Do the Joneses Help You Keep Up? A Natural Experiment in Exposure to Nonpoor Neighbors

This study capitalizes on a natural experiment in Montgomery County, Maryland, where low-income applicant families are randomly assigned to public housing that is either (a) clustered within seven public housing developments or (b) scattered into market-rate subdivisions via the county's inclusionary zoning policy. Through a survey of 453 public housing residents, we find that adults who lived in scattered public housing reported a lower proportion of low-socioeconomic status (SES) social ties generally and a lower proportion of low-SES neighbors specifically in their social networks. They also counted more high-SES individuals in their social networks, and this effect was related to the amount of time they lived in the neighborhood. Living in scattered public housing had no adverse effect on feelings of neighborhood belonging or satisfaction. The socioeconomic composition of respondents' social networks was associated with two health outcomes for respondents (smoking and depression) and modestly associated with respondents' household income.     

The Contracting Quandary: Managing Local Authority–VNPO Relations

Problems with competitive transactional contracting raise the possibility of relational contracting as an attractive alternative for managing local authority–VNPO (voluntary non-profit organisation) relations. This empirical study of 45 relational social service contracts examines the conditions under which advantages such as flexibility and social capital development emerge as opposed to dangers of political abuse, defiance and resource frustrations. Findings suggest that successful relational contracting requires partners whose professional and management reputations inspire competence trust and whose commitment encourages goodwill trust. Decisions between competitive transactional contracting and relational contracting present difficult dilemmas. The costs and benefits of relational contracting need to be weighed against those of transactional contracting. At the same time there are political and ideological pressures, as well as public service norm constraints.     

Housing Affordability and Health: Evidence From New York City

It is generally understood that households make tradeoffs between housing costs and other living expenses. In this article, we examine the relationship between health-related outcomes and housing-induced financial burdens for renters in one of the most expensive cities in the world, New York, New York. Drawing from the Housing Vacancy Survey for 2011, a representative survey conducted by the U.S. Census Bureau of more than 16,000 households in New York City, we estimate the effect of housing cost burden on the overall health of renters and the extent to which they have postponed various types of medical services for financial reasons. Results show that higher out-of-pocket rent burdens are associated with worse self-reported health conditions and a higher likelihood to postpone medical services for financial reasons. This relationship is particularly strong for those households with severe rent burdens. In addition, housing cost burden is equally or more important than other physical housing characteristics in explaining the variation in self-reported general health status and health care postponement. These findings are robust across specifications with different degrees of household, unit/building, and neighborhood controls, and among longstanding and newer renters. Our findings point to the importance of considering health-related outcomes when designing housing policies, and that housing subsidies should target both renters' out-of-pocket costs and place-based repair and maintenance.     

Phenibut screening and quantification with liquid chromatography–tandem mass spectrometry and its application to driving cases

An analytical strategy for identification by an LC–MS/MS multitarget screening method and a suitable LC–MS/MS based quantification were developed for the psychotropic drug phenibut. The samples analyzed were collected during traffic control and were associated with driving under the influence of drugs. A positive sample for phenibut was identified in a single case of driving under the influence. The quantification revealed a drug concentration of 1.9 μg/mL. An interaction with blood alcohol (BAC = 0.10%) was discussed as the explanation of the way of driving and deficit manifestations observed (swaying, nystagmus, quivering of the eyelid, and reddened eyes). According to the available information, the quantified phenibut concentration could be explained by an intake of four tablets (self-reported) during the day containing 250 mg of the drug. Chromatography was performed with a Luna 5 μm C18 (2) 100 A, 150 mm × 2 mm analytical column, and a buffer system consisted of 10 mM ammonium acetate and 0.1% acetic acid (v/v) included in mobile phases marked as A (H₂O/methanol = 95/5, v/v) and B (H₂O/methanol = 3/97, v/v). An effective limit of detection (LOD = 0.002 μg/mL) could be achieved for the multitarget screening method. The quantification of phenibut was performed on a second LC–MS/MS system with LOD/LOQ values of 0.22/0.40 μg/mL. Since phenibut quantification data are rare, the presented information can be used with caution for evaluation of positive cases in the future.     

Fat embolism syndrome associated with atraumatic compartment syndrome of the bilateral upper extremities: An unreported etiology

Fat embolism syndrome (FES) is a potentially life-threatening condition that develops when fat embolism leads to clinical symptoms and multisystem dysfunction. The classic triad of respiratory distress, neurologic symptoms, and petechial rash are non-specific, and the lack of specific laboratory tests makes the diagnosis of FES difficult. Although FES is most common after long bone fractures, multiple conditions some of which are atraumatic have been associated with the development of FES. We report a case of FES that occurred in the setting of a non-traumatic compartment syndrome of the upper extremities. The pathologic and clinical findings, pathophysiology, diagnostic challenges, and pathologic methods to properly diagnose FES are discussed with a review of the relevant literature. This case highlights the importance of the autopsy in making a diagnosis of FES in cases where death could otherwise be incorrectly attributed to multi-organ system failure, shock, or sepsis.     

A case of fatal overdose involving both hydromorphone and kratom

Kratom is a plant originating in Southeast Asia that has been used for its dose-dependent stimulant and opioid effects. The main active compound in kratom is mitragynine, an alkaloid with affinity for the mu-opioid receptor. Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44-year-old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with >4 L of ascites. Toxicology testing was performed on femoral blood which showed 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.