Occult Adrenocortical Carcinoma and Unexpected Early Childhood Death

A four‐year‐old previously well boy collapsed unexpectedly and was taken immediately to hospital, where he developed seizures and cardiogenic shock with lethal, rapidly progressing multi‐organ failure. At autopsy, the height was >90th percentile and there were indications of early virilization. Internally, a friable tumor of the left adrenal gland was identified that had invaded the left renal vein and inferior vena cava. Histology revealed typical features of an adrenocortical carcinoma with aggregated trabeculae of cells containing abundant eosinophilic cytoplasm and large pleomorphic nuclei. There was strong positive cytoplasmic staining for inhibin; mitochondria were shown on electron microscopy to contain prominent electron‐dense granules. Death was due to massive pulmonary tumor embolism. Although adrenocortical carcinomas are very rare and are more commonly found in adults, the current case demonstrates that they may also occur in childhood and be responsible for unexpected death by the very unusual mechanism of tumor embolism.     

From walls to membranes: fortress polis and the governance of urban public space in 21st century Britain

Drawing on the work of Paul Virilio, this paper addresses changes in the architectural and legal topography of the urban landscape through an examination of regulatory patterns, which increasingly intensify governance through, and as, ‘control’. Such regulation is ambivalent in that it cuts across many traditionally discrete regimes of power melding them into new forms with new effects; as a consequence it is no longer sufficient to think in terms of such distinctions as private/public, civil/criminal, and so on. This paper argues that a concern with patterns of enclosure and privatisation in our urban centres must now be placed within the context of changes in architectural practice and technology, which the authors term ‘open architecture’, and the embedding of governance through partnership, which give particular emphasis to the use of dematerialised and diffused modes of control. The paper utilises Virilio’s history and image of the fortress, which he tracks from a material form to a dematerialised form, to envisage these developments and to provide the foundation for an understanding of the importance of the development of practices of surveillance into, what the authors term, ‘total registration’ as a feature and function of governance through ‘control’.

Sudden infant death syndrome (SIDS)--standardised investigations and classification: recommendations

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variety of heritable and idiosyncratic endogenous factors interacting with exogenous factors. This has been elegantly summarised in the "three hit" or "triple risk" model. Contradictions and lack of consistencies in the literature have arisen from diverse autopsy approaches, variable applications of diagnostic criteria and inconsistent use of definitions. An approach to sudden infant death is outlined with discussion of appropriate tissue sampling, ancillary investigations and the use of controls in research projects. Standardisation of infant death investigations with the application of uniform definitions and protocols will ensure optimal investigation of individual cases and enable international comparisons of trends.     

The Ethical Health Lawyer: An Empirical Assessment of Moral Decision Making

Writing in 1999, legal ethics scholar Brad Wendel noted that "[v]ery little empirical work has been done on the moral decision making of lawyers." Indeed, since the mid-1990s, few empirical studies have attempted to explore how attorneys deliberate about ethical dilemmas they encounter in their practice. Moreover, while past research has explored some of the ethical issues confronting lawyers practicing in certain specific areas of practice, no published data exists probing the moral mind of health care lawyers. As signaled by the creation of a regular column "devoted to ethical issues arising in the practice of health law" in the Journal of Law, Medicine & Ethics , the time to address the empirical gap in the professional ethics literature is now. Accordingly, this article presents data collected from 120 health care lawyers. Presenting this population with a number of hypothetical scenarios relating to how they would respond when confronting an ethical dilemma without an obvious solution or when facing a situation in which their personal values were in tension with their professional obligations, this article represents a first step toward better understanding how lawyers who practice in health care settings understand and resolve the moral discomfort they encounter in their professional lives.     

Using Administrative Data to Monitor Racial/Ethnic Disparities and Disproportionality Within Child Welfare Agencies: Process and Preliminary Outcomes

Child welfare administrative data are increasingly used to identify racial/ethnic disproportionality and disparities at various levels of aggregation. However, child welfare agencies typically face challenges in harnessing administrative data to examine racial/ethnic disproportionality and disparities at meaningful levels of analysis due to limited resources and/or tools for reporting. This article describes the process through which a multi-state workgroup designed and developed management reports to monitor racial/ethnic disparities and disproportionality using a web-based child welfare administrative data reporting system. The article provides an overview of the process, outcome, and challenges of the group’s work with the goal of offering a starting point for discussion to others who may be seeking to monitor racial/ethnic disparities and disproportionality, regardless of their reporting system.     

Gender inequality and homicide: a cross-national examination

Studies examining gender inequality and crime have often explored the connection between female victimisation and crime. However, feminist theories do provide a rationale for gender inequality affecting all crime, not just female victimisation. Using the ameliorative and the backlash hypothesis the current analysis examined gender inequality and homicide in 94 countries. Using a gender inequality index, we found that as gender inequality increased the homicide rate increased. This finding supports the ameliorative hypothesis, which states that as societies become more equal crime will decrease.     

A Rapid,Confirmatory Test for Body Fluid Identification,

We have developed a technique that allows investigators to confirm the presence of blood, semen, and/or saliva in a crime scene sample. It is a confirmatory test where multiple samples can be processed in less than an hour, and it is potentially portable, permitting samples to be processed at the crime scene. Samples at a scene giving a positive result can be further processed while those failing to do so may be ignored. There is a large and growing backlog of DNA evidence in the USA, slowing down the criminal justice system. This backlog has continued to grow despite an increase in the ability to process evidence faster. This technique uses quantum dot molecular beacons to test for tissue‐specific RNA species, identifying particular body fluids. We have demonstrated the tissue specificity of molecular beacons for blood, semen, and saliva.     

Correlativity

In a celebrated article, published nearly a century ago, Wesley Newcomb Hohfeld endeavored to elucidate the various types of jural relations. Hohfeld’s scheme has been justly regarded as a seminal contribution to analytical jurisprudence, and has stimulated lively debate since. This Essay aims to refute one of Hohfeld’s fundamental and most influential theses: the axiom of right–duty correlativity. To do so, it employs the simplest refutation strategy in first-order logic, namely providing a valid counterexample. Part I discusses earlier attempts to do likewise, and explains why they failed. For the most part, previous illustrations of ostensibly standalone rights or standalone duties neglected relevant parties who could owe the correlative duties or hold the correlative rights, respectively. Part II puts forward a simple argument: There are abstract duties in private law that ban certain types of conduct without reference to specific victims. Those duties are not necessarily correlative with rights, although their breach may generate secondary duties with corresponding rights. In particular, tort law allows plaintiffs to recover for harm caused by breach of duty that occurred before they acquired legal personality. This is tantamount to recognizing duties that are not correlative with rights, and therefore invalidates the correlativity axiom.