Sickle cell lung disease and sudden death: a retrospective/prospective study of 21 autopsy cases and literature review

Sudden death in the setting of sickle cell lung disease (SCLD), is periodically seen in the practice of medical examiners. The goal of the present study was to identify the most common pathologic findings of SCLD associated with sudden or unexpected death. A retrospective/prospective review of 21 autopsy cases from sickle cell patients between 1990 and 2004 was performed. Review of medical records, autopsy reports, and H&E-stained slides of lung tissue was performed. Oil-Red-O and elastic staining of lung tissue were evaluated. All cases were screened for both acute and chronic forms of SCLD. Patients admitted for sickle cell pain crisis ranged in age from 8 months to 65 years. Fifteen out of 21 cases (71.4%) showed significant pulmonary pathology. The most frequent lung findings included pulmonary edema (47.6%), pulmonary thromboembolism (38.1%), fat emboli (33.3%), pulmonary hypertension, grades I-IV (33.3%), and microvascular occlusive thrombi (28.5%). Our study demonstrates higher-than-expected percentages of acute and chronic sickle cell-related lung injury such as fat embolism (33.3%) and pulmonary hypertension (33.3%), with right ventricular hypertrophy (33.3%). Therefore, we propose a simple and high-yield autopsy algorithm of ancillary procedures that should be applied on all known and suspected autopsy cases of sickle cell disease.     

What drives punitive beliefs?: Demographic characteristics and justifications for sentencing

Punitive attitudes of the general public were the focus of a considerable amount of research. Much of the work focused on the demographic correlates of punitive attitudes and only a limited amount of research focused on how punitive attitudes were justified. That is, what does the public want to get out of punishing criminal offenders? In this research, how a sample of Virginia residents recommended sanctioning five different offenses was examined. Multivariate models were used to assess the relationships between demographic and ideological orientations, punishment justifications, and punitive attitudes. Finally, separate models were estimated for males and females, and African Americans and Whites to explore whether these factors operated differently across groups. The results suggested that in comparison to demographic factors, justifications were relatively strongly linked to punitive attitudes. These effects were similar across subgroups, but there was an interaction suggesting that the relationship between general deterrence and punitive attitudes varied across gender and race. Implications of the study are discussed.     

In-Service training: Outside looking in

This paper describes and explores prominent issues pertaining to in-service training of law enforcement personnel. The overall situation in in-service training is examined, with special coverage being given to state mandates, availability and expense, the nature of programs, and the potential role of non law enforcement personnel in providing in-service training. Some possible solutions to current problems are discussed and general conclusions are offered.     

A 10-year epidemiologic review of homicide cases in children younger than 5 years in Fulton County, GA: 1996-2005

The primary purpose of this study was to present the epidemiologic review of homicide deaths certified by the Fulton County Medical Examiner's Office from January 1, 1996 through December 31, 2005 in children younger than 5 years. The secondary purpose of this study was to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County are significantly greater than expected when compared with those in the State of Georgia. For purposes of this study, only homicide deaths of Fulton County residents were included. The authors reviewed all homicide cases in children younger than 5 years: infancy (<1 year) and early childhood (1-4 years). χ values were calculated using Epi Info (version 3.4.1; Centers for Disease Control and Prevention, Atlanta, Ga) to determine differences in homicide among age group, race, and sex variables. In addition, a χ test at the α level of 0.05 was done to determine if the observed cases of homicide deaths among children younger than 5 years in Fulton County were significantly greater than expected when compared with those in the State of Georgia. There were 49 homicide cases in children younger than 5 years identified over this 10-year period. The yearly distribution of these 49 homicide deaths ranged from 1 death in 2003 to 9 deaths in 2004. Most of the patients were male (n=29, 59.2%) and black (n=44, 89.8%). Between infancy and early childhood cases, homicide victims were nearly equally divided between the 2 groups. However, χ values showed that decedents younger than 5 years are more likely to have died of homicide compared with decedents 5 years or older (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.29-2.35). Black decedents younger than 5 years are more likely to have died of homicide compared with other races (OR, 3.21; 95% CI, 1.21-9.28). Male and female decedents are equally at risk to have died of homicide (OR, 1.14; 95% CI, 0.61-2.11). The authors also determined that the total homicide risk for children younger than 5 years in Fulton County during the years 1996 to 2005, at the α level of 0.05, is 1.8 relative to the state. Brain injury was the primary cause of death in most cases (n=23, 46.9%). Although this study was unable to collect information on the victim's suspect/offender characteristics, it was noted that only 37% of the cases (n=18) went to trial. Most homicide investigations were under the Atlanta police jurisdiction (n=28, 57.1%). Results from this study may assist local and state government officials in recognizing the epidemiologic characteristics of children at risk to help them allocate limited resources efficiently and implement preventive measures to at-risk populations effectively.     

The layered prisoners' dilemma: Ingroup versus macro-efficiency

In the N-prisoners' dilemma (NPD), cooperation produces ingroup efficiency. But if ingroup gains from cooperation are less than outgroup losses, then macro-efficiency for the collectivity (defined as ingroup plus outgroup) is harmed. We call this situation a layered prisoners' dilemma (LPD). The LPD models diverse real world situations — from OPEC's effect on consumers to interest groups' effect on citizens. We developed an experimental analogue to test three hypotheses about LPD behavior. We found that subjects' behavior was not motivated by a concern for macro-efficiency but, instead, was a function of ingroup interaction. Specifically, ingroup discussion decreased macro-efficient behavior, but the amount of the decrease depended on decision-making structures and ingroup perceptions of outgroup worthiness. The results suggest that macro-inefficient behavior will be ubiquitous due to the ease with which subjects form ingroups. But the results also suggest tactics for constraining macro-inefficient behavior, though the success of the tactics depends on the existence of crosscutting group loyalities. We wish to acknowledge with graditude the help of Robyn Dawes, Carnegie Mellon University; John Francis, University of Utah; Mike Lyons, Utah State University; and John Orbell, University of Oregon.     

Who graduates from drug courts? Correlates of client success

Drug courts combine punishment and treatment to provide an intermediate sanction for offenders. This paper contains an analysis of drug court case files for 196 participants in one mid-Atlantic jurisdiction. Logistic regression reveals that employment status before and during the program, race, education, and referral time are significant predictors of successful completion. Policy implications and suggestions about participant screening and program administration are offered. The authors would like to thank the editor and the anonymous reviewers for their very helpful comments and suggestions.