Armanni–Ebstein Lesions in Terminal Hyperglycemia

Armanni–Ebstein lesions (AEL) occur in deaths related to uncontrolled diabetes mellitus. To investigate the relationship between AEL and terminal hyperglycemia, we retrospectively reviewed 71 cases with vitreous glucose levels ≥11.1 mmol/L; 27 (38%) cases had AEL (vitreous glucose 14.0–77.3 mmol/L); and 44 cases (62%) did not (vitreous glucose 11.1–91.9 mmol/L). There was no significant difference (p = 0.271) in vitreous glucose levels between the cases with AEL (mean 39.2, SD 16.7 mmol/L) and those without (mean 34.2, SD 19.8 mmol/L). Similarly, there was no difference in the degree of dehydration, renal failure, or osmolality. However, there was a significantly higher level of β‐hydroxybutyrate among the cases with AEL compared to those without (p = 0.007), suggesting that ketoacidosis may facilitate the development of AEL. Given the possible synergistic role of β‐hydroxybutyrate, the correlation between AEL and terminal hyperglycemia in animal studies may not be applicable to humans. AEL may also possibly occur with sublethal elevations in glucose.     

Basal Vacuolization in Renal Tubular Epithelial Cells at Autopsy and Their Relation to Ketoacidosis

Basal vacuolization of renal tubular epithelial cells is a useful postmortem marker for ketoacidosis. To investigate its incidence and relationship to the severity of ketoacidosis, 158 autopsy cases with elevated β‐hydroxybutyrate (>1 mmol/L) over a 7‐year‐period were retrospectively reviewed. Sixty‐eight cases (43%) exhibited basal vacuolizations (vitreous β‐hydroxybutyrate: 1.16–29.35 mmol/L, mean 10.28 mmol/L), and 90 cases (57%) did not (vitreous β‐hydroxybutyrate: 1.03–13.7 mmol/L, mean 2.84 mmol/L). Quantitative analysis revealed on average a fourfold elevation in β‐hydroxybutyrate in cases with basal vacuolizations compared to those without; 10.3% of cases with β‐hydroxybutyrate concentrations between 1.01 and 2.00 mmol/L had basal vacuolizations, and this incidence increased to 33.3% with concentrations between 4.01 and 6.00 mmol/L. A marked increase in incidence to >70% was observed with concentrations >6.00 mmol/L, and basal vacuoles were invariably present (100%) with concentrations >14.01 mmol/L. This study demonstrates that basal vacuolizations are a sensitive marker for significant ketoacidosis and reaffirms its use as an indicator for likely cases of fatal ketoacidosis at autopsy.     

Research note: challenges of identifying female human trafficking victims using a national 1-800 call center

Human trafficking is a complex global and national crime problem harming victims physically, psychologically, and financially. The Trafficking Victims Protection Act of 2000 (TVPA), Pub. La 106–386, and subsequent reauthorizations, provide assistance and benefits to foreign born victims of labor or sexual human trafficking who are here in the United States. The strategies used to encourage victims to come forward were modeled on those used in the anti- domestic violence (DV) and child protection movements. These include initiatives alerting the public to domestic violence situations through awareness campaigns to increase tips as well as calls for service to police. Other public service initiatives urge victims themselves to self-identify by calling 1-800 numbers. While these techniques have shown success in reducing incidences of domestic violence and providing help to victims, their use to combat sex trafficking has not produced the same level of results. This note explores the challenges for immigrant women victims to self-identify as trafficking victims and urges that evidence-based research is needed to determine the efficacy of a national call center approach.     

Staphylococcal scalded skin syndrome mimicking child abuse by burning

Determining the cause for the sudden death in young adults tends to be complex and difficult. Two cases of death of young people were autoptically investigated who died suddenly while carrying out their hobbies (a 22-year-old male musician and a 20-year-old female dancer). In both cases neither the police investigation, the autopsy, nor the toxicological investigations gave any relevant results. However, when investigating the histology fatty and fibrotic tissue in the right ventricle of the myocardium were found, whereas the myocytes proved to be degenerated--typical for arrhythmogenic right ventricular cardiomyopathy (ARVC). It is important to consider the possibility of heart rhythm failure if a clear reason for sudden death in young adults cannot be detected. Heart rhythm failure often involves the genetic background of the case, which suggests that genetic analysis should be carried out as a supportive means of diagnostics.     

DETECHIP®: A Sensor for Drugs of Abuse*

Abstract: The design and preliminary characterization of a novel sensor for drugs of abuse, DETECHIP^®, is described in this proof‐of‐concept note. Combining both colorimetric and fluorimetric assays, DETECHIP^® is suitable for lab and field use. More than a conventional spot test which provides a single “yes or no” answer, DETECHIP^® provides twenty responses for a more complete characterization of suspect material. This is accomplished by visually noting colorimetric and fluorescent changes of carefully selected dyes upon the addition of test analytes, including drugs of abuse, with respect to controls. Color and fluorescence changes are recorded numerically so that a 20 digit identification code can be constructed for comparison of test analytes and known compounds. DETECHIP^® is applicable to a variety of drugs, both plant‐derived and synthetic, addressing the need to use several different spot tests simultaneously for a single sample.     

Female sex offenders who abuse children whilst working in organisational contexts: offending,conviction and sentencing

To date, there has been very little research into the phenomenon of female-perpetrated institutional child sexual abuse (CSA). This study explored 71 cases of CSA perpetrated by women working with children, considered by UK police and courts between 2000 and 2016. Qualitative and quantitative content analysis was employed to examine court reports, professional regulatory body decisions, media reports and an online sentencing database in order to identify perpetrator and victim characteristics, the nature of the offending behaviour, modus operandi and criminal justice system responses. Findings indicate most women offended alone and had no previous criminal or employment records of concern. Victims were typically male and 15–16 years old. Most women received custodial sentences, typically of 2–3 years in length. Implications for policy and practice are also discussed.     

Conflicts of Interest and Governance Mechanisms in Italian Local Public Utilities

Stemming from different theoretical perspectives the article examines the conflicts of interest arising among the actors (citizens, local governments, private shareholders, service providers) that at various levels are involved in local public utilities governance systems. The main results of a multiple case study analysis on 10 Italian listed local public utilities are summarized. Different and coexisting situations of conflicts of interest among multiple principals and agents are identified. In this context, governance mechanisms (e.g., the board of directors) have different roles and functions and may prevent and mitigate such conflicts. However, our findings suggest that the ownership structure influences board composition and functioning and that higher numbers of independent directors do not necessarily mean “actual” board independence. The article contributes to the debate on conflicts of interest and governance mechanisms in local public utilities.     

Hot spot trafficking: a theoretical discussion of the potential problems associated with targeted policing and the eradication of sex trafficking in the United States

Throughout the United States, legal professionals and advocates have taken measures to address the access to victims of sex trafficking. A commonly accepted practice has been to advocate for the removal of ‘sex for sale’ advertising in free media such as Craigslist and Backpage. Although this action against the solicitation of prostitution has been celebrated by many advocates and legal professionals, the removal of such advertisements does not directly affect the prevalence of sex trafficking. In fact, displacement theory suggests that the removal of solicitation advertisements and targeted policing forces traffickers to simply advertise elsewhere or become more creative in selling the victims, thereby concealing the act of sex trafficking and making it less identifiable. Although we do not advocate for the maintenance of ‘sex for sale’ advertisements, the process of removing these ads is counterproductive, having little positive impact on the incidence of sex trafficking in the United States. Rather, it forces both traffickers and victims to bury deeper in the already hidden world of sex trafficking. Policy implications derived from criminal displacement theory and research are provided.