73例儿科医疗损害的法医病理学鉴定

目的通过对73例儿科医疗损害的法医病理学鉴定案例进行分析,探讨法医病理学在解决儿科医疗损害等问题上的重要性。方法收集南京医科大学司法鉴定所2002年1月—2016年8月受理的、死亡年龄在28 d~10岁的儿科医疗损害病理检验案例73例,对死亡原因及与涉案医疗机构的关系进行回顾性分析。结果 73例中,男女性比例1.70∶1,年龄在28 d~1岁的居多,为26例(35.62%),其次是1~3岁,为21例(28.77%)。通过尸体检验确定死亡原因的71例中,死亡原因以疾病为主,其中呼吸系统疾病占首位,为33例(46.48%),其次是心血管系统疾病,为12例(16.90%)。医疗损害涉及医疗机构共75所,三级医疗机构32所(42.67%),其次为二级以下(不包括二级)医疗机构23所(30.67%)。临床诊断与法医病理学诊断相符及基本相符的有38例(52.05%),未明确或者误诊的35例(47.95%)。结论法医学尸体解剖及病理学鉴定有助于确定死亡原因,不仅为儿科医疗损害提供了科学的依据,并且丰富和发展了临床医学知识,可在一定程度上提高诊疗水平。     

59例过敏反应死亡案例分析

目的通过对过敏反应死亡案例分析,探索过敏反应死亡法医学鉴定标准,为法医学鉴定提供依据。方法收集上海地区1998—2008年59例诊断为过敏反应死亡案例,对案例中死者的临床病史、过敏反应临床表现、尸体检验结果等进行分析。结果 59例过敏反应死亡案例中有58例死于药物过敏(其中77.6%为抗生素),正规医院与非法行医各占37.3%和61.0%,过敏症状主要为呼吸困难、颜面发绀等,自接触过敏原至死亡从1 min到3 d,血清总Ig E浓度50~576.92 IU/m L,临床表现和病理解剖检查结果也有明显改变。结论在排除其他死因基础上,综合分析案情、病史、临床表现、尸检结果,可以得出过敏反应死亡的鉴定结论。其中案情调查(包括过临床病史、过敏原接触史、临床表现)对诊断过敏反应死亡具有关键性作用。     

61例儿童病毒性肺炎死亡案例回顾性分析

目的回顾性分析儿童病毒性肺炎死亡原因鉴定案例的法医病理学尸体检验及临床资料,探讨儿童病毒性肺炎的发病特点及病理学特征,为儿童因2019新型冠状病毒感染导致病毒性肺炎的病理诊断提供参考。方法收集南方医科大学司法鉴定中心近年来儿童死亡原因鉴定意见为病毒性肺炎死亡的尸体检验资料共61例,对性别、年龄、临床症状及病理学特征等进行比较分析。结果 61例病毒性肺炎死亡儿童中,年龄主要集中在2岁以内(83.61%),发病后2周内死亡占比较大(91.80%)。尸体检验大体改变包括呼吸道黏膜充血、胸腔积液、肺膨隆、肺胸膜浆膜花斑样改变、肺局灶性出血及肺水肿,肠系膜淋巴结肿大占比较高(83.61%),有21.31%的患儿存在胸腺发育不良。组织病理学改变主要包括肺泡和间质水肿、肺出血、肺泡上皮细胞脱落、肺泡内浆液性和(或)纤维素性渗出、病毒包涵体形成、透明膜形成,间质及肺泡内以巨噬细胞和淋巴细胞为主的炎症细胞浸润。病毒感染常累及心脏和胃肠道。结论儿童病毒性肺炎临床表现隐匿,因儿童免疫系统发育不健全、自身免疫力差,极易转化成重症甚至死亡。通过分析法医学尸体解剖及组织病理学特点,可为病毒性肺炎的病理诊断提供参考。     

54例氯化琥珀胆碱中毒案件的法医学分析

目的观察分析氯化琥珀胆碱中毒案件的法医学表现,以期提高氯化琥珀胆碱中毒的检验鉴定。方法收集54例氯化琥珀胆碱中毒案例,通过病理学、毒理学变化及案件特点进行回顾性分析,观察氯化琥珀胆碱中毒的检验鉴定规律。结果氯化琥珀胆碱中毒的病理学表现以急性肺淤血、肺水肿等一般猝死改变为主,部分死者心肌排列紊乱及断裂。死者心血中均检见琥珀胆碱成分,皮肤组织部分检见琥珀胆碱成分。结论氯化琥珀胆碱中毒具有死亡快、手段隐蔽、难以抢救、易漏检等特点。对于猝死案件、死因可疑案件应将氯化琥珀胆碱作为常规检验指标,防止此类案件的未检或漏检。     

