Review of pathologic findings in remnant hearts following valve donation

The failure of medical examiners/coroners (ME/C) to allow heart valve donation is a major problem encountered by tissue agencies. Even though many ME/C favor tissue donation they remain responsible for determination of cause and manner of death. In 2001, the Jesse E. Edwards Registry of Cardiovascular Disease was approached by one of the nation's largest tissue procurement agencies (The American Red Cross--ARC) for the purpose of performing cardiovascular pathologic examinations following valve donation. The affiliation existed from October 2001 to January 2005. This study was undertaken to review all 593 postvalve recovery heart remnants received during that time period to tabulate the abnormalities identified and to determine whether donation interfered with the determination of cause of death. For each case, a preliminary cause of death was provided by the ARC. The decedent's body height and weight were also provided. Using the preliminary cause of death, the 593 cases were divided into natural and nonnatural manner of death groups. This division of the cases resulted in 106 cases placed in the natural manner of death group and 487 cases in the nonnatural manner of death group. For each case, all cardiac findings including significant conditions, additional findings, incidental findings, and congenital abnormalities were tabulated. Within the natural manner of death group, 15 cases had a noncardiac cause of death and 91 cases had a cause of death suspected to be cardiac related. In the 91 cases, a total of 132 significant cardiac findings were identified and there were six structurally normal hearts including two infants. In the nonnatural manner of death group, 214 significant cardiac findings were identified and 222 cases had a structurally normal heart. In both natural and nonnatural groups, the most common cardiac abnormality was atherosclerotic coronary artery disease. Other frequently encountered conditions were also identified including 11 cases with acute angle of origin of a coronary artery (five cases natural group; six cases nonnatural group). An important feature of this review was the recognition of potentially inheritable conditions that were diagnosed in both natural and nonnatural manner of death groups. There were three cases of hypertrophic cardiomyopathy (one natural; two nonnatural), three cases of arrhythmogenic right ventricular cardiomyopathy (one natural; two nonnatural), and one case of mitral valve prolapse (natural). In reviewing these cases, we did not feel that valve donation severely impaired cardiac pathologic examination. The benefits of cardiovascular pathologic examination by a cardiac pathologist include the identification of significant and incidental findings and recognition of potentially inheritable conditions.     

Ventilatory and metabolic demands during aggressive physical restraint in healthy adults

We investigated ventilatory and metabolic demands in healthy adults when placed in the prone maximal restraint position (PMRP), i.e., hogtie restraint. Maximal voluntary ventilation (MVV) was measured in seated subjects (n=30), in the PMRP, and when prone with up to 90.1 or 102.3 kg of weight on the back. MVV with the heaviest weight was 70% of the seated MVV (122+/-28 and 156+/-38 L/min, respectively; p<0.001). Also, subjects (n=27) were placed in the PMRP and struggled vigorously for 60 sec. During the restrained struggle, ventilatory function (V(E)/ MVV) was 44% of MVV in the resting PMRP. While prone with up to 90.1 or 102.3 kg on the back, the decrease in MVV was of no clinical importance in these subjects. Also, while maximally struggling in the PMRP, V(E) was still adequate to supply the ventilatory needs.     

The Role of Perceived Justice,Political Ideology,and Individual or Collective Framing in Support for Environmental Policies

Effectively addressing environmental challenges such as climate change will require adopting policy measures that have some impact on collective human behavior. The present research examined attitudes toward different environmental policies, specifically focusing on the role of perceived justice. Justice was measured in two ways: as an assessment of the fairness of a particular policy and as a general tendency to endorse statements related to environmental justice. Because justice judgments can be context specific, policies were presented in four conditions, in a 2 × 2 design manipulating the type of impact described, ecological or societal, and the level of focus, individual or collective. The roles of political ideology and environmentalism were also investigated. Results from an online sample of 162 US residents showed that non-coercive policies, overall, were rated as more acceptable. Environmental justice statements were strongly endorsed, and justice in both its specific and general forms was a determinant of policy acceptance. In particular, ratings of the fairness of specific policies were a stronger determinant of acceptability than perceived effectiveness of the policy. Type of impact had little effect, but policies tended to be rated as more acceptable when they were framed in terms of the collective rather than the individual. Although a liberal ideology was associated with acceptance of environmental policies in general and with endorsement of environmental justice, controlling for endorsement of environmental justice eliminated the effect of political ideology in most, but not all, cases. Implications for policy support are discussed.     

