Beyond Paternalism: The Role of Counsel for Children in Abuse and Neglect Proceedings

[Excerpt] “Across the nation, lawyers routinely represent children who enter the juvenile court system. Juvenile court systems typically handle two types of cases: delinquency and dependency. Delinquency refers to those cases where children are accused of wrongdoing, which generally means a criminal offense. Dependency cases involve situations where the child is alleged to be mistreated, i.e. abused or neglected, by parents or guardians. Lawyers are involved in both types of proceedings most traditionally as representatives of the state. Lawyers represent the state and bring forth charges of criminal conduct against the child in delinquency proceedings. Lawyers represent the state and bring forth allegations of abuse and neglect against the parents or guardians of the child in dependency proceedings. In both types of proceedings, lawyers function as advocates for the state’s position. Lawyers are also appointed to represent parents in dependency matters and function as advocates for their clients, by protecting the fundamental rights and interests of parents in these cases where parental rights are directly at issue. The right to counsel for children in juvenile court proceedings is a relatively recent phenomenon. Prior to 1967, children did not have a right to counsel in juvenile court. In 1967, the U.S. Supreme Court in In re Gault held that children in juvenile delinquency proceedings have due process rights, including the right to counsel. A few years later in 1974, Congress enacted the Child Abuse Prevention and Treatment Act (“CAPTA”) which mandated that states appoint representatives for children in abuse and neglect proceedings in order to receive federal child abuse prevention and treatment funding. For over four decades, the roles, duties and responsibilities of the child’s attorney in juvenile court have been the subject of extensive debate and discussion among scholars, judges and practitioners. Currently, a general consensus exists that in delinquency matters, children have a right to counsel who functions as a legal advocate in the traditional sense. However, the right to counsel and the role of the counsel in dependency proceedings continues to be the subject of debate.

Surface-enhanced Raman spectroscopy substrates based on nanoporous silicon and pattern transfer

Surface-enhanced Raman scattering enhances the weak Raman scattering by using a roughened metal-coated surface as a catalyst. Roughness in the nanometer range provides the best enhancement. The nanostructures for the surface-enhanced Raman spectroscopy (SERS) substrates, in this work, are generated using an electrochemical etching process on silicon substrates. The patterns of nanoporous silicon thus generated are transferred onto transparent polydimethylsiloxane (PDMS) substrates using the “lift-off” process. An incomplex sputtering technique is employed to coat this substrate with a ~20 nm aluminum layer. Rhodamine 6G (R6G) molecules, when adsorbed to this metal surface, form the final SERS substrate that undergoes Raman spectroscopy characterization. This technique is expected to be useful when simple and photolithography-free techniques need to be employed for SERS substrate fabrication

A study of mediastinal tumours in a tertiary care centre: a retrospective study

Background: Recent advances in diagnostic and surgical techniques have brought major changes in the clinical presentation, diagnosis and the surgical management of mediastinal masses. Indian literature in this scenario is deficient, which our retrospective descriptive study aims to address.Methods: Details of patients operated for mediastinal masses from January 2007 November 2013 in two units at NIMS were collected. Clinical presentation, symptomatology, radiological/pathological findings, surgical approaches, intraoperative/immediate/intermediate post-operative results were evaluated and analysed.Results: Of the 75 patients, (48 males, range 10 years to 65 years) 2 deaths were due to complications following exacerbation of myasthenia gravis, and two patients died due to post-operative bleeding. Thymicneoplasms were the most common, followed by neurogenic tumours. Most common presentation was myasthenia gravis, followed by nonspecific back pain. 4% of patients had symptoms due to local compressive effects. Tumour was in the anterior mediastinum, middle and posterior mediastinum in 53, 16 and 6 cases respectively. Surgery done with a curative intent was through sternotomy (59), posterolateral thoracotomy (14), and combined sternotomy and cervical route (2). Residual tumour was present in 5 cases due to nerve involvement. Follow up was 98% (2 months to 6 years). 3 patients died of unrelated causes and one developed multiple lung metastases. 2 patients with neurogenic tumours developed recurrence.Conclusions: Inadequately optimized myasthenia patients and superior vena cava obstruction are poor prognostic factors. Complete excision may not be possible in neurogenic extension to spine even with concomitant neurosurgery. Neurological infiltration has a poorer prognosis

Evaluation of adenosine deaminase activity in serum and pleural fluid of pulmonary tuberculosis patients with pleural effusion

