Caffeine fatalities--four case reports

Four cases of fatal intoxications with caffeine are described. Caffeine is widely available in beverages and in different OTC-products, in many of them in combinations with other drugs like ephedrine. Caffeine is not as harmless as one might believe. An overdose of caffeine alone, intentional or not, might be deadly. It seems to be warranted to include caffeine in the drug-screening of forensic autopsy cases. It is not motivated from a medical point of view to sell pure caffeine over the counter.     

Bureaucracies,Neoliberal Ideas,and Tax Reform in New Zealand and Ireland

Why did New Zealand adopt one of the most neoliberal tax systems in the world, whereas Ireland pursued a heterodox tax policy of low rates, deep deductions, and distortionary tax incentives? The diverging tax policy trajectories of these two small liberal market economies since 1980 are not well accounted for by conventional ideational, partisan, or political‐institutional explanations. The article argues that the varying degree of neoliberal reform is better understood as the result of differences in the institutionalization of economic knowledge within the state. Distinct administrative institutions in New Zealand and Ireland gave rise to profound differences in the identities, expertise, economic ideas, and policy advice approach of tax policy bureaucrats, which had a major impact on tax policymaking in the two countries.     

The emergence of self-managing schools in South Africa: Devolution of authority or disguised centralism?

This paper considers the devolution of authority to public school governing bodies (SGBs) in the context of self-managing schools. It examines the nature of the powers, functions and duties assigned to them in legislation and asks whether the manner in which South African legislation provides for the devolution of authority and power represents authentic devolution of power, or whether it can be characterised as centralisation in disguise. The question is answered by examining, against the backdrop of general and education-specific legal provisions, two examples of functions of SGBs, namely those to determine language and admission policies.     

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

Buprenorphine is considered to have little respiratory side effects at therapeutic doses and the partial agonistic properties should produce a "ceiling effect" for respiratory depression at higher doses. Still, there are several reports on buprenorphine related deaths. Most deaths involve drug users and the co-administration of other CNS depressant drugs as well as reduced tolerance have been suggested to be risk factors. The primary aims were to investigate if lack of tolerance and/or co-ingestion of other psychotropic drugs are significant risk factors in buprenorphine fatalities. From July 2005 to September 2009, all autopsy cases where buprenorphine or norbuprenorphine had been detected in femoral blood and where analysis of buprenorphine had been performed in urine were selected. Results from the postmortem examination and toxicology were compiled. Postmortem toxicology was performed using the routine methodology at the laboratory. In total, 97 subjects were included in the study. These were divided into four groups; Intoxication with buprenorphine (N=41), Possible intoxication with buprenorphine (N=24), Control cases where buprenorphine was not the cause of death (N=14), and Unclear (N=18). The metabolite to parent compound ratios in both blood and urine in the Intoxication group were significantly different from those in the Control and Unclear groups. An extensive poly-drug use was seen in all groups with several additional opioids in the Possible group (54%) and in the Unclear group (78%) and hypnotics or sedatives in more than 75% of the Intoxication, Possible, and Unclear cases. Illicit drugs were present in all groups but not to a great extent with amphetamine and tetrahydrocannabinol as the main findings. Interestingly, 4 cases in the Intoxication group presented with no other significant drugs in blood other than buprenorphine. We conclude that a lethal concentration of buprenorphine in blood cannot be defined. Instead the analysis of blood as well as urine can be an important tool to show that the drug was taken shortly before death and to rule out a continuous use of buprenorphine supporting the notion that abstinence is an important risk factor. The presence of alprazolam in more than 40% of the Intoxications and the presence of hypnotics and sedatives in 75% of the Intoxications suggests that these drugs interact with buprenorphine producing toxic effects that buprenorphine alone would not have produced. Still, in 10% of the Intoxications no other drugs were found indicating that under certain circumstances buprenorphine alone may produce respiratory depression resulting in death.     

Water always finds its way: Identifying new forms of money laundering

Money laundering regulations have become stricter over time and involve more and more actors. This means that the accountability of laundering regulation will become more important; theoretically, money laundering should have decreased with the implementation of new regulations. However, as this paper shows, it is difficult to estimate even the sign of the trend in the proceeds of crime and of laundering over time with particular reference to the drug trade. There seems to be a substitution from hard to softer drugs, and no substantial decline in the proceeds of crime and likewise no substantial decline in money laundering. Criminals seem to switch from the more controlled banking sector into still less controlled parts of financial markets, and from financial markets to other sectors. These new sectors include electronic payments, trade and real estate. The paper shows how one can empirically approach the latter two by using economic information of unusual prices and other characteristics in order to identify the amount of laundering in these sectors. Combining economic information with criminological data facilitates the development of a new tool for identifying money laundering in some important sectors.     

Some recent developments in the legal relationship between parent and child

This article is based on a paper read at the Oxford Round Table Sir William Blackstone Colloquium on Public School Law in Oxford in 2000. Living and working in the 18th century, Sir William Blackstone was one of the most prominent English lawyers of all time, his influence still enduring in England and in many other countries with historical links with England. Because Blackstone regarded the relationship between parent and child as very important, the author therefore traced it through three broad periods: Blackstone's own times, South Africa before 1994 and South Africa after 1994. In preparing the paper, the author realised that many changes had taken place in the legal relationship between parent and child in South Africa since 1994 and that their implications for education management need to be explored. Education law literature in South Africa is certainly still largely dominated by the law as it was before 1994; so are the management implications drawn from it. The article has four sections: first, aspects of the parent-child relationship in South African law before the new Constitutional dispensation; second, relevant developments in South African under the new Constitution(s) and finally, a conclusion.