数学学习困难儿童的认知加工机制研究

与数学学习优秀儿童相比,数学学习困难儿童的语音加工速度、短时记忆、中央执行功能以及整体工作记忆能力方面都存在明显不足,但只有工作记忆能力不足才能明确解释数学学习困难,即数学学习困难与工作记忆能力下降有密切关系.进一步分析发现,由工作记忆能力下降引起的数学学习困难与特定的工作记忆能力不足有关,即数学学习困难几乎完全是由于数字工作记忆能力下降引起,而与视空间工作记忆能力下降无关,这种由数字工作记忆下降而引起数学学习困难的更深层次原因可能在于较差的语音加工速度与中央执行功能二者的共同影响.     

Intracranial sewing needle in a man with seizure: a case of child abuse?

Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.     

Sudden Death Due to Recent Hemorrhage From an Intrathoracic Chronic Expanding Hematoma

Chronic expanding hematoma (CEH) is a rare disease that can develop in any region of the body, but it most frequently develops in the thorax. When intrathoracic CEH is left untreated, gradually expanding hematoma can be life‐threatening, leading to respiratory failure or hemoptysis. We encountered an 89‐year‐old man with cardiopulmonary arrest on arrival. He had been healthy, and it was unclear whether CEH had previously been detected. A very large mass was observed on chest computed tomography (CT), but the cause of death could not be determined. In the autopsy, this mass was identified as CEH and no malignant findings were noted. A fresh hemorrhage had occurred in the hematoma and perforated the bronchial lumen, which caused airway obstruction/asphyxia and resulted in sudden death. CEH should be suspected when a very large tumorous lesion occupying the entire hemithorax is observed on chest imaging, and it is important to recognize that sudden death can occur in the natural course of CEH.     

Architects of the State: International Financial Institutions and the Reconstruction of States in East Asia

For international financial institutions (IFIs), it is a continuing puzzle why the global norms they propagate are enacted either reluctantly or not at all. This article shows that failures of enactment and implementation frequently occur because many IFI‐initiated law reforms go far beyond changing the law; they amount to a restructuring of the state itself and the accompanying redistributions of power. This article demonstrates how state restructuring can occur in a technical area of commercial law by reanalyzing the ways global and transnational designs of corporate bankruptcy regimes fared between 1998 and 2006 in three countries variously affected by the Asian financial crisis: China, Indonesia, and South Korea. State restructuring occurred by (1) shifting the boundary between the market and state, (2) shifting power inside the state, and (3) vesting new powers in the state. The article identifies the recursive dynamics through which the changes unfolded and shows how variations in the efficacy of international architects of the state can be attributed to the interplay of four sets of factors: the coherence of global norms, the relative power of global versus state actors, domestic demand and mobilization for restructuring, and the extent of state restructuring that reforms will induce.     

Beyond Traumatic Brain Injury: Advancing Forensic Neuropsychological Assessment

As research on the cognitive impact of medical conditions and mental health disorders advances, it is imperative for forensic neuropsychologists to stay abreast of rapidly accumulating new empirical evidence from neuroscience and neuropsychology to disentangle multiple determinants of cognitive impairment. Although medicolegal neuropsychological assessments traditionally focused on traumatic brain injury (TBI) sequelae, it is equally important to consider the potential impact of any other acquired, or secondarily induced brain impairments, regardless of their source. Such injuries or conditions are at times assumed to cause a lesser cognitive impact than TBIs; however, their effects depend entirely on the factor in question. Injuries and illnesses implicated in civil litigation—and eventually affecting competency—can indeed involve TBI, but also anoxic/hypoxic injuries, pain, depression, posttraumatic stress disorder (PTSD), sensory deficits (e.g., tinnitus), and fatigue, and all, in turn, can affect an individual’s cognitive function and quality of life. Impairments caused by these conditions can be disabling and resistant to treatment, particularly, when the treatment is based on incorrect diagnostic, prognostic, and causality assumptions.     

Simulation of brain damage: assessment and decision rules

The possibility of fabricated or exaggerated organic deficits is a frequent concern in both civil and criminal forensic cases. Additionally, organic deficits may exist, but be incorrectly attributed to a claimed cause. Exaggeration or fabrication can apply to primary cognitive or emotional effects of brain damage or to secondary emotional effects. These categories of deficits, and their relationship to physical brain damage, must be clearly understood in order to comprehensively evaluate the possibility of malingering. This includes evaluation of different forms of consistency between (1) behaviors during evaluation, (2) claimed deficits and known organic syndromes, (3) behavior or claims during evaluation and actual life-functioning, and (4) test performance and known principles of cognitive functioning. Psychometric procedures and clinical strategies are described which can substantially aid in assessing consistency and distinguishing between honest and exaggerated self-reports. Limitations of available assessment techniques are described and a general decision model for evaluation of dissimulation of organic deficits is presented.     

