Sudden death in an adolescent due to undiagnosed classic Hodgkin lymphoma

Few cases of natural sudden death presenting as an undiagnosed lymphoma have been reported in the literature, especially in adolescents. Herein we provide a report of sudden death caused by undiagnosed classic Hodgkin lymphoma (cHL). We describe an 18-year-old female who collapsed after several weeks of weight loss, decreased appetite, and dyspnea. At autopsy, a bulky mass arising in the mediastinum and neck compressed the esophagus and trachea, surrounded the great vessels, obliterated the pericardial sac, and infiltrated the myocardium. The lungs were collapsed and large pleural effusions were present. The tumor burden, which weighed at least 2710 g in aggregate, was entirely above the diaphragm. Microscopic examination of the masses showed features typical for nodular sclerosis cHL including large bands of sclerosis, numerous Hodgkin/Reed-Sternberg (HRS) cells, and an eosinophil-rich mixed inflammatory cell infiltrate. Immunohistochemical stains showed the HRS cells to be uniformly positive for CD30 and CD15 and negative for CD3, CD20, CD45, and PAX5. This case exemplifies a rare sudden natural death due to previously undiagnosed cHL in a young patient.     

Caregiving and quality of life

ABSTRACT

The increase in life expectancy for adults with learning disabilities has extended the caring role for their parents. This study examined the experiences of older parents who provide long-term care for their adult children with learning disabilities and how they conceptualise their quality of life. Data were collected using semi-structured interviews with 27 older parent carers from four London boroughs and were analysed using framework technique. Findings indicate that most parents appraised their quality of life positively and reported benefits, despite the challenges they had to negotiate daily. The benefits from caregiving, more so in later life, were: a connected family from shared caregiving; a sense of belonging; purposeful living; a reciprocal relationship with their adult children; and personal transformations from providing care that improved their quality of life. The challenges that participants regularly encountered were: multiple losses (sleep, career, identity and friends); the added stress of the government’s Personalisation Agenda of caring services; struggles for access to services; searching for a diagnosis; worry about future care and fear of abuse when carers are unable to continue in their role; unhelpful attitudes of health and social care professionals; and a lack of empathy from friends as well as the public towards people with learning disabilities. Caregiving and quality of life are inextricably linked and the difficulties that parents experienced were mainly associated with socio-structural barriers, rather than their children’s disabilities. Importantly, the findings inform the practice of social workers and others who support this unique group of carers by providing new insights into how caring impacts on quality of life over time and how best these parents’ needs can be met. This study makes a specific contribution to understanding the lived realities of older carers and extends current conceptualisations of caregiving and quality of life among older people.     

The Heathrow Case in the Supreme Court: Climate Change Legislation and Administrative Adjudication

In R (on the application of Friends of the Earth Ltd and others) v Heathrow Airport Ltd the UK Supreme Court allowed an appeal against the Court of Appeal's decision that there had been a series of legal errors in the designation of the Airport National Policy Statement. This case note analyses the case from an ‘internal’ doctrinal perspective and argues that the Supreme Court could have engaged more explicitly with the legal issues that arise from climate change legislation for administrative law adjudication. For courts to adjudicate well in such circumstances they need to be prepared to develop administrative law doctrine, particularly in light of the issues of integrating climate change into public decision-making and of scientific/policy uncertainty which lie in the background of climate change legislation.     

Managing policy‐making in the local climate governance landscape: The role of network administrative organizations and member cities

Trans‐municipal networks (TMNs) have reshaped the landscape around local government action on global climate policy. Past research has focused on why cities join TMNs and the impact that membership has on local action. This study considers a potential reverse effect: namely, that cities' membership choices position them to influence TMNs' overall priorities. In considering this, we emphasize the role of network administrative organizations (NAOs) and posit that the multiple climate‐related networks, which share members and operate in overlapping geographic and issue spaces, are bound together as part of a meta‐network. We utilize social network analysis and data on membership in four climate‐related TMNs to examine the factors that shape how cities can influence meta‐network priorities. We find that cities with local vulnerabilities tend to be located in network positions that enable them to influence the meta‐network's overall priorities.     

