Revealed preferences of a state bureau: Case of New Mexico's underground storage tank program

Leaking underground storage tanks (USTs) are a pervasive national environmental problem. Cleanup of leaking USTs is largely publicly financed and under the control of state agencies. In the transition to new compliance standards, individual states have taken advantage of provisions in federal regulations to implement their own programs. This raises the policy question of environmental federalism and the appropriate locus of government control. The objectives of this study are to examine the revealed preferences of a state UST bureau. New Mexico was one of the first state programs to use risk assessments in setting funding priorities. We analyze the statistical determinants of funding decisions and find strong evidence that risk information is used. Although our case study provides a measure of support for state control, the argument is strengthened if public financing is limited to the cleanup of historical pollution, rather than a means for providing insurance for prospective pollution. ©1999 by the Association for Public Policy Analysis and Management.     

Complex Congenital Heart Malformation Including Transposition of the Great Vessels,Presenting as Sudden Unexplained Infant Death

Transposition of the great vessels (TGV) is a common congenital heart defect that is difficult to diagnose before birth. Antenatal diagnosis is associated with increased survival. Unusual features such as anomalous pulmonary artery origin may delay cyanosis, decreasing clinical suspicion. A three‐week old female infant who had never been cyanotic presented for forensic autopsy due to onset of unresponsiveness at home. History included risk factors for TGV and signs of heart enlargement that were not recognized during life. Cardiac pathology consultation identified D‐type TGV with additional rare anomalies. TGV may present as sudden unexplained infant death (SUID) for forensic autopsy if variant features prevent development of cyanosis. Cardiac pathology consultation is helpful in clarifying these features.     

Predictors of Initial Court Agreement and 1‐Year Relitigation in Title IV‐D Contested Paternity Cases

We examined potential predictors of initial court agreement and 1‐year relitigation in a sample of contested paternity cases involving unmarried parents coming to court to establish paternity, child support, and other issues. Cases participated in an RCT of a parent program and of a waiting period between establishment of paternity and court hearing. We controlled for RCT study factors and used baseline assessment data to predict likelihood of reaching full agreement in the initial court hearing and relitigation in the following year. Findings suggest that cases in which parents get along better outside of court are more likely to reach agreement and less likely to return to court. Additionally, particular parent demographics predict lower likelihood of reaching initial agreement (e.g., parents are non‐White, father earns below $10,000 yearly), more relitigation (e.g., parents are non‐White, mother earns above $10,000 yearly, father has children with others), and less relitigation (e.g., father earns above $10,000 yearly). Child demographics and most parent relationship characteristics did not predict outcomes. We discuss findings and offer suggestions for court interventions.     

The Relationship Between Deprivation and Forensic Material Recovered from Stolen Vehicles: Is it Affected by Vehicle Condition and Tidiness?

Previous research has shown that as crime scene location deprivation increases (lower socioeconomic status), the recovery of forensic material, principally DNA and fingerprints, also increases. However, this increase does not result in more crimes being solved by forensic means. In this study, we analyze stolen vehicle data and find a statistically significant positive association between deprivation and the amount of forensic material that matched either the victim or an associate of the victim on a criminal database. The nature of this association was investigated further by inspecting recovered stolen vehicles to establish whether the condition of a stolen vehicle and the tidiness of its interior influenced the recovery of forensic material that was attributed to the victim or an associate. Contradictory results suggest that other factors may contribute to understanding the association between the recovery of victim- or associate-attributable forensic material and crime scene location deprivation.     

The decision to lobby bureaucrats

Despite a good deal of interest in lobbyists?? tactics, virtually no research has been published examining the conditions under which interest groups lobby the bureaucracy rather than or in addition to the legislature. Using two comprehensive datasets, I show that lobbying increases in both branches when conflict is higher and when the lobbyist has professional or political connections to that venue. In addition, certain conditions cause lobbyists to specialize in one branch or a particular branch only, depending on the issue area being lobbied, the interest group type being represented, the lobbyist??s resources, and other factors.     