Further observations on the speed of death in hanging

Given that most fatal hangings are suicidal and occur in locations that have been selected to conceal this activity (thus maximizing the chances of a lethal outcome), there has been very little corroboration of the speed with which unconsciousness and death may occur. A 35-year-old male is reported who committed suicide by hanging immediately after talking to his spouse. Police investigations confirmed her reliability as a witness indicating that lethal anoxia in this case had occurred within a very short time (most likely in less than 1 min) of suspension. The speed with which death may result from hanging not only gives an insight into fatal pathophysiological mechanisms, but also provides useful information for situations where a lethal outcome is to be avoided, or is not intended. For example, individuals at risk of suicide who are being monitored in institutional facilities need to be constantly under direct visual surveillance as significant hypoxia can be rapidly induced, parents and caregivers with infants and children in potentially unsafe sleeping environments need to realize how swiftly death or irreversible anoxic brain damage may occur from neck compression, and those who engage in recreational asphyxia should be informed just how quickly a fatal outcome may ensue.     

Evaluation of methyl tert-butyl ether (MTBE) as an interference on commercial breath-alcohol analyzers.

Anecdotal reports suggest that high environmental or occupational exposures to the fuel oxygenate methyl tert-butyl ether (MTBE) may result in breath concentrations that are sufficiently elevated to cause a false positive on commercial breath-alcohol analyzers. We evaluated this possibility in vitro by establishing a response curve for simulated breath containing MTBE in ethanol. Two types of breath-alcohol analyzers were evaluated. One analyzer's principle of operation involves in situ wet chemistry (oxidation of ethanol in a potassium dichromate solution) and absorption of visible light. The second instrument uses a combination of infrared absorption and an electrochemical sensor. Both types of instruments are currently used, although the former method represents older technology while the latter method represents newer technology.The percent blood alcohol response curve was evaluated over a breath concentration range thought to be relevant to high-level environmental or occupational exposure (0-361 microg/l). Results indicate that MTBE positively biases the response of the older technology Breathalyzer when evaluated as a single constituent or in combination with ethanol. We conclude that a false positive is possible on this instrument if the MTBE exposure is very high, recent with respect to testing, and occurs in combination with ethanol consumption. The interference can be identified on the older technology instrument by a time dependent post-reading increase in the instrument response that does not occur for ethanol alone. In contrast, the newer technology instrument using infrared and electrochemical detectors did not respond to MTBE at lower levels (0-36 microg/l), and at higher levels (>72 microg/l) the instrument indicated an "interference" or "error". For this instrument, a false positive does not occur even at high MTBE levels in the presence of ethanol.     

Critique of interpretation of high levels of heteroplasmy in the human mitochondrial DNA hypervariable region I from hair

The phenomenon known as heteroplasmy can be operationally observed in some human mitochondrial DNA (mtDNA) samples. Typically, heteroplasmy manifests itself in an individual presenting two mtDNA species that differ at a single base. Heteroplasmy at two, and even possibly three sites, also may occur, but at very low rates. A recent report (Grzybowski, 2000, see ref. [13]) suggests that much higher levels of mtDNA (point substitution) heteroplasmy can occur in hair. This observation is contrary to the experience of the forensic mtDNA community. There are several explanations for the unusual findings of high levels of heteroplasmy. First, the template quantities of DNA are approximately three orders of magnitude higher than required for mtDNA sequencing, and an excessive number of amplification cycles were used. Thus, the protocol used did not follow routine practices by the forensic community. Second, there are misidentifications and tabular errors that call into question the reliability of the findings. Third, by comparing the natural human mtDNA variation with a reference sample population with that observed in the heteroplasmy in hair study, the data are inconsistent with population genetic expectations. The observation of high levels of heteroplasmy may be due to contamination of the samples and/or possibly the amplification of nuclear pseudogenes. The results observed in the heteroplasmy in hair study do not apply to other methods of mtDNA analysis and cannot be used to question the reliability of the current forensic mtDNA practices.     

Atypical Accommodations for Employees with Psychiatric Disabilities

People with psychiatric disabilities often need atypical accommodations to participate in today's workforce. Some of these accommodations, including structural and social changes in the workplace, can address biases against people with psychiatric disabilities, while others ameliorate deficits that may affect performance or interaction with others. Many courts have denied requests for such accommodations based on employers' assumptions about performance or the direct threats purportedly posed by people with psychiatric disabilities. By challenging these assumptions, which can be influenced by stigma and stereotypes, and by enforcing an employer's duty to interact regarding potential accommodations, employees with psychiatric disabilities could benefit from structural and social accommodations. Courts should consider social science research in determining which nontraditional accommodations may be reasonable and whether the employer can establish that they impose any undue hardship. Such consideration will expand opportunities for people with psychiatric disabilities in the workplace without unduly interfering with employers' interests.     