‘I can’t remember a more depressing time but I don’t blame anyone for that’: remembering and commemorating the wartime internment of enemy aliens in Britain

ABSTRACT

In October 2000, David Cesarani decried the unnecessary internment of refugees from Nazi Germany in Britain during the Second World War on the BBC Radio 4 programme Behind the Wire. Until the last few decades, little was known about the internment of enemy aliens by the British during the war. However, in recent years, novels such as David Baddiel’s The Secret Purposes, published in 2004, and exhibitions such as ‘Schwitters in Britain’ at the Tate Britain in 2013, have introduced a wider audience to this oft-forgotten part of the British wartime narrative. Some of those interned in Britain were sent to Canada and Australia, which led to the greatest tragedy of the entire internment debacle, the sinking of the Arandora Star. The year 2015 marked the seventy-fifth anniversary of this tragedy, and the memory of those who were lost lives on in the British–Italian community. However, outside those affected by the Arandora Star disaster, little is commemorated or understood by the general public. Yet the legacy of the former internees is all around us. Who has not, on visiting the British Library, walked past former internee’s Eduardo Paolozzi’s statue of Newton? What connoisseur of classical music has not enjoyed the sound of the Amadeus Quartet, perhaps the only positive outcome of internment? Pistol’s article will examine the memory of the camps and consider the differences between how internment has been remembered and commemorated by former internees and the general public.     

Victim-warriors and iconic heroines: photographs of female combatants in Aceh,Indonesia

Analyzing photos and narratives of the “widows’ battalion” in Aceh, Indonesia that appeared in international and local print media between 2000 and 2002, this article traces how images of female combatants initially provided evidence of a uniformed, armed ethno-nationalist movement motivated by past state violence and linked to historical legends of women involved in armed resistance to colonialism. Subsequently, the heroines were recast as immoral young women pursuing inappropriate sexual relationships with the occupying military. The problems of intelligence gathering, double agents, and the indeterminate zone of overlap in which male soldiers collaborated in the past were rewritten as a problem of sexual or intimate relations that violated religious and cultural norms. In Aceh, the affective power and complexity of women’s positioning as both victim and combatant is fueled by the invocation of the iconic heroines of the anticolonial resistance and ideas about international human rights. Images and narration of the widows’ battalion appear to champion female combatants past and present, but in fact, contribute to the consolidation of the power of male commanders and combatants in the resistance movement. Analyses of human rights photography must consider the affective power of images beyond engaging the empathy of distant spectators to consider their role in conflict dynamics.     

System management and compensatory parenting: Educational involvement after maternal incarceration

Research has demonstrated that paternal incarceration is associated with lower levels of educational involvement among fathers and primary caregivers, but little is known regarding caregiver educational involvement when mothers have been incarcerated. In this study, we present the first analysis of variation in school- and home-based educational involvement by maternal incarceration history, pairing survey and interview data to connect macro-level group differences with micro-level narratives of mothers’ involvement in their children's education. Our survey data demonstrate that children of ever-incarcerated mothers experience increased school-based educational involvement by their primary caregivers, regardless of whether the caregiver is the mother herself. Our interview data point to compensatory parenting as a key motivating factor in educational involvement, wherein a caregiver endeavors to “make up for” the child's history of maternal incarceration. Findings add to the literature demonstrating maternal incarceration as a distinct experience from both paternal incarceration and material disadvantage alone, and they suggest the need to explore the role of schools as potential points of productive institutional involvement for mothers with an incarceration history.     

Organic impurity profiling of fentanyl samples associated with recent clandestine laboratory methods

Nearly a decade ago, fentanyl reappeared in the United States illicit drug market. In the years since, overdose deaths have continued to rise as well as the amount of fentanyl seized by law enforcement agencies. Research surrounding fentanyl production has been beneficial to regulatory actions and understanding illicit fentanyl production. In 2017, the Drug Enforcement Administration (DEA) began collecting seized fentanyl samples from throughout the United States to track purity, adulteration trends, and synthetic impurity profiles for intelligence purposes. The appearance of a specific organic impurity, phenethyl-4-anilino-N-phenethylpiperidine (phenethyl-4-ANPP) indicates a shift in fentanyl production from the traditional Siegfried and Janssen routes to the Gupta-patent route. Through a collaboration between the DEA and the US Army's Combat Capabilities Development Command Chemical Biological Center (DEVCOM CBC), the synthesis of fentanyl was investigated via six synthetic routes, and the impurity profiles were compared to those of seized samples. The synthetic impurity phenethyl-4-ANPP was reliably observed in the Gupta-patent route published in 2013, and its structure was confirmed through isolation and structure elucidation. Organic impurity profiling results for illicit fentanyl samples seized in late 2021 have indicated yet another change in processing with the appearance of the impurity ethyl-4-anilino-N-phenethylpiperidine (ethyl-4-ANPP). Through altering reagents traditionally used in the Gupta-patent route, the formation of this impurity was determined to occur through a modification of the route as originally described in the Gupta patent.