Tissue distribution of mirtazapine and desmethylmirtazapine in a case of mirtazapine poisoning

An ingestion of an unknown quantity of mirtazapine in a suicide attempt leading to death is described. Sertraline and amitriptyline have been co-ingested. Because mirtazapine is reported to be relatively safe in overdose, body fluids and tissues were investigated for both mirtazapine and desmethylmirtazapine by high-pressure liquid chromatography/tandem mass spectrometry following liquid-liquid extraction. The limit of detection was sufficiently low to also apply the assay in pharmacokinetic studies. The levels of amitriptyline and nortriptyline were very low (38 and 19 ng/mL femoral venous blood) and the amount of sertraline in blood taken from the femoral vein (880 ng/mL) was considerably lower than those seen in overdosage. Accumulation of mirtazapine and N-desmethylmirtazapine was evident in fluids and tissues involved in enterohepatic circulation and excretion. The concentration determined in a brain sample suggests a contribution of the metabolite to the drug's pharmacodynamic activity. Based on literature data, significant adverse or synergistic effects among the drugs detected as well as adverse reactions such as a serotonin reaction appeared less probable. Mirtazapine exhibits alpha(1)-antagonistic properties on the cardiac-vascular system and may cause hyponatraemia. In the face of the cardiac findings at autopsy and the lack of an apparent cause of death, these effects of mirtazapine may have initiated a process leading to death.     

Welfare policies and migration of the poor in the United States: An empirical note

This paper has investigated the impact of geographic welfare benefit differentials upon migration in the United States. Unlike other related studies, which typically focus upon black migration (as a surrogate measure of migration of the poor), the present study focuses directly upon migration of the poor per se. A variety of reduced-form estimates are provided. The evidence strongly suggests that the net in-migration of the poor is positively and significantly influenced by higher nominal AFDC levels and by higher real AFDC levels. These findings support the welfare magnet hypothesis, which alleges that relatively high welfare levels act to attract poor migrants. Moreover, given that poor migrants are attracted non only by high nominal welfare levels but also by high real welfare levels, an argument can be made for establishing geographically uniform real welfare benefit levels in the United States. This uniformity presumably should act, over the long run, to eliminate the human resource distortions being caused by the currently prevailing welfare system.The authors are indebted to Michael Greenwood, Dick Muth, Jim Kau and Janet Pack. Naturally, the usual caveat applies.     

Collectivism or Isolation? Gender Relations in Urban La Paz,Bolivia

Latin American women's extensive collective action outside and inside the household has been paid much attention in the literature over the years. Only a handful of studies have challenged the arguments that Latin American women generally organise together and show solidarity with one another. This paper argues that women's collective action in contemporary urban Bolivia is relatively weak, both outside and within the household. The consequence is that women are isolated to a degree not hitherto recognised, an isolation women cope with in different ways.     

Fiscal Stress Management During the Financial and Economic Crisis: The Case of the Baltic Countries

The Baltic countries—Estonia, Latvia, and Lithuania—were severely hit by the global financial and economic crisis in 2008–2011. In response to the crisis, all three states chose to undertake extensive fiscal consolidations. This article examines the strategies adopted by the Baltic governments for managing fiscal stress and consolidating their budgets in the light of the existing literature on cutback budgeting. In all three countries, the governments combined expenditure and revenue measures, with a larger share of adjustment taking place on the expenditure side. Among expenditure measures, a mix of across-the-board and targeted cuts was adopted, though the importance of targeted cuts increased over time. The case studies also indicate that although the theoretical propositions of the cutback budgeting literature point to the correct directions overall, further refinement is needed in several theoretical issues.