Deaths associated with liposuction: case reports and review of the literature

Tumescent liposuction is a common cosmetic procedure that is performed as an outpatient service in physician's offices and is largely believed to be safe. The protuberant areas of the body containing the undesirable fat deposits are injected with normal saline containing lidocaine and epinephrine for pain control and hemostasis, and the waterlogged cells are suctioned out via cannula through a small incision. We recently encountered three cases in which deaths were attributed to this procedure. Two showed fat embolization in the lung and one died from fluid overload. The osmium tetroxide post-fixed lung sections showed fat emboli in the interstitial capillaries and arterioles. We reviewed the recent literature and found that pulmonary thromboemboli, fat embolization, fluid overload, and lidocaine and epinephrine intoxication are found at autopsy in many cases. Forensic pathologists responsible for determining the cause and manner of death should become familiar with the postmortem findings and risks of liposuction therapy and communicate them to their clinical colleagues and communities.     

Understanding Ripple Effects: The Cross–National Adoption of Policy Instruments for Bureaucratic Accountability

This article examines different explanations for the cross–national diffusion of three recent innovations in bureaucratic accountability—the institution of the ombudsman, freedom of information legislation and data protection (information privacy) law. The first two explanations are based on the assumption that these innovations are by–products of modernization, either the growth of the state or democratization. The third assumes that policy is shaped through processes of international communication. A combination of methodologies is employed to conclude that while the growth of government and liberal democratic values are necessary conditions for the adoption of all three policy instruments, they are not sufficient conditions. The pattern of adoption observed is best explained by examining how evidence about these respective policies flows from adopting states to non–adopters. In the case of the ombudsman, this process can be characterized as one of lesson–drawing; for freedom of information, evidence is used for legitimation purposes; for data protection, the diffusion is attributable to harmonization through international organizations. Policy transfer is hence a multi–faceted concept that embraces a number of distinct processes of transnational learning and communication.     

A Prospective Study of Adolescents' Peer Support: Gender Differences and the Influence of Parental Relationships

This longitudinal study investigates parent and child predictors of adolescents' perceived social support from peers. Adolescents (285) and their parents filled out surveys when students were 11 and 15 years of age. Parent reports of their own social support and child reports of parental support to them, depression, and self-esteem were used as predictors of adolescents' peer social support. Path analyses revealed functional dissimilarity in the predictive model, for boys and girls. For boys and girls, the amount of spousal support parents' reported impacted the amount of parent to child support that children reported. For boys, this relationship impacted their perceptions of peer support indirectly through depression. However, for girls, parents' own supportive relationships directly impacted both their self-esteem and depression, above and beyond parent to child support, which then impacted girls' peer social support.     

When Initial Interviews Are Delayed a Year: Effect on Children's 2-Year Recall

Three- to nine-year-old children were interviewed about a medical emergency (injury requiring hospital ER treatment) two years after it occurred. Half of the number of children had been interviewed shortly after injury as well as 6 and 12 months later, while the remaining children had had only one prior interview a year after injury. There was remarkably little long-term deterioration in memory by both groups. Having a delayed initial interview had two effects, and both were relevant only to the harder-to-remember hospital treatment event: (a) The late-interview group was less accurate, and (b) early-interview children had more extensive free recall, suggesting that multiple prior interviews teach children the “rules of the memory game' when they are asked open-ended questions. Forensic implications are discussed.     

The who, what, and why of risk adjustment: a technology on the cusp of adoption

Risk adjustment (RA) consists of a series of techniques that account for the health status of patients when predicting or explaining costs of health care for defined populations or for evaluating retrospectively the performance of providers who care for them. Although the federal government seems to have settled on an approach to RA for Medicare Advantage programs, adoption and implementation of RA techniques elsewhere have proceeded much more slowly than was anticipated. This article examines factors affecting the adoption and use of RA outside the Medicare program using case studies in six U.S. health care markets (Baltimore, Seattle, Denver, Cleveland, Phoenix, and Atlanta) as of 2001. We found that for purchasing decisions, RA was used exclusively by public agencies. In the private sector, use of risk adjustment was uncommon and scattered and assumed informal and unexpected forms. The most common private sector use of RA was by health plans, which occasionally employed RA in negotiations with purchasers or to allocate resources internally among providers. The article uses classic technology diffusion theory to explain the adoption and use of RA in these six markets and derives lessons for health policy generally and for the future of RA in particular. For health policy generally, the differing experiences of public and private actors with RA serve as markers of the divergent paths that public and private health care sectors are pursuing with respect to managed care and risk sharing. For the future of RA in particular, its history suggests the need for health service researchers to consider barriers to use adoption and new analytic technologies as they develop them.