Adult Hirschsprung's disease diagnosed during forensic autopsy

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences.     

Dissemination of health technology assessments: identifying the visions guiding an evolving policy innovation in Canada

Health technology assessment (HTA) has received increasing support over the past twenty years in both North America and Europe. The justification for this field of policy-oriented research is that evidence about the efficacy, safety, and cost-effectiveness of technology should contribute to decision and policy making. However, concerns about the ability of HTA producers to increase the use of their findings by decision makers have been expressed. Although HTA practitioners have recognized that dissemination activities need to be intensified, why and how particular approaches should be adopted is still under debate. Using an institutional theory perspective, this article examines HTA as a means of implementing knowledge-based change within health care systems. It presents the results of a case study on the dissemination strategies of six Canadian HTA agencies. Chief executive officers and executives (n = 11), evaluators (n = 19), and communications staff (n = 10) from these agencies were interviewed. Our results indicate that the target audience of HTA is frequently limited to policy makers, that three conflicting visions of HTA dissemination coexist, that active dissemination strategies have only occasionally been applied, and that little attention has been paid to the management of diverging views about the value of health technology. Our discussion explores the strengths, limitations, and trade-offs associated with the three visions. Further efforts should be deployed within agencies to better articulate a shared vision and to devise dissemination strategies that are consistent with this vision.     

The hidden costs of power-sharing: Reproducing insurgent violence in Africa

This article analyzes some factors underlying the spread ofinsurgent violence in Africa. It focuses on the impact externalfactors have on power struggles on the continent. The firstof these is the unsteady support for democracy from Westerndonors, which has impeded more far-reaching domestic changesin much of Africa. Second are wider changes in the internationalsetting that dramatically enhanced the international standingof armed movements in the post-1989 period. The article arguesthat the interplay of both factors has induced would-be leadersto conquer state power by violent rather than non-violent means.This becomes particularly evident in regard to Western effortsto solve violent conflict through power-sharing agreements.The hypothesis is put forward that the institutionalizationof this practice for the sake of ‘peace’, i.e. providingrebels with a share of state power, has important demonstrationeffects across the continent. It creates an incentive structurewould-be leaders can seize upon by embarking on the insurgentpath as well. As a result, and irrespective of their effectivenessin any given case, power-sharing agreements may contribute tothe reproduction of insurgent violence.     

Fat Transfer and Fatal Macroembolization

Fat embolism is usually associated with long bone fractures or other trauma. The diagnosis is usually clinical, and in most cases, emboli are not fatal and not usually seen on gross examination. At the Los Angeles County Coroner's Office, we autopsied the victim of fatal macroscopic fat embolization to the lungs. The patient died during buttock enhancement surgery when fat from liposuction was injected into her buttocks. Fat embolism from liposuction and fat injection is reportedly rare, and macroscopic embolization is rarer still. Varicose veins can occur in the area of the sciatic notch and are known to cause painful sciatica symptoms. We suggest them as a potential conduit for macroscopic fat to reach the lungs. Simple pre‐operative questioning for sciatica symptoms and possible radiologic study to rule out sciatic varices seem prudent before undertaking buttock‐enhancing surgery. Careful fat injection with pre‐aspiration is always advised.     

Developmental Relations Between Bullying Victimization and Suicidal Ideation in Middle Adolescence and Emerging Adulthood: Do Internalizing Problems and Substance Use Mediate Their Links?

Journal of Youth and Adolescence - Previous research has suggested that bullying victimization is associated with higher suicidal risk among young people; however, the mechanisms underlying this...     

A policy mix experiment to promote start-up success: exploratory evaluation of the NSF Small Business Innovation Research (SBIR)/Industry University Cooperative Research Center (IUCRC) membership supplement

The Journal of Technology Transfer - This paper investigates the outcomes of a policy experiment, the NSF SBIR/IUCRC Membership Supplement, designed to promote the success of small high-tech...