Adolescent death: a 15-year retrospective review

Adolescents comprise an eclectic mix of people vitally important to society yet long-term comprehensive studies on the circumstances of their deaths are lacking in the pediatric forensic literature. The authors reviewed all forensic cases referred to the Medical University of South Carolina Forensic Pathology section over the fifteen years between January 1989 and December 2003. In accordance with the World Health Organization (WHO) definition of adolescents, only decedents 10-19 years of age were included. The authors examined the cause and manner of death, age, gender, and race of the victims in all cases. The toxicology results, perpetrator, death scenario and location, and victim traits were analyzed when available. For all adolescents, the most common manner of death was accident followed by homicide, suicide, natural, and undetermined. Within the adolescent population two distinct groups, 10-14 years old and 15-19 years old, were identified. Though both groups were similar in that they experienced a high number of accidental deaths, decedents of older age group suffered a higher percentage of violent deaths while decedents of the younger group were more likely to die of natural causes. Many of the accidental deaths in this review were preventable, including deaths due to motor vehicle collisions and drowning. In deaths due to homicide, the perpetrator was often known to the victim, whether as an acquaintance or family member. Toxicology testing was often positive in decedents of the older age group, while only rarely positive in decedents of the younger age group. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of adolescent death. The authors present their findings in this 15-year retrospective study to better aid forensic pathologists, death investigators, law enforcement, and epidemiologists.     

Psychopathy in Youth: Pursuing Diagnostic Clarity

Psychopathy in youth has received increased recognition as a critical clinical construct for the evaluation and management of troubled adolescents (e.g., Frick, P. J. (1998). In Cooke, D. J., Forth, A. E., and Hare, R. D. (eds.), Psychopathy: Theory, Research and Implications for Society. Kluwer Academic Publishers, Boston, MA, pp. 161–187; Lynam, D. R. (1998). J. Abnorm. Psychol., 107: 566–575). To date, clinical research has examined psychopathy simply as a global construct rather than focusing on its specific criteria. In addition, researchers have tended to utilize downward extensions of adult conceptualizations of psychopathy to understand this syndrome in youth. This study was designed to assist in clarifying the construct of psychopathy in youth from a fresh perspective via prototypical analysis. Psychologists from the Clinical Child Psychology Section of the American Psychological Association (i.e., Division 53; N = 511) rated the prototypicality of the psychopathy construct for both male and female youth. Factor analyses for both genders resulted in 2 dimensions that reflected both personality and behavioral components of the disorder. Prototypicality ratings revealed important adult-to-child and male-to-female differences. In addition, child psychologists' views of their effectiveness at treating psychopathy in youth was surveyed. Contrary to the prevailing pessimism, clinical child psychologists reported that children and adolescents made moderate gains in psychotherapy. These results provide a framework for clinical child psychologists in their evaluations and treatment of psychopathic youth.     

A Large-Scale Meta-Analysis Relating the Hare Measures of Psychopathy to Antisocial Conduct

The present meta-analysis integrated effect sizes from 95 non-overlapping studies (N=15,826) to summarize the relation between Hare Psychopathy Checklists and antisocial conduct. Whereas prior meta-analyses focused on specific subdomains of the literature, we used broad inclusion criteria, incorporating a diversity of samples, settings, methodologies, and outcomes in our analysis. Our broad perspective allowed us to identify general trends consistent across the entire literature and improved the power of our analyses. Results indicated that higher PCL Total, Factor 1 (F(1)), and Factor 2 (F(2)) scores were moderately associated with increased antisocial conduct. Study effect sizes were significantly moderated by the country in which the study was conducted, racial composition, gender composition, institutional setting, the type of information used to score psychopathy, and the independence of psychopathy and transgression assessments. However, multiple regression analyses indicated that the information used to assess psychopathy did not have a unique influence on effect sizes after accounting for the influence of other moderator variables. Furthermore, racial composition of the sample was related to the country in which the study was conducted, making it unclear whether one or both of these moderators influenced effect sizes. We provide potential explanations for the significant findings and discuss implications of the results for future research.     

Bleedings, purges, and vomits: Dr. Benjamin Rush's republican medicine, the bilious remitting yellow-fever epidemic of 1793, and the non-origin of the law of informed consent

To the consternation of many physicians, the modern law of informed consent imposes certain constraints on their actions, not least that they respect patients' decisions to redefine at will the scope of care. The consequences of this transfer of power are often a nuisance and occasionally fatal, but always a reflection of democracy's leveling march: Physicians now take orders rather than give them. However frustrating the modern preference for process over result might be, we should ask ourselves-before condemning the law's evolution-about the consequences for patients' health of a more radically democratic practice of medicine. This paper proposes to examine this question as framed by the life of Dr. Benjamin Rush, who, in addition to signing the Declaration of Independence, crafted a medical practice uniquely suited to the young Republic's presumed moral character: Self-aware sufferers would promptly identify their own maladies and courageously treat themselves. In the end, his enterprise was flawed because his democratic instincts misled not only his scientific inquiries (disease is complex, not simple) but also his practice recommendations (patients are scared, not intrepid). Reflection on Rush's failed project should give pause to those who lament the passing of paternalistic medicine, for the law's requirements, however onerous they might be, tolerably accommodate both patients' need for physicians' expertise and our democratic belief that consent is the fundamental precondition of all rule.     

Becoming an entrepreneurial university? A case study of knowledge exchange relationships and faculty attitudes in a medium-sized,research-oriented university

This paper seeks to contribute to the growing literature on the entrepreneurial university by mapping knowledge exchange relationships of entrepreneurial faculty in a comprehensive manner and also capturing faculty attitudes towards measures taken by the university administration to promote entrepreneurship. We report on an exploratory study of Sussex University, a medium-sized, research-oriented university, which launched technology transfer activities in the mid-1990s. Our results show that, in spite of a comparatively late start, a considerable number of researchers engage in knowledge exchange processes with industry and other non-academic partners. We present evidence that suggests faculty in the social sciences and humanities as well as natural sciences and engineering maintain links to industrial partners, including multinational corporations. Furthermore, our observations indicate that schools differ in the way their faculty engage in university–industry collaborations. Further differences can be observed with respect to faculty attitudes towards technology transfer and awareness of the university’s respective codes of practice.