Heart valve tissue donation does not preclude the diagnosis of clinically significant pediatric cardiac abnormalities

Medical examiners/coroners often have the responsibility of deciding whether to allow organ and tissue donation to proceed in cases under their jurisdiction. A 10-year retrospective study was conducted of autopsy cases in children younger than 6 years to determine whether the donation of cardiac valve tissue would preclude the diagnosis of clinically significant pediatric cardiac abnormalities. Only 1 case (0.1%) was found in the entire 10-year period in which valve tissue donation might have prevented the correct diagnosis. According to the results of the study, (1) most cardiac findings in forensic pediatric autopsies are not clinically significant; (2) clinically significant findings will be diagnosed in properly examined hearts, even those processed for valve tissue donation, and special studies will remain possible in nearly all hearts except those with suspicion of conduction defects; and (3) as long as there is good communication between forensic pathologists and organ and tissue procurement organizations, the concern of failing to diagnose significant cardiac findings should not inhibit medical examiners/coroners from allowing the donation of pediatric cardiac valve tissue.     

The Coefficient of Party Influence

In a 2000 article in American Journal of Political Science,James Snyder and Tim Groseclose develop and apply an innovativemethod for detecting and estimating the frequency and magnitudeof party influence in congressional roll call voting. This paperpresents a framework for assessing the coefficient that theauthors interpret as "party influence." The analysis revealsthat, and shows why, the coefficient manifests two troublesomecharacteristics. The coefficient cannot discriminate betweendisparate types of party influence because the mapping betweentypes of partison influence and signs of the coefficient isnot one-to-one. Similarly, the coefficient has a responsivenessproblem because a marginal increase in one party's influencecan cause the estimate of the coefficient to increase, decrease,or remain constant. Because the literature on parties in Congressemphasizes majority-party strength, the inability of the coefficientto isolate party-specific effects is a serious drawback in theongoing hunt for genuine party discipline.     

Seasonality in suicide: a study of farming suicides in England and Wales

Seasonality in suicide rates has long been reported. Spring peaks in suicide deaths have been positively correlated with the proportion of the workforce engaged in agriculture. Some studies have indicated that suicides using violent methods are more likely to show seasonality. Recent research has suggested that seasonal patterns have diminished. This study examined deaths in male farmers, an occupational group which might be expected to be more vulnerable to seasonal influences because of the nature of their work and the relatively high proportion of farmers using violent methods for suicide. Data on suicides between 1982 and 1999 by males in England and Wales aged 15 years and over were provided by the Office for National Statistics. Seasonal patterns of suicide in farmers and nonfarmers were examined by nonparametric tests and harmonic analysis. No significant seasonal variation was found for farmers. For nonfarmers, although a chi-square test showed significant variation in monthly distribution, this was not found when a harmonic analysis was applied. There was no significant difference in the variation of violent suicides throughout the year. This study reinforces recent findings that seasonal variation in suicide appears to be diminishing, even in an occupational group where this might be expected.     

Book reviews

Sibyl Crowe and Edward Corp, Our Ablest Public Servant, Sir Eyre Crowe GCB, GCMG, KCB, KCMG, 1864-1925 (Braunton Devon: Merlin Books, 1993) £17.95. ISBN 0 86303 607-4.

Richard J. Aldrich, The Key to the South: Britain, the United States, and Thailand during the Approach of the Pacific War, 1929-42 (Kuala Lumpur: Oxford University Press, 1993).

John Saville, The Politics of Continuity: British Foreign Policy and the Labour Government, 1945-46 (London and New York: Verso, 1993). ISBN 0 86091 456 9.

John Kent, British Imperial Strategy and the Origins of the Cold War, 1944-49 (Leicester, London and New York: Leicester University Press, 1993). ISBN 0 7185 1330 4.

Frederick W. Marks III, Power and Peace: The Diplomacy of John Foster Dulles (Westport, CT & London: Praeger, 1993) £45. ISBN 0 275 94497 2.

Charles Grant, Delors: Inside the House that Jacques Built (London: Nicholas Brealey, 1994) pp.305. £12.99. ISBN 1 85788 039 0.     

A threat or a promise: acquisition of teaching hospitals by investor-owned chains

In the early 1980s, acquisition of a small number of teaching hospitals by investor-owned chains raised the spectre of a for-profit takeover of teaching institutions. Drawing on experience to date, as well as interviews with affected parties, this article assesses the likely scope of such acquisitions and their impact on the education, research, and indigent care that teaching hospitals provide. Our assessment concludes that relatively few teaching hospitals are likely to satisfy the financial criteria chains apply to acquisitions; that hospitals with modest rather than extensive commitments to education and research are most likely to satisfy these criteria; and that terms of sale typically enhance, rather than undermine, these institutions' resources for research, education, and, to a lesser extent, indigent care, at least in the short run. In the long run, continuation of these activities is more likely to be a function of third-party payment policies than of proprietary versus nonprofit hospital ownership.