Fatal diphenhydramine intoxication in infants

Diphenhydramine is an antihistamine available in numerous over-the-counter preparations. Often used for its sedative effects in adults, it can cause paradoxical central nervous system stimulation in children, with effects ranging from excitation to seizures and death. Reports of fatal intoxications in young children are rare. We present five cases of fatal intoxication in infants 6, 8, 9, 12, and 12 weeks old. Postmortem blood diphenhydramine levels in the cases were 1.6, 1.5, 1.6, 1.1 and 1.1 mg/L, respectively. Anatomic findings in each case were normal. In one case the child's father admitted giving the infant diphenhydramine in an attempt to induce the infant to sleep; in another case, a daycare provider admitted putting diphenhydramine in a baby bottle. Two cases remain unsolved; one case remains under investigation. The postmortem drug levels in these cases are lower than seen in adult fatalities. We review the literature on diphenhydramine toxicity, particularly as it pertains to small children, and discuss the rationale for treating these cases as fatal intoxications.     

Managing incidental findings in human subjects research: analysis and recommendations.

No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed.     

Rocks and Hard Places: Managing Two Tensions in Negotiation

Theorists posit two fundamental tensions in negotiation. One is strategic: the tug-and-pull between creating value and claiming one's share of it. The other is interpersonal: the tension between asserting one's own interests and, at the same time, empathizing with the feelings and needs of other parties. ¹ This research report analyzes how negotiators experience these tensions in practice. Specifically, their self-perceptions about their relative competence in several key areas allow us to see how strength along one dimension (like getting the maximum) is correlated with other important skills. Some of the authors' findings confirm familiar models. For example, people implicitly feel that being successful at asserting their own interests imposes a cost with respect to understanding others. There were some surprises, however: most notably, people who rated themselves as strong value claimers also saw themselves as good value creators. The authors explore some of the implications of their findings for both practice and teaching, and foreshadow a follow-up report they plan. They also note how other researchers can access their data for their own studies.     

Building the Evidence Base for Intensive Family Preservation Services

This article examines the state of intensive family preservation services (IFPS) research. Using studies of IFPS in five states, this article seeks to establish whether IFPS can be regarded as an evidence-based practice, an increasingly important standard for publicly funded services. While reporting rates of repeat child maltreatment, the analysis uses placement rates as the main outcome measure and compares effect sizes using Cohen's arcsine transformation for data reported as proportions. Significant differences in rates of child out-of-home placement and repeat maltreatment were found in some studies, particularly for higher risk families. The findings also underscore the difficulty of identifying which families to serve (targeting), ensuring treatment fidelity, and employing rigorous and appropriate evaluation methods. Overall, additional research is needed to move IFPS from a promising practice to an evidence-based practice.     

Competing for Foreign Direct investment: Efforts to Promote Nontraditional FDI in Costa Rica, Brazil, and Chile

This article examines government efforts in Costa Rica, Rio Grande do Sul in Brazil, and Chile to promote nontraditional foreign direct investment (FDI). Rather than attempting to account for the overall level of FDI attracted, this article seeks to explain the ability of governments to develop a well-targeted, responsive, and sustained strategy specifically to attract nontraditional FDI. It concludes that three independent variables play an important role in making some governments more effective than others at developing strategies to promote nontraditional FDI. These are the extent of the government's autonomy from special interest groups, both domestic and foreign; the extent of the government's transnational learning capacity; and the extent to which there is an ideological consensus among political parties in the country or state in favor of working closely with the business community. Roy C. Nelson is an associate professor of International Studies at Thunderbird, the Garvin School of International Management. He is currently completing a book entitledHarnessing Globalization: The Promotion of Nontraditional Foreign Direct Investment in Latin America.