Aberrant MN bloodgroup inheritance in a German family: a 'silent' allele?

By means of extensive serogenetic testing of a family, RFLP analysis and biostatistic evaluation we present evidence for the rare transmittance of a 'silent' information at the MN blood group locus in a Caucasian family.     

Implementing regulatory reform: the saga of Michigan's debedding experiment

This paper traces the implementation of Michigan's program for hospital bed reduction through four phases in the critical first 30 months following enactment: standard-setting, plan development, plan approval, and legislative oversight. Procedural complexity and goal conflict complicated implementation from the start: what began as a simple proposal to close unneeded beds soon became enmeshed in efforts to address long-standing issues of equity in access to care. A combination of administrative, political, and economic factors peculiar to Michigan, as well as the more generic problems incurred in applying a regulatory approach to containing medical care costs, contributed to the difficulties encountered in implementing bed reduction. Long-range prospects for the program depend upon whether the modest results it is likely to achieve are deemed to be worth the costs incurred in administering it.     

Making non-discriminatory fitness-for-duty decisions about persons with disabilities under the Rehabilitation Act and the Americans with Disabilities Act

This article describes an assessment role performed by clinical psychologists in the employment context, and examines how it has been evaluated by the courts from the standpoint of discrimination against persons with disabilities. Guidelines are offered for making fitness-for-duty decisions which are legally defensible, and examples of the decision-making process are provided. Data-based limitations on professional expertise are articulated, and conclusions drawn are aimed at practicing psychologists and the courts dealing with these uncertainties. Issues are analyzed principally in courts dealing with these uncertainties. Issues are analyzed principally in relation to Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA), which has been passed by both houses of Congress.     

Identification of mechanical asphyxiation in cases of attempted masking of the homicide

Five homicides are described that had remained unexplained as to the causes of death after gross pathology. Although general signs of asphyxiation were present, they were lacking injuries specific of strangulation or oro-nasal occlusion. The diagnoses of asphyxiation were established by microscopical investigation of the lung and confirmed by subsequent police inquiries. An oro-nasal occlusion was involved in three cases, a strangulation or an oro-nasal occlusion, in another case. The victims were young and healthy. Toxicological investigations remained negative in four cases; one victim was anaesthetized by bromazepam and ether and had a blood alcohol concentration of 80 mg/100 ml. Lung histology and electron microscopy revealed acute emphysema, the development of a haemorrhagic-dysoric syndrome and a microembolism syndrome. With regard to the haemorrhagic-dysoric syndrome, the development of alveolar-interstitial edema is particularly important. This finding may also be diagnosed by light microscopy in semi-thin sections. It is emphasized that the combined action of several pathomechanisms is responsible for the rapid manifestation of the pulmonary lesions. Especially, the haemorrhagic-dysoric syndrome is brought about by the combined action of inspiratory intrapulmonary vacuum and raised intracapillary pressure. The complex pattern allows to compile the diagnosis of mechanical asphyxia even if there is no corresponding injury.