Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death

Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy‐based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.     

Russia in the European Home? Convergence,Cosmopolitanism and Cosmism in Late Soviet Europeanisation

The aim is to present a conceptual and historical reconstruction of Gorbachev's notion of a ‘European home’, its underlying philosophy of history as well as its relation to Russian cosmism. The concept is contextualised within the convergence debate of the post-war period, in which a rapprochement between communism and capitalism was posited. The essay concludes with reflections on what the conceptualisation can tell us about the fall of communism and what impact the concept has had on today's search for a common European identity. An argument is advanced that the notion contained paradoxes that contributed to the dislocation of post-Soviet Russia from Europe.     

Distribution of Enantiomers of Methadone and Its Main Metabolite EDDP in Human Tissues and Blood of Postmortem Cases

Knowledge concerning the distribution of methadone in postmortem human tissue and the effect of postmortem redistribution on methadone is today limited making the choice of a suitable substitute for femoral blood difficult when this is not available. Cardiac blood, femoral blood, muscle, and brain tissue concentrations of the enantiomers of methadone and its metabolite 2‐ethyl‐1,5‐dimethyl‐3,3‐diphenylpyrrolinium were recorded for 155 postmortem cases. Brain and muscle tissue concentrations exceeded the femoral blood concentrations with a median fold of 2.3 and 1.6, respectively, but both had a better correlation than cardiac blood to femoral blood concentrations. The Kruskal–Wallis test showed a significant dependency on time and body mass index for some of the matrix ratios over femoral blood. We conclude brain or muscle tissue may constitute a better alternative for measurement of methadone than cardiac blood for situations in which femoral blood is not available, despite concentrations in both matrices being systematically higher.     

A Moveable Place With A Moveable Past: Perspectives on Central Europe

This paper discusses whether the region which in the 1990s has been called "the Visegrád Four" is a political and/or cultural whole and if so, in what respects. Using the concepts "centre" and "periphery" the paper argues that parts of contemporary Central Europe were political and cultural centres of the European civilisation in previous eras. The interpretation and use of this past in the Central European states' contemporary endeavour to join NATO and the EU is discussed. That historical chronology is superseded by what may be labelled the "mythological presence" of things past is especially noted.     

Location, Location, Location: An MCMC Approach to Modeling the Spatial Context of War and Peace

This article demonstrates how spatially dependent data witha categorical response variable can be addressed in a statisticalmodel. We introduce the idea of an autologistic model wherethe response for one observation is dependent on the value ofthe response among adjacent observations. The autologistic modelhas likelihood function that is mathematically intractable,since the observations are conditionally dependent upon oneanother. We review alternative techniques for estimating thismodel, with special emphasis on recent advances using Markovchain Monte Carlo (MCMC) techniques. We evaluate a highly simplifiedautologistic model of conflict where the likelihood of war involvementfor each nation is conditional on the war involvement of proximatestates. We estimate this autologistic model for a single year(1988) via maximum pseudolikelihood and MCMC maximum likelihoodmethods. Our results indicate that the autologistic model fitsthe data much better than an unconditional model and that theMCMC estimates generally dominate the pseudolikelihood estimates.The autologistic model generates predicted probabilities greaterthan 0.5 and has relatively good predictive abilities in anout-of-sample forecast for the subsequent decade (1989 to 1998),correctly identifying not only ongoing conflicts, but also newones.     

Why Democracies May Actually Be Less Reliable Allies

Recent research builds on the observation that democracies have more durable alliances to argue that democracies make more reliable allies. This need not be the case. Alliances serve as commitment devices, adding ex ante credibility to states' claims about ex post behavior. Variation in alliance durability must reflect differences in the desirability of formalizing alignments. Put simply, democracies are "most improved" by formal commitments. We offer two related explanations for why democracies might actually be less reliable alliance partners. Information costs for participating in policymaking and the advantages of organized interest groups combined with distributional incentives generated by the periodic turnover of governments may conspire to make informal commitments on the part of democracies problematic. Determining the net effect of democratic virtue and vice is best done empirically. We test alliance reliability by focusing on intervention, rather than on the duration or the number of commitments. Our results suggest that democracies make less reliable allies.     

Curriculum Reform in The Common Core Era: Evaluating Elementary Math Textbooks Across Six U.S. States

Can a school or district improve student achievement simply by switching to a higher-quality textbook or curriculum? We conducted the first multi-textbook, multi-state effort to estimate textbook efficacy following widespread adoption of the Common Core State Standards (CCSS) and associated changes in the textbook market. Pooling textbook adoption and student test score data across six geographically and demographically diverse U.S. states, we found little evidence of differences in average achievement gains for schools using different math textbooks. We found some evidence of greater variation in achievement gains among schools using pre-CCSS editions, which may have been more varied in their content than post-CCSS editions because they were written for a broader set of standards. We also found greater variation among schools that had more exposure to a given text. However, these differences were small. Despite considerable interest and attention to textbooks as a low-cost, “silver bullet” intervention for improving student outcomes, we conclude that the adoption of a new textbook or set of curriculum materials, on its own, is unlikely to achieve this goal.     

Reputation reform strategies in local government: investigating Denmark and Norway

This article investigates reputation reform in Norwegian and Danish local government and whether they have the same strategy content depending on the degree of administrative involvement and municipality size. Political and administrative actors are likely to cultivate different types of reputation strategies (place or organisational reputation), which explicitly embrace the potentially diverging interests cultivated by the two types of actors. We use a comparative design and quantitative method with an empirical ambition to explore local government reputation strategies in two national contexts. We find that local government responses to reputation reform depend on the size of the municipality and the type of actors involved; the larger the municipality, the more the administration is involved. And the more that administrative actors are involved, the more the strategies target organisational reputation. The country-specific factors do not appear to be the most important determinants for reputation reform strategies.