Etiology of pulmonary thromboembolism in the absence of commonly recognized risk factors

Pulmonary thromboembolism is an often fatal complication of venous thrombosis. Any component or combination of the components composing Virchow's triad (venostasis, hypercoagulability, and endothelial damage) increases the propensity for a thrombophilic state. Hypercoagulable states may be inherited or acquired. While the etiology in many cases may be evident either on physical examination or on evaluation of the decedent's medical history, this is often not the case. We conducted a retrospective study of cases presenting to the Jefferson County Coroner/Medical Examiner's Office in Birmingham, Alabama, who were given a diagnosis of pulmonary embolism. A search of cases within the past 23 years yielded 81 cases. An underlying cause was determined in 70 cases (86%). The remaining 11 (14%) cases had no identifiable cause. We believe that a number of these cases may represent an underlying thrombophilic disorder. Since these disorders may be of an inherited or acquired nature, the determination of an etiology may be relevant to the decedent's family. Postmortem blood analyses may in selected cases be useful and appropriate for the detection of some of these disorders. However, such analyses are not practical in all cases, with each case having to be evaluated on its own merits.     

Murder, Extramarital Affairs, and the Issue of Probative Value

A paper previously published in Law and Human Behavior by D. Davis and W. C. Follette (2002) argued that certain "profiling" characteristics commonly admitted into court have little or no probative value. They argued that this is especially likely to be true when the characteristic used as evidence (e.g., having an extramarital affair) is rather common in the population whereas the act in question (e.g., a man murdering his wife) is rare. Their analysis has prompted a strong response by Friedman and Park and by Kaye and Koehler with a rejoinder by Davis and Follette (all three follow this paper in this issue of Law and Human Behavior). This paper describes some of the nature of this controversy.     

Polydrug fatality involving metaxalone

A 29-year old female with a history of depression was found dead in a hotel room. The death scene investigation found empty pill bottles and an empty liter bottle of wine. Metaxalone, a centrally acting muscle relaxant, along with citalopram, ethanol, and chlorpheniramine were identified in the postmortem samples and quantitated by gas chromatography-mass spectrometry. The concentration of metaxalone in femoral vein blood was 39 mg/L. The heart blood concentration was 54 mg/L. Femoral vein blood concentrations of citalopram and chlorpheniramine were 0.77 mg/L and 0.04 mg/L, respectively. Ethanol levels were 0.13 g/dL in vitreous and 0.08 g/dL in heart blood. Other tissue samples were also analyzed. The authors consider the metaxalone concentrations toxic and potentially fatal. The citalopram concentrations were lower than those reported in fatal cases for this drug alone. Death was ascribed to polydrug abuse/overdose with metaxalone a major contributor. This represents the first reported case to our knowledge in which a metaxalone overdose significantly contributed to death.     

Logistic Regression in Rare Events Data

We study rare events data, binary dependent variables with dozensto thousands of times fewer ones (events, such as wars, vetoes,cases of political activism, or epidemiological infections)than zeros ("nonevents"). In many literatures, these variableshave proven difficult to explain and predict, a problem thatseems to have at least two sources. First, popular statisticalprocedures, such as logistic regression, can sharply underestimatethe probability of rare events. We recommend corrections thatoutperform existing methods and change the estimates of absoluteand relative risks by as much as some estimated effects reportedin the literature. Second, commonly used data collection strategiesare grossly inefficient for rare events data. The fear of collectingdata with too few events has led to data collections with hugenumbers of observations but relatively few, and poorly measured,explanatory variables, such as in international conflict datawith more than a quarter-million dyads, only a few of whichare at war. As it turns out, more efficient sampling designsexist for making valid inferences, such as sampling all availableevents (e.g., wars) and a tiny fraction of nonevents (peace).This enables scholars to save as much as 99% of their (nonfixed)data collection costs or to collect much more meaningful explanatoryvariables. We provide methods that link these two results, enablingboth types of corrections to work simultaneously, and softwarethat implements the methods developed.     

Infighting and Ideology: How Conflict Informs the Local Culture of the Chicago Dyke March

Although the study of local cultures has become established in American sociology, it often ignores the contested nature of how culture emerges and is negotiated within the context of small groups. To this end, we address the concept of infighting, a subtype of conflict, as it operates within a small group framework. Building on an ethnographic study of the Chicago Dyke March, we demonstrate that infighting highlights competing ideologies that may remain implicit in the absence of such conflict. Infighting treats divergent meaning systems as part of local contention between rival cliques and power centers. These ideological battles both reflect pre-existing differences between subgroups and serve to make explicit and public such differences, both in their background characteristics and in their interests. In the process infighting directs attention away from shared concerns and group building to questions of strategy, transforming the small group into an arena of ideological production and factional rivalry. Infighting recasts a group from a space of consensus to a contested political arena. We elaborate four analytic processes through which infighting connects to ideology and small group culture: infighting emphasizes the multivocality of meaning, cultural heterogeneity, an equilibrium of inclusion and group boundaries, and planning in light of ideologies of power.