Deaths associated with liposuction: case reports and review of the literature

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.     

Detection of ketosis in vitreous at autopsy after embalming

Ketosis occurs in ketoacidosis or malnourishment. When either is suspected in relation to a death, it may be important to analyze for ketosis at autopsy. We encountered a case where starvation was suspected in a deceased nursing home resident, where the body had been embalmed prior to autopsy. Gas chromatography (GC) was unable to separate acetone from formaldehyde, a component of embalming fluid. The Acetest is a simple test that can detect acetone and acetoacetate in body fluids. We validated the Acetest with GC on vitreous. The Acetest and GC were consistent except at very low levels of acetone or acetoacetate. The sensitivity of the Acetest for acetoacetate in vitreous was 10 mg/dL, consistent with early starvation. Significant interference from embalming fluid did not occur. The Acetest was negative in the described case. The Acetest is a simple and useful test for the detection of ketosis in embalmed autopsies.     

The Cultural Politics of Curricular Reform in China: a case study of geographical education in Shanghai

This article will examine the development and implementation of the new geography curriculum in secondary schools in Shanghai. Analysis of the processes and mechanisms which underlie curricular change in China reveals how embedded bureaucratic, social and cultural norms have profoundly influenced the degree to which reforms to the geography curriculum have achieved the desired results. The analysis begins with a detailed examination of the wider institutional hierarchies which initiated and managed curricular reforms in Shanghai. Interviews with teachers and extensive classroom observations, and a review of the new curriculum and geography textbooks are utilised to evaluate the practical outcomes of curricular change in Shanghai. The findings reveal a deep dichotomy between the intended goals of curricular reform, the processes of curriculum development and implementation, and an examination system which compels teachers to cling to traditional teaching methods of lecturing and rote learning. These findings are discussed in the context of the established educational hierarchies, the cultural politics of curricular reforms in Shanghai and the nature of geography teaching in China. A more balanced approach which addresses the provision of adequate resources and professional development for teachers, and which recognises the need for a fundamental restructuring of the examination system, is suggested.     

Need Public Policy Ignore the Third Sector? Government Policy in Australia and the United Kingdom

The policy of Australian governments, both Commonwealth, state and territory, toward those organisations that comprise a third sector of the organised economy is patchy and piecemeal. Absent is any recognition that they constitute a distinct sector; absent too is any recognition of their contribution to economy, society and politics. Such a situation is not inevitable. After identifying some of the gaps and contradictions in Australian policy toward the third sector, this article outlines the many policy initiatives to encourage the third sector or social economy (in European Union terms) taken by the Blair government in the United Kingdom. Given that there is a good deal of policy borrowing between Australia and the United Kingdom, the stark contrast between the two countries in this policy field is puzzling. This article concludes by identifying four developments that led to this policy explosion in the United Kingdom and finds them largely missing in Australia. This leads to a conclusion that a similar range of policies are unlikely to develop here.     

Coming to Terms with Intramural Differences Over Policy Frameworks: How Policy Researchers Accommodate Rival Claims Among their Peers

Although we readily scrutinize conflicts among political stakeholders, similar attention is seldom paid to how we deal with contestable understandings within our own field of inquiry. Debates over competing scholarly perspectives and contested models are rarely subject to any systematic postmortem or attempts to account for differential survival. Given the indeterminacy of many of our conceptual schemes, empirical data seldom carry the day to a resolution all can accept. Accordingly, there are eventually many different versions of any given dispute, each offering a different path to resolution or equanimity. Disputants retire and conflicts fade, providing a demographic resolution of sorts, but not a scientific or a conceptual one. The work presented here claims that there is much to be gained from systematic scrutiny of our conceptual disputes, especially as a means to access the different perspectives we assume to handle them. We argue that there is an internal logic to the different perspectives on any given dispute. It is not the dispute per se that draws our interest; but rather, how any given dispute generates multiple interpretations and reconstructed versions. We propose and illustrate an approach to analyzing disputes that makes their internal logic more transparent and attends to the pathways that emerge for resolution. We will find, in the process, that there are some reliable routes to conciliation and some fault lines that remain unstable.     

Demands of a Two-Horse Company

YANG Jie, 23, starts work at his office on Youth Road in Wuhan, Hubei Province at 9 am each day and returns to his dorm to sleep at 10 pm. He eats a modest lunch in the small restaurant downstairs and has a takeaway for supper. It was in the summer of 2005 that Yang Jie and Li Chao opened their Qi Hang Advertising Company. Their small firm deals with large and small concerns alike, and in order to stay solvent, they spend their lives either at the office, where they deal with clients an…     

Searching for Symptoms of Political Shirking: Congressional Foreign Travel

Despite the hypothesized propensity for shirking to marklegislative institutions, the evidence is rather equivocal;moreover, most of the research has focused exclusively onlegislator voting, thereby constraining whatevergeneralizations might emerge. The purpose of this paper is tocontribute to the debate over the question of politicalshirking by extending the range of phenomena examined toinclude congressional foreign travel. Our analysis providesevidence that opportunism is a problem in Congress. We findthat last-period problems have arisen in the area of foreigntravel, and that increased scrutiny to the problem on the partof Congress only shifted consumption patterns, i.e.,legislators began taking foreign junkets near, but not at theend of, their legislative careers. Not all foreign travelshould be construed as worthless junketing since there isstrong evidence that some foreign travel is related tomembers' responsibilities on congressional committees.     

Threats, institutions and regulation in common pool resources

Can bureaucracies respond to threats marked by both potentially high costs and fundamental uncertainty? Standard guidelines such as maximizing expected value to the society over a period of time may be ineffective; yet, state action is often most demanded for such situations. I argue that the precautionary principle of reserved rationality helps explain the ability of bureaucracies to choose appropriate actions under uncertainty. Such bureaucracies are empowered when there is sufficient informal institutional support for their expertise and the bureaucracy has the discretion to take necessary precautions. I draw historical information from the case of Singapore's regulation of the formerly common pool resource of water catchment areas. This case reveals decision making when it is not clear that the expected-value criterion would support action, as well as the importance of political and institutional support for such action.