple and diverse elements, concepts, and variables interact according to each author's conceptions, knowledge, and experience of planned change and change phenomena. Such representations depict a sense of order under a particular model configuration or system notion, involving contexts where action takes place and events occur. This paper is based on the commonality analysis of 46 models related to technology transfer. Within the framework of previously published research, complementary findings are presented here. The discussion is focused on the characteristics of the models' contexts, appealing to some technology transfer aspects widely omitted or neglected. It is suggested that the understanding of intervention contextual domains is important to formulate and implement better technology transfer models.     

Insights from Ted Palmer: experimental criminology in a different era

Objectives  

Report insights from the career of the noted evaluation researcher, Ted Palmer, on emerging issues in correctional research and correctional treatment.     

The effect on reconviction of an intervention for drink-driving offenders in the community

This study reports an evaluation of the Drink-Impaired Drivers program in the English and Welsh probation service. Participants were adult male offenders who had been convicted of a drink-driving offence and were serving community sentences. The 1-year drink-drive reconviction rates were compared for offenders who completed the program, offenders who started but did not complete the program, and a comparison group who were not allocated to the program. At 1-year follow-up, there was no reconviction among offenders who had completed the program. Multivariate analysis showed that the noncompleters had a significantly higher rate of reconviction than the completers and comparison group.     

Overcoming the weight of history: 'Getting to yes' in the Peru-Ecuador border dispute

This article presents and analyzes the elements of the Western Hemisphere's longest standing boundary dispute and the crucial role of the region's oldest multilateral conflict resolution mechanism in working out an historic agreement in October 1998. Other factors in combination were also critical for success: an existing international legal framework, multilevel bilateral and multilateral diplomacy, decisive leadership and statecraft, and public diplomacy. The analysis suggests that the final settlement is a significant milestone in international diplomacy, demonstrating that even the most deeply ingrained differences between states can be resolved by the patient and persistent efforts of all parties involved.     

Polarization and Issue Consistency Over Time

The polarization of the political and social environment over the past four decades has provided citizens with clearer cues about how their core political predispositions (e.g., group interests, core values, and party identification) relate to their issue opinions. A robust and ongoing scholarly debate has involved the different ways in which the more polarized environment affects mass opinion. Using heteroskedastic regression, this paper examines the effect of the increasingly polarized environment on the variability of citizens’ policy opinions. We find that citizens today base their policy preferences more closely upon their core political predispositions than in the past. In addition, the predicted error variances also allow us to directly compare two types of mass polarization—issue distance versus issue consistency—to determine the independent effects each has on changes in the distribution of mass opinion.