Sickle cell trait-associated deaths: a case series with a review of the literature

This study presents a series of 16 carriers of hemoglobin S (HbS) who died during various circumstances. Many of the cases were associated with mild to moderate exertion. The onset and/or duration of symptoms varied from a few minutes to several hours with many displaying a prolonged lucid interval with stable vital signs. Despite seeking medical treatment, sickle cell trait-related micro-occlusive crisis was never considered in the differential diagnosis. Several cases were associated with sudden death. In those deaths which were delayed, high anion gap and uncompensated metabolic acidosis were typical and were not heat related. Also characteristic were large increases in creatine kinase, alanine aminotransferase, and aspartate aminotransferase along with myoglobinemia. Although the antemortem diagnosis of rhabdomyolysis was made, the underlying cause was never deduced by the clinicians. The sickling found at autopsy is not always a postmortem artifact, and in the right circumstances can be diagnostic.     

The intellectual legacy of J.E. Hodgetts

Abstract: J.E. (Ted) Hodgetts was influenced by both the political economy approach that he learned at the University of Toronto and by the comprehensive historical method developed by Leonard White, under whom he studied at Chicago. His first great project, Pioneer Public Service, convinced him that responsible government was impossible without responsible public administration. The authors examine how his response to management theories and practices evolved following his participation in the Glassco, Lambert and Gomery commissions. Hodgetts consistently refused the complete separation of politics and administration, and he promoted the use of management techniques to strengthen parliamentary supervision of the public service. The two key components of his legacy are thus a commitment to the democratic values of representative government and the comprehensive study of the internal dynamics of public administration in interaction with the relevant environmental factors.     

Posttraumatic Stress Disorder: Current Concepts and Controversies

The diagnosis of posttraumatic stress disorder (PTSD) sometimes is raised in compensation claims, in tort settings, and in other medical–legal settings. Accordingly, health-care and legal professionals working in these areas need to be familiar with the current findings and controversies concerning the disorder. The purpose of this article is twofold. First, we review the most important findings concerning the clinical features, etiology, and treatment of PTSD. Second, we examine six major controversies concerning the disorder that are relevant to psychologists and other medical–legal practitioners: (a) the issue of what qualifies as a traumatic stressor, (b) the question of whether traumatic stress causes brain damage, (c) the validity of the concept of delayed-onset PTSD, (d) the recovered memory controversy, (e) the question of whether PTSD can arise when the person has no memory of the trauma (e.g., due to concussion), and (f) issues concerning PTSD malingering. Throughout this article we offer recommendations for psychological and other medical–legal practice in relation to the evaluation of PTSD claims.