Thrombotic thrombocytopenic purpura causing sudden, unexpected death--a series of eight patients

Eight patients were presented to the medical examiner after dying suddenly and unexpectedly from thrombotic thrombocytopenic purpura. Compared with patients who die after prolonged hospitalization and treatment, these patients showed fewer neurologic symptoms and correspondingly fewer or no microthrombi within the brain. Only four of eight subjects developed fever, which further contributed to misdiagnosis. The differences in clinical presentation between our cases and most published series is striking and may be explained by shorter duration and no treatment. Each case contained the characteristic histology of thrombotic thrombocytopenic purpura. Ischemic injury to the heart and conduction system was the most likely mechanism of sudden death. Included in this series is a patient with acquired immunodeficiency syndrome (AIDS) diagnosed at autopsy, a concurrence that is now appearing more frequently in the medical literature.     

The ethical poverty of cost-benefit methods: Autonomy,efficiency and public policy choice

The principle of efficiency holds as the basic standard of market decision-making. Routinely however, it has been applied as a standard of judgement to public choices as well. This essay proceeds on the basis of four assumptions. First, that efficiency, outside the market context, has two manifestations (Cost-Effectiveness Analysis and Cost-Benefit Methods) which are made distinct by one's concentration on judging the most cost-effective means to policy ends otherwise arrived at, and the other's use of efficiency to judge both the means and end of policy choice. Second, that although efficiency is a fit primary decision standard within a competitive market a principle with more distinctly moral weight is needed to judge ends outside of markets. Third, that one possible source of this moral weight is individual autonomy or freedom that is a fit ethical principle upon which to set the ends of public policy. Fourth, that the use of cost-benefit methods rather than cost-effectiveness analysis implies that it can satisfy the requirements of both efficiency and autonomy. If the efficient policy choice also provided protection of individual autonomy then cost-benefit methods could be used for the analysis of public policy ends, but if it fails to have a deeper moral justification then the role of efficiency in the public sector must be limited only to its judgement of cost-effective means to policy ends arrived at by a non-efficiency standard. I will argue that the autonomy of individual choice in a market is a thin and morally impoverished ethical standard of judgement that adds no additional moral weight to market efficiency for the judgements of policy ends. This conclusion limits efficiency to the consideration of public means alone, eliminating cost-benefit methods as a fit approach to policy analysis while simultaneously promoting cost-effectiveness analysis and the search for an independent moral standard for the assessment of public ends.This essay was originally prepared for the 1989 meeting of the APSA in Atlanta and I wish to thank all those who read and commented on my work at that time. In addition, I would like to thank those who participated in its evolution to this form: Douglas MacLean, Mark Sagoff, Brian Barry, Alan Donagan, Russell Hardin, Maurice Wade, Andy Gold, Thomas Reilly, Diana Evans, an anonymous reviewer at Policy Sciences and its two editors, William Ascher and G. Brewer.     

The lay component in Scottish juvenile justice

A recently completed study of the Scottish juvenile justice system, employing a variety of methodological approaches, is used as a source of information on the behavior and attitudes of the lay volunteers who make up children's panels and are responsible for decisions concerning young people who are alleged to have committed an offense or are believed to be in need of care and protection. The reported data relate to the beliefs of panel members as to the causes of delinquency and the objectives of intervention and alternative disposals; the topics they raise for discussion in children's hearings and the factors which influence the decisions they make; and the manner in which they are perceived by the children and parents who have appeared before them.     

Assessment of methods of homicides in a Brazilian city: a preliminary study

Homicides in the city of Ribeir?o Preto, state of S?o Paulo, Brazil, were analyzed with regard to methods (firearms or others) and gender, in a retrospective study from 1993 to 1997. There was a progressive increase in the number of homicides, mainly after 1995, with an increment of 86.6% in 1997 in comparison to 1993. The incidence of homicides was higher among males, with firearms being the most common method in this group since 1993. In addition, a 10% increase in this method was observed since 1995, in association with a proportional reduction in the use of other methods. The incidence of homicides among females remained stable until 1996 and increased by 51.3% in 1997. Simultaneously, firearms have become the most common method among female victims (71.4%), pattern similar to that observed among males. Attention is drawn to the social and economic conditions and their relationships with drug traffic in the city.     

