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.     

Validation of the AmpFlSTR Profiler Plus PCR amplification kit for use in forensic casework

According to TWGDAM guideline 4.5 (1), prior to implementing a new DNA analysis procedure or an existing DNA analysis procedure developed by another laboratory, the forensic laboratory must first demonstrate reliability of the procedure in-house. Seven phases were designed to validate the use of the AmpFlSTR Profiler Plus PCR Amplification Kit, as well as the PE Applied Biosystems 310 Genetic Analyzer. This report summarizes the results obtained for each of the seven phases of the validation study which included the following evaluations: polymer, reproducibility, sensitivity, stutter, precision, mixtures and nonprobative casework.     

Beliefs and errors in voting choices: A restatement of the theory of fiscal illusion

This paper reformulates the theory of fiscal illusion to make it more compatible with the median-voter model of collective choice. It emphasizes the requirement that misperceptions about marginal tax-costs and benefits must be permanent to have any significant effect on the level of public expenditures. The Lancaster-Becker model of consumer demand is then used to demonstrate the peculiar effects of permanent misperceptions on consumer demand. It can be shown, for example, that other things being the same, a Republican who underestimates continuously the marginal benefits of public activities may demand more public goods than a Democrat who overestimates those same benefits in a permanent fashion.     

Linguistic and socioemotional influences on the accuracy of children's reports

A basic but largely neglected issue in research on the reliability of children's testimony is the impact of certain questioning tactics (e.g., use of legalese and socioemotional intimidation) on the accuracy of children's reports. In the present study, 5- to 7-year-old children were interviewed about a standardized play event with free-recall cues and detailed questions that were specific or misleading. Linguistic complexity of questions (complex or simple) and socioemotional context of interview (supportive or intimidating) were varied between subjects. Results indicated that children were significantly less accurate in reporting the event when questioned with complex, developmentally inappropriate questions rather than simple questions, yet children rarely voiced their comprehension failures. In addition, children interviewed by a warm, supportive interviewer were more resistant to misleading questions about the event than were children interviewed in an intimidating manner. Theoretical interpretations and implications for investigative interviewing and policy are discussed.