Cor triatriatum sinistrum: a rare congenital cardiac anomaly presenting in an adult with chronic atrial fibrillation

Cor triatriatum is a rare congenital cardiac anomaly in which the left atrium is divided into proximal (dorsal or upper) and distal (ventral or lower) chambers by a fibromuscular septum. The upper chamber receives the pulmonary veins and the lower chamber contains the atrial appendage and the mitral valve. The 2 chambers communicate through a defect in the membrane. Cor triatriatum is often associated with other congenital cardiac anomalies. Most frequently, the upper chamber communicates with the right atrium through a patent foramen ovale or atrial septal defect, and the clinical symptoms simulate anomalous pulmonary venous return. Less commonly, the foramen ovale communicates with the distal chamber and the clinical features mimic mitral stenosis. When cor triatriatum is the only abnormality, the clinical findings are also similar to mitral stenosis with development of pulmonary hypertension and subsequent right ventricular hypertrophy and atrial enlargement. The diagnosis is usually made in infancy or childhood, and the lack of treatment results in death in 75% of patients.We report the case of a woman who presented much later in life. The patient was a 57-year-old female with a clinical history of chronic atrial fibrillation who presented to the emergency department because of a "funny sensation" in her chest, though she denied chest pain, nausea, vomiting, or diaphoresis. EKG revealed atrial fibrillation with a rapid ventricular response and a tachycardic rate of 157. She had a therapeutic level of digoxin, and cardiac enzymes were normal. The patient was admitted and placed on Cardizem drip. Serial EKGs remained normal and heart rate control was achieved. On hospital day 2, the patient became dyspneic and cyanotic. She went into cardiac arrest and died.Autopsy revealed cardiomegaly (610 g) with 4-chamber dilatation. A septum divided the left atrium into 2 chambers. The defect in the dividing membrane measured 1 cm in diameter. No other congenital defects were noted. The large size of the defect in the membrane likely accounted for the late onset of symptoms that allowed this patient to survive into adulthood without previous diagnosis or surgical intervention (which is usually required in childhood).     

Globalization and the Retreat of Citizen Participation in Collective Action: A Challenge for Public Administration

Globalization challenges the ability of contemporary public administration to encourage citizen participation in collective action through behaviors such as tax compliance and contributions to public goods. The authors introduce a new individual‐level approach to globalization, arguing that people vary in the extent to which they are globalized and that an individual's level of globalism (ILG) reflects attitudes and dispositions that influence the way he or she resolves the social dilemma of participation in collective action (i.e., the decision to contribute versus follow a “free‐ride” strategy). Using a four‐country sample, the article examines the relationship between ILG and collective action participation decisions in three behavioral experiments. Findings support the hypothesis that regardless of country‐level globalization, a more globalized individual complies less willingly with tax codes, donates less to local nongovernmental organizations, and prefers to adopt a free‐ride strategy in a public goods game. The consequences for public administration are discussed.     

Assessing the Impact of State Human Trafficking Legislation on Criminal Justice System Outcomes

Since 2003, state legislatures in the United States have been active in passing legislation aimed at combating human trafficking. To date, all states have passed laws that criminalize acts of human trafficking, though with significant variation in the penalty structure and associated legal provisions. This article examines what aspects of state human trafficking laws are most impactful at increasing the arrest and prosecution of human trafficking suspects. Using panel data on state laws and associated enforcement actions from 2003 to 2012, this study confirms that more comprehensive state laws that invest in antitrafficking resources are most strongly associated with human trafficking arrests and prosecutions. States that make legislative provisions for victim assistance, law enforcement training, statutory task forces, and mandatory reporting have higher antitrafficking criminal enforcement. The political environment in which state human trafficking laws are enacted also influences their enforcement.     

Reconciling Intra-Party and Intra-Coalition Dissent in Morality Politics: Parliamentary Debates on Marriage Equality in the German Bundestag

This article analyses parliamentary debates on marriage equality in Germany to understand what factors shape how parties deal with morality politics argumentatively. I argue that the internal divisions of parties and their coalition parties are crucial for the argumentation strategies used in parliamentary debates on morally charged wedge issues. Internally divided parties and parties that must be loyal to coalition partners confronted with internal divisions are likely to employ a discursive avoidance strategy to mitigate the potential for intra-party and intra-coalition polarization. To test this empirically, I examine the speeches of the German Bundestag on the Life Partnership Act in 2000 and Marriage for All in 2016 and 2017. The qualitative content analysis confirms my argument: The internally divided CDU and its coalition partners applied avoidance strategies by framing the issue primarily around constitutional principles and using procedural arguments, rather than framing the discourse as an issue of morality politics.

Zusammenfassung

Der Artikel analysiert parlamentarische Debatten zur Anerkennung gleichgeschlechtlicher Partnerschaften und Ehen in Deutschland, um zu verstehen, welche Faktoren die Argumentationen von Parteien im Wettbewerb um Moralpolitik beeinflussen. Ich argumentiere, dass die interne Spaltung von Parteien und ihrer Koalitionsparteien entscheidend für die Argumentationsstrategien ist, die in parlamentarischen Debatten über moralisch aufgeladene „wedge issues “verwendet werden. Intern gespaltene Parteien und Parteien, die loyal zu Koalitionspartnern sein müssen, die mit internen Spaltungen konfrontiert sind, verwenden eine diskursive Vermeidungsstrategie, um das Potenzial für eine innerparteiliche und koalitionsinterne Polarisierung abzuschwächen. Das Argument wird anhand einer qualitativen Inhaltsanalyse von Reden von Abgeordneten des Deutschen Bundestages zum Lebenspartnerschaftsgesetz im Jahr 2000 und zur Ehe für Alle im Jahr 2016/2017 bestätigt: Die innerparteilich zerstrittene CDU und ihre Koalitionspartner wendeten Vermeidungsstrategien an, indem sie das Thema in erster Linie in Zusammenhang mit verfassungsrechtlichen Grundsätzen thematisieren und prozedurale Argumente verwendeten, anstatt den Diskurs als eine moralpolitische Frage zu gestalten.

Résumé

Cet article analyse les débats parlementaires afin de comprendre les facteurs qui façonnent la manière dont les partis traitent la politique morale sur le plan argumentatif. Je soutiens que les divisions au sein des partis et entre les partis d'une coalition représentent un facteur décisif dans les stratégies d'argumentation utilisées dans les débats parlementaires sur les questions morales portant à controverse (« wedge issues »). Les partis divisés en interne et les partis devant rester loyaux envers leurs partenaires de coalition, eux-mêmes confrontés à des divisions internes, sont susceptibles d'employer une stratégie discursive d'évitement pour atténuer le potentiel de polarisation intra-parti et intra-coalition. Pour tester cela empiriquement, j'examine les discours du Bundestag allemand sur la loi relative au partenariat de vie enregistré en 2000 et celle instituant le mariage pour tous en 2016/17. L'analyse qualitative de ces textes confirme mon argument: La CDU, divisée en interne, et ses partenaires de coalition ont appliqué des stratégies d'évitement en abordant la question principalement autour des principes constitutionnels et en utilisant des arguments procéduraux, plutôt que de cadrer le discours comme une question de politique morale.