Sudden unexpected death in infancy and childhood due to undiagnosed neoplasia: an autopsy study

Sudden unexpected death due to clinically undiagnosed neoplasia in infancy and childhood (SUDNIC) is a rare phenomenon, with only small numbers of cases reported in the literature. In the majority of instances, the tumors involve critical structures within the heart or central nervous system and include gliomas, medulloblastomas, rhabdomyomas, and neoplasms of stromal elements. A 20-year retrospective review of autopsy records from the Hospital for Sick Children, Toronto, was performed (1984-2003, n = 4926), and 7 cases of SUDNIC were identified (0.14%). In addition, 1 case was obtained from the files of the Children's and Women's Health Centre of British Columbia, Vancouver. Diagnoses included 2 cases of acute leukemia (1 myelogenous, 1 lymphoblastic), 2 cases of mediastinal lymphoblastic lymphoma (pre-T cell type), 1 papillary fibroelastoma of the mitral valve prolapsing into and totally occluding the left anterior descending coronary artery, 1 medulloblastoma, 1 Wilms tumor associated with fatal intraperitoneal hemorrhage, and 1 widely disseminated gastric carcinoma. These cases demonstrate that infants and children may have minimal or no symptoms in the presence of significant disease and highlight the need for a thorough autopsy examination in cases of sudden unexpected death in infancy and childhood.     

Shifting Terrain: Styles of Liberalism, Periodization, and Levels of Analysis

The appraisal of background conditions is an important but often neglected element of political interpretation. Influential interpretations of American politics, such as Louis Hartz's The Liberal Tradition in America, dismiss the importance of changing political contexts. Set in terms of the debate over American exceptionalism, this article explores changes in political mood in the United States during the twentieth century. Hartz is not wrong to assert the persistence of a uniform underlying political culture in the United States, nor the lasting impact of Lockeanism in establishing boundaries to possibility—for the left and the right. But a finer-grained appraisal of the interaction between political-cultural ethos and activism is possible. As David Greenstone rightly argued, contestation still occurs within a predominantly liberal society. This article contends that the character of this contestation is determined by the nature of political periods produced by interpretations of the underlying Lockean bedrock by political actors. It makes explicit that Hartz and Greenstone were operating at different levels of analysis—Hartz established the persistence of dedication to Lockean liberal tenets in the deep structure of American politics, while Greenstone's interpretation established a meso-level of analysis, above this deep structure. The present article adds temporal periodization to this meso-level. Political actors make history upon a stage received from the past—in the United States, the Lockean bedrock—but they inflect this stage with crucial interpretations that set or stretch the limits of political expression in a new period. It discerns four varieties of liberalism—economic liberalism, social state liberalism, social movement liberalism and cold war liberalism—that have interpreted the deep structure differently since the 1920s. It also suggests that sensitivity to historical changes in political mood does not necessitate repudiation of Hartz's thesis of Lockean liberal predominance in the United States.     

Editors' Note

Note

Editors' Note     

Medical study: aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby

Although many have argued that assisted reproductive technologies ("ARTs") attract those with a desire to genetically engineer their offspring, this claim has yet to be verified. To address this question, we surveyed three groups: the general public, people enrolling in an in vitro fertilization ("IVF") program, and pregnant couples. We asked subject which traits they would select in their children if it were possible to use a magic wand to do so and to value genetic relatedness. In our sample, the potential parents who were using ARTs were less likely to express a desire to select traits in their offspring than were the general public, and just as likely as the pregnant couples, Those using ARTs , however, place greater importance on having genetically related children than the others. Thus, the widely held view that reproductive technology is utilized by those most likely to favor genetic engineering is falsified by out findings.     

Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources

CHAT (Choosing Healthplans All Together) is an exercise in participatory decision making designed to engage the public in health care priority setting. Participants work individually and then in groups to distribute a limited number of pegs on a board as they select from a wide range of insurance options. Randomly distributed health events illustrate the consequences of insurance choices. In 1999-2000, the authors conducted fifty sessions of CHAT involving 592 residents of North Carolina. The exercise was rated highly regarding ease of use, informativeness, and enjoyment. Participants found the information believable and complete, thought the group decision-making process was fair, and were willing to abide by group decisions. CHAT holds promise as a tool to foster group deliberation, generate collective choices, and incorporate the preferences and values of consumers into allocation decisions. It can serve to inform and stimulate public dialogue about limited health care resources.