A Unique Type of Birth Trauma Mistaken for Abuse

Pediatric abusive head trauma is a challenging subject across many disciplines. Of particular importance is the identification of mimics of abuse, so cause and manner of death can be properly assigned. We present the case of suspected child abuse involving an infant who presented unresponsive to the hospital with hypoglycemia, hypothermia, and bilateral parietal fractures. An autopsy revealed fractures associated with organizing scalp hemorrhage and gross leptomeningeal congestion and hemorrhage. The fractures were circular with external displacement, rounded margins, and subperiosteal new bone formation indicative of healing. Birth records revealed vacuum assist and cesarean section delivery. Although vacuum extraction‐related injuries are typically cephalohematomas and/or linear fractures, the outbending and circular morphology of the fractures are consistent with vacuum extraction. Moreover, microscopic neuropathological examination revealed hemorrhagic purulent leptomeningitis. This unique case demonstrates the importance of considering birth trauma in the determination of cause and manner of death of an infant.     

How pay equity legislation came to Ontario

Abstract: This paper presents a detailed case analysis of the emergence of far-reaching pay equity legislation (Bill 154) in Ontario in 1987 in order to test a general analytical framework designed to explain major changes in public policy. Three factors are postulated to be instrumental in the attainment of new legislative initiatives: changes in environmental variables (e.g., economic and demographic variables, historical trends and precedents); shifts in political power (e.g., electoral changes resulting in a minority government or a new governing party, the perception of voter mandated change); and changes in pressure group behaviour (e.g., a shift in the “balance of power” amongst pressure groups due to changes in resources, leadership, political influence strategies or tactics, or the creation of new pressure groups). The authors conclude that all three factors were important in explaining this significant change in public policy, with the greatest weight being attributed to shifts in political power. This framework appears to be a useful step in developing a general theory of major changes in public policy. Sommaire: Cet article présente une analyse détaillée de la manière dont a été adoptée en Ontario, en 1987, une importante loi sur l‘équité salariale (projet de loi 154), afin de verifier la validité d'un cadre analytique général visant à expliquer des changements importants de la politique gouvernementale. Trois facteurs semblent requis pour que se réalisent de nouvelles initiatives législatives: une évolution des variables du milieu (les variables économiques et démographiques, les tendances et les précédents historiques par exemple); l’évolution du pouvoir politique (les modifications qui découlent d'une élection entraînant un gouvernement minoritaire ou portant un nouveau gouvernement au pouvoir, la perception des changements souhaités par les électeurs entre autres); et les changements de comportement des groupes de pression (par exemple, un changement de “l‘équilibre des pouvoirs” parmi les groupes de pression à cause du changement des ressources, du leadership, des stratégies ou tactiques d'influence politique ou la création de nouveztux groupes de pression). Selon les auteurs, chacun de ces trois facteurs a joué un rôle important dans ce changement considérable des politiques publiques, l’évolution du pouvoir politique éant sans doute le plus déterminant. Ce cadre semble utile pour amorcer l‘élaboration d'une théorie générale des changements importants des politiques gouvernementales.     

THEORIES OF REGULATORY IMPACT: THE ROLES OF THE REGULATOR, THE REGULATED, AND THE PUBLIC

Berry reviews the major theories for why legislative intent differs from regulatory output including: (1) theories of commission inadequacy, (2) group theories of political science, and (3) group theories of regulation offered by economists. He reviews the salient literature in each type and concludes that none alone incorporates a sufficient explanation for the wide range of regulatory outcomes. Such an explanation, he maintains, requires an analysis of all three actors, and of the variation in the incentives, resources, and goals of each.     

Expanding a community's justice response to sex crimes through advocacy, prosecutorial, and public health collaboration: introducing the RESTORE program

Problems in criminal justice system response to date-acquaintance rape and nonpenetration sexual offenses include (a) they are markers of a sexual offending career, yet are viewed as minor; (b) perpetrators are not held accountable in ways that reduce reoffense; and (c) criminal justice response disappoints and traumatizes victims. To address these problems, a collaboration of victim services, prosecutors, legal scholars, and public health professionals are implementing and evaluating RESTORE, a victim-driven, community-based restorative justice program for selected sex crimes. RESTORE prepares survivors, responsible persons (offenders), and both parties' families and friends for face-to-face dialogue to identify the harm and develop a redress plan. The program then monitors the offender's compliance for 12 months. The article summarizes empirical data on problems in criminal justice response, defines restorative justice models, and examines outcome. Then the RESTORE program processes and goals are described. The article highlights community collaboration in building and sustaining this program.     

No Five-Finger Exercise: Digital Law to Manage Legal Complexity

This article considers the following. Digital coding of information is far less extensive than the complexity and much less radical than the digital coding of selection among information which establishes the legal system. Niklas Luhmanns theory is the principal example of an appreciation for the latter. Luhmann presented the design for understanding law as autopoietic, a law legitimated and sustained by legal procedure.     

How does private finance affect public health care systems? Marshaling the evidence from OECD nations

The impact of private finance on publicly funded health care systems depends on how the relationship between public and private finance is structured. This essay first reviews the experience in five nations that exemplify different ways of drawing the public/private boundary to address the particular questions raised by each model. This review is then used to interpret aggregate empirical analyses of the dynamic effects between public and private finance in OECD nations over time. Our findings suggest that while increases in the private share of health spending substitute in part for public finance (and vice versa), this is the result of a complex mix of factors having as much to do with cross-sectoral shifts as with deliberate policy decisions within sectors and that these effects are mediated by the different dynamics of distinctive national models. On balance, we argue that a resort to private finance is more likely to harm than to help publicly financed systems, although the effects will vary depending on the form of private finance.     

Optimum methamphetamine profiling with sample preparation by solid-phase microextraction

Solid-phase microextraction (SPME) is a relatively new technique in which a small, polymer-coated fiber is employed to extract volatile and semivolatile organic compounds from the sealed headspace above a questioned sample. SPME, coupled with gas chromatography/mass spectrometry (GC/MS), was used to characterize impurities in illicit methamphetamine samples. Trace impurities present in a specimen were tentatively identified using mass-spectral databases and included 1,2-dimethyl-3-phenyl-aziridine (indicating synthesis via a halogenated ephedrine intermediate), ethyl vanillin (a flavoring compound), and caffeine (a stimulant used as cutting agent). The types and numbers of organic compounds sampled by SPME were compared with those collected by various solvent extraction protocols. In addition to unambiguously confirming the presence of methamphetamine, SPME-GC/MS analyses detected approximately 30 more organic analytes than were found by GC/MS following the ethyl acetate extraction method adopted by the United Nations International Drug Control Programme. SPME-GC/MS is a superior method for generating material "fingerprint" profiles in methamphetamine samples. The detection and characterization of increased points of comparison in drug samples provide more detailed chemical signatures for both intelligence and operational information.