Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.     

Complications following cell therapy

So far, the law in the Federal Republic of Germany still allows the injection of fresh-cell preparations from animals as a roborant to increase the vitality of the organism and to strengthen the body's immune defense system. The use of "sicca-cell" preparations was provisionally forbidden in 1987 by the Federal Health Organization (Bundesgesundheitsamt; BGA). Prohibition of fresh-cell injections would have exceeded the authority of this office, although the same serious reservations also applied in the case of this treatment method. Several publications that have appeared since 1955 have reported serious complications of this therapy, some life-threatening and some even lethal. Two further cases are now added: (1) A woman aged 69 had been receiving treatment with cell injections for 9 years. Immediately after an injection of sicca cells she collapsed and was hospitalized; 7 days thereafter she developed an ascending paralysis with increasing inability to swallow or breathe. She died 25 days after the injection as a consequence of central and peripheral respiratory failure. Autopsy revealed the alterations typical for acute Landry-Guillain-Barré-Strohl syndrome. (2) A 76-year-old healthy woman had been receiving treatment with fresh-cell preparations for several years. After an injection of cell suspensions a painful local swelling was observed. The symptoms were interpreted as the consequence of an iatrogenic local hematoma, and repeated punctures were performed to obtain blood. The patient was transferred to a surgical department for further therapy. Two days after the injection she suddenly died with signs of acute cardiovascular failure. Autopsy revealed the signs of a fulminating clostridial infection and also the characteristic signs of Landry-Guillain-Barré syndrome with involvement of the autonomic nervous system. In both cases the development of an inflammatory process in the peripheral nervous system could be interpreted as an immune-mediated allergic disease, related to the repeated injection of heterologous antigenic material containing nervous tissues. This hypothesis would also explain the two other cases already published and would be consistent with the observed perivenous leukoencephalopathy of the central nervous system. The human disease pictures correspond to the well-established animal models of EAEM (experimental allergic encephalomyelitis) and EAN (experimental allergic neuritis). The pathogenesis is discussed; the major role of the central and peripheral nervous system is stressed, with special reference to the risk of acute autonomic failure. The need for specific autopsy techniques for the investigation of the entire nervous system, including spinal cord, roots, spinal ganglia and peripheral nerves with sympathetic chains, is raised.     

Injuries of the large arteries of the brain and vital reactions. An electron microscopy study

In 90 forensic autopsies (Craniocerebral injury, gunshot, stabbing, blow, strangulation, etc.), semithin sections of great arteries were prepared from around 770 Epon blocks and checked for vital reactions at the mural and intimal ruptures. In 21 cases in which death had occurred immediately or soon after the trauma, with three exceptions, there was a subsequent electron microscopic investigation. In all six mural ruptures and in five of ten intimal ruptures, thrombocyte aggregates were found at the rupture margins. In five intimal ruptures, the possibility of the occurrence of preparations injuries had to be considered. In five cases, the results of the histological study were negative. The success rate is limited in principle in such a screening test since there are technical difficulties in preparing serial sections on long vessels. Death was rapid and the thrombocytes were observed to adhere to the injured wall sites immediately after the trauma. The "thrombocyte sign" is thus of substantial importance as the earliest local vital reaction. In two control cases (strangulation), thrombocyte aggregates were found at intimal ruptures of the basilar artery, which were regarded as the results of stretching via the vertebral arteries during attacks to the neck. The healing processes of intimal ruptures and traumatic medial necrosis in incomplete ruptures occurring later in life are discussed. Even if a cadaver is a few days old, the histological findings at the level of the thrombocytes can be evaluated.     

The cutaneous ink sign: a tipoff to suicide or suicide notes

The presence of smeared or unsmeared ink on the skin resulting from the writing process has been observed in a number of suicide victims who have left suicide notes. The authors report a case of a palmar "cutaneous ink sign" and discuss its forensic science import.     

System of cities dynamics in newly industrializing nations

Rapid industrialization in such countries as Korea, Malaysia, and Taiwan suggests that the complex functional structures of cities in the periphery may appear early in development. This paper proposes a 4-stage framework for the dynamics of a system of cities in a developing country undergoing industrialization and encompassing both nonindustrial and industrial development. The synthesis is assessed with evidence from the newly industrializing Asian nations of Korea, Malaysia, and Taiwan. The 4 stages of cities' industrial change include 1) increasing primacy with industrial satellites, 2) increasing primacy with industrial satellites and nodal towns on a transport network, 3) rapidly increasing primacy with rapidly growing industrial satellites and nodal towns on the transport network, and 4) decreasing primacy with slowly growing industrial satellites and rapidly growing peripheral industrial towns. The 4-stage synthesis suggests that economic development in the periphery may occur even while the primate city maintains its hegemony over control and coordination functions. Peripheral industrial growth does not challenge this hegemony. The growth of industrial cities is, instead, part of a process of regional specialization in which the low cost labor in the periphery becomes an attraction for industry. These stages are not inevitable. Government efforts are necessary to develop rural areas in terms of social improvements (education and health), capital infrastructure (transportation and utilities), and fair payments to farmers for their outputs. These seem to be the lessons learned from the industrialization process in Korea, Malaysia, and Taiwan.     

Adjunctive use of scanning electron microscopy in bite mark analysis: a three-dimensional study

An examination of a case in which adjunctive use of scanning electron microscopy (SEM) demonstrated the presence of unusual three-dimensional characteristics in a bite mark. Despite the fact that many bite marks do not show "depth," demonstration of the presence of this third dimension can produce significant data for evidentiary purposes. In some instances, these data may transform what seem to be class characteristics of a bite mark into individual characteristics and thus impart much more uniqueness to the evidence. Because of the high level of resolution and magnification of SEM, some three-dimensional characteristics not visible to the eye can be shown quite clearly by its use. Emphasis will be given to the value of SEM as a tool of the forensic odontologist in bite mark analysis.     

Book reviews

Handbook of Legal Information Retrieval Edited by J Bing, Norwegian Research Centre for Computers and Law, Oslo, in co‐operation with T Fjeldvig, T Harvold and R Svoboda North‐Holland 1984, US $96.25

Information Technology: The Challenge to Copyright. James Lahore, Gerald Dworkin and Yvonne Smyth Sweet & Maxwell and The Centre for Commercial Law Studies 1984, £12.00

Data Processing and the Law Edited by Colin Campbell Sweet and Maxwell 1984, £20.00

Le droit des Contrats Informatiques — Principes — Applications Centre de Recherches informatique et droit des Facultes Universitaires de Namur Maison Ferdinand Larder (Brussels), 1983, 45 FB

Computer Insecurity Adrian R.D. Norman Chapman and Hall 1983, £14.95

The Data Protection Act Richard Sizer and Philip Newman Gower Publishing, 1984, £16.95

The Data Protection Act 1984 Professor Bryan Niblett Oyez Longman Publishing, 1984, £18.00

The Data Protection Act 1984 — A Guide to the New Legislation J. A. L. Sterling CCH Editions, 1984, £15.00

Privacy and Data Protection — An International Bibliography Professor David H. Flaherty Mansell Publishing, 1984, £23.50

Computer Contracts R Morgan & G Stedman Oyez Longman Publishing 1984, 2nd Edition, £27.50

Computer Contracts Handbook Michele Rennie Sweet & Maxwell 1984, £15.00

Computer Contracts — An International Guide to Agreements and Software Protection Hilary Pearson Financial training 1984, £14.95