Data registers in respiratory medicine: a pilot project evaluating compliance with privacy laws and the National Statement on Ethical Conduct in Research Involving Humans

This article reports on data from a small pilot survey evaluating the compliance of voluntary databases in respiratory medicine with privacy laws and the National Health and Medical Research Council's National Statement on Ethical Conduct in Research Involving Humans. The increasing complexity of privacy law, including the recent private sector amendments, creates many challenges for database administrators. The impact of privacy laws upon voluntary or non-statutory databases, and upon doctors reporting patient data to such databases, is far from straightforward. The article suggests way in which the law might be adapted in order to better facilitate the role of voluntary data registers in health research and public health surveillance, while still protecting the privacy of patient information. The article also briefly considers how database administrators might "future-proof" their existing data holdings to ensure compliance with legal and ethical standards.     

The Great Disconnect: Global Governance and Localised Conflict in the Cases of India and the EU

Academic scholarship displays a curious disconnect between two trends, connecting peace and governance issues. At the same time when conflicts tended to shift inwards (from inter-state to civil wars), global governance approaches seemed to decentre the management of peace and conflict outwards (from the nation state to international forums). This paper investigates this disjuncture by examining the European Union and India's governance strategies in different conflict contexts. It studies whether their strategies operate close to the global governance model and/or whether they are able to connect with and effectively support local peace initiatives in conflict-ridden areas.     

Lethal Laryngopyocele

A 44‐year‐old man collapsed after complaining of difficulty breathing. Layer dissection of the neck at autopsy revealed a large mixed internal and external laryngopyocele occluding the upper airway. It contained 30 mls of yellow‐gray pus. Mechanisms of death in laryngoceles involve obstruction of the opening into the larynx resulting in accumulation of mucus or air within the sac causing airway occlusion. Once infection supervenes, deaths in laryngopyocoeles result either from accumulated pus causing airway occlusion from a mass effect (as in the current case) or the discharge of pus into the airway causing death from aspiration. Sudden death in laryngopyoceles is a very rare event that requires careful dissection at autopsy to demonstrate the characteristics of the underlying lesion and the possible mechanism of death. Laryngopyocele should be considered in the differential diagnosis of natural conditions causing acute, potentially lethal, upper airway obstruction.     

Labouring in the Shadow of the British Political Tradition: The Dilemma of ‘One Nation’ Politics in an Age of Disunification

The British state is in flux and the Labour party is struggling to shape an effective response to the politics of disunification. This article reflects on the nature of Labour's governing project and its conception of modern statecraft which has evolved since the party became a serious contender for power in the aftermath of the First World War. We argue that Labour's initially pluralising instincts cultivated in opposition have been checked by the ongoing reality of a state‐centric mode of governing, in which the party continued to robustly defend the Westminster model operating within the parameters established by the British Political Tradition (BPT). Ed Miliband's conception of ‘One Nation’ Labour threatens to reinforce this historical pattern of reversion to the Westminster model, at precisely the moment when devolutionary forces are destabilising the existing political settlement. To break out of this impasse, Labour must look elsewhere in its ideological lexicon for inspiration, chiefly to the tradition of socialist pluralism and associationalism.     

Lethal Epistaxis

Epistaxis or nosebleed refers to bleeding from the nostrils, nasal cavity, or nasopharynx. Occasional cases may present with torrential lethal hemorrhage. Three cases are reported to demonstrate particular features: Case 1: A 51‐year‐old woman with lethal epistaxis with no obvious bleeding source; Case 2: A 77‐year‐old man with treated nasopharyngeal carcinoma who died from epistaxis arising from a markedly neovascularized tumor bed; Case 3: A 2‐year‐old boy with hemophilia B who died from epistaxis with airway obstruction in addition to gastrointestinal bleeding. Epistaxis may be associated with trauma, tumors, vascular malformations, bleeding diatheses, infections, pregnancy, endometriosis, and a variety of different drugs. Careful dissection of the nasal cavity is required to locate the site of hemorrhage and to identify any predisposing conditions. This may be guided by postmortem computerized tomographic angiography (PCTA). Despite careful dissection, however, a source of bleeding may never be identified.     

Pig Organ Energy Loss Comparison Experiments Using BBs

Torso models for ballistics research require that the mechanical properties of simulant materials must match the heterogeneous nature of tissues/organs within the human thorax/abdomen. A series of energy loss experiments were conducted on fresh porcine organs/tissues at room temperature and 37°C, using steel 4.5 mm BBs fired from a Daisy^® brand air rifle. They were compared to FBI and NATO specification ordnance gelatin and a candidate surrogate material called Simulant “A”. Two CED M2 chronographs measured BB velocity. The resulting energy loss was established using KE = 1/2 mv² before and after target perforation. The combined results at room temperature and 37°C were as follows: FBI specification gelatin was similar (p > 0.05) to heart and lung, spleen was similar to NATO specification gelatin, Simulant “A” was similar to hindquarter muscle, and hindquarter muscle, kidney, and spleen were similar to each other regarding energy retardation. These results can be used as a basis for the development of simulant materials to create an anatomically correct heterogeneous model.     

Incidence of Low Body Mass Index in the Elderly in Forensic Cases—A Possible Marker for Frailty Syndrome?

Diagnosing frailty syndrome at autopsy may be difficult if no adequate clinical history is provided. As low body mass index (BMI) may be associated with frailty in the elderly, the following study was undertaken to determine the percentage of medicolegal cases with BMIs < 18.5 in decedents aged over 75 years. Review was undertaken over three time periods: January to December 1986, January to December 2006, and January to December 2012. In 1986, 16% (15 of 93) of individuals aged ≥75 years had BMIs < 18.5, in 2006, 15% (50 of 336), and in 2012, 13% (35 of 274). In no case was frailty syndrome mentioned. This study demonstrates that frailty syndrome appears to be an underappreciated diagnosis in forensic practice despite a significant percentage of elderly decedents (13–16% over a 27‐year period) having low BMIs. Prospective assessment of this group is required to determine the incidence and contribution to mortality of frailty syndrome in a forensic context.     

Histological Changes in the Thyroid Gland in Cases of Infant and Early Childhood Asphyxia—A Preliminary Study

A retrospective blinded study of thyroid gland histology was undertaken in 50 infants and young children aged from 1 to 24 months. Deaths were due to (i) suffocation (N = 7), hanging (4), wedging (3), and chest and/or neck compression (4), and (ii) SIDS (20), noncervical trauma (7), organic disease, (4) and drug toxicity (1). In the asphyxia group (N = 18), thyroid gland congestion ranged from 0 to 3+ with 39% of cases (7/18) having moderate/marked congestion. In three cases, focal aggregates of red blood cells (blood islands) were observed within the intrafollicular colloid. These deaths involved chest compression, chest and/or neck compression, and crush asphyxia in a vehicle accident, and all had facial petechiae. Only 22% of the 32 control cases (7/32) had moderate/marked congestion with no blood islands being identified (p < 0.05). Blood islands within the thyroid gland may be caused by congestion associated with crushing or compression and may provide supportive evidence for this diagnosis.     

Africa in the global climate change negotiations

The African Group of Negotiators (AGN) has become a much more significant bargaining coalition in the global climate change negotiations. It has been participating more proactively and on a much more significant scale, and, as a result, it has had a greater impact on bargaining outcomes, notably in Nairobi, Copenhagen and Durban. Yet, at present, the group remains poorly understood by both scholars and policymakers. Compared to other groups in the climate negotiations, such as the Group of 77 and Alliance of Small Island States, it has received relatively little attention. This paper fills this gap by tracking the evolution of the AGN over the course of the climate change negotiations. In the early years after the Earth Summit, it shows that the AGN faced tremendous difficulties pursing regional objectives effectively, largely due to a number of “internal” barriers to participation, which compounded the structural barriers that the continent faced by making it difficult to use “low-power” negotiating strategies such as coalition building, agenda-setting and persuasion. However, in recent years, the group has become much more proactive as a result of greater access to material, ideational and institutional resources. These have relieved, somewhat, the internal barriers that the group faced, making it possible for the AGN to negotiate much more confidently and effectively than before.