Case Files Research Articles

Intersectional injustices: police responses to migrant, Black and minoritised victim-survivors of rape and other sexual offences in England and Wales

ABSTRACT Research has explored how gender discrimination and sexist stereotypes in the form of rape myths permeate police investigations in England. Yet, scant attention has been given to the impact of intersectional structural disadvantages on shaping police responses to rape. Recent quantitative studies reveal a criminal justice gap for Black and minoritised victim-survivors of sexual and gender-based violence, pointing to a troubling policing reality that demands further scrutiny. This paper turns to that by drawing on data from 25 cases from four forces collected between 2021 and 2022 as part of Operation Soteria Bluestone (OSB) through a novel method in which police investigators critically peer review their colleagues’ case files to assess strengths and weaknesses. Our study provides a unique methodological and empirical contribution to the field, as qualitative research on Black and minoritised women’s experiences of policing as victim-survivors of sexual and domestic violence has primarily relied on interviews with police officers, victim-survivors and practitioners. The framework of institutional racism and intersectionality sheds light on how the police may inadequately respond to rape cases and the intersecting needs of migrant, Black and minoritised women. As Black feminists contend, the intersection of multiple categories of oppression both generates and invisibilises specific forms of violence and institutional responses to them. Our findings indicate that migrant, Black and minoritised victim-survivors are being failed on multiple fronts, including police neglect and inaction in rape investigations, ineffective addressing of language needs of migrant victim-survivors involved and a lack of referral to by-and-for specialist support services.

SALUS-A Study on Self-Tonometry for Glaucoma Patients: Design and Implementation of the Electronic Case File.

In times of omnipresent digitization and big data, telemedicine and electronic case files (ECFs) are gaining ground for networking between players in the health care sector. In the context of the SALUS study, this approach is applied in practice in the form of electronic platforms to display and process disease-relevant data of glaucoma patients. The SALUS ECF is designed and implemented to support data acquisition and presentation, monitoring, and outcome control for patients suffering from glaucoma in a clinical setting. Its main aim is to provide a means for out- and inpatient exchange of information between various stakeholders with an intuitive user interface in ophthalmologic care. Instrument data, anamnestic data, and diagnostic assessments need to be accessible and historic data stored for patient monitoring. Quality control of the data is ensured by a reading center. Based on an intensive requirement analysis, we implemented the ECF as a web-based application in React with a Datomic back-end exposing REST and GraphQL APIs for data access and import. A flexible role management was developed, which addresses the various tasks of multiple stakeholders in the SALUS study. Data security is ensured by a comprehensive encryption concept. We evaluated the usability and efficiency of the ECF by measuring the durations medical doctors need to enter and work with the data. The evaluation showed that the ECF is time-saving in comparison to paper-based assessments and offers supportive monitoring and outcome control for numerical and imaging-related data. By allowing patients and physicians to access the digital ECF, data connectivity as well as patient autonomy were enhanced. ECFs have a great potential to efficiently support all patients and stakeholders involved in the care of glaucoma patients. They benefit from the efficient management and view of the data tailored to their specific role.

Characteristics of Bilateral Adrenal Lesions: Experience from an Indian Tertiary Care Centre.

The aetiologies in unilateral and bilateral adrenal lesions can be different with different clinical implications and management guidelines, the latter having aetiologies like hyperplasia, infections, infiltrative lesions and neoplasia. Bilateral tumours are more likely to have hereditary/syndromic associations. There is limited data on the clinical and pathological profile of bilateral adrenal lesions. This was a retrospective study where patients with bilateral adrenal lesions were selected from a total of 266 patients with adrenal lesions who presented to our institute between January 2016 and August 2022. The demographic, laboratory and imaging data were retrieved from the Hospital Information System and patient case files. The study included 51 patients; the mean age at presentation was 51.15 years (range 14 to 82 years). Forty-eight patients (94.1%) were symptomatic at presentation with an average duration of symptoms being 10.68 months (range 10 days to 1 year). The most common presentation was adrenal insufficiency in 18 cases (38%), followed by fever in 17 cases (36%). The commonest aetiology, as revealed on histopathology, was histoplasmosis (n = 22, 43%), followed by pheochromocytoma (n = 11, 21.5%), metastases (n = 6, 11.7%), adrenal hyperplasia (n = 5, 9.8%), adrenocortical adenoma (n = 1, 1.9%), lymphoma (n = 3, 5.8%), neuroblastoma (n = 1, 1.9%), myelolipoma (n = 1, 1.9%) and tuberculosis (n = 1, 1.9%). Histoplasmosis and metastatic lesions were commonly seen in older people, and pheochromocytoma was associated with young age. 6/11 patients with a diagnosis of bilateral pheochromocytoma were associated with family history, genetic mutation and extra-adrenal involvement. The approach to bilateral adrenal lesions differs from that of unilateral lesions due to differences in aetiologies and the more significant role of genetics in some bilateral tumours. The age at presentation, presenting symptoms, lesion size and biochemical features help delineate varied underlying aetiologies.