Fatal birth trauma due to an undiagnosed abdominal teratoma: case report and review of the literature

The fetus is subjected to mechanical forces during labor and delivery, which may result in traumatic injuries. Such injuries include intracranial hemorrhage, spinal cord lesions, cephalhematoma, cranial or peripheral nerve palsies, intraabdominal organ rupture, or bony fractures. Risk for perinatal trauma and mortality is increased in primigravidas, multiple gestations, abnormal presentations, maternal-fetal disproportion, oligohydramnios, forceps or vacuum extractions, and internal version maneuvers. Very-low-birth-weight neonates (<1500 g) are at high risk due to ease of deformity of the cranium. Infants with certain congenital anomalies or pathologic processes that distort normal anatomy are also at increased risk, especially when a prenatal diagnosis is lacking. The authors present a case of a term gestation neonate who sustained a cervical spine dislocation fracture of C5-7, with subtotal transection of the spinal cord and resultant paralysis. The fetus was in vertex presentation, and a manual vaginal delivery was attempted. When the infant lodged in the birth canal following a difficult delivery of the head and arms, its enlarged abdomen was palpated, and the delivery was converted to an emergent cesarean section. The infant lived for 3 days and then expired due to neurologic complications of trauma sustained during the attempted vaginal delivery. Autopsy revealed a previously undiagnosed intraabdominal immature teratoma. The pathology of teratomas, the most common neonatal tumor and occasionally implicated in cases of birth trauma, will be addressed, followed by a review of the literature concerning birth trauma.     

The predictive value of history and scene investigation for toxicology results in a medical examiner population

Medical examiner offices vary in the extent to which they pursue postmortem toxicology. Our office routinely tests decedents for ethanol and drugs of abuse, and we decided to evaluate the usefulness of our practice. We reviewed 1180 medical examiner cases examined in 2002-2003. History and scene investigation indicated that alcohol or drugs of abuse were likely to be detected in 369 cases, yet toxicology testing revealed an intoxicating substance in 589 cases, a prevalence of 50%. Screening for toxicology testing based on investigative findings had a sensitivity of 0.47, a specificity of 0.84, and a positive predictive value of 0.74. Moreover, even in the 811 cases where initial investigation did not suggest substance abuse, toxicology testing revealed at least 1 substance that was pertinent to the subsequent investigation in one third of the cases (260), and the intoxicating substance was sufficiently important to merit inclusion as a cause of death or contributing factor in nearly half of those cases (113). We conclude that investigation alone is ineffective at predicting the presence of intoxicating substances within decedents.     

Back to the future? Diabetes, HIV, and the boundaries of public health

The control of infectious diseases has traditionally fallen to public health and the clinical care of chronic diseases to private medicine. In New York City, however, the Department of Health and Mental Hygiene (DOHMH) has recently sought to expand its responsibilities in the oversight and management of chronic-disease care. In December 2005, in an effort to control epidemic rates of diabetes, the DOHMH began implementing a bold new plan for increased disease surveillance through electronic, laboratory-based reporting of A1C test results (a robust measure of blood-sugar levels). The controversy A1C reporting produced was relatively contained, but when Dr. Thomas Frieden, New York City health commissioner, called for the state to begin tracking viral loads and drug resistance among patients with HIV, both the medical community and a wider public took notice and have started to grapple with the meaning of expanded surveillance. In the context of the past century of medical surveillance in America, we analyze the current debates, focusing first on diabetes and then HIV. We identify the points of contention that arise from the city's proposed blend of public health surveillance, disease management, and quality improvement and suggest an approach to balancing the measures' perils and promises.     

Waxing grave about adipocere: soft tissue change in an aquatic context

When postmortem environmental conditions are "just right," according to the "Goldilocks Phenomenon," soft tissues (and associated fatty acids) are converted into and preserved as adipocere. To better understand this conversion process and the development of adipocere three human cadavers were immersed in outside, water-filled pits for over 3 months to observe adipocere formation in an underwater context simulating actual field conditions. Recordings of environmental conditions showed that temperatures were between 21 degrees C and 45 degrees C, a range sufficient for the growth of Clostridium perfringens. Chemical analysis of liquid and tissue samples revealed an increase in palmitic acid and decrease in oleic acid. This study tracked the remarkable gross morphological changes that can occur in human bodies subjected to an aquatic postmortem environment. The results support the "Goldilocks Phenomenon" and substantiate previous findings that the presence of bacteria and water is crucial for adipocere to form.