Truman's revenge: Social control and corporate crime

Many criminologists have found that corporate crime does more harm than street crime, whether measured by property lost, money stolen, or lives taken. Yet, public concern about crime is almost exclusively focused on street crime and “just deserts” for the offender. The authors argue that corporate criminality is more likely than individual criminality to be planned and subjected to cost/benefit analysis than street crime and therefore more likely to be deterred by raising the costs of corporate criminality. The Model Penal Code is used to demonstrate that both individual and corporate crime produce a comparable array of avoidable harms. Public policies that demand just deserts for individual offenders (natural persons) are revealed as highly inconsistent with policies that protect corporations (juristic persons) from accountability for the harms they create. A philosophical and legal foundation for corporate crime control strategies is provided. The authors propose a sanctions regime for corporate criminals comparable to the sanctions regime imposed on natural persons for street crimes. Strategies to avoid risk shifting by corporations are suggested. This revised version was published online in July 2006 with corrections to the Cover Date.     

Farmer Representation in Australia: Avenues for Changing the Political Environment

This paper focuses on changes in the way Australian farmers have sought to influence their political environment. A taxonomy of avenues for change is constructed and used to illustrate the broad transitions in the way farmers have engaged with the formal political process. It is argued that Australian farmers have proceeded from parliamentary/electoral through militant/sectoral forms of action, and are currently pursuing sectoral action supplemented by promotional and consultative actions. Using the New South Wales Farmers' Association (NSWFA) as an example, we show how these changes in political engagement relate to a number of trends in the economic and political environment, for example economic deregulation, electoral change, administrative change, the declining economic significance of agriculture and the increasing impact of sociopolitical movements. These trends and perceived inadequate responses by sectoral interest groups and political parties have also led to rural people experimenting with alternative political avenues such as new 'populist' movements, rural summits and social movements such as Landcare and Women in Agriculture. The significance of Landcare as an avenue for renewal of rural identity and new forms of rural governance is briefly outlined.     

Havel versus Klaus: Public Policy Making in the Czech Republic

In Central and Eastern Europe, we can observe and analyze an ongoing social experiment euphemized as the process of the transformation of totalitarian countries with centrally planned economies into democratic countries with market economies. This article offers an analysis of what has been happening in the Czech Republic in this regard. Attention is given to the impact of political philosophies (those represented by names of Václav Havel and Václav Klaus) upon legal and institutional changes. Key terms for better understanding of these processes are the free market, civil society, civic sector, and participation of citizens in public affairs. Channels, developmental threats, and opportunities for public policy formation and implementation are studied as well.     

The National Transportation Act and Western Canada: a case study in co-operative federalism

Abstract. The transformation of the Canadian federal system from classical to co-operative federalism has placed greater importance on consultations between federal and provincial governments prior to the balkation of policy within their respective jurisdictions. There is, however, an absence of case studies that examine the interaction among provincial governments, provin-cially or regionally based pressure groups, Members of Parliament from a particular region or province and the federal cabinet in the formulation of policies in areas of federal jurisdiction. Using the enactment of The National Transportation Act of 1967 as a case study, the paper examines the policy-making process within the Canadian federal system as it affects the Western Canadian provinces. The central thesis of the paper is that the consultative mechanisms employed by the federal government in areas of provincial jurisdiction limit the extent to which provincial policy inputs are injected into the decision-making process. Co-operative federalism is entering a new phase that will be characterized by the establishment of specialized structures to permit the input of regional views at the federal level on a regularized basis. Furthermore, the provinces will attempt to develop regional policies in the hope that this will strengthen their bargaining position with the federal government. Sommaire. La transformation du système fédéral canadien, de fédéralisme classique en fédéralisme coopératif, a donné une grande importance aux consultations entre le gouvernement fédéral et les gouvernements provinciaux avant l'adoption définitive de politiques dans leurs juridictions respectives. On manque cependant d'études portant sur des cas d'espèce qui illustreraient l'interaction des gouvernements provinciaux, des groupes de pression provinciaw ou régionaux, des députés d'une région ou d'une province donnée et du cabinet fédéral, dans la formulation des politiques du ressort fédéral. En se servant comme cas d'espèce de l'adoption de la loi nationale sur les transports de 1967, l'auteur de la communication étudie le processus d'é'laboration des politiques dans le cadre du système fééral canadien, du point de vue de ses répercussions dans les provinces de l'Ouest. Sa thèse centrale, c'est que les mécanismes consultatifs employés par le gouvernement fédéral dans les domaines qui sont du ressort des provinces limitent l'incorporation des apports provinciaux dans le processus de prise de décision. Le fédéralisme coopératif entre dans une nouvelle phase qui sera caractérisée par la création de structures spécialisées afin de permettre l'apprt méthodique des opinions régionales au niveau fédéral. De plus, les provinces essaieront d'élaborer des politiques régionales, espérant ainsi renforcer leur position dans les négociations avec le gouvemement fédéral.