Pediatric toxicologic deaths: a 10-year retrospective study

A 10-year retrospective study of pediatric toxicologic deaths was performed at the Medical University of South Carolina (Charleston, SC) from January 1989 to December 1998. During this time, 709 pediatric forensic autopsies were performed on children younger than 18 years of age. Eleven deaths were determined to be secondary to toxic exposures (excluding carbon monoxide poisonings secondary to fires). The remaining deaths were reviewed for the presence of alcohol or illicit drugs. The 11 toxicologic deaths were analyzed for age, sex, race, type of toxic exposure, cause and manner of death, location of incident, witness, and, in the younger age group, the primary caregiver at the time of exposure. The deaths had a bimodal age distribution (6 deaths in victims ages 15 to 17 and 5 deaths in victims ages 4 or younger), involving a wide range of toxins. The teenage group was composed of five males and one female, all white. The preschool group had three females and three males, all black. The manner of death ranged from accidental to suicidal to homicidal. In addition, in eight neonatal and fetal deaths, the victims tested positive for maternal cocaine use, and five of these victims tested positive for cocaine or benzoylecgonine. However, the cause of death was not stated to be cocaine in any of these neonatal and fetal cases.     

Fatal cervical necrotizing fasciitis (a report of two cases of confirmed odontogenic origin and one of possible odontogenic origin).

Three cases of cervical necrotizing fasciitis (CNF), two of confirmed odontogenic origin and one of probable odontogenic origin, were observed from 1993-1999. This is in addition to three cases previously reported by this office. A rare sequelae of dental infection, CNF can be a severe, rapidly progressing infection of the cervical tissues having a mortality rate of up to 50%. "Hospital gangrene" was first described during the Civil War. It was later to be described as necrotizing fasciitis and later yet was designated as a separate clinicopathological diagnosis.     

The legal status of clinical and ethics policies, codes, and guidelines in medical practice and research

This article examines the legal status of "soft law" in the fields of medicine and medical research. Many areas of clinical practice and research involve complex and rapidly changing issues for which the law provides no guidance. Instead, guidance for physicians and researchers comes from what has often been called "soft law"--non-legislative, non-regulatory sources, such as ethics policy statements, codes, and guidelines from professional or quasi-governmental bodies. This article traces the evolution of these "soft law" instruments: how they are created, how they are adopted within the professional community, and how they become accepted by the courts. It studies the relationship between soft law instruments and the courts. It includes an examination of the approaches to judicial analysis used by the courts in theory and in practice. The authors then examine the jurisprudence to see how courts will adopt professional norms as the legal standard of care in some circumstances and not others. They consider the legal concerns and ethical issues surrounding the weight attached to professional practices and norms in law. The authors demonstrate how practices and policies that guide professional conduct may ultimately bear weight as norms recognizable and enforceable within the legal sphere.     

Relationship status of battered women over time

A longitudinal study of 114 women, all having serious problems in intimate relationships, recruited from the community was undertaken in order to investigate relationship and battering status over time. In the original sample (N=193), 97 women were battered and 96 were not battered, as determined by an adaptation of the Conflict Tactics Scale. Of the 114 who returned approximately 2 and 1/2 years later, only 25% of the 51 originally battered women were still in that category. Discriminant function analysis using a combination of variables from established instruments (depression, self-esteem, physical symptoms, self-care agency) and in depth interview (education, relationship control, relationship duration, childhood abuse) failed to distinguish those battered from those not abused at Time 2. Results do not support a learned helplessness model for most women experiencing abuse, and they suggest that battered women seen in the health care and/or social services systems should be supported in a process of healthy decision making about their relationship status.     

Institutional competitiveness in the global economy: Denmark,the United States,and the varieties of capitalism

Despite high taxes, a large welfare state, and much economic regulation, Denmark competes successfully against other advanced capitalist economies. Denmark’s success is based in large part on its institutional competitiveness – its capacity to achieve socioeconomic success as a result of the competitive advantages that firms derive from operating within a particular set of institutions. The institutional basis for successfully coordinating labor markets and vocational training programs are examined for Denmark and the US – two countries that were very different institutionally but very successful in the 1990s and in the 2000s. We show that there is no one best way to achieve success in today’s global economy, except with respect to social inequality; that the mechanisms underlying institutional competitiveness are more complex than often recognized; that institutional hybrids can be as successful as purer political economic cases; and that high taxes and state spending can enhance socioeconomic performance. As such, this paper challenges both neoliberalism and the varieties of capitalism school of comparative political economy.