Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.     

The predictive value of history and scene investigation for toxicology results in a medical examiner population

Medical examiner offices vary in the extent to which they pursue postmortem toxicology. Our office routinely tests decedents for ethanol and drugs of abuse, and we decided to evaluate the usefulness of our practice. We reviewed 1180 medical examiner cases examined in 2002-2003. History and scene investigation indicated that alcohol or drugs of abuse were likely to be detected in 369 cases, yet toxicology testing revealed an intoxicating substance in 589 cases, a prevalence of 50%. Screening for toxicology testing based on investigative findings had a sensitivity of 0.47, a specificity of 0.84, and a positive predictive value of 0.74. Moreover, even in the 811 cases where initial investigation did not suggest substance abuse, toxicology testing revealed at least 1 substance that was pertinent to the subsequent investigation in one third of the cases (260), and the intoxicating substance was sufficiently important to merit inclusion as a cause of death or contributing factor in nearly half of those cases (113). We conclude that investigation alone is ineffective at predicting the presence of intoxicating substances within decedents.     

Back to the future? Diabetes, HIV, and the boundaries of public health

The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.     

Waxing grave about adipocere: soft tissue change in an aquatic context

When postmortem environmental conditions are "just right," according to the "Goldilocks Phenomenon," soft tissues (and associated fatty acids) are converted into and preserved as adipocere. To better understand this conversion process and the development of adipocere three human cadavers were immersed in outside, water-filled pits for over 3 months to observe adipocere formation in an underwater context simulating actual field conditions. Recordings of environmental conditions showed that temperatures were between 21 degrees C and 45 degrees C, a range sufficient for the growth of Clostridium perfringens. Chemical analysis of liquid and tissue samples revealed an increase in palmitic acid and decrease in oleic acid. This study tracked the remarkable gross morphological changes that can occur in human bodies subjected to an aquatic postmortem environment. The results support the "Goldilocks Phenomenon" and substantiate previous findings that the presence of bacteria and water is crucial for adipocere to form.     

Assessing the victim-offender overlap among Puerto Rican youth

Purpose

Knowledge about offenders and knowledge about victims has traditionally been undertaken without formal consideration of the overlap among the two. A small but growing research agenda has examined the extent of this overlap. At the same time, there has been a minimal amount of research regarding offending and victimization among minority youth, and this is most apparent with respect to Hispanics, who have been increasing in population in the United States.

Materials &; Methods

This study explores the joint, longitudinal overlap between offending and victimization among a sample of Puerto Rican youth from the Bronx, New York.

Results

Results indicate: (1) an overlap between offending and victimization that persists over time, (2) a considerable overlap in the number, type, direction, and magnitude of the effect of individual, familial, peer, and contextual factors on both offending and victimization, (3) some of the factors related to offending were only relevant at baseline and not for the growth in offending but that several factors were associated with the growth in victimization, and (4) various risk factors could not explain much of the overlap between offending and victimization.

Conclusions

Theoretical, policy, and future research directions are addressed.     

Therapeutic jurisprudence: A framework for evidence-informed health care policymaking

Translation of evidence-based practice (EBP) into health care policy is of growing importance, with discussions most often focused on how to fund and otherwise promote EBP through policy (i.e., at system level, beyond the bedside). Less attention has been focused on how to ensure that such policies - as enacted and implemented, and as distinguished from the practices underlying policies - do not themselves cause harm, or at least frustrate accomplishment of "therapeutic" goals of EBP. On a different front, principles of therapeutic jurisprudence (TJ) in law have been developed, most prominently in certain areas of law (e.g., mental health and family law), to support more collaborative, less traumatic advocacy and conflict resolution. This paper draws on current applications of TJ and translates such into a therapeutic approach to health care policymaking that moves beyond promotion of EBP in policy. Health care policy itself may be viewed as an intervention that impacts health, positively or not. The goal is to offer a framework for health care policymaking grounded in TJ principles that does not focus on which evidence is "right" for policy use, but rather how we can better understand how consequences of policy, intended or not, affect the well-being of populations. Such framework thus moves policymaking from an either/or debate to a data- and human-driven process. Utilizing TJ framing questions, policies can be developed and evaluated through open dialogue among diverse voices at the table, including - like interventions - the "patients" or, here, targets of such policies. Collectively, they clarify how ends sought - to enhance (or at least not impair) health - can best be achieved through policy when needed, recognizing that as an intervention, there are limits to and boundaries on the usefulness of policy.     

Politics of Law and the Lacanian Real

The paper explores the role of Jacques Lacan’s Ethics of Psychoanalysis in debates in law and legal philosophy. It proceeds by considering a debate between Slavoj Žižek and Judith Butler over Lacan’s concept of the real, which forms part of a larger discussion over the future of democracy and the rule of law (Butler et al. 2000). Through reference to discussions of the relationship between law and ethics based on the Antigone tragedy, I argue that the difference between Žižek and Butler’s positions should not be understood in terms of the correctness of their reading of Lacan, but in terms of the political commitments that inform their respective interpretations. I explain the implications of this debate over one of Lacan’s most enigmatic concepts, thereby showing how Lacan’s theory can be used to rethink the politics of law in light of the increased emphasis on ethics in contemporary legal debates.     

REPRESENTATION DISPARITIES AND IMPARTIALITY: AN EMPIRICAL ANALYSIS OF PARTY PERCEPTION OF FEAR,PREPARATION, AND SATISFACTION IN DIVORCE MEDIATION WHEN ONLY ONE PARTY HAS COUNSEL

While other authors have regarded both the presence and the absence of attorneys in family law mediation as cause for concern, little attention has been given to the questions raised when one party is represented and the other is pro se. This article presents data on mediating parties' premediation concerns, fears, and feelings of preparedness, as well as their postmediation satisfaction with the mediation process. The mediating parties are grouped based on each couple's representation status, for example, both represented by attorneys, both pro se, or one attorney‐represented party and one pro se party (mixed representation cases). The data show that mixed representation cases are the most likely to report concern, fear, and unpreparedness. Mixed‐representation cases also reported the lowest levels of satisfaction after the mediation. Some implications for mediation practice are discussed, as are suggestions for future research.     

Trace DNA Sampling Success from Evidence Items Commonly Encountered in Forensic Casework

Trace DNA analysis is a significant part of a forensic laboratory's workload. Knowing optimal sampling strategies and item success rates for particular item types can assist in evidence selection and examination processes and shorten turnaround times. In this study, forensic short tandem repeat (STR) casework results were reviewed to determine how often STR profiles suitable for comparison were obtained from “handler” and “wearer” areas of 764 items commonly submitted for examination. One hundred and fifty‐five (155) items obtained from volunteers were also sampled. Items were analyzed for best sampling location and strategy. For casework items, headwear and gloves provided the highest success rates. Experimentally, eyeglasses and earphones, T‐shirts, fabric gloves and watches provided the highest success rates. Eyeglasses and latex gloves provided optimal results if the entire surfaces were swabbed. In general, at least 10%, and up to 88% of all trace DNA analyses resulted in suitable STR profiles for comparison.