Postmortem genetic testing in sudden unexplained death: A public health laboratory experience

Sudden unexplained death in the young poses a diagnostically challenging situation for practicing autopsy pathologists, especially in the absence of anatomic and toxicological findings. Postmortem genetic testing may identify pathogenic variants in the deceased of such cases, including those associated with arrhythmogenic channelopathies and cardiomyopathies. The Wisconsin State Laboratory of Hygiene (WSLH) is a state-run public health laboratory which performs postmortem genetic testing at no cost to Wisconsin medical examiners and coroners. The current study examines sequencing data from 18 deceased patients (ages 2 months to 49 years, 5 females) submitted to WSLH, from 2016 to 2021. Panel-based analysis was performed on 10 cases, and whole exome sequencing was performed on the most recent 8 cases. Genetic variants were identified in 14 of 18 decedents (77.8%), including 7 with pathogenic or likely pathogenic variants (38.9%). Whole exome sequencing was more likely to yield a positive result, more variants per decedent, and a larger number of variants of uncertain significance. While panel-based testing may offer definitive pathogenic variants in some cases, less frequent variants may be excluded. Whole exome testing may identify rare variants missed by panels, but increased yield of variants of uncertain significance may be difficult to interpret. Postmortem genetic testing in young decedents of sudden unexplained death can provide invaluable information to autopsy pathologists to establish accurate cause and manner of death and to decedent's relatives to allow appropriate management. A public health laboratory model may be a financially advisable alternative to commercial laboratories for medical examiner's/coroner's offices.     

Implementation of Antibullying Legislation in Iowa Schools: A Qualitative Examination of School Administrators’ Perceived Barriers and Facilitators

Adolescent bullying is linked to numerous adverse psychosocial effects that can persist into adulthood. In response to this problem, in 2007 Iowa adopted an antibullying statute requiring all school districts to adopt an antibullying policy. From 2013–2014, 47 semistructured interviews were conducted with school and district administrators in Iowa. Administrators identified many policy implementation challenges including limited funding and staff, and difficulties selecting prevention programs, applying the law’s bullying definition in investigations, and understanding the school’s jurisdiction for policy enforcement. Contextual barriers to implementation (e.g., media portrayals of bullying and parental attitudes) also emerged. This is the first study to use the interactive systems framework to examine antibullying law implementation, highlighting the importance of coordination among research translators, supportive organizations, and on-the-ground implementers.     

Informing the future of capacity building: lessons from an NGO partnership

Despite a recent surge in popularity, critical gaps remain in effectively building the capacity of organisations through global development projects. Two non-governmental organisations, FHI 360 and Conservation Through Public Health (CTPH), established a partnership focused on strengthening CTPH's organisational capacity to conduct high quality monitoring and evaluation and to effectively advocate for integrated population, health, and environment work. To help inform the design and implementation of future capacity building programmes, the partners describe their lessons learnt as illustrated through the five key capacity building steps: stakeholder engagement and partnership formation; capacity needs assessment; capacity plan design; plan implementation; and evaluation.     

Implications of Partner Agreement of IPV for the Gender Symmetry Controversy

Because romantic partners frequently disagree on the violence in their relationship, relying on nondyadic data for perpetration and victimization rates, especially to inform the gender symmetry controversy, is problematic. In order to have a more nuanced understanding of gender symmetry, we urge researchers to be cautious when drawing symmetry conclusions from non-dyadic samples. Furthermore, using both partners, we suggest that researchers employ more qualitative approaches to ascertain IPV agreement, note times in which either partner reports IPV as an indicator of the presence of violence, and investigate the extent to which conclusions regarding gender symmetry stem from participant selection bias.     

Patient narrative: an ‘on-switch’ for evaluating best interests

This article examines how the wishes, feelings, values and beliefs of adults lacking capacity can be evaluated and the extent to which they are given effect in best interests decision-making. One way of fulfilling the clinician’s legal responsibilities to take a patient’s preferences into account is to explicitly link these to the notion of narrative. Narratives provide a compelling grounding and give weight to views and values that may have been informally and consistently expressed in the past. An evaluation of recent case law suggests that the trajectory of a person’s life, their character and personality, and the perspectives of those with whom the patient has valued relationships are given increasing judicial recognition. Attending to the narrative of the patient could lead to a more sophisticated judgement of best interests than an objective ‘balance sheet’ approach would allow and enable greater alignment with the UN Convention on the Rights of Persons with Disabilities.