Death during transforaminal epidural steroid nerve root block (C7) due to perforation of the left vertebral artery

Treatment for individuals suffering from migraines and pain due to an inflammation or impingement of a nerve range from noninvasive methods such as massage, physical therapy, and medications to invasive methods such as epidural steroid injections and surgery. Each method of treatment has an associated level of risk. While minor to moderate complications from such procedures do occur, deaths are very rare. We report the first cited case of a death associated with the pain management procedure called nerve root block, also referred to as a transforaminal epidural steroid injection. We present the medical history and autopsy findings of a 44-year-old white female who died of massive cerebral edema secondary to the dissection of the left vertebral artery and subsequent thrombosis due to the perforation of that artery by a 25-gauge spinal needle during a C-7 nerve root block.     

The Indian Movement and Political Democracy in Ecuador

This article examines the implications of the Ecuadorian Indian movement for democratic politics. During the 1990s, the movement successfully fostered indigenous and popular participation in public life, influenced government policies, and became a contender in power struggles. But in the institutional domain, the participatory breakthrough had mixed effects. While the movement fulfilled functions of interest representation and control of state power, its involvement in a coup attempt demonstrated that its political socialization had not nurtured a sense of commitment to democracy. The evidence is discussed by reference to the proposition that civil society actors may or may not contribute to democracy. The article argues that the study of the democratic spinoffs of civil activism requires a context-specific approach that considers the particularistic orientations of civil associations and pays attention to their definition of means and ends, the institutional responses evoked by their initiatives, and the unintended consequences of their actions.     

More than a Friendly Visit: A New Strategy for Improving Local Governing Capacity

This article argues that in order to take into account changes in the governance era, performance assessment at the local level may well have to be refocused. Researchers will have to reconsider their strategies. They should consider the governance character of public administration and pay attention to co-operative settings and democratic aspects. In addition, researchers should think not just about gathering facts about the performance of local government, they should also try to contribute to a learning process. This paper presents a new strategy for assessing the capacity that local governments have to get things done. This strategy acknowledges the governance context of local authorities and casts a keen eye on the way local governments fulfil their functions and aim to involve various stakeholders. The evaluation of this assessment strategy shows its relevance, although minor improvements could be made.     

Chinese Geopolitics: Space Program Cooperation among China,Brazil, and Russia

With the Obama Administration’s foreign policy pivot to Asia, the Chinese government is concerned about the possibility of new challenges in their foreign policy sphere of influence. Since the 1990s, many political and military analysts have explored the eventual rivalry between these two states. However, events in the Middle East preoccupy U.S. attention, leaving China moderately free in Southeast Asia, though it is uncertain for how long this will persist and if the United States will reallocate its attention to contain China. In this case, the Chinese government will need to develop countermeasures to sustain its geopolitical interests. There are two focuses in this analysis: (1) the Chinese geopolitical naval situation, exploring the problems in the geosphere surrounding China and the eventual competition with other regional powers and the United States in East Asia; and (2) the potential for space program cooperation with Russia and Brazil, which, in turn, dramatically changes the balance of power in outer space through positive aspects of Russian technical capabilities and strategic Brazilian geographic (Alcântara launch site).     

A Molecular Method to Correlate Bloodstains with Wound Site for Crime Scene Reconstruction

Bloodstain pattern analysis to determine the wound‐of‐origin of bloodstains is problematic with nonspecific patterns. In this proof‐of‐concept study, the authors examined a molecular approach to correlate bloodstains with injuries using the rat as a model. Specifically, investigations were conducted on the rat brain marker, rno‐miR‐124‐3p, with the QIAGEN miScript System and real‐time PCR analysis. Rno‐miR‐124‐3p was detected in brain homogenates diluted 100,000 times; in 3‐week‐old, room temperature stored, simulated brain–blood stains; and in bloodstains from head gunshot wounds collected with swabs and subsequently frozen for 9–18 months; however, rno‐miR‐124‐3p was not detected in whole blood. Proof‐of‐principle was demonstrated by the ability to distinguish bloodstains from a gunshot wound to the head versus bloodstains from a gunshot wound to the chest, by the testing of otherwise identical bloodstains from the two patterns for the presence of the marker. The results suggest a viable approach to a longstanding problem in casework.