Fatal outcome of poisoning with the benzodiazepines flunitrazepam and diazepam

On a wintry day a 29-year-old woman was found dead beside her car showing head injuries and signs of hypothermia. Several empty packets of sedative and hypnotic drugs were lying inside the car. Toxicological analysis revealed the presence of flunitrazepam (heart blood of the left and right chamber 0.033 mg/L each), norflunitrazepam (left heart blood 0.029 mg/L, right heart blood 0.027 mg/L), 7-amino-flunitrazepam (left heart blood 0.090 mg/L, right heart blood 0.104 mg/L), diazepam (left heart blood 0.395 mg/L, right heart blood 0.386 mg/L), nordazepam (left heart blood 0.112 mg/L, right heart blood 0.115 mg/L) and temazepam (left heart blood 0.034 mg/L, right heart blood 0.033 mg/L). Neither alcohol nor other drugs were found. It was concluded that benzodiazepine intake led to a disturbance of consciousness. Whether the woman died in this situation due to the icy temperature as a result of hypothermia or whether she died or would have died solely due to benzodiazepine overdosage could not be clarified.     

Central-Local Government Relations in Transition: The Case of Swedish Child Care

The provision of subsidized child care has grown to become asizeable economic activity in Sweden during recent decades.This paper examines the changed financial relation betweencentral and local governments and the impact of child-caregrants on local government behaviour. We find that during anearlier regime, with a system of matching grants, localgovernments responded strongly to the incentives of the rules.This resulted in both intended and unintended outcomes, aswell as a distortion of information to the central government.Experiences from a recent transition of regime towards a kindof closed block grant system, illustrates new types ofadaptive behaviour but also the problem of finding a formulafor a fair allocation of resources among local governments.When designing a block grant system a distinction must be madebetween expenditures and resource needs; cost expenditure datado not necessarily reflect resource needs in cases where thereare national categorical equity goals related to socialservices of a merit-want character.     

Bureaucratic Resistance to International Intelligence Cooperation – The Case of Europol

Abstract

This article analyses the gap between government ambitions and actual outcomes in the case of European counter terrorism intelligence cooperation. Specifically, it investigates why Europol has not managed to live up to its tasks despite outspoken government support. Drawing on rational choice institutionalism, the study suggests why bureaucrats might be motivated to resist calls for international cooperation. By examining the process by which Europol has developed as an actor in the counter terrorism field, this article shows how development in the field of intelligence cooperation is not exclusively the reflection of government preferences. It concludes by suggesting that scholars could gain greater insight from a less state centric approach to the study of intelligence. In addition, the article suggests that policy makers cultivate a greater familiarity with bureaucratic factors and that they continually work with those factors in mind.     

Death from Nitrous Oxide

Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available.     

Influence of CYP2D6 genotype on the disposition of the enantiomers of venlafaxine and its major metabolites in postmortem femoral blood

Venlafaxine (VEN) is an antidepressant drug mainly metabolized by the cytochrome P450 (CYP) enzyme CYP2D6 to the active metabolite O-desmethylvenlafaxine (ODV). VEN is also metabolized to N-desmetylvenlafaxine (NDV) via CYP3A4. ODV and NDV are further metabolized to N,O-didesmethylvenlafaxine (DDV). VEN is a racemic mixture of the S- and R-enantiomers and these have in vitro displayed different degrees of serotonin and noradrenaline reuptake inhibition. The aim of the study was to investigate if an enantioselective analysis of VEN and its metabolites, in combination with genotyping for CYP2D6, could assist in the interpretation of forensic toxicological results in cases with different causes of deaths. Concentrations of the enantiomers of VEN and metabolites were determined in femoral blood obtained from 56 autopsy cases with different causes of death. The drug analysis was done by liquid chromatography tandem mass spectrometry (LC/MS/MS) and the CYP2D6 genotyping by PCR and pyrosequencing. The mean (median) enantiomeric S/R ratios of VEN, ODV, NDV and DDV were 0.99 (0.91), 2.17 (0.93), 0.92 (0.86) and 1.08 (1.03), respectively. However, a substantial variation in the relationship between the S- and R-enantiomers of VEN and metabolites was evident (S/R ratios ranging from 0.23 to 17.6). In six cases, a low S/R VEN ratio (mean 0.5) was associated with a high S/R ODV ratio (mean 11.9). Genotyping showed that these individuals carried two inactive CYP2D6 genes indicating a poor metabolizer phenotype. From these data we conclude that enantioselective analysis of VEN and ODV can predict if a person is a poor metabolizer genotype/phenotype for CYP2D6. Knowledge of the relationship between the S- and R-enantiomers of this antidepressant drug and its active metabolite is also important since the enantiomers display different pharmacodynamic profiles.     

Does Separation or Divorce Make any Difference? An Interactional Perspective on Intimate Partner Violence with Focus on Marital Status

This article reports a study of the impact of marital status on interactional aspects of intimate partner violence (IPV) among help-seeking women. Are there differences among marital status groups concerning (a) other sociodemographic variables, (b) IPV categories, (c) interactional IPV variables, and (d) perception and interpretation of IPV? A representative sample of 157 women recruited from family counseling, the police, and shelters were interviewed. There was no significant sociodemographic difference among the marital status groups. There were no significant differences pertaining to IPV categories, neither for IPV severity, injury, duration, frequency, mortal danger, and regularity, nor for physical, psychological, or sexual IPV. However, multivariate logistic regression showed that post-separation women were significantly more likely to have (a) had longer duration since the last psychological and sexual IPV episode, (2) reported the physical IPV to be more predictable, and (3) used more active coping strategies against physical IPV. However, our research was not able to determine if perception and interpretation predict actual leaving behavior, or vice versa, or how the victim’s subjective perception and interpretation of the IPV changes over time.     

Petechial Hemorrhages and Ethanol in Deaths from Intoxication

Petechiae in conjunctivae and in the palpebrae/skin of the eyelids are of particular interest for the forensic pathologist, because of their association with pressure on the neck. They have been described in the eyelids of intoxicated persons both in case reports and in text books of forensic pathology. We studied 590 deaths caused by intoxication, and 75 had petechiae either in the conjunctivae, the eyelids, or in both locations. We examined the influence of drugs and ethanol on the location of the petechial hemorrhages in these deaths. Deaths with ethanol in blood and in urine/vitreous humor more often had petechiae in both locations than those without. This association was statistically significant, independent of body position and livor mortis. No association between the location of petechiae, medicinal drugs, or narcotics was found. These results suggest that ethanol may contribute to the development of petechial hemorrhages in deaths from intoxication.