Background: In endemic regions, a high adenosine deaminase (ADA) activity in lymphocyte predominant exudate is a valuable adjunct in diagnostic evaluation and treatment initiation in tuberculous pleural effusion. Tuberculosis is highly endemic in India, requiring prompt diagnosis, effective treatment and control of the disease. The present study was aimed to evaluate the serum and pleural fluid ADA activities in pulmonary tuberculosis patients with pleural effusion.Methods: This study includes a total of 240 subjects; 40 pulmonary tuberculosis patients (PTB), 40 PTB with pleural effusion (PE), 40 PTB treated for one month, 40 healthy controls, 40 transudative PE patients and 40 nontuberculous exudative PE patients, between 20-70 years of age. ADA activity was estimated by the Guisti-Galanti method along with routine parameters in all study subjects.Results: Serum ADA activity was significantly higher (p<0.001) in PTB with PE (37.68±12.42U/L) than healthy controls (12.15±5.38U/L), transudative PE (22.43±9.12U/L), nontuberculous exudative PE (16.92±4.98U/L) and treated PTB (19.39±4.54U/L). Pleural fluid ADA activity was significantly higher (p<0.0001) in PTB with PE (78.94±36.75U/L) than in transudative PE (11.25±3.12U/L) and nontuberculous exudative PE (17.56±10.42U/L). ADA activity was significantly higher (p<0.001) in pleural fluid than serum in PTB with PE. Lymphocyte percentage was significantly higher (p<0.001) in pleural fluid (86.57±9.64) than peripheral blood (37.48±8.49) in PTB with PE.Conclusions: The pleural fluid ADA activities were elevated in lymphocyte predominant exudates of PTB patients with PE from endemic regions, prompting treatment initiation in high suspicion cases with elevated ADA activity

Design and Implementation of a Data Stream Management System

The amount of data stored by companies has grown exponentially over the last decade. Of late, data is being continuously collected for various purposes - click stream analysis, credit card transactions for fraud detection, weather monitoring, stock tickers in nancial services, link statistics in networking, user logins and web surng statistics, highway trac congestion analysis and so on. The data that is being collected is in the form of a stream - arrives continuously, at a variable rate, and can occupy potentially innite storage. As organizations have realized that fast and ecient processing of this data can help in protable predictions, there exists a need for developing systems to handle this collected data eectively. We present in this thesis, the architecture of a generic Database Stream Management System (DBSMS) to handle streaming data. While literature has provided insights into Data Stream Management Systems (DSMS), the DBSMS is a dierent approach that tries to integrate a DSMS with the traditional Database Management Systems (DBMS). We discuss the need for such a generic DBSMS and present the system that we have implemented using the discussed architecture. We also present the performance of our system, in terms of space taken, time taken to answer a query and the accuracy of the result compared to a DBMS. Finally, we conclude with brief discussion on certain goals and open challenges that are of interest and which still need to be addressed by the system

Case of extranodal non-hodgkins lymphoma involving the endometrium and the ovaries: a rare case report

Non-Hodgkin’s lymphoma(NHL) is most commonly encountered during childhood and rarely among the adults. Primary malignant lymphoma in the female genital tract are rare Moreover they present with non-specific symptoms and hence there may be delay in the diagnosis. It is difficult to distinguish this condition from the more common uterine neoplasm such as uterine fibroids or sarcoma. Diffuse large B-cell lymphoma (DLBCL) is most commonly seen among the cases of NHL, contributing to among one third of NHL in the western world. DLBCL is common in elderly population. A 69-year-old postmenopausal woman who came with watery discharge since, 15 days was evaluated clinically and radiologically and was found to have thickened endometrium and enlarged ovaries, for which endometrial biopsy was taken that showed non-secretory endometrium with atrophic changes. Tumor markers found to be normal. TAH+BSO was done and the histopathology showed Non-Hodgkin’s lymphoma, diffuse large B cell type of the endometrium and both ovaries which was confirmed by immune histochemical marker study. PET-CT was done that showed metabolically active para aortic and common iliac lymph nodes thereby she was diagnosed with stage II (Ann Arbor Staging) non-Hodgkin’s lymphoma, hence she received 6 cycles of R-CHOP. As evident in our case, non-Hodgkin’s Lymphoma of the endometrium and the ovaries being an extremely rare condition, high-degree of suspicion is required for its prompt diagnosis and treatment

Reviewing and designing the operational processes and systems on clinical operations and activities for achieving higher efficiencies.

The purpose of this dissertation is to understand the issues regarding the operational efficiencies, quality of service and use of IT systems and to provide recommendations to get better at the existing system. The work is primarily based in Nottingham University Hospital, associated with NHS-Trust, which currently is facing issues regarding Clinical Handover, Accountability, Missed-Results and use of IT systems. The root causes of the issues could be much wider and deeper than they appear. For understanding the current scenario, I got to know the systems and processes in place for various activities through observation and interaction with the staff. Also analysed the past data regarding the incidents in relation with these issues and had a detailed discussion with reviewers. Then, I conducted interviews with different people in the organization for finding the limitations and gaps in the process. This includes meeting people from different roles and different medical units within the organization. I also had discussions with the initiative teams on what has been done so far and what is planned for improving the processes. I collected inputs from the people and also gained feedback on the processes that they are personally involved in. The issues were then analyzed through literature review – both operational and health care literature, for getting better insight in to identifying the root causes. To gain a broader perspective on the best practices, conducted interviews with professionals from different sectors. This helped in understanding the advantages and identifying several activities that can be considered for incorporating at different phases of the existing process. Following the analysis, listed the suggestions for each matter of concern, highlighted the limitations that can impact the implementation process and discussed them with the staff members in higher roles. After gaining the feedback from staff members and their inputs on several aspects, drafted the recommendations for achieving higher efficiencies, better quality of the service and as a result, customer satisfaction