Decisional Capacity and Personality Disorders: Substantially Unable or Substantially Unwilling?

Capacity assessments are performed when there is suspicion that a person is unable to adequately care for their physical, medical, or financial well-being. The purpose of these assessments is to inform the legal system as to whether or not guardianship may be necessary. It is well established that certain mental illnesses, such as neurocognitive disorders (dementia) or psychotic disorders (like schizophrenia), may diminish capacity and, in some cases, lead to the need for establishment of a legal guardian. However, personality disorders are another common category of mental illness which may impair decision-making. There is very little information in the literature about how or why these disorders could impair capacity, and thus, it can often be difficult to discern whether clients with personality disorders are substantially unable to care for themselves—versus unwilling to act in a way contrary to their ingrained habits. We present a series of three cases in which clients are determined to lack capacity primarily mediated by a personality disorder diagnosis. They are demonstrated to have mild deficits in cognitive functioning, but they show impaired decision-making out of proportion to these deficits. In all three cases, it is apparent that the personality disorder is substantially impairing their ability to care for themselves. Discussion includes consideration for ways to incorporate evaluations of cognitive function, activities of daily living, and personality considerations into capacity assessments, and how to approach recommendations (such as guardianship vs. less restrictive option) based on both level and scope of impairment.     

Primary, Secondary, and Tertiary Losses in Chronic Pain Patients

Treating individuals with chronic illness and disability requires attention to physical, psychological, and social factors. These unique challenges are optimally addressed by utilizing a biopsychosocial approach, while considering the potential array of both gains and losses that chronic pain patients experience. The benefits a patient receives from remaining ill are often referred to as secondary gain. In medicolegal settings, a common example of a secondary gain issue is the effort to obtain financial compensation. While secondary gain can be one factor that contributes to perpetuating illness and disability, there are often more powerful losses that lead to such perpetuation. The losses associated with pain and disability are not frequently discussed. The overall purpose of this paper is to identify primary, secondary, and tertiary loss issues in chronic pain patients, and address issues related to how these factors are important within a medicolegal/forensic context.     

Disseminated Neonatal Herpes Simplex Virus Infection with Escherichia Coli Coinfection

Neonatal herpes simplex virus (HSV) infection is an uncommon disease that rarely presents as sudden unexpected death of a previously healthy newborn. Clinical manifestations are variable; signs and symptoms may be subtle and nonspecific. Neonatal infection may present with mucocutaneous (skin, eye, and/or mouth), disseminated, or central nervous system disease. Morbidity and mortality are dependent upon disease presentation and treatment. The infection is most frequently transmitted during the peripartum period, although the majority of mothers have no known history of HSV infection at the time of delivery. Findings at autopsy include gastrointestinal or mucocutaneous ulcers, diffuse hepatic necrosis, adrenal necrosis, pneumonitis, and splenic necrosis. Characteristic intranuclear viral inclusions are identified on microscopic examination. Coinfection with bacterial organisms may contribute to death. Autopsy examination with appropriate ancillary studies, including cultures, is critical given that many infants lack cutaneous manifestations of disease and remain undiagnosed prior to death.     

Supravalvular aortic stenosis, Williams syndrome and sudden death. A case report

Supravalvular aortic stenosis (SVAS) is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or associated with Williams syndrome (WS) which is a neurodevelopmental disorder affecting connective tissue and the central nervous system. Sudden death is a well-known complication of non-syndromic SVAS but few cases have been reported associated with WS. We present a case of sudden death in a woman with the diagnosis of SVAS and WS since the age of 3 years who refused surgical correction and died at the age of 27 years. At autopsy, the aorta and pulmonary trunk were narrowed and the walls showed peculiar microscopical characteristics. In the cardiac conduction system the His bundle was small and intramyocardial. The incidence, pathology, pathogenesis and prognosis of both conditions (SVAS and WS) are reviewed.     

Evolution of the content of THC and other major cannabinoids in drug-type cannabis cuttings and seedlings during growth of plants

In Europe, authorities frequently ask forensic laboratories to analyze seized cannabis plants to prove that cultivation was illegal (drug type and not fiber type). This is generally done with mature and flowering plants. However, authorities are often confronted with very young specimens. The aim of our study was to evaluate when the chemotype of cannabis plantlets can be surely determined through analysis of eight major cannabinoids content during growth. Drug-type seedlings and cuttings were cultivated, sampled each week, and analyzed by high-performance liquid chromatography with diode array detection. The chemotype of clones was recognizable at any developmental stage because of high total Δ(9)-tetrahydrocannabinol (THC) concentrations even at the start of the cultivation. Conversely, right after germination seedlings contained a low total THC content, but it increased quickly with plant age up, allowing chemotype determination after 3 weeks. In conclusion, it is not necessary to wait for plants' flowering to identify drug-type cannabis generally cultivated in Europe.     