711例道路交通事故死亡案例分析

目的分析711例道路交通事故死亡案例,探讨道路交通死亡事故的特点。方法收集相关市区711例道路交通事故死亡案例,按照死者性别、年龄、死亡原因、死者交通方式等项目分类进行统计分析。结果 711例死者中男性多于女性(2.18∶1),21~60岁占70.6%,气温较低的季节发生交通事故较多,一天中高发时间段为6~8、18~20及23~1时,死者中以非机动车驾乘者和步行者居多,分别占41.4%和29.1%;肇事车辆主要为货车和轿车,分别占38.2%和25.1%;交通事故造成颅脑损伤导致死亡的占损伤致死亡的比例最高(54.7%),联合损伤致死的其次(30.9%)。结论本文数据来源地交通事故造成人员死亡案例的特点,与沿海其他较发达城市的相关调查数据相符,需综合治理以减少相关事故的发生。     

54例意外烧死尸体的法医学分析

本文通过对54例意外烧死尸体的法医学检验,结合文献进行分析,以供法医学实践参考。1案例资料1.1基本情况54例意外烧死尸体的相关资料均来自上海市2002年1月至2006年1月间委托尸体解剖的35起火灾案例。案件性质均认定为意外事故,其中单起事故中死亡2人以上的有8起,死亡人数最多的一起为10人。35起火灾意外中32起发生在居民住宅,且20年以上的老式居民住宅占多数(26起),3起发生在工厂仓库中;起火原因大多为电线老化和电器使用不当(33起),此外还有化学物质爆炸或爆燃等(2起);起火时间多为夜间(28起)。1.2性别和年龄本组案例死者中,男性33例,女性…     

新生儿呼吸系统疾病死亡的法医病理学分析

目的分析和探讨呼吸系统疾病引起新生儿死亡的病理学特点,为法医学死亡原因鉴定和相关医疗纠纷鉴定提供科学依据。方法回顾性总结分析1993～2008年16年间攀枝花市公安局尸检档案中85例新生儿死亡案例。结果呼吸系统疾病是引起新生儿死亡的首要因素（共56例,占65.88%）,其中新生儿吸入性肺炎20例（23.53%）、新生儿感染性肺炎14例（16.47%）、新生儿窒息12例（14.12%）、新生儿肺透明膜病6例（7.59%）、新生儿肺出血4例（4.71%）。结论新生儿尸检应重视呼吸系统的检查,根据新生儿发病特点和肺部病理变化明确临床诊断和死亡原因。     

药物不良事件及其法医学鉴定

目的研究药物不良事件的法医学鉴定原则及注意事项,为此类案件的法医学鉴定提供参考并积累基础资料。方法通过对33例药物不良事件法医学鉴定案件的回顾性分析,总结药物不良事件相关案件的法医学鉴定原则及注意事项。结果药物不良事件的法医学鉴定案件有增长趋势,患者以女性多见(20例,60.6%)。33例药物不良事件中,以医疗过错鉴定案件多见(21例,63.6%),21例医疗过错鉴定案件中,只有1例(4.8%)与医院过量使用药物有关,其他均未发现医院存在医疗过错;非法行医案8例(24.2%),均与使用药物不当有关。法医鉴定类型以活体鉴定为主(27例,81.8%),死亡案件6例(18.2%)。结论药物不良事件的法医学鉴定案例在不断增加并具有自身特点和复杂性,应引起鉴定人的重视。     