Pelaksanaan Penuntutan Oditur Militer Terhadap Oknum Tentara Nasional Indonesia Angkatan Darat (TNI AD) dalam Tindak Pidana Umum

This research is aimed at finding out more about the implementation of prosecutions by Military Prosecutors starting from the case files resulting from the investigation being received by the Military Prosecutor until the transfer of case files to the Military Court. The aim of this research is to determine the implementation of prosecutions carried out by Military Prosecutors against TNI AD personnel who commit criminal acts and to find out what the obstacles are and how to overcome obstacles in carrying out prosecutions against TNI AD individuals who commit criminal acts. This type of research is a field research located at the I-04 Military Prosecutor's office, Padang, West Sumatra. The data used are primary data and secondary data obtained from interviews, statutory regulations and literature studies. The informant in this research was the Head of the I-04 Padang Military Authority. The results of this research are that the implementation of the prosecution begins when the case file is received by the Oditur, the Oditur examines the case file, makes a Sph Father, makes an indictment, and transfers the case file to the Military Court.

Integrating Family Strengths in Child Protection Goals

ABSTRACTOver the last decades, child protection workers (CPWs) have largely focused on improving their work with a strength‐based approach in order to empower families. This study investigates to what extent CPWs draw on families' strengths, that is, by promoting autonomy and competencies and by involving their informal networks in goal formulation. This quantitative study analysed the goals, as stated in case files, formulated by CPWs for 177 families within a single Dutch child protection service. 48.6% of CPWs prioritise promoting families' autonomy in goal formulation. With regard to competencies, only 40.1% of the goals refer to the families' competencies. In addition, the support system that the goals call upon tends to be dominated by formal rather than informal networks (in 71.2% of cases). While it is true that child protection cases can benefit from the support of a formal networks, CPWs overwhelmingly failed to encourage support from existing informal networks (in 95.5% of cases). There were no relationships between these percentages and the nature of the family problems or the question of whether or to what extent the CPWs identified the specific strengths of families. These findings show that half of the CPWs had integrated a strength‐based approach in their daily practice to some extent, and therefore improvements are needed in order to more successfully encourage families to change.

Prevalence of uterine fibroids among women resident in Ogoni, Rivers State, Nigeria.

Background: Uterine fibroids are benign tumor cells of the uterus composed of smooth muscle cells and fibroblasts rich in extracellular matrix. Due to the increased likelihood of women developing leiomyomas within their lifetime, there is a noticeable impact on quality and other aspects of life, such as financial burden and medical expenses Objective: To determine the Prevalence, age distribution, most occurring types and clinical characteristics of patients with uterine fibroid. Methods: This study is a six-year retrospective analysis on the Prevalence and age distributions of uterine fibroid among women resident in Ogoni, Rivers State, Nigeria, from January 2017 to December 2022. Medical records from Hospitals in the area were used for this study. Results: result revealed that 821 out of 5800 case files were positive for uterine fibroid giving a prevalence of 14.2. The year 2022 recorded the highest incidence of uterine fibroid (22.6), followed by the year 2021 (14.9.), 2019 (13.9), 2018 (11.9), 2020 (9.6), and 2017(8.3) respectively. Women within 26 – 35 years were significantly affected in all the years under review, with a prevalence rate of 62.6%, while older women (>35) and those younger (<26), presented an incident rate of 29.4% and 7.9% respectively. Conclusion: The study revealed that the most prevalent type of uterine fibroid in Ogoni is intramural while the least prevalent is submucosal. It also showed that women of age 26-35 years had the highest prevalence of uterine fibroid while those of age 16- 25 years had least prevalence.

