Fatal salmonella aortitis with mycotic aneurysm rupture

Salmonellae most commonly cause uncomplicated cases of gastroenteritis but have a predilection for damaged blood vessels, especially those damaged by atherosclerosis. The abdominal aorta is most frequently affected. The most serious complication of aortitis is mycotic aneurysm formation with subsequent rupture. The authors present the case of a 61-year-old man who was found unresponsive at home 3 days after discharge from the hospital for treatment of gastroenteritis with bacteremia. Postmortem examination revealed a ruptured mycotic aneurysm with a large retroperitoneal hematoma. Numerous gram-negative rods were embedded in the wall of the aorta and surrounding inflammatory infiltrate, compatible with the patient's previously isolated. Whereas abdominal aortic aneurysm rupture is most commonly associated with atherosclerosis, the isolation of from blood cultures, coupled with radiographic evidence of gas surrounding the aorta, should raise the suspicion of infectious aortitis. Whereas fatal rupture of an aortic aneurysm secondary to atherosclerosis alone or in conjunction with aortitis will not have an impact on the manner of death, infections are reportable and thus have public health implications.     

The identification of sodium fluoroacetate (compound 1080) employing NMR spectroscopy

Nuclear magnetic resonance (NMR) spectroscopy was employed for the purpose of identifying samples of materials suspected of containing sodium fluoroacetate (Compound 1080). Acquisition of routine proton (1H) and carbon (13C) NMR spectra provided a straight-forward means for determining the presence of Compound 1080 in the samples and thus afforded a simple method for analysis and identification of this compound.     

What could be achieved with greater public hospital autonomy? Comparison of public and PNFP hospitals in Uganda

The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not‐for‐profit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals' performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy. Copyright © 2002 John Wiley & Sons, Ltd.     

A coffee can, factor analysis, and prediction of antisocial behavior: the structure of criminal risk

The predictive accuracy of the Psychopathy Checklist-Revised, Level of Service Inventory-Revised, Violence Risk Appraisal Guide, and the General Statistical Information on Recidivism were compared to four instruments randomly generated from the total pool of original items. None of the four original instruments better predicted post-release failure than the four randomly generated instruments. These results suggest two conclusions: (a) the instruments are only measuring criminal risk, and (b) no single instrument has captured sufficient risk assessment theory to result in better prediction than randomly derived instruments measuring criminal risk. A two-stage factor analysis was completed on 1614 cases. This analysis of the risk items indicated a 4-factor solution and all 4 factors were equal to the original instruments in predicting post-release failure. Thus, the original instruments did not improve prediction over randomly structured scales, nor did the restructuring of items improve risk assessment, suggesting substantial deficiencies in the conceptualization of risk assessment and instrumentation. We argue that developing a risk-based construct, which involves hypothesis testing and an explanation of behavior, is the optimal method to advance risk assessment within the criminal justice and mental health systems. Such an approach would provide targeted areas for clinical intervention that are salient to risk.     

Some implications of the Human Rights Act 1998 for the medical treatment of children

Although the Gillick decision was hailed as an important step in the furtherance of respect for children's autonomy, subsequent judgments seemed to undermine this important principle. While it would be difficult to criticise the outcomes of some of the key cases, the reasoning by which these were achieved is rather more contentious. There have been some interesting discussions suggesting more constructive approaches but there is still a great deal of anecdotal evidence indicating that conservative assessments of children's ability to be involved in decisions about their medical treatment remain the norm. The new Department of Health consent forms should help to create a climate where assessment of a child's competence will become more sophisticated. This paper will argue that the Human Rights Act 1998 offers another opportunity to reassess more traditional approaches to children's capacity; indeed, this could be violation, inter alia, of the right not to be subject to inhuman and degrading treatment under Article 3 in extreme circumstances and the right to private and family life enshrined in Article 8. Clearly, it is not always practicable to carry out assessments rigorously and some health professionals may feel they do not have the expertise to do this, but some basic criteria could assist here; courts are not likely to expect more than a demonstration that best endeavors have been employed in reasoned decision-making. Additionally, other privacy rights may have implications for the medical decision-making process as it affects children and their carers particularly where conflict arises. Disputes may also ensue from the right to manifest religion and other beliefs",' under the Act. This paper will explore how such challenges to those responsible for the medical treatment of children may fare.     

Lineup Administrators' Expectations: Their Impact on Eyewitness Confidence

This research focuses on how lineup a administrators influence eyewitnesses' postidentification confidence. What happens to witness confidence when a witness makes an identification that confirms the lineup administrator's expectations; what happens when this expectation is not confirmed? In Experiment 1, participant interviewers (n = 52) administered target-absent photo lineups to participant witnesses (n = 52). The interviewers did not view the simulated crime, but were told the thief's position in the lineup. In every instance this information was false (we used a target-absent lineup). A one-way ANOVA revealed that eyewitness identification confidence was malleable as a function of interviewers' beliefs about the thief's identity. In Experiment 2, participant jurors (n = 80) viewed 40 testimonies of Experiment 1 witnesses (2 participants viewed each testimony). Participant jurors judged all participant witnesses as equally credible despite their varying levels of postidentification confidence.

     

The Effects of Juror Anonymity on Jury Verdicts

This study examined the effects of anonymity on jurors' verdicts and on jurors' feelings of accountability for their jury's verdicts. Twenty four-person anonymous juries and 20 four-person nonanonymous juries rendered individual and group verdicts for three student defendants charged with selling drugs on a school campus. When unanimous guilty verdicts were reached, juries imposed one of five punishments. Finally, jurors completed postdeliberation opinion and accountability questionnaires. As predicted, anonymous juries showed a higher rate of conviction (70%) than did nonanonymous juries (40%) when the evidence against the defendant was strong, supporting the hypothesis that anonymity would have a greater effect for situations in which there was relatively strong evidence of the defendant's guilt. Anonymous juries imposed the harshest punishment (expulsion) significantly more often than did nonanonymous juries. Contrary to predictions from differential self-awareness theory, anonymous juries did not report feeling less accountable than did nonanonymous juries. However, anonymous juries did see the process as significantly more fair than did identifiable juries.