Bringing Community Based Participatory Research to Domestic Violence Scholarship: an Online Toolkit

In the absence of ongoing involvement in the communities that are the subjects of research, even well-intentioned researchers can develop questions that are not relevant to community needs, employ methods that hurt community members, or disseminate findings in ways that are inaccessible to those most affected. Recognizing these harms, a growing number of domestic violence (DV) researchers have embraced community-based participatory research (CBPR), an approach in which researchers and community members share power at every level of the research process, co-creating knowledge that can be applied to enhance community well-being. Despite growing interest in this approach, however, there are insufficient opportunities for interested researchers to learn how to actually engage in it, especially in the DV context. To remedy this gap, the authors of this paper collaborated to develop an online toolkit for emerging researchers interested in CPBR. This brief report frames the need for CBPR in DV research using short vignettes that come from our own research experience; introduces Power Through Partnerships: A CBPR Toolkit for Domestic Violence Researchers; and presents recommendations for developing, promoting, and disseminating future CBPR research. We chose to announce the development and availability of this toolkit in an academic journal in order to highlight its scholarly and practical relevance for researcher audiences who might be less familiar with the CBPR approach.     

The “strange power of speech”: The unprecedented but limited success of telephone company First Amendment arguments

The Telecommunications Act of 1996 rendered moot recent successful telephone company constitutional challenges to the Cable Act ban on telephone company provision of video. The cases, however, suggest the “strange power”; of the First Amendment to shatter well‐established structural regulations and present evidence that well‐heeled actors can gain through the courts regulatory concessions not readily attainable from Congress or the FCC.

Neither precedent nor logic supports these court rulings, which eliminated economic regulation based upon speculative First Amendment gains rather than upon demonstrated abridgments of speech or changes in the video market     

Using context and difference in sex offender treatment: An integrated systemic approach

Summary

The primary objective of this paper is to promote a re-examination of the current use of cognitive-behavioural programmes in work with men who have sexually offended against children or adults and to encourage the application of ideas from the systemic field. In order to support this objective, the paper puts forward and develops the following arguments:

1. That the current content of manualised programmes in this field has been distilled too far and left behind some of the most important principles of the cognitive approach. Returning to the work of Marshall et al (1999), the need for a thorough and broad-based assessment of each individual prior to deciding treatment goals is clearly recommended. Further, there is a need to pay much more attention to differences between, as well as similarities of those who sexually offend.

2. That ideas from within the systemic therapeutic field be integrated within existing approaches to attempt to address some of the limitations of cognitive-behaviour therapy as currently employed. Evidence for the potential benefits of this comes from a broad personal experience of working directly with offenders and consulting to group facilitators.

It is concluded that all therapeutic approaches reach a ‘moment of integration’ (Pinsof, 1994), when their failures are recognised and other approaches are drawn on. It is suggested that this moment may be upon us in this area.     

Impacts of housing and mortgage market discrimination racial and ethnic disparities in homeownership

Abstract

There are persistent differences in homeownership rates across racial and ethnic groups. Homeownership rates for whites are over 20 percentage points higher than for blacks or Hispanics. This paper uses a model of the housing tenure decision to gain a better understanding of these racial and ethnic differentials in homeownership and employs a decomposition technique that has been applied to labor market discrimination to report the results of the empirical testing of two hypotheses: (1) race (ethnicity) influences the probability of ownership through differences in household endowments (income, education, age, gender, and family type) and market endowments (price and location); and (2) race (ethnicity) directly influences the probability of ownership through racial or ethnic discrimination and other factors that may be correlated with race or ethnicity.

We find endowment effects important in explaining the persistent racial and ethnic disparities in homeownership. In brief, logit analysis of 1989 American Housing Survey (AHS) national sample data reveals that 81 percent (78 percent) of the differences between the predicted probability of ownership between black and white households (Hispanic/non‐Hispanic) are due to differences in group endowments. Direct effects explain 19 percent of the black‐white differentials and 22 percent of the Hispanic/non‐Hispanic differentials. Because the direct effects are modeled as residual differences, it must be realized that the residual components could also be capturing the influence of important omitted or harder to measure variables internal to the market process and correlated with race or ethnicity. These include wealth, household location, employment history, credit history, and cultural predisposition toward homeownership.     

Comment on “Does the Likely Demographics of Affordable Housing Justify NIMBYism?”

Abstract

Automated underwriting (AU) systems have become the tool of choice in mortgage lending decisions. While these systems provide significant benefits to mortgage originators and investors, questions have been raised about their impact on underserved populations. The questions focus on the relative accuracy of AU compared with manual underwriting and whether AU has increased the flow of mortgage credit to underserved consumers.

Using information from Freddie Mac's Loan Prospector AU service, we provide statistics useful in examining these issues. The data strongly support our view that AU provides substantial benefits to consumers, particularly those at the margin of the underwriting decision. We find evidence that AU systems more accurately predict default than manual underwriters do. We also find evidence that this increased accuracy results in higher borrower approval rates, especially for underserved applicants.     

Book reviews

Bremmer I &; R Tarras (eds), Nations and Politics in the Soviet Successor States. Cambridge: Cambridge University Press, 1993. 565pp., index.

Bulloch J &; H Morris, No Friends but the Mountains: The Tragic History of the Kurds. London: Penguin Books, 1993 (new epilogue). 257pp., index.

Cable J, Gunboat Diplomacy 1919 ‐ 1991: Political Applications of Limited