To assess the impact of covid-19 on maintenance haemodialysis patients: A retrospective study in a tertiary care hospital in south Kerala

COVID-19 was started as a global pandemic in March 2020. It is an infectious disease caused by the SARS COV-2 virus and it has affected the care and outcomes of patient treated with dialysis. Patients with CKD could be more vulnerable to a severe form of COVID-19. Higher risk of mortality caused by COVID-19 in haemodialysis patient is detected with older age, comorbidities and impaired immune response. Clinical presentation of COVID-19 on haemodialysis patient is fluctuating from asymptomatic or mild disease to severe life threatening illness. Initially, common symptoms were presented including fever, dry cough, fatigue, diarrhea and dyspnea. On computerized tomography scan patients had shown bilateral ground-glass opacities revealing that COVID-19 predominantly affected the respiratory system. Maintenance haemodialysis is the most widely used treatment for end stage CKD patients and it has the higher risk of initial mortality from coronavirus 2019. CKD is a severe medical entity with a higher prevalence of comorbid conditions, mostly including diabetes, hypertension, disproportionally affecting older adults. The aim of this study is to assess the impact of COVID-19 on maintenance haemodialysis patient and the objective of the study is to assess the mortality of COVID-19 on maintenance haemodialysis patient and risk factors associated with it and also the severity of COVID19 on maintenance haemodialysis patient. We performed a retrospective cross sectional study using 39 samples. The samples were collected from the case files of the patients who fulfill the inclusion criteria and then the collected data was statistically interpreted using SPSS software version 22.0 and then the severity and mortality of the COVID-19 on maintenance haemodialysis patient was analyzed. The final analysis included 39 patient who met the inclusion criteria .Here the incidence of COVID-19 on maintenance haemodialysis patient is more prone on 41-60 years of age.

The Urgency of Terminating Investigations in Handling Corruption Cases in the Jurisdiction of the High Prosecutor's Office South Sulawesi

Objective: This study aims to investigate the urgency of terminating investigations in handling corruption cases within the jurisdiction of the High Prosecutor's Office South Sulawesi. It seeks to identify the factors influencing the decision to terminate investigations, evaluate the effectiveness of such decisions, and propose recommendations for improvement. Methodology: A mixed-methods approach is employed, combining quantitative analysis of case data with qualitative examination of legal documents and interviews with legal practitioners. Data is collected from corruption case files, legal statutes, and interviews with prosecutors and anti-corruption experts. Theoretical Framework: Theoretical Framework adopts a normative case study approach as the main method to understand and analyse the urgency of stopping investigations in handling corruption cases in the jurisdiction of the South Sulawesi High Prosecutor's Office. In this context, the main focus of the research is on the concept of law as a norm or rule that applies in society, which guides the behaviour of each individual. Normative legal research, in essence, aims to identify, analyse and evaluate various legal aspects relevant to the termination of investigations in corruption cases. This includes an in-depth study of legal regulations, legal principles, and legal doctrines related to the investigation termination process. Conclussion: The urgency of halting investigations into corruption cases lies in efforts to recover and restore state finances, as outlined in Article 109 paragraph (2) of the Criminal Procedure Code. Reasons for terminating investigations include insufficient evidence, absence of criminal offense, and adherence to legal principles. Investigators possess the authority to issue Investigator's Termination Orders, particularly in cases where no unlawful acts, strong evidence, or state losses are found. The application of Restorative Justice facilitates the return of state losses by corruption perpetrators while maintaining criminal sanctions against them.

The correlation between the latency of child abuse and the functioning of the system

Aim: The study shows how the level of latency of domestic violence and child abuse is related to the functioning of the child protection and criminal justice systems. Methodology: The three research methods used for the study include both qualitative and quantitative elements. The research was conducted over five years. The total number of criminal case files processed for the offence of child endangerment exceeds 1300. The documentary analysis involved the inclusion of nearly 40 variables, and the results were obtained using both mathematical statistical methods (SPSS) and content analysis. Findings: Effective child protection and a well-functioning justice system lead to less latency. However, challenging and inefficient machinery increases the level of latency. Findings based on empirical research point to exactly how and by what means the functioning of the system, its shortcomings and failings, lack of child-centeredness focus, contributes to high levels of latency and undermines public trust. Value: The study aims to contribute to more effective child protection by identifying dysfunctional systemic elements.

