Fatal Disseminated Cryptococcus as the Initial Presentation of HIV Infection in the Era of Highly Active Antiretroviral Therapy

Abstract:  Despite the availability of highly active antiretroviral treatment, many HIV-positive patients still present for the first time with a low CD4 count or an acquired immune deficiency syndrome (AIDS) defining illness. This may be due to patients' refusal to be tested for HIV, delay in seeking medical treatment, or the misdiagnosis of an AIDS-associated condition. We present a 39-year-old African American male with undiagnosed HIV, who died shortly after arrival to the emergency room. An autopsy was performed at the Dallas County Medical Examiners' Office, and the cause of death was determined to be disseminated cryptococcosis. Further investigation at autopsy revealed HIV 1/2 antibody positivity and HIV western blot positivity. This case demonstrates the importance of considering complications of HIV as a cause of death, even when the patient has no prior history.     

Public Attitudes in Australia to the Reintegration of ex-Offenders: Testing a Belief in Redeemability (BiR) scale

We report the results of a large scale Australian survey of public attitudes to offender reintegration. A representative sample of 1215 respondents gave their views about the possibility that offenders could make a good life for themselves after having committed crime. Views expressed were significantly positive with around four out of five respondents indicating they believed reintegration was possible and should be attempted. On the basis of the responses an overall score was calculated for each respondent. Analysis of the data suggested that three factors contributed to the overall score. We named these: Human capital, Possibility of change and Agency and the rationale for these is discussed. Some demographic factors (age, gender, presence of children in the household and highest level of schooling) were significantly related to scores in one of the components. Respondents also reported whether they, or someone close to them, had been a victim of crime or had been arrested, and whether they had worked in the field of law enforcement or the field of human services. Inclusion in these categories was found to be significantly related to certain components of the overall score. These findings are discussed in the light of related surveys in other jurisdictions and we invite other researchers to use the scale and suggest improvements.     

“In the public interest”: The privacy implications of international business-to-business sharing of cyber-threat intelligence

This article reports on preliminary findings and recommendations of a cross-discipline project to accelerate international business-to-business automated sharing of cyber-threat intelligence, particularly IP addresses. The article outlines the project and its objectives and the importance of determining whether IP addresses can be lawfully shared as cyber threat intelligence.The goal of the project is to enhance cyber-threat intelligence sharing throughout the cyber ecosystem. The findings and recommendations from this project enable businesses to navigate the international legal environment and develop their policy and procedures to enable timely, effective and legal sharing of cyber-threat information. The project is the first of its kind in the world. It is unique in both focus and scope. Unlike the cyber-threat information sharing reviews and initiatives being developed at country and regional levels, the focus of this project and this article is on business-to-business sharing. The scope of this project in terms of the 34 jurisdictions reviewed as to their data protection requirements is more comprehensive than any similar study to date.This article focuses on the sharing of IP addresses as cyber threat intelligence in the context of the new European Union (EU) data protection initiatives agreed in December 2015 and formally adopted by the European Council and Parliament in April 2016. The new EU General Data Protection Regulation (GDPR) applies to EU member countries, a major focus of the international cyber threat sharing project. The research also reveals that EU data protection requirements, particularly the currently applicable law of the Data Protection Directive 95/46/EC (1995 Directive) (the rules of which the GDPR will replace in practice in 2018), generally form the basis of current data protection requirements in countries outside Europe. It is expected that this influence will continue and that the GDPR will shape the development of data protection internationally.In this article, the authors examine whether static and dynamic IP addresses are “personal data” as defined in the GDPR and its predecessor the 1995 Directive that is currently the model for data protection in many jurisdictions outside Europe. The authors then consider whether sharing of that data by a business without the consent of the data subject, can be justified in the public interest so as to override individual rights under Articles 7 and 8(1) of the Charter of Fundamental Rights of the European Union, which underpin EU data protection. The analysis shows that the sharing of cyber threat intelligence is in the public interest so as to override the rights of a data subject, as long as it is carried out in ways that are strictly necessary in order to achieve security objectives. The article concludes by summarizing the project findings to date, and how they inform international sharing of cyber-threat intelligence within the private sector.     

Whither Suffering? The Potential Impact of Tort Reform on the Emotional and Existential Healing of Traumatically Injured Chronic Pain Patients

Approximately half of the state legislatures in the USA have enacted tort reform, generally focused on reducing noneconomic damages such as those awarded for pain and suffering of traumatically injured parties. Traumatic injury has been empirically associated with the development of chronic pain, which in turn has been associated with the concept of human suffering. This analysis examines the meaning of suffering within the context of traumatically induced chronic pain, recognizing that this population is at heightened risk of experiencing long-term emotional as well as physical pain. Factors contributing to profound suffering include the potential development of post-traumatic stress disorder, depression and anxiety, role/identity loss, maltreatment by a medical system generally inept in its management of chronic pain, and the negative manner in which personal injury victims are often treated by the legal system. While the American medical system struggles to identify suffering, the legal system—through tort reform—has chosen to simply ignore it, demonstrating little concern for the integrity of the vulnerable chronic pain sufferer. In doing so, the “destructed” chronic painient is further “deconstructed”. We argue that by limiting the size of settlements and jury awards, tort reform serves to potentially deny personal injury victims of a critical vehicle for finding meaning in their suffering, and accordingly limits their likelihood of achieving relief.     

The drugs-violence nexus among rural felony probationers

Little research has focused on the drugs-violence nexus in rural areas. As such, the purpose of this study is to use Goldstein's tripartite conceptual framework to examine the relationship between drugs and violence among felony probationers in rural Appalachian Kentucky (n = 799). Data on demographics, substance use criminal history, and violence were collected between 2001 and 2004 using an interviewer-administered questionnaire. Rural probationers are partitioned into four groups based on lifetime violent victimization/perpetration experiences: (a) neither a perpetrator nor a victim, (b) perpetrator only, (c) victim only, and (d) both a perpetrator and a victim. Chi-square analyses indicate substance use, and criminal history varies across the four groups. Binary logistic regression analyses are used to explore the significant correlates of both perpetration and victimization. Multivariate analyses support both the psychopharmacological model and the economic compulsive models of perpetration and victimization. Further implications of these findings are discussed.     

Participation in prevention programs for dating violence: beliefs about relationship violence and intention to participate

This study utilizes the Health Belief Model (HBM) to examine the factors related to the intention to participate in prevention programming for dating violence. Perceptions of susceptibility to future violence and the benefits of prevention programming appear to be the strongest predictors of participation in prevention programs. Perceptions of the severity of dating violence do not appear to be related to intentions to participate. There were no differences in intention between those reporting psychological or physical violence in their dating relationship, although some of the HBM factors were associated with a history of violence. Contrary to hypotheses, psychological and physical violence did not moderate the impact of the HBM factors on intention. Implications of these findings are discussed and recommendations for recruiting participants for primary and secondary prevention programs are offered.