Is there progress in the autopsy diagnosis of sudden unexpected death in adults?

Sudden death is now currently described as natural unexpected death occurring within 1h of new symptoms. Most studies on the subject focused on cardiac causes of death because most of the cases are related to cardiovascular disease, especially coronary artery disease. The incidence of sudden death varies largely as a function of coronary heart disease prevalence and is underestimated. Although cardiac causes are the leading cause of sudden death, the exact incidence of the other causes is not well established because in some countries, many sudden deaths are not autopsied. Many risk factors of sudden cardiac death are identified: age, gender, heredity factors such as malignant mutations, left ventricular hypertrophy and left ventricle function impairment. The role of the police surgeon in the investigation of sudden death is very important. This investigation requires the interrogation of witnesses and of the family members of the deceased. The interrogation of physicians of the rescue team who attempted resuscitation is also useful. Recent symptoms before death and past medical history must be searched. Other sudden deaths in the family must be noted. The distinction between sudden death at rest and during effort is very important because some lethal arrhythmia are triggered by catecholamines during stressful activity. The type of drugs taken by the deceased may indicate a particular disease linked with sudden death. Sudden death in the young always requires systematic forensic autopsy performed by at least one forensic pathologist. According to recent autopsy studies, coronary artery disease is still the major cause of death in people aged more than 35 years. Cardiomyopathies are more frequently encountered in people aged less than 35 years. The most frequent cardiomyopathy revealed by sudden death is now arrhythmogenic right ventricular cardiomyopathy also known simply as right ventricular cardiomyopathy (RVC). The postmortem diagnosis of cardiomyopathies is very important because the family of the deceased will need counseling and the first-degree relatives may undergo a possible screening to prevent other sudden deaths. In each case of sudden death, one important duty of the forensic pathologist is to inform the family of all autopsy results within 1 month after the autopsy. Most of the recent progress in autopsy diagnosis of sudden unexpected death in the adults comes from molecular biology, especially in case of sudden death without significant morphological anomalies. Searching mutations linked with functional cardiac pathology such as long-QT syndrome, Brugada syndrome or idiopathic ventricular fibrillation is now the best way in order to explain such sudden death. Moreover, new syndromes have been described by cardiologists, such as short-QT syndrome and revealed in some cases by a sudden death. Molecular biology is now needed when limits of morphological diagnosis have been reached.     

Systems analysis and emergency command and control systems for municipalities and law enforcement

This article is designed to provide insight into methodologies that can be used to assess alternative emergency command and control systems for municipalities and law enforcement. Some potential pitfalls and errors are highlighted.     

Political Journals in Germany

Germany in the 18th and 19th centuries possessed a wealth of monthly political journals. The period after the Second World War saw a renaissance of monthly journals, which offered orientation to a populace disoriented by National Socialism and war. Today there is a limited number of monthly political journals and their total circulation does not exceed 100,000. But their readership constitutes the small group of citizens who take an interest in politics and in political discourse. Their quantitative influence cannot be measured, their qualitative influence cannot be overestimated. The article focuses mainly on the magazines Neue Gesellschaft/Frankfurter Hefte and Die Politische Meinung. The former is supported by the Friedrich-Ebert-Stiftung, the latter by the Konrad-Adenauer-Stiftung.     

Hostage-Taking in the Context of Domestic Violence: Some Case Examples

Initial reports of domestic violence are generally made to law enforcement officers who must respond and intervene. A subset of these episodes involves cases in which the victim, and, in many instances her child(ren), have been taken hostage by her husband or partner. Moreover, there are indications that the number of such incidents is growing. The purpose of this project was twofold: (1) to provide one of the first reports on the prevalence and characteristics of these events, and (2) to more closely analyze domestic crisis (hostage) situations using actual case examples. All information was obtained from the Hostage Barricade Database System (HOBAS) of the FBIs Crisis Negotiation Unit. HOBAS is a postincident information collection tool which stores historical data from law enforcement agencies across the nation on hostage/barricade incidents. An examination of this database yielded different types of domestic hostage-taking acts and outcomes (e.g., tactical vs. negotiated resolutions, survival vs. death/injury of perpetrator and/or victim[s]). Implications of the findings, for future crisis negotiation efforts directed toward nonviolent resolution of these high-risk critical incidents, are discussed.     

Negotiated Third Party Access—An Industrial Organisation Perspective

In the course of the liberalization of European energy markets, the German government opted—diverging from all other European countries—for Negotiated Third-Party Access. In this article we analyze if, theoretically, this institutional regime can be superior to regulation. We review empirically whether certain aspects of the actual implementation, in particular publication of the network access charges for each network supplier, facilitated or inhibited competition. In the first place we reconsider previous research, showing that NTPA can—under certain conditions—be economically effective. Our empirical analysis shows that the duty of publishing access charges supported market transparency and imposed a regulatory threat, particularly to suppliers with significantly above-average charges. On the other hand observable price adjustments over time serve as an indicator of tacit collusion. Although the expensive suppliers cut their prices, the cheaper ones raised theirs.We thank Maik Heinemann, Joachim Wagner and two anonymous referees for helpful comments and the Lower Saxonian Ministry of Science and Culture for financial support.JEL Classification: D42, L43, L94     

The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis

The article reports a meta-analysis on controlled outcome evaluations of sexual offender treatment. From 2,039 documents published in five languages, 69 studies containing 80 independent comparisons between treated and untreated offenders fulfilled stepwise eligibility criteria (total N = 22,181). Despite a wide range of positive and negative effect sizes, the majority confirmed the benefits of treatment. Treated offenders showed 6 percentage points or 37% less sexual recidivism than controls. Effects for violent and general recidivism were in a similar range. Organic treatments (surgical castration and hormonal medication) showed larger effects than psychosocial interventions. However, this difference was partially confounded with methodological and offender variables. Among psychological programs, cognitive–behavioral approaches revealed the most robust effect. Nonbehavioral treatments did not demonstrate a significant impact. There was no outcome difference between randomized and other designs, however, group equivalence was associated with slightly larger effects. Various other moderators had a stronger impact on effect size (e.g., small sample size, quality of outcome reporting, program completion vs. dropout, age homogeneity, outpatient treatment, and authors’ affiliation with the program). More differentiated, high-quality evaluations are needed to clarify: What works for whom under which circumstances?     

Graduation and Deepening: An Ambitious Post-2012 Climate Policy Scenario

In the second commitment period 2013–2017, the Kyoto Protocol structure is strengthened considerably. The current Annex B countries agree to reduction targets averaging 23% reductions from 1990 level. This induces non-Annex B countries to take up emissions targets according to a multi-tiered graduation system. Graduation is undertaken according to thresholds defined by per capita GDP and emissions. Compared to the current Annex B, coverage of emissions by absolute caps would increase by about 25%; large low-income countries such as India and China do not graduate. Therefore, large emitters above 50 million t. p.a. can utilise a policy-based Clean Development Mechanism. Sinks of all types – terrestrial, marine and geological can be used. To achieve this policy scenario, voter pressure due to extreme meteorological events and a coordination of all progressive forces in the international climate negotiations are necessary. Moreover, a judicious combination of carrots and sticks has to be developed to entice Non-Annex B countries to graduate.