Changing etiological spectrum of acute liver failure.

Acute liver failure (ALF) is an uncommon but potentially dramatic syndrome characterized by massive hepatic necrosis and has a very high mortality rate of 50% to75% without liver transplantation. This study is aimed at analyzing the etiological spectrum of ALF patients and compare these with ALF mimicssuch as malaria, dengue fever and other tropical infectious diseases. The study population included patients who presented with ALF and ALF mimics in a tertiary care center over two years. We retrospectively analyzed the patient case files and a comparison was made concerning the baseline demographic details, clinical profile, laboratory values and outcomes. Sixty-three patients were assessed, with 32 in ALF and 31 in ALF mimics group. The most common cause for ALF was hepatitis A virus (25%), followed by hepatitis B virus (18.7%), drug-induced liver injury (12.7%), autoimmune hepatitis (12.5%), hepatitis E virus (9.3%) and Wilson's disease (6.25%). In the ALF mimics group, malaria (58.06%) was the most common cause, followed by dengue fever (16.1%), leptospirosis (12.9%) and scrub typhus (12.9%). Patients in the ALF mimics group had significantly higher incidence of fever (p = 0.001), hepatosplenomegaly (p = 0.01), anemia (p = 0.02) and shorter jaundice to encephalopathy duration (p = 0.032) as compared to the ALF group, while higher transaminase levels (p = 0.03), bilirubin (p = 0.01), prothrombin time (p = 0.01), serum ammonia (p = 0.02) and mortality (p = 0.02) were observed in ALF patients. The most common cause for ALF was hepatitis A virus, followed by hepatitis B virus, while in ALF mimics it was malaria followed by dengue fever, in our study. Patients of ALF mimics can have similar presentation, but a high index of suspicion and awareness is required to identify the common infectious ALF mimics for early diagnosis.

Factors Associated With Stability for Children in Family Foster Care: A Study of Case Files in Six Municipalities in Sweden

ABSTRACTStability is vital for the development, health and relationships of children in family foster care. Instability can lead to social and school issues, low self‐esteem and diminished trust in caregivers. This article examines the risk and protective factors for stability for these children. Data, drawn from case files in six municipalities (n = 116), combine qualitative and quantitative analyses for a comprehensive understanding. Twenty children from each municipality were selected, with 10 in stable placements (lived in one family foster home for over a year) and 10 in unstable placements (lived in at least two different family foster homes). Quantitative results highlight the importance of factors like familiar placements, a child's age at the time of placement, behavioural challenges and the number of children in the foster home. Stable placements were more common in homes with fewer children (including foster and biological children). Qualitative findings show that in some instances, breakdowns in foster care placements could not be foreseen, often arising from stressful events within the foster family's life after the child's placement. Additionally, we observed that breakdowns sometimes resulted from foster parents lacking the necessary resources to address the child's requirements, particularly in cases involving children with behavioural challenges or extensive needs.

The effectiveness of Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: A study protocol of a Multiple Case Experimental Design.

Juvenile antisocial behavior can have long-lasting and devastating effects for juveniles themselves, victims, and society. Evidence-based treatment is vital. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles showing severe antisocial behavior including aggression, (domestic) violence, and delinquent behavior. FAST has a flexible intensity and length, addresses individual and systemic risk and protective factors, and is responsive to the abilities of the client (system), intervention characteristics all considered crucial for effective treatment. The current study will investigate whether FAST is effective in reducing aggression of the juvenile, reaching client formulated subgoals, and improving family functioning. Processes of change will be examined, as well as mediation by reaching client formulated subgoals and improved family functioning. A Multiple Case Experimental Design (MCED) with an ABC design will be performed (A = baseline, B = intervention, and C = follow-up). Juveniles with primary aggression and/or anger problems (N = 15) and their caregiver(s) will be recruited. Data collection will consist of self-report questionnaires and case file analysis. Participants fill out frequent short self-report questionnaires (twice a week during phase A, every other week during phase B, and every week during phase C) and two main questionnaires at the start of the intervention and immediately after intervention end, thereby covering a period of 5 to 11 months. Both visual and statistical analyses will be performed. This study will generate robust knowledge and inform clinical practice on the effectiveness, processes of change, and mediating mechanisms of FAST, aiming to improve the treatment of future families within youth forensic care. This trial was registered at ClinicalTrials.gov on 28/08/2023, protocol ID 60-63600-98-1138a.

Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria

Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina. It is classified into the conventional, unicystic, extraosseous/peripheral and metastasizing variants. It is the most common odontogenic tumour in Nigeria and other developing countries. It affects individuals of all ages, has a peak of occurrence in the fourth and fifth decades with no sex predilection. The Mandible is the most commonly affected site and the conventional variant is predominant. The aim of this study is to document the demographics and Pathomorphology of ameloblastoma diagnosed at the Jos University Teaching Hospital over the past nine years. There is no previous documentation of the pattern of this tumour in the North-central region of Nigeria making this study relevant. This is a retrospective observational review of all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital between January 1st 2015 to December 31st 2023. Materials utilized consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts. Fifty one cases of ameloblastoma were diagnosed during the 9 years of review. Their ages ranged between 6 and 65 years with a mean age of 30.9±13.8 years and a peak of occurrence in the third decade. There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1. Ninety-two percent of cases occurred in the mandible and 8% in the maxilla. The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5%. The follicular type accounted for 64.8% of cases of conventional ameloblastoma. Ameloblastoma occurred more commonly in males with a peak in the third decade. A vast majority of cases involved the mandible and the conventional type was predominant. This demographic pattern supports existing evidence that ameloblastoma occurs more commonly in males and in relatively younger patients in Africa.

Operational criteria application does not change clinicians' opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study.

Our objective was to check if the ICD-10 operational criteria application changes non-operational, prototype-based diagnoses obtained in a real-life scenario. Psychiatry residents applied the diagnostic criteria of the ICD-10 as a "diagnostic test" to five outpatient patients they were already following who had a prototype-based diagnosis. Tests were used to ascertain whether changes in opinion were significant and if any of the diagnostic groups were more prone to change than others. The present paper is part of the study with UTN U1111-1260-1212. Seventeen residents reviewed their last five case files, retrieving 85 diagnostic pairs of non-operational-based vs. operational-based diagnoses. The Stuart-Maxwell test did not indicate a significant opinion change (χ2 = 5.25, p = 0.39; power = 0.94) besides 30% of diagnostic changes. Despite not being statistically significant, 20.2% of all evaluations resulted in a change that would affect treatment choices. Using ICD-10 operational criteria slightly increased the number of observed diagnoses, but probably without clinical relevance. None of the non-operational diagnoses have a higher tendency to change with operational criteria application (χ2 = 11.6, p = 0.07). The female gender was associated with a higher diagnostic change tendency. Applying ICD-10 operational criteria as a diagnostic test does not induce a statistically significant diagnostic opinion change in residents and no diagnostic group seems more sensible to diagnostic change. Gender-related differences in diagnostic opinion changes might be evidence of sunk cost bias.Although not statistically significant, using operational criteria after diagnostic elaboration might help to deal with subjects without adequate treatment response.

Petitions for Extreme Risk Protection Orders and Second Amendment Sanctuary Status in Colorado

ImportanceExtreme risk protection orders (ERPOs) temporarily bar individuals adjudicated as being at risk of violence (including suicide) from buying or possessing firearms. In protest, many US jurisdictions have declared themselves “Second Amendment sanctuaries” (2A sanctuaries). Many 2A sanctuaries continue to use ERPOs in low numbers, suggesting a poorly defined risk threshold at which they are acceptable.ObjectiveTo characterize circumstances under which ERPOs are used in 2A sanctuaries, highlighting their most broadly acceptable applications.Design, Setting, and ParticipantsThis cross-sectional study of civil court documents analyzed petitions for ERPOs filed in Colorado from January 2020 to December 2022. All petitions during the study period were included following de-duplication. These include petitions filed by law enforcement and family members against adults allegedly at risk of firearm violence across the state. Data were analyzed on a rolling basis between January 2020 and June 2023.ExposureERPO petition filed in Colorado.Main Outcomes and MeasuresSeventy-seven data elements defined a priori were abstracted from all petitions and case files, including respondent demographics, petitioner types (family or law enforcement), types of threats (self, other, mass violence, combination), violence risk factors, and case outcomes (granted, denied).ResultsOf a total 338 ERPOs filed in Colorado, 126 (37.3%) occurred in 2A sanctuaries. Sixty-one of these 2A petitions were granted emergency orders, and 40 were full 1-year ERPOs after a hearing. Forty ERPOs (31.7%) were petitioned for by law enforcement. Petitions in non-2A counties were more likely to have been filed by law enforcement (138 of 227 [64.9%] vs 40 of 126 [31.7%]; P < .001) and to have had an emergency order granted (177 of 227 [78.0%] vs 61 of 126 [48.4%]; P < .001) than in 2A sanctuaries. Qualitative analysis of cases in 2A sanctuaries revealed common aggravating risk characteristics, including respondents experiencing hallucinations, histories of police interaction, and substance misuse. ERPOs have been granted in 2A sanctuaries against individuals threatening all forms of violence we abstracted for (themselves, others, and mass violence).Conclusions and RelevanceIn this examination of ERPO petitions across Colorado, more than a third of filings occurred in 2A sanctuaries. Nonetheless, law enforcement represent proportionately fewer petitions in these areas, and petitions are less likely to be granted. Serious mental illness, substance misuse, and prior interactions with law enforcement featured prominently in 2A sanctuary petitions. These case circumstances highlight dangerous situations in which ERPOs are an acceptable risk-prevention tool, even in areas politically predisposed to opposing them.

