Tissue concentrations at autopsy in infants and children receiving therapeutic digoxin

Therapeutic tissue concentrations of digoxin have been reported for relatively small numbers of infants and children. In forensic medicine, knowledge of these concentration ranges is important for confirming or excluding digoxin overdosage in different age groups. In addition to age and weight, other factors such as dosage, duration of treatment, route of administration, sampling site, time of last dose, and death-autopsy interval may influence tissue concentrations. In this paper we report on tissue concentrations in 36 infants and children who received therapeutic digoxin before death.     

Public participation in decision making: A three-step procedure

This article introduces a novel model of public particpation in political decisions. Structured in three consecutive steps, the model is based on the view that stakeholders, experts, and citizens should each contribute to the planning effort their particular expertise and experience. Stakeholders are valuable resources for eliciting concerns and developing evaluative criteria since their interests are at stake and they have already made attempts to structure and approach the issue. Experts are necessary to provide the data base and the functional relationships between options and impacts. Citizens are the potential victims and benefactors of proposed planning measures; they are the best judges to evaluate the different options available on the basis of the concerns and impacts revealed through the other two groups. The three-step model has been developed and frequently applied as a planning tool in West Germany. We compare this experience with the model's first application in the United States, and conclude that the three-step procedure offers a limited, but promising future for democratizing policy making in the United States.     

Cerebral massive hemorrhage in congophilic angiopathy and its medicolegal significance

The principles of a special type of senile cerebromeningeal angiopathy, these days usually named “congophilic angiopathy”, are demonstrated on the basis of eight cases, complicated by spontaneous massive intracranial hemorrhages in seven and late traumatic hemorrhage in one of them. The occurrence of massive hemorrhages associated with congophilic angiopathy has until now only rarely been reported. The medicolegal significance of this vascular disease is emphasized by the eighth, traumatic, case, which became forensically relevant; the late massive hemorrhage had to be regarded as significantly favoured by amyloid angionecrosis, which is the main feature of congophilic angiopathy.     

The self‐in‐reading

At play are not the signifiers we are the ones who are playing. (Goelz 1997: 243)

Writing only remains in control at the expense of our ability to read. (Goelz 1997: 117.)     

Government Size and Unemployment: Evidence from Industrial Countries

Using data from 19 industrial countries for the period 1985 to 2002, this paper analyzes how the size of the government sector affects unemployment. Controlling for the impact of the business cycle as well as for the impact of all major labor market institutions and unobserved country effects, we find that a large government sector is likely to increase unemployment. It appears to have a particularly detrimental effect on women and the low skilled and to substantially increase long-term unemployment. It seems that dominant stateowned enterprises, a large share of public investment in total investment as well as high top marginal income tax rates and low income threshold levels at which they apply are particularly detrimental.     

Fulminant liver failure in a patient on carbamazepine and levetiracetam treatment associated with status epilepticus

A 22-year-old female with a history of developmental delay and seizures successfully treated with carbamazepine and levetiracetam developed fulminant hepatic failure and subsequently died. She had been admitted to the hospital following secondary generalized seizures of 35 min duration. A circulatory shock as well as intoxication was taken into consideration during the clinical course. Autopsy failed to reveal a macroscopically discernible cause of death. Significant findings on microscopic examination included acute tubular necrosis in the kidneys, pre-existing marked accumulation of neutral lipid within the hepatocytes as well as hyperacute liver damage with evidence of almost complete hepatocyte necrosis. Carbamazepine and levetiracetam were simultaneously determined from blood and tissues such as liver, lungs, muscle and kidneys by LC-MS/MS following addition of lamotrigine as an internal standard and liquid-liquid extraction. Validation data are given for levetiracetam. Both carbamazepine and levetiracetam were present in blood at concentrations within or below the therapeutic range, respectively. Moreover, tissue concentrations suggested long-term administration of anticonvulsant drugs, which is in accordance with the medical history. After excessive drug concentrations could be ruled out, the metabolic consequences of a prolonged carbamazepine therapy to cause severe hepatic injury in the present case are discussed. A mechanism of injury to the hepatocytes may be membrane damage by either an increased production of free radicals and/or a decreased free radical scavenging capacity. Following ischemia with reperfusion and during hyperthermia, large amounts of free radicals are formed. Induction of the mixed oxidase activity during longterm administration of carbamazepine may also increase production of free radicals, leaving the hepatic cell more vulnerable to oxidative injury.     

Buufis amongst Somalis in Dadaab: the Transnational and Historical Logics behind Resettlement Dreams

The Somali word buufis is commonly used in the Kenyan refugeecamps of Dadaab, referring to a person's dream of resettlement.It is an ambiguous phenomenon, bringing hope and remittancesinto the camps but also removing investments from the regionand, when the dream cannot be reached, sometimes having adversepsychological effects. Buufis is triggered by the fact that,due to transnational flows of remittances and information, refugeesin remote camps like Dadaab can compare their lives in the campsto those of others elsewhere. This illustrates how the opportunities,constraints, hopes and dreams that refugees experience locallyare often determined by transnational factors. Whereas the resettlementdreams analysed in this article are thus likely to occur inother contexts as well, it is argued that they are more intenseand elaborate amongst refugee communities with a strong cultureof migration, like the Somalis.     

Duverger's concept: Semi-presidential government revisited

Abstract The article attempts to follow up the fate of the concept Maurice Duverger created to explain the regime of the French Fifth Republic: semi–presidential government. Duverger expounded the concept in his fundamental book Échec au roi in 1978, trying to illustrate the fact that regimes of this type worked quite differently in the seven Western and Northern European countries that institutionalized it. 'Semi–presidentialism' is now widely, but very often controversially, used. The recent appearance of such regimes in newly democratizing states points to the fact that this form of government is often the preferred solution in times of transition. A critical review of Duverger's concept seems expedient as the diversification of these regimes raises new and perhaps intriguing questions. Due to the rejection of Duverger's concept or its ignorance in parts of the European scientific community, it is necessary to defend it as an important tool for political analysis. Moreover, it opens the opportunity for the examination of fundamental problems in political science.