Laboratory investigation of deaths due to anaphylaxis.

To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 micrograms/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic therapeutic agents. Tryptase levels were normal (less than 10 ng/mL) in 57 sequential sera obtained postmortem from six control patients. Tryptase could not be measured in pleural or pericardial fluids for technical reasons. Serum IgE antibodies were elevated in five of the nine Hymenoptera sting fatalities and in eight of the eight fatal food reactions; assays were unavailable for the two diagnostic/therapeutic agents. If elevated, the victim's serum IgE antibodies to food could be used to identify allergens in uneaten portions of foods consumed shortly before the anaphylactic event. IgE antibodies were moderately stable during storage in a variety of anticoagulants at room temperature for up to 11 weeks. Elevated mast-cell-derived tryptase levels in postmortem sera reflect antemortem mast cell activation and may be used as a marker for fatal anaphylaxis. If assays are available for IgE antibodies to relevant allergens, such assays provide evidence for antemortem sensitization; these assays may be modified to identify allergens in foods consumed by victims of food-induced anaphylaxis.     

Procedural Justice and Conflict Management at School

In this research, we explored the contributions of perceived procedural justice (PPJ) to the conflict management behaviors of adolescents when they experience conflict with their teachers. We tested an extensive model to determine how PPJ contributes to conflict management. We also extended research on PPJ to examine its impact on adolescents. Our results, acquired from a large and diverse sample of 256 high school students, indicate that PPJ had an impact on adolescents' approach to managing conflicts with their teachers. Students who perceived that their teachers' decision processes were just were less dominating and more avoiding, obliging, and compromising. In addition, we found that students' perceptions about the legitimacy of their teachers' authority mediated the relationships between PPJ and conflict management style. This study contributes to the rather scarce research on PPJ's role in conflict management and should be useful for educators searching for constructive, relationship‐based tools for conflict management.     

Development of an Audit Tool to Evaluate the Documentation of Partner Abuse Assessments within a Provincial Emergency Department: An Exploratory Study

The aim of this study was to develop a clinically valid and reliable audit tool that evaluates the assessment documentation of females presenting to the emergency department following an assault secondary to partner abuse. A 5-step process informed by a quality improvement approach was used to develop the tool and good inter-rater reliability was achieved. The tool developed has wide utility in services implementing family violence intervention in which nurses have a key role.     

Medical liability and health care reform

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.     

MMPI-2 and MMPI-2-Restructured Form Validity Scales: Complementary Approaches to Evaluate Response Validity

Responsible forensic assessment is dependent on an appreciation for how validity scales differ from one another and function across different evaluation contexts. The primary goal of this review is to evaluate whether there is sufficient empirical support to provide expert testimony using MMPI-2 or MMPI-2-RF validity scales. Towards this goal, we briefly describe the development of MMPI-2 and MMPI-2-RF validity scales and review empirical studies that support interpretative strategies. We describe and illustrate with case examples how the respective sets of MMPI-2 and MMPI-2-RF validity scales utilize complementary strategies to detect over- and under-reporting of psychological, cognitive, and physical symptoms. Additionally, the review describes standards for expert psychological testimony and illustrates how MMPI-2 and MMPI-2-RF validity scales are particularly well suited to assess symptom validity and psychological status in secondary-gain settings.     

Observing Environmental Destruction Stimulates Neural Activation in Networks Associated with Empathic Responses

The negative impacts of environmental disruption disproportionately affect marginalized and underprivileged communities; thus, the degree to which society is complicit in allowing unchecked environmental destruction to occur has important social justice applications. Although decades of research have sought to understand factors which determine acceptance of environmental destruction, most of this research has been based on self-report surveys. In the present work, we used neuroimaging techniques to examine the neural correlates of environmental concern. To do this, we compared responses to observing suffering dogs with responses to observing suffering ecosystems. Our results extend previous findings which had shown largely overlapping neural response patterns to observing animal and human suffering. Critically, we found activation in regions previously identified as active in empathy processes in response to viewing harm to ecosystems (i.e., without any animals present in the images). We also found relative differences in response patterns between the two types of stimuli: witnessing harm to environments (vs. dog suffering) led to reduced activation in some regions, but similar activation in others. We discuss these findings in terms of their potential implications for behavioral interventions and possibilities for continued neuroimaging research examining neural responses to environmental ecosystems and other nonhuman entities.