IJCM_51A: Comorbidities among COPD patients admitted to a tertiary care hospital in Mangalore

Background: According to WHO, Chronic obstructive pulmonary disease (COPD) associated mortality in India is more than 64.7 estimated age- standardized death rate per 100,000 amongst both sexes. Various studies conducted on COPD, worldwide suggest that patients are more likely to die of comorbid conditions than from COPD. Objective: To find out the various co-morbidities among COPD patientsattending tertiary care hospitals in Mangalore. Methodology: This is a records-based study set in KMC Hospital Attavar, Mangalore. Records of all the COPD patients who attended the hospital in the last 2 years (2016-2017) in KMC Attavar were collected. Case files in which more than 50% of data is incomplete were excluded. Results: A total of 473 COPD patients were admitted in the last two years in KMC Attavar Hospital. The Mean (SD) age of patients was 68 (10) years. Males were found to be affected in a larger proportion than females. Median (IQR) duration of diseases was 2.28(1, 2) years. The maximum duration was 22 years and the minimum was 2 months. GOLD’s classification was available for 66 patients, wherein most of the patients had moderate to severe forms of COPD. Around 408(86%) of the COPD patients had one or the other comorbidities. Most COPD patients suffered from metabolic disorders (58%) common being HTN (66%) and DM (45%). The mortality rate was 5.7% which corresponds to 27 patients, with the most common cause being respiratory failure followed by sepsis. Conclusion: The most common comorbidity among COPD patients was Diabetes mellitus and Hypertension so the patients should also be screened for the same in the hospital. The most common cause of mortality seen among COPD patients was Respiratory failure which is a complication of COPD so it should also be kept in mind during treatment.

FGFR1 fusions as a novel molecular driver in rhabdomyosarcoma.

The wide application of RNA sequencing in clinical practice has allowed the discovery of novel fusion genes, which have contributed to a refined molecular classification of rhabdomyosarcoma (RMS). Most fusions in RMS result in aberrant transcription factors, such as PAX3/7::FOXO1 in alveolar RMS (ARMS) and fusions involving VGLL2 or NCOA2 in infantile spindle cell RMS. However, recurrent fusions driving oncogenic kinase activation have not been reported in RMS. Triggered by an index case of an unclassified RMS (overlapping features between ARMS and sclerosing RMS) with a novel FGFR1::ANK1 fusion, we reviewed our molecular files for cases harboring FGFR1-related fusions. One additional case with an FGFR1::TACC1 fusion was identified in a tumor resembling embryonal RMS (ERMS) with anaplasia, but with no pathogenic variants in TP53 or DICER1 on germline testing. Both cases occurred in males, aged 7 and 24, and in the pelvis. The 2nd case also harbored additional alterations, including somatic TP53 and TET2 mutations. Two additional RMS cases (one unclassified, one ERMS) with FGFR1 overexpression but lacking FGFR1 fusions were identified by RNA sequencing. These two cases and the FGFR1::TACC1-positive case clustered together with the ERMS group by RNAseq. This is the first report of RMS harboring recurrent FGFR1 fusions. However, it remains unclear if FGFR1 fusions define a novel subset of RMS or alternatively, whether this alteration can sporadically drive the pathogenesis of known RMS subtypes, such as ERMS. Additional larger series with integrated genomic and epigenetic datasets are needed for better subclassification, as the resulting oncogenic kinase activation underscores the potential for targeted therapy.

