Sudden unexpected death due to a previously undiagnosed plasma cell dyscrasia

The plasma cell dyscrasias are a diverse group of disorders characterized by the production of a clonal paraprotein. Sudden death is a recognized complication of the plasma cell dyscrasias, most commonly in individuals with cardiac involvement by amyloidosis. However, the current forensic literature has no reported cases in which sudden death resulted from complications of a plasma cell dyscrasia that was first diagnosed by postmortem histologic examination. We present the case of a woman whose sudden and unexpected death resulted from a seizure. Postmortem examination revealed no evidence of trauma or a grossly identifiable natural disease process that would have accounted for her death. However, microscopic and immunohistologic studies revealed a previously undiagnosed plasma cell dyscrasia, the clonality of which was determined by immunohistochemical studies for immunoglobulin light chains, that was not associated with amyloid deposition. This case elucidates a previously unrecognized cause of sudden unexpected death and illustrates the importance of microscopic studies in selected cases examined in medical examiner/coroner offices.     

Investigation of Postmortem Absorption and Redistribution After the Application of a Fentanyl Patch

Fentanyl deaths have increased with availability of transdermal patches. Interpretation of postmortem fentanyl levels may be complicated by postmortem redistribution and absorption of fentanyl from a patch. We applied an unused 100‐μg/h fentanyl patch onto the lower abdomen of a decedent with no premortem fentanyl exposure. Ocular fluid, blood, and urine were collected prior to placement, and the decedent was refrigerated for 23 h. Prior to the autopsy, urine, subcutaneous tissue under the patch, and samples from the same anatomic sites were obtained. We observed no fentanyl in any postpatch placement samples (LOD: 0.1 ng/mL for blood and vitreous fluid, 1.0 ng/mL urine, 2.0 ng/g for tissues). Although we observed no postmortem absorption of fentanyl, this was only a single case; therefore, we recommend that patches be removed after receipt of a cadaver before initiation of an autopsy, with the location of removed patch documented.     

Competition Law Fragmentation in a Globalizing World

Beaton‐Wells, Caron, and Ariel Ezrachi (eds.). 2011 . Criminalising Cartels: Critical Studies of an International Regulatory Movement . Oxford: Hart Publishing. Pp. xvi + 455. Gerber, David J. 2010 . Global Competition: Law, Markets, and Globalization . Oxford: Oxford University Press. Pp. xx + 394. Lianos, Ioannis, and D. Daniel Sokol (eds.). 2012 . The Global Limits of Competition Law . Stanford, CA: Stanford University Press. Pp. xiv + 282. This is a review essay of Caron Beaton‐Wells and Ariel Ezrachi (eds.), Criminalising Cartels: Critical Studies of an International Regulatory Movement ( 2011 ); David J. Gerber, Global Competition: Law, Markets, and Globalization (2010); and Ioannis Lianos and D. Daniel Sokol (eds.), The Global Limits of Competition Law ( 2012 ). It explores the fragmented nature of national competition laws in the context of globalization and several harmonizing trends: the defining role of economics, the strong influence of US antitrust economics and law internationally, and the relative insularity of competition law from other subdisciplines of law. The recent emergence of competition regimes, especially in the BRICS countries, challenges these harmonizing trends, reducing US hegemony. Economics will remain central but cultural and institutional factors that reflect societal values will become more significant. This leads to a contradiction of convergence as to the benefits of competition law internationally and continuing fragmentation along national lines.     

Mortality under and after sentence of male convicts transported to Van Diemen's Land (Tasmania), 1840–1852

This article reports on mortality in a cohort of 7084 English, Irish and Scottish-born convict men who were transported on 30 ships to Tasmania between 1840 and 1852. To the authors' knowledge, this is the first study of convict mortality that systematically traces the mortality of convicts after emancipation as well as under sentence. This pilot study investigates the relationship between pre-transportation characteristics, convict discipline, reactions to convict discipline, and mortality under and after sentence of the male convict population. The convict men were various in their origins but shared the experience of penal servitude under the gaze of a paper panopticon. Controlling for other factors, the authors find that the convicts were more likely to die under sentence if they were born in Scotland, London or an industrial-urban area; if they exhibited disturbed mental behaviour under sentence, such as tearing their clothes; or if they had more time in solitary confinement or more accumulated insults of their mind and body. For those who survived sentence, mortality was higher for those born in an industrial-urban area, those who had more alcohol-related offences under sentence, those with more time in solitary confinement under sentence, and those who were violent or threatened violence while under sentence.     

Categorical Municipal Expenditures with a Focus on the Flypaper Effect

Using data for Wisconsin cities and villages the effects of grants in aid from state government on 10 categories of municipal expenditures are examined. We build on the traditional grants in aid public finance literature by looking for evidence of the flypaper effect. By focusing on the Wisconsin state shared revenues program, a pure grant of considerable size for many Wisconsin municipalities, we offer a clean test of the flypaper effect. We find a positive flypaper effect on 8 of the 10 categorical expenditures. We also find the impact of unconditional grants on categorical expenditures is stronger on nonessential “luxury” goods (e.g., parks and recreation, culture, and educational services) than on essential “normal” municipal goods (e.g., police and fire protection).