Democratic Order,Autonomy, and Accountability

Accountability is a principle for organizing relations between rulers and ruled, and making public officials accountable is a democratic achievement. There are, however, competing claims about what is involved in demanding, rendering, assessing, and responding to accounts; what are effective accountability institutions; and how accountability regimes emerge and change. This article provides a frame for thinking about institutional aspects of accountability regimes and their cognitive, normative, and power foundations. A distinction is made between accountability within an established regime with stable power relations and role expectations and accountability as (re)structuring processes in less institutionalized contexts and in transformation periods. A huge literature is concerned with the first issue. There is less attention to accountability as (re)structuring processes. The article, therefore, calls attention to how democracies search for, and struggle over, what are legitimate accountability regimes and political orders.     

Caffeine fatalities--four case reports

Four cases of fatal intoxications with caffeine are described. Caffeine is widely available in beverages and in different OTC-products, in many of them in combinations with other drugs like ephedrine. Caffeine is not as harmless as one might believe. An overdose of caffeine alone, intentional or not, might be deadly. It seems to be warranted to include caffeine in the drug-screening of forensic autopsy cases. It is not motivated from a medical point of view to sell pure caffeine over the counter.     

Hypothermia Secondary to Glioblastoma Multiforme? Autopsy Findings in Two Cases

Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia‐related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes.     

Asking Routinely About Intimate Partner Violence in a Child and Adolescent Psychiatric Clinic: A Qualitative Study

Among children visiting child and adolescent psychiatric clinics (CAP), the prevalence of exposure to intimate partner violence (IPV) is reported to be approximately 25 %. The extent to which CAP clinicians are aware of this violence, however, is unclear. Some researchers recommend asking about IPV at intake, both to raise disclosure rates and to ensure adequate treatment. Many clinicians are reluctant to do so as a matter of routine when there is no indication of occurrence of IPV in the family. When we interviewed 14 clinicians about their experiences using a standard questionnaire about IPV, three themes emerged: (a) constraint (the questions hinder the development of good relationships with patients), (b) uncertainty (upon reflection, screening is acknowledged as important, but somewhat deficient), and (c) utility (the questionnaire provides a useful framework). Our findings indicate that clinicians’ negative feelings and ambivalence make the implementation of routinely asking about IPV a long process.