The Failure to Recognize Continuing Harm: Post-Separation Domestic Abuse in Child Contact Cases.

This article presents findings from a case file review of post-separation parenting cases in England and Wales. It first outlines that jurisdiction's legal framework relevant to these cases, before providing an overview of the findings relating to the profile of the cases and their outcomes. It then describes the types of abuse most frequently encountered in these cases, and examines the attitude of the courts to post-separation abuse by looking at both interim and final court orders. The study finds that key legal provisions governing these cases are not being followed, with little understanding shown for the nature of post-separation abuse.

Eksaminasi Khusus Kejaksaan Agung Dalam Perkara Tindak Pidana

Introduction: Special Examination is the process of conducting research and looking for certain case files that attract the attention of the media or other cases which, in the opinion of the leadership, need to be examined both for active cases and cases that have been handled by prosecutors or public prosecutors and which have obtained permanent legal force.Purposes of the Research: The purpose of this study is to find out and analyze the authority of the Attorney General's Office in taking over the prosecution of criminal cases from the Public Prosecutor's Office and to find out and analyze the application of special examinations conducted by the Attorney General's Office in accordance with the provisions of the Laws and Regulations. The type of research used is normative legal research with an analytical descriptive type which examines the findings from the literature review which are then analyzed into several chapters with a systematic flow.Results of the Research: The results of the research are that the Attorney General, who is the main public prosecutor in handling criminal cases, has the authority to delegate some of his rights to the public prosecutor in handling criminal cases in accordance with a mechanism that is in accordance with positive law.

A retrospective observational study to determine the role of High Flow Nasal Oxygen in terms of recovery, mortality and need for invasive ventilation in COVID-19 cases

Background: Hypoxemic respiratory failure in COVID-19 is managed by conventional oxygen, High Flow Nasal Oxygen (HFNO), and invasive ventilation. Multiple studies have proven that using HFNO in the early stages of acute hypoxemia failure can lead to better outcomes and delay or avoidance of invasive ventilation. This observational study was conducted to further establish this hypothesis. Also, no difference was found in mortality rates between the usage of HFNO Conventional Oxygen Therapy. However, there are very limited studies comparing outcomes of HFNO and Invasive ventilation usage. Hence, this study was undertaken to gain insight into comparing HFNO and invasive ventilation. Materials and Methods: A retrospective data collection was performed from 06/05/2021 to 15/12/2021 after approval from the Institutional Ethics Committee. The collection was performed at MMFHA Ratna Hospital, Pune. All Indoor patient department files of positive cases of COVID first wave (2020) and second wave (2021) were screened. Reverse Transcription Polymerase Chain Reaction COVID-positive cases belonging to both genders, aged 18-100 years and where HFNO was part of management were selected, and data was extracted about socio-demographic data, clinical profile, and routine investigations advised, course of the patient in the hospital with respect to vital parameters, daily HFNO parameters, all the medications received, any other interventions if required, and the time points of taking patients off HFNO, the requirement of invasive ventilation, shifting out of Intensive Care Unit discharge, or death. Immunocompromised cancer patients and pregnant women were excluded. Outcomes were measured in terms of recovery, need for mechanical ventilation, and mortality. Results: Out of 700 cases screened, HFNO was used in 38 (5.4%) participants. The duration of HFNO ranged from less than one day to more than seven days. Of those 38, 30 (78.9%) received HFNO and 8 (21.05%) were shifted to mechanical ventilation. Out of these 30, eight (21.05%) expired on HFNO, eighteen (47.36%) were discharged, and four (10.52%) were shifted to another hospital on HFNO. All eight participants on mechanical invasive ventilation expired. Conclusions: In terms of recovery from HFNO use, discharge with a recovery rate was higher than mortality and the need for mechanical ventilation. The need for invasive mechanical ventilation was much lower in HFNO used participants (26 versus 8). All those on mechanical ventilation expired. HFNO can be a useful modality for oxygenation in COVID-19 patients. The exact role of HFNO in the trajectory of the management of hypoxemic respiratory failure due to COVID-19 needs to be defined.