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Over the past 30 years, a number of social, political, and economic forces have influenced public policy decisions regarding residential services for persons with mental retardation and other developmental disabilities (MR/DD). One of the most striking outcomes of these forces has been a steady decrease of persons with MR/DD residing in state institutions. In this paper we show the changes over the past 30 years in state institutional populations, interstate variability, movement of individuals into and out of state institutions, costs of state institutional care, and state institution closures as a result of social policy.

Two cases of death involving methylenedioxymethamphetamine (MDMA) are reported; one case is a fatal acute overdose and the other is a drug-related death. The tissue distribution of MDMA is reported in both cases.

Recent research has indicated that substantial differences may exist between the concentration of organic bases in heart blood specimens and that in peripheral blood specimens. This study was designed to determine the distribution characteristics of ethyl alcohol in postmortem blood. The heart blood/femoral blood ethyl alcohol ratio was determined for 100 cases. In the majority of cases exhibiting alcohol concentration differences greater than 0.02 mg/dL, the specimens were suspect because of their physical appearance, trauma to the decedent in the area of specimen collection, gross differences in hematocrits, or large volume differences in the two specimens. An additional set of experiments was conducted to illustrate that the volume of blood and the amount of sodium fluoride preservative placed in the collection tube can have a substantial effect upon the subsequently measured ethyl alcohol concentration. These factors can adversely affect the observed heart blood/femoral blood alcohol ratio and must be considered when evaluating the distribution characteristics of ethyl alcohol in postmortem specimens.

A fatality due to the ingestion of fluoxetine and ethanol is reported. Quantitation of the drug and its active normetabolite was accomplished by gas chromatography with a flame ionization detector. Identification of the compounds was performed by gas chromatography/mass spectrometry. Tissue distribution of fluoxetine and norfluoxetine, as well as analytical details, is presented.

A 31-year-old male died from a suicidal overdose of nortriptyline. An unusually high heart blood concentration of 86.4 mg/L is reported, along with femoral blood and tissue concentrations.