窒息死亡的法医病理学分析

目的探讨窒息死亡的法医病理学特点。方法对四川大学华西法医学鉴定中心1982年10月1日～2006年9月30日所作160例窒息死亡尸体剖验病理材料进行统计分析。结果窒息死亡案例占整个法医学检案的9.9%,年龄:30～39岁的死者占整个研究对象的29.4%,平均年龄为31.25岁。性别:男性103例,女性57例。男女比例1.81∶1。死亡方式:意外死亡最多(63.1%),其次为自杀(24.4%)和他杀(12.5%)。死亡原因:缢死最多(21.9%),其次为CO中毒(17.5%)、溺死(16.25%)等。医疗纠纷共计39例,均为新生儿窒息,主要发生在乡镇医院和县级医院(76.92%)。结论加强法制教育,提高安全隐患意识等是减少窒息死亡的重要手段。提高城乡医疗水平,加强窒息急诊抢救的临床技能是防止窒息引起医疗纠纷的关键。     

300例心源性猝死案例的法医学鉴定分析

目的探讨心源性猝死案例的病因、诱发因素及法医病理学特点,以期为心源性猝死案件的法医病理诊断提供参考。方法收集法医病理检案中的心源性猝死案例,对其年龄、性别、死亡时间、死因、诱因及场所等流行病学特点进行回顾分析。结果 300例心源性猝死案例中男性多于女性,18~45岁发病最多;病因包括冠心病(129例),心肌病(78例),心肌炎(36例)等;应激为SCD最常见的诱发因素(157例)。结论 1应激和冠心病是心源性猝死的重要危险因素。2心源性猝死的法医学鉴定除了要进行系统的尸检及病理学检查外,还要对死者的相关资料如:基础疾病、诱因、死亡时间、死亡经过等进行全面系统的分析以明确死因。     

Bhartṛhari and Maṇḍana on Avidyā

The concept of avidyā is one of the central categories in the Advaita of Śaṇkara and Maṇḍana. Shifting the focus from māyā, interpreted either as illusion or as the divine power, this concept brings ignorance to the forefront in describing duality and bondage. Although all Advaitins accept avidyā as a category, its scope and nature is interpreted in multiple ways. Key elements in Maṇḍana’s philosophy include the plurality of avidyā, individual selves as its substrate and the Brahman as its field (viṣaya), and the distinction in avidyā between non-apprehension and misapprehension. A closer investigation shows that Maṇḍana is directly influenced by Bhartṛhari’s linguistic non-dualism in developing the concept of avidyā. This study also compares other key constituents such as vivartta and pariṇāma that are relevant to the analysis of avidyā. As the concept of counter-image (pratibimba) emerges as a distinct stream of Advaita subsequent to Maṇḍana, this study also compares the application of pratibimba in the writings of Bhartṛhari and Maṇḍana.     

Immigration,intermarriage and the changing face of Europe in the post war period

In this article we compare the propensity to intermarry of various migrant groups and their children who settled in Germany, France, England, Belgium and the Netherlands in the post-war period, using a wide range of available statistical data. We try to explain different intermarriage patterns within the framework of Alba and Nee's assimilation theory and pay special attention to the role of religion, colour and colonial background. We therefore compare colonial with non colonial migrants and within these categories between groups with ‘European’ (Christian) and non-European (Islam, Hinduism) religions. First of all, religion appears to be an important variable. Migrants whose faith has no tradition in Western Europe intermarry at a much lower rate than those whose religious backgrounds correspond with those that are common in the country of settlement. The rate of ethnic endogamous marriages in Western Europe are highest in Hindu and Muslim communities, often regardless if they came as guest workers or colonial migrants. Whereas differences in religion diminish the propensity to intermarry, colour or ‘racial’ differences on the other hand seem to be less important. This is largely explained by the pre-migration socialisation. Furthermore, the paper argues that the attention to institutions, as rightly advocated by Richard Alba and Victor Nee, needs a more refined and layered elaboration. Institutions, often as barriers to intermarriage, do not only emanate from the receiving society, but also—be it less formalized—within migrant communities. Especially religions and family systems, but also organized nationalist feelings, can have a profound influence on how migrants think about endogamy. Finally, strong pressures to assimilate, often through institutionalized forms of discrimination and stigmatization, not only produce isolation and frustrate assimilation (with resulting low intermarriage rates), but can also stimulate assimilation by 'passing' mechanisms. These factors, together with a more comparative perspective, are not completely ignored in the new assimilation theory, but—as this study of Western European intermarriage patterns stresses—deserve to be included more systematically in historical and social scientist analyses.     