State autonomy, policy paralysis: paradoxes of institutions and culture in the French health care system

In this article, we assess the recent performance of the French state at containing costs in health care using political science concepts such as path dependency and incentives, which are central to an economic approach. The article focuses on institutional capacities and cultural immobilism and attempts to lay bare the tensions at play in seizing (or not) opportunities for structural change. In particular, we attempt to delineate what constitutes real change in this policy arena (big reforms versus the accumulation of many small policy movements) and to understand the variables at play in the coming together of conjunctures that provide for the big, as well as the underlying structures that allow the accumulation of the small. Except in cases of favorable conjuncture, the analysis bodes very ill for nonincremental reform and, indeed, for significant change over the long term.     

Skipping clues: forensic importance of the family Piophilidae (Diptera)

Among the insects which are typically considered of forensic interest, the family Piophilidae (Diptera) is frequently cited because of its common occurrence on carcasses in different stages of decay. Piophilids are mainly known from the cosmopolitan species Piophila casei, which can be also a major pest for the food industry and an agent of myiasis. However, many other species of Piophilidae occur frequently on carrion, including human corpses; hence, it is essential to ensure a careful identification of specimens. Reviews of relevant published information about the Piophilidae species of potential forensic use, including recent interesting records, are presented.     

Pain as a fact and heuristic: how pain neuroimaging illuminates moral dimensions of law

In legal domains ranging from tort to torture, pain and its degree do important definitional work by delimiting boundaries of lawfulness and of entitlements. Yet, for all the work done by pain as a term in legal texts and practice, it has a confounding lack of external verifiability. Now, neuroimaging is rendering pain and myriad other subjective states at least partly ascertainable. This emerging ability to ascertain and quantify subjective states is prompting a "hedonic" or a "subjectivist" turn in legal scholarship, which has sparked a vigorous debate as to whether the quantification of subjective states might affect legal theory and practice. Subjectivists contend that much values-talk in law has been a necessary but poor substitute for quantitative determinations of subjective states--determinations that will be possible in the law's "experiential future." This Article argues the converse: that pain discourse in law frequently is a heuristic for values. Drawing on interviews and laboratory visits with neuroimaging researchers, this Article shows current and in-principle limitations of pain quantification through neuroimaging. It then presents case studies on torture-murder, torture, the death penalty, and abortion to show the largely heuristic role of pain discourse in law. Introducing the theory of "embodied morality," the Article describes how moral conceptions of rights and duties are informed by human physicality and constrained by the limits of empathic identification. Pain neuroimaging helps reveal this dual factual and heuristic nature of pain in the law, and thus itself points to the translational work required for neuroimaging to influence, much less transform, legal practice and doctrine.     

Martyrs’ Last Letters: Are They the Same as Suicide Notes?

Abstract: Of the 800,000 suicides worldwide every year, a small number fall under Emile Durkheim’s term of altruistic suicides. Study on martyrdom has been limited. There has to date, for example, been no systematic empirical study of martyr letters. We examined 33 letters of Korean self‐immolators, compared with 33 suicide notes of a matched sample of more common suicides. An analysis of intrapsychic factors (suicide as unbearable pain, psychopathology) and interpersonal factors (suicide as murderous impulses and need to escape) revealed that, although one can use the same psychological characteristics or dynamics to understand the deaths, the state of mind of martyrs is more extreme, such that the pain is reported to be even more unbearable. Yet, there are differences, such as there was no ambivalence in the altruistic notes. It is concluded that intrapsychic and interpersonal characteristics are central in understanding martyrs, probably equal to community or societal factors. More forensic study is, however, warranted.     

The “Hired Gun” Effect: Assessing the Effect of Pay,Frequency of Testifying,and Credentials on the Perception of Expert Testimony

Three experiments addressed the proposition that jurors use short cuts in processing information when confronted with expert scientific testimony. The results of the first two studies demonstrated that experts who are highly paid for their testimony and who testify frequently are perceived as hired guns. They are neither liked nor believed. The results of the third experiment replicated the hired gun effect and showed that it is most likely to occur when the testimony is complex and cannot be easily processed. The results were discussed in terms of the theoretical differences between central and peripheral processing of persuasive messages in a legal context.