The economic impacts of the tobacco settlement.

Recent litigation against the major tobacco companies culminated in a master settlement agreement (MSA) under which the participating companies agreed to compensate most states for Medicaid expenses. Here the terms of the settlement are outlined and its economic implications analyzed using data from Massachusetts. The financial compensation to Massachusetts (and other states) under the MSA is substantial. However, this compensation is dwarfed by the value of the health impacts induced by the settlement. Specifically, Medicaid spending will fall, but only by a modest amount. More importantly, the value of health benefits ($65 billion through 2025 in 1999 dollars) from increased longevity is an order of magnitude greater than any other impacts or payments. The net efficiency implications of the settlement turn mainly on a comparison of the value of these health benefits relative to a valuation of the foregone pleasure of smoking. To the extent that the value of the health benefits is not offset by the value of the pleasure foregone, the economic impacts of the MSA will include a share of these health benefits.     

International joint ventures in space: The international space welding experiment

The International Space Welding Experiment (ISWE) was a joint venture between the NASA George C. Marshall Space Flight Center (MSFC) in Huntsville, Alabama and the E.O. Paton Welding Institute (PWI) in Kiev, Ukraine. ISWE was manifested as an element of the United States Microgravity Payload-4 (USMP-4) to demonstrate the feasibility of space welding as an operational maintenance process. On December 6, 1996, ISWE was demanifested due to conflicts between various experiments vying for limited astronaut EVA opportunities. Current plans include possible manifesting to the Russian space station MIR for welding to be performed by Russian cosmonauts. This paper illustrates the conflicts that can arise when designing and building a set of spaceflight hardware under one set of standards and trying to launch that hardware on another nation's vehicle. Issues which became areas of concern included language/communication, openness, qualification test procedures, material standards, and safety. The significant number of issues identified in this relatively small project in international space cooperation indicates how important it will be to reach a new consensus for conducting future large scale cooperative ventures. Imperative to attaining this consensus is an international conference where all space faring nations mutually develop and agree to a uniform set of standards.     

Fatal postpartum spontaneous liver rupture: case report and literature review

Maternal hepatic rupture is a rare complication of pregnancy that can be fatal to both mother and child. This phenomenon is most often associated with preeclampsia/eclampsia and/or HELLP syndrome, which is defined by a collection of clinical features including hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). These disease processes are typically identified and treated during pregnancy, often in the last trimester. The described case is unusual in that the decedent had no known history of preeclampsia/eclampsia or HELLP syndrome during this pregnancy, and she died suddenly several days postpartum of liver rupture with massive intraperitoneal hemorrhage following a routine cesarean section delivery and an uneventful hospital course. Similar cases are infrequent in the literature, which is reviewed in this report.     

Amitriptyline abuse and misuse

Deaths related to amitriptyline toxicity are relatively common and are typically related to suicidal overdose. A less well-recognized situation of amitriptyline intoxication occurs when the drug is abused for its euphorigenic effects. An amitriptyline-related death due to a mixed drug intoxication is presented. Death investigation revealed that the death was accidental rather than suicidal. The case serves to remind forensic investigators that not all amitriptyline overdose deaths represent suicides. A segment of the population is known to abuse amitriptyline.