Loperamide as a Potential Drug of Abuse and Misuse: Fatal Overdoses at the Medical University of South Carolina

Loperamide is an over‐the‐counter, μ‐opioid receptor agonist commonly used as an antidiarrheal agent. Loperamide was thought to have minimal abuse potential due to its low bioavailability and limited central nervous system activity; however, there have been increasing reports of loperamide misuse in supratherapeutic doses to achieve euphoria and/or avoid opioid withdrawal. A literature review suggests a rise in loperamide abuse was inevitable, with substantial increases in reported cases over the last decade. Five fatal cases of toxic medication use where loperamide was listed as a primary or contributory cause of death were identified at the Medical University of South Carolina. The characteristic autopsy demographics and findings are described, and the mechanisms of abuse and toxicity of loperamide are reviewed. Loperamide overdoses are a growing concern from both a forensic and clinical standpoint, and the frequency of reported cases will likely increase as awareness grows within the medical and toxicological communities.     

Resilient Social Contracts and Peace: Towards a Needed Reconceptualization

ABSTRACT

This article makes the case for rethinking the social contract concept with attention to countries affected by conflict, fragility, and fraught transition. Inspired by related policy efforts and engaging scholarship across multiple disciplines, this piece and the multi-country research represented in this Special Issue aim to build the intellectual lineage of the concept. A conceptual framework and proposed heuristic device for enhancing policy and practice is presented. Five case studies and a thematic paper on inclusion are discussed with this in mind. Comparative findings and implications are assessed for how resilient social contracts aid the attaining and sustaining of peace.     

How Do I Feel About Feelings? Emotion Socialization in Families of Depressed and Healthy Adolescents

Emotional and cognitive changes that occur during adolescence set the stage for the development of adaptive or maladaptive beliefs about emotions. Although research suggests that parents’ behaviors and beliefs about emotions relate to children’s emotional abilities, few studies have looked at parental socialization of children’s emotions, particularly in families with depressed adolescents. The present study examined associations between parent and adolescent meta-emotion philosophies (MEP), defined as thoughts, reactions, and feelings about their own emotions. Additionally, adolescent depressive status was tested as a moderator of relationships between parents’ and adolescents’ MEP. One hundred and 52 adolescents, aged 14–18 (65.8% female), and their parents (148 mothers, 106 fathers) participated in a study on emotion socialization in families of depressed and healthy adolescents. Depressed adolescents (n = 75) and matched healthy adolescents (n = 77) were recruited based on research criteria for mental health status. The sample was largely Caucasian (82%) and of middle socioeconomic class status. Results indicated that mothers’ and fathers’ MEP about their children’s emotions were associated with adolescents’ MEP, although parents’ MEP about their own emotions was unrelated to adolescents’ MEP. Fathers’ MEP about children’s emotions made unique contributions to adolescents’ MEP across both adolescent groups. Adolescents’ depressive status moderated the relationship between mothers’ and adolescents’ MEP such that mothers’ MEP was particularly relevant for depressed adolescents. The continued influence of parents in the emotional lives of adolescents is discussed as well as differences in emotion socialization in families with depressed and healthy adolescents.     

Quality of Social Relationships and the Development of Depression in Parentally-Bereaved Youth

Fear of abandonment has been found to be associated with mental health problems for youth who have experienced a parent’s death. This article examines how youth’s fears of abandonment following the death of a parent lead to later depressive symptoms by influencing relationships with caregivers, peers, and romantic partners. Participants were 109 youth ages 7–16 (50% male), assessed 4 times over a 6-year period. The ethnic composition of the sample was non-Hispanic Caucasian (67%), Hispanic (16%), African American (7%), Native American (3%), Asian (1%), and Other (6%). Youth’s fears of abandonment by their surviving caregiver during the first year of data collection were related to their anxiety in romantic relationships 6 years later, which, in turn, was associated with depressive symptoms measured at 6 years. Youth’s caregiver, peer, and romantic relationships at the 6-year follow-up were related to their concurrent depressive symptoms. The relationship between youth’s attachment to their surviving caregiver and their depressive symptoms was stronger for younger participants. Implications of these findings for understanding the development of mental health problems following parental bereavement are discussed.     

Patterns of Onset and Decline Among Terrorist Organizations

Despite considerable speculation among terrorism researchers regarding the conditions leading to organizational desistance from terrorism, quantitative analysis of terrorism frequently focuses on terrorist attacks as the unit of analysis, resulting in a near complete absence of analyses of terrorist organizations themselves. Moreover, research on organizations that engage in terrorism has generally been limited to case studies of individual organizations. Toward a more general understanding of what conditions predict organizational desistance from terrorism, this study uses newly available data from the Global Terrorism Database to analyze the terrorist activity of 557 organizations that were active for at least 365 days between 1970 and 2008. Much like research on conventional crime, prior research on terrorism has focused almost exclusively on the onset of criminal behavior and has neglected determinants of declining activity. Here I use group-based trajectory models to investigate patterns of decline in organization-level terrorist activity. In particular I examine how patterns of onset relate to patterns of decline among these organizations. I first estimate the trajectory models for the organizations’ frequency of attacks, and then calculate the annual ratio of attacks to attacks-at-peak for each organization in order to isolate patterns of decline, independent of the magnitude of activity. I then repeat the trajectory analysis to determine if the relative shape of the organizational trajectory has significance beyond the overall frequency of attacks. I find that the speed and magnitude of an organization’s emergence are correlated with its longevity such that those organizations characterized by rapid onset are two to three times more likely than those characterized by moderate onset to reach moderate or high levels of attacks per year. Likewise, as the rate and overall volume of attacks at onset increase, so does the likelihood that the group will follow a persistent pattern of decline. I conclude with a discussion of the implications of patterns of decline among terrorist organizations for research and policy.     

STR melting curve analysis as a genetic screening tool for crime scene samples

In this proof-of-concept study, high-resolution melt curve (HRMC) analysis was investigated as a postquantification screening tool to discriminate human CSF1PO and THO1 genotypes amplified with mini-STR primers in the presence of SYBR Green or LCGreen Plus dyes. A total of 12 CSF1PO and 11 HUMTHO1 genotypes were analyzed on the LightScanner HR96 and LS-32 systems and were correctly differentiated based upon their respective melt profiles. Short STR amplicon melt curves were affected by repeat number, and single-source and mixed DNA samples were additionally differentiated by the formation of heteroduplexes. Melting curves were shown to be unique and reproducible from DNA quantities ranging from 20 to 0.4 ng and distinguished identical from nonidentical genotypes from DNA derived from different biological fluids and compromised samples. Thus, a method is described which can assess both the quantity and the possible probative value of samples without full genotyping.