Unraveling the <Emphasis Type="Italic">Kāvyaprakāśa</Emphasis>: Jayadeva Pīyūṣavarṣa’s idiosyncratic sequence of topics in the <Emphasis Type="Italic">Candrāloka</Emphasis>

In his twelfth century alaṃkāraśāstra, the Candrāloka, Jayadeva Pīyūṣavarṣa reverses the sequence of topics found in Mammaṭa’s Kāvyapr-akāśa, an earlier and immensely popular work. With such a structural revisionism, Jayadeva asserts the autonomy of his own work and puts forth an ambitious critique of earlier approaches to literary analysis. Jayadeva investigates the technical and aesthetic components of poetry in the first part of the Candrāloka, prior to his formal semantic investigations in the latter half of the text, thus suggesting that aesthetic evaluations of poetry beneficially inform scientific investigations of language. Jayadeva’s organization of his chapters on the semantic operations, moreover, intimates that the study of suggestive and metaphoric functions of language clarifies our understanding of denotation, which is conventionally understood to be the primary and direct path of verbal designation.     

Illumination,Imagination, Creativity: Rājaśekhara,Kuntaka, and Jagannātha on <Emphasis Type="Italic">Pratibhā</Emphasis>

Sanskrit poeticians make the visionary faculty of pratibhā a necessary part of the professional poet’s make-up. The term has a pre-history in Bhartṛhari’s linguistic metaphysics, where it is used to explain the unitary perception of meaning. This essay examines the relation between pratibhā and possible theories of the imagination, with a focus on three unusual theoreticians—Rājaśekhara, Kuntaka, and Jagannātha Paṇḍita. Rājaśekhara offers an analysis of pratibhā that is heavily interactive, requiring the discerning presence of the bhāvaka listener or critic; he also positions pratibhā in relation to Bildung (vyutpatti) and practice. For Kuntaka, pratibhā, never an ex nihilo creation by a poet, serves as the basis for the peculiar forms of intensified insight and experience that constitute poetry; these may also involve the creative scrambling and re-articulation of the object in terms of its systemic composition. At times, Kuntaka’s pratibhā comes close to a strong notion of imaginative process. But the full-fledged thematization of the imagination, and of pratibhā as its support and mechanism, is best seen in the seventeenth-century debates preserved for us by Jagannātha. A link is suggested between the discourse of poetic imagination in Jagannātha and similar themes that turn up in Indo-Persian poets such as Bedil.     

Preventing Homelessness for System‐Involved Youth

Too many youth and young adults find themselves on the streets, couch‐surfing with friends, in emergency shelters or worse, after exiting the child welfare and juvenile justice systems. In some circumstances, youth have had court hearings until their exit from the legal system, but those hearings have not focused on long‐range plans of youth and emergencies youth may encounter. In other circumstances, there has been little or no planning prior to discharge, especially for young people who leave the juvenile justice system. Courts can and should prevent, alleviate or end youth homelessness for youth who appear before them through strategies that are enumerated in the recently‐passed NCJFCJ resolution. This article expounds on three of these strategies – coordinating transition and re‐entry plans, insisting on effective legal representation of youth, and utilizing sound judicial leadership. It also describes the concurrent efforts of the Coalition for Juvenile Justice and the American Bar Association's Homeless Youth Legal Network to remove legal barriers and improve outcomes for youth and young adults experiencing homelessness.     

Best practices for structuring a family court parenting plan evaluation under the 2022 AFCC Guidelines

Evaluation appointment orders provide enforceable scaffolding for conduct of family court parenting plan evaluations, and use of the evaluator's reports, feedback, file, and testimony. Unlike a contract, a stipulated or adjudicated appointment order is directly enforceable by the family court. It unambiguously positions the evaluator as the family court's appointee – answerable directly to the court and, in some jurisdictions, protected by quasi-judicial immunity from damages claims. A well-crafted appointment order governs the roles and expectations of the court, the evaluator, the parties, the lawyers, and the collateral witnesses. An appointment order mandates the legal duties, rights, powers, and responsibilities of the professionals, the parties, and the collateral witnesses. At minimum, an appointment order articulates the legal basis for the appointment, the purpose and scope of the evaluation, compensation of evaluator, and the duty of the parties to participate in the process. A written evaluation protocol or procedures statement discloses in advance the methods of investigation and assessment that the evaluator intends to use. Together, the appointment order and written protocol help the evaluator, lawyers, parents, and judge manage the complexity of the evaluation process.     

The Supreme Array Scripture: A New Interpretation of the Title “Gaṇḍavyūha-sūtra”

This article argues for a new interpretation of the Sanskrit compound gaṇḍa-vyūha as it is used in the common title of the Mahāyāna text the Gaṇḍavyūha-Sūtra.The author begins by providing a brief history of the sūtra’s appellations in Chinese and Tibetan sources. Next, the meanings of gaṇḍa (the problematic member of the compound) are explored. The author proposes that contemporary scholars have overlooked a meaning of gaṇḍa occurring in some compounds, wherein gaṇḍa can mean simply “great,” “big” or “massive.” This general sense is particularly common in the compound gaṇda-śaila (a “massive rock” or “boulder”) and is found in such texts as the Bhāgavata Purāṇa, the Harivaṃśa and the Harṣacarita. Following the discussion of Gaṇḍa, the author examines the term vyūha (“array”) as it is used in the Gaṇḍavyūha-sūtra. The article concludes with the suggestion that a more appropriate translation of the Gaṇḍavyūha-sūtra would be “The Supreme array Scripture.”     

Evaluation of six presumptive tests for blood, their specificity, sensitivity, and effect on high molecular-weight DNA

Luminol, leuchomalachite green, phenolphthalein, Hemastix, Hemident, and Bluestar are all used as presumptive tests for blood. In this study, the tests were subjected to dilute blood (from 1:10,000 to 1:10,000,000), many common household substance, and chemicals. Samples were tested for DNA to determine whether the presumptive tests damaged or destroyed DNA. The DNA loci tested were D2S1338 and D19S433. Leuchomalachite green had a sensitivity of 1:10,000, while the remaining tests were able to detect blood to a dilution of 1:100,000. Substances tested include saliva, semen, potato, tomato, tomato sauce, tomato sauce with meat, red onion, red kidney bean, horseradish, 0.1 M ascorbic acid, 5% bleach, 10% cupric sulfate, 10% ferric sulfate, and 10% nickel chloride. Of all the substances tested, not one of the household items reacted with every test; however, the chemicals did. DNA was recovered and amplified from luminol, phenolphthalein, Hemastix, and Bluestar, but not from leuchomalachite green or Hemident.     

<Emphasis Type="Italic">Anyathākhyāti</Emphasis>: A Critique by Appaya Dīkṣita in the <Emphasis Type="Italic">Parimala</Emphasis>

In this paper, the problem of illusory perception, as approached by the Nyāya and Advaita Vedānta schools of philosophy, is discussed from the standpoint of the Parimala. This seminal work belonging to the Bhāmatī tradition of Advaita Vedānta was composed in the sixteenth century by the polymath Appaya Dīk?ita. In the context of discussing various theories of illusion, Dīk?ita dwells upon the Nyāya theory of anyathākhyāti, and its connection with jñānalak?a?apratyāsatti as a causal factor for perception, and closely examines if such an extraordinary (alaukika) perception is tenable to explain illusory perception. He then proceeds to point out the deficiencies of this model and thereby brings to the fore the anirvacanīyakhyāti of Advaitins as the only theory which stands scrutiny.     

Monks Who Have Sex: Pārājika Penance in Indian Buddhist Monasticisms

In the study of Buddhism it is commonly accepted that a monk or nun who commits a pārājika offence is permanently and irrevocably expelled from the Buddhist monastic order. This view is based primarily on readings of the Pāli Vinaya. With the exception of the Pāli Vinaya, however, all other extant Buddhist monastic law codes (Dharmaguptaka, Mahāsāṅghika, Mahīśāsaka, Sarvāstivāda and Mūlasarvāstivāda) contain detailed provisions for monks and nuns who commit pārājikas but nevertheless wish to remain within the saṅgha. These monastics are not expelled. Rather, they are granted a special status known as the śikṣādattaka. In this paper I explore the rules. concerning pārājika penance and the śikṣādattaka with specific regard to monastic celibacy. Given that five out of six extant law codes recognise this remarkable accommodation to the rule of celibacy, I argue that we must look to Vinayas other than the Pāli Vinaya if we are to arrive at a nuanced and representative view of Indian Buddhist monasticism.

Grant me chastity and continence, but not yet. Augustine of Hippo (354–430 C.E.)