Problems in using high performance liquid chromatography for drug analysis

Some problems encountered in using high performance liquid chromatography (HPLC) for drug analysis are discussed. These include high procurement and operational costs, lengthy training required, excessive downtimes , lower precision in HPLC versus gas chromatography (GC) and lack of a universal sensitive detector. Some solutions to these difficulties are presented.     

Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

Profiling of illicit fentanyl using UHPLC-MS/MS

Methodology is presented for the profiling of fentanyl in seized drugs using ultra high performance liquid chromatography in combination with tandem mass spectrometry (UHPLC-MS/MS). Target analysis was performed for 40 fentanyl processing impurities, several of which are markers for a specific synthetic route (Siegfried or Janssen). For the separation of these solutes, an Acquity BEH C18 1.7 μm particle column (150 mm × 2.1 mm) with a binary 1% formic acid (pH 2.0)/acetonitrile gradient was used. For MS/MS detection, an atmospheric pressure positive electrospray source was employed with selected reaction monitoring (SRM). The coupling of the high separation power of UHPLC with the highly selective and sensitive detection of MS/MS is amenable to the determination of synthetic route and linking of drug seizures. The technology is also applicable to exhibits containing trace levels of fentanyl in the presence of significantly excess amounts of heroin and/or adulterants.     

Analysis of carbohydrates in seized heroin using capillary electrophoresis

Illicitly produced heroin is commonly cut with carbohydrates to increase bulk. The analysis of these solutes is important for legal and intelligence purposes. A capillary electrophoresis (CE) method was developed for the qualitative analysis of dextrose, lactose, sucrose, inositol, and mannitol in heroin exhibits. For this method, a 64 cm (55.5 cm to detector window) by 50 mum capillary was used with the Agilent Basic Anion Buffer modified to pH 12.1. This separation was performed at 25 degrees C with a voltage of 20 kV and indirect detection with 2,6-pyridinedicarboxylic acid as the visualization reagent. The methodology is also applicable for the screening of inorganic and organic anions using indirect detection, and acidic adulterants using direct detection. For a run time of 13 min, the relative standard deviation (n = 6) of the methodology was better than 0.36% for migration times and less than 2.6% for corrected peak areas. For the analysis of carbohydrates and acidic adulterants in seized heroin, excellent agreement was obtained between CE and nuclear magnetic resonance spectroscopy.     

The Deductibility of State and Local Taxes

President Reagan's tax reform proposals of May 1985 recommendedeliminating the deduction of state and local taxes in computingfederal taxable income. Arguments for and against deductibilityappeal to equity for taxpayers facing levies from multiple governmentsand to concern for the roles and responsibilities of governmentsin a federal system. Intense criticism and lobbying againstthe president's proposal was spearheaded by New York. The debatewas soon recast to emphasize the impact of change on other states,especially in the Northeast and Midwest, and the potential widespreadnegative effects on government services, especially education.The broadened base of opposition to change was sufficient tosustain deductibility in the bill passed by the House of Representativesin December 1985, illustrating that a cohesive lobbying effortinvoking the concept of federalism as a partnership can be fashionedby appealing to states on the basis of the negative consequencesof change.     

The Implementation of Welfare Reform Policy: The Role of Public Managers in Front-Line Practices

This study examines the extent to which staff in local welfare systems have embraced new welfare reform goals and, if so, the extent to which local management practices contribute to the alignment of staff priorities with policy objectives. It looks at agency structure and several aspects of public management from a microperspective that prior research has linked to agency performance including training, performance monitoring, staff resources, leadership characteristics, and personnel characteristics. The research indicates that front-line workers in welfare offices continue to believe that traditional eligibility determination concerns are the most important goals at their agencies. It also finds that management practices and the structuring of agency responsibilities matter: To the extent that public managers want to redirect local staff to focus their attention on the new goals associated with welfare reform, they can create the conditions under which staff have clear signals about what is expected and could provide them with the resources and incentives to realign their priorities.     

DTC Advertising Harms Patients and Should Be Tightly Regulated

Like all interventions in health care, direct-to-consumer (DTC) advertising should be evaluated by comparing its risks to its benefits, in the context of the available or potentially available alternatives. The objective, of course, is to realize any unique benefits while minimizing the risks. On balance, the adverse effects of DTC advertising outweigh the still-unde-monstrated benefits of the advertising.