Fatalities Due to Failure of Continuous Subcutaneous Insulin Infusion Devices: A Report of Six Cases

Diabetes mellitus type 1 and type 2 are diseases characterized by impaired regulation of blood glucose due to decreased insulin production and insulin resistance, respectively. Management of diabetes mellitus often requires injection of exogenous insulin. Continuous subcutaneous insulin infusion (CSII or insulin pump) is a diabetes treatment modality utilizing a device to aid in regulation of glycemic control. Malfunctions in device components can have rare fatal consequences. Described in this report are six fatalities due to one such malfunction, the failure of plastic cannulas of CSII devices to penetrate the skin and deliver insulin, resulting in fatal diabetic ketoacidosis (DKA). The cases derive from four different death investigation systems. For each case, scene and autopsy findings are presented, as well as selected toxicology and histology findings. These cases illustrate the importance of careful examination of CSII devices in death investigations and introduce a discussion on discrepant manner of death classifications.     

The energy factor in China’s foreign policy

This paper argues that China’s foreign policy behavior has been influenced by growing energy dependence. As a major importer, China can pursue energy security through strategies that result in conflict; alternatively, energy vulnerability might lead it toward cooperation with rival oil consuming nations through participation in multilateral organizations and other forums. After outlining the argument for the strategic nature of energy, China’s increasing energy dependence is assessed, as are Beijing’s efforts to shift China’s energy balance. China’s energy diplomacy with the Middle East, Russia and Central Asia, the Asia-Pacific, Africa and Latin America are examined, and Beijing’s efforts toward greater energy security through multilateral organizations are discussed. The evidence supports the liberal hypothesis that economic interdependence promotes international cooperation. Energy demands have accelerated China’s rise to global prominence, and appear to moderate conflictual aspects of Chinese foreign policy. He is co-editor of and contributor toRussia’s Far East: A Region at Risk (University of Washington Press, 2002), and author ofThe History of Russia (Greenwood, 1999),Foreign Policy and East Asia (Cambridge University Press, 1993), andEnvironmental Policy in the USSR (University of Massachusetts Press, 1987). His articles have appeared inProblems of Post-Communism, Asian Survey, Pacific Affairs, Comparative Politics, Political Science Quarterly, British Journal of Political Science, and many other journals and edited books. The author would like to thank Igor Danchenko for his able research assistance on this project.     

Quality Control and Contracting Out of Legal Aid

This article reports on an evaluation of a pilot project in the tendering out of legal aid defence services for criminal matters in the Queensland District Court. Comparisons were made on quality and cost between the assignment of matters through competitive contracting and conventional assignment to private practitioners through a panel and scale fee system. Results show no significant differences in case outcomes and client perceptions of quality. In the interests of further cost reductions, any extension of tendering would need to focus on relatively simple, high-volume areas of prescribed crime, where there is less risk that competitive pricing will reduce the quality of service delivery. In addition, the evaluation indicated that greater savings might in future be obtained by enhanced utilisation of in-house (salaried) legal aid practitioners.     

Agreements of Economic Integration and the Choice of National Environmental Policies

This paper analyzes the question whether and in which respect agreements of (regional) economic integration affect the choice of environmental policies by individual countries. We focus our interdisciplinary analysis on the agreements of the World Trade Organization (WTO), the European Union (EU) and the European Economic Area (EEA). We find that these agreements primarily restrict a country's choice among possible instruments to achieve a certain environmental level or target, but do, in principle, not restrict its choice with regard to the environmental target or level itself. We also show that this type of restriction is likely to benefit the individual countries and the world as a whole because it tends to promote the implementation of more efficient environmental policy instruments. A brief analysis of the case of Switzerland illustrates this point.