An autopsy case of intraoperative death due to pulmonary fat embolism—possibly caused by release of tourniquet after multiple muscle-release and tenotomy of the bilateral lower limbs

We report a case of a juvenile male with muscle rigidity caused by cerebral palsy who experienced intraoperative sudden death due to pulmonary fat embolism after multiple muscle-release and tenotomy of the bilateral lower limbs. Data were obtained through review of the surgical and anesthesia records, as well as from autopsy and histopathological examination. All surgical procedures were performed within the same operation, beginning with the right lower limb and then proceeding with the left lower limb, with application of a pneumatic tourniquet to avoid intraoperative hemorrhage. Slight changes in the hemodynamics were noticed after release of the right tourniquet. Further, sudden onset of hypotension, severe bradycardia, and a marked decrease in percutaneously monitored oxygen saturation occurred just after release of the left tourniquet when the left limb was raised for casting. The patient died despite immediate and vigorous cardiopulmonary resuscitation. At autopsy performed 20 h after death, examination of the lungs revealed a pale surface, slight edema, and obvious fat droplets in the vessels at the cut surfaces. Histopathological examination with fat staining was notable for the presence of pulmonary fat embolism. These results suggest that restoration of venous return after removal of the tourniquet combined with massive fat embolism from dead spaces was the likely cause of death.     

Stage of Change as a Predictor of Attrition Among Men in a Batterer Treatment Program

This study assessed the contribution of the men's stage of change to the prediction of attrition among men attending a batterer treatment program. As outlined by the transtheoretical model of change, men were classified into the precontemplation, contemplation, or action stage based on their level of change motivation and behavior. It was hypothesized that men in the precontemplation stage would dropout of treatment at higher rates than men in later stages of change. Participants were 308 men who enrolled in a batterer treatment program over the course of 1 year, 61.4% of whom dropped out of treatment. Counselor rated, but not self-rated stage of change significantly predicted treatment completion once traditionally used demographic, contextual, and personality variables were taken into account. Specifically, men identified by counselors as being in the precontemplation stage were 2.3 times as likely as men rated in the contemplation stage and 8.8 times as likely as men rated in the action stage to dropout of treatment. Referral source, age, and history of arrest also made significant contributions to the prediction of attrition. The best combination of predictors led to the successful classification of 72% of the cases, 98% of the dropouts but only 19% of the completers. Discussion focuses on the limitations of current findings and their implications for the use of the transtheoretical model to predict attrition from batterer treatment.     

AMERICAN BAR ASSOCIATION POLICY REQUIRING LICENSURE,REGULATION, AND MONITORING OF PRIVATELY OPERATED RESIDENTIAL TREATMENT FACILITIES FOR AT‐RISK CHILDREN AND YOUTH

Well‐meaning parents send an estimated 10,000 to 14,000 at‐risk children each year to unregulated private residential treatment facilities, which for as much as $3,000 to $5,000 per month promise to modify troublesome behaviors and make bad kids good. The facilities that compose this booming, billion‐dollar business are generally not regulated, licensed, or monitored by state or federal governments; too many aspects of this alternative care system for youth are rife with mistreatment, including physical, sexual, and mental abuse by facility staff. This American Bar Association policy resolution urges state, territorial, and tribal legislatures to pass laws that require the licensing, regulating, and monitoring of residential treatment facilities that are not funded by public or government systems but offer treatment to at‐risk children and youth for emotional, behavioral, educational, or other problems or issues.     

医疗损害赔偿纠纷案件法律适用的冲突与调适

医疗损害赔偿是当今社会的热点问题,也是司法审判实践中的重点、难点问题。由于该类案件处理中现行法律适用原则存在的误区,导致审判实践中同案不能同判的现象时有发生。这不仅损害当事人的合法权益,而且严重损害我国法律的尊严。文中阐述了现行法律适用原则存在的主要问题及由此产生的严重影响,并从理论上通过对现行适用原则中区分对待的医疗事故以及其它医疗损害的剖析,明确了医疗损害的内涵及其责任性质,进而提出对《条     

罪犯心理状况研究与心理矫治体系的构建

监狱作为一个特殊的社会予系统,干警与罪犯、监管与改造的这种特殊人际关系会影响他们的知觉、观念、行为导向,形成监狱内特殊的心理体系。罪犯的心理状况极大地影响改造成效,我国从80年代起建立罪犯心理矫治体系,它对于稳定监狱工作秩序和监管安全起到积极的作用。文章在分析当前犯罪心理矫治存在不足的基础上提出一些粗浅的构想,以期对监狱心理矫治的进步提供有益探索。     

The stop and think group: Changing sexually aggressive behaviour in young children

Abstract

Until recently, relatively little attention has been paid to young children who are sexually aggressive to other children. In this paper, cognitive-behavioural group techniques which have been used in the treatment of aggressive, impulsive behaviour in young children were applied in a small group setting to the sexually aggressive behaviour of pre-pubescent boys. The boys initially learned a ‘Stop and Think” model for general interpersonal problem-solving, which was then used to work on their difficulties with verbal and physical sexual aggression. Observation of the children's behaviour, reports from carers, school staff and social workers indicated that the group programme increased the children's ability to inhibit impulsive, aggressive behaviour. In the nine months after the group finished there were no known incidents of sexual aggression. In the context of certain limitations discussed in the paper, this positive outcome suggests that these methods have potential for reducing the likelihood of sexually aggressive behaviour becoming habitual.     

论我国民事撤诉制度的完善

我国现行民事撤诉制度完全由原告自由决定而无需被告同意,且无次数限制,缺乏关于撤诉与诉讼时效关系的规定,难以实现双方当事人的平等地位,有效保护当事人合法权利。应当赋予被告对原告撤诉的否决权,并对原告撤诉次数加以限制,改革＂按撤诉处理＂的法律情形,增加规定起诉后又撤回的诉讼时效依然中断,由此对我国民事撤诉制度进行完善。     

社区矫正的性质再论

社区矫正的性质关乎其今后的发展方向。针对我国现阶段社区矫正的实践现状,必须对社区矫正的性质进行准确定位,由此引发对社区矫正有关的处遇定义、理论根基、价值理念、法律规定、国外经验的梳理,最终认定其为一种综合性的非监禁处遇措施,并在正确定位后进行了一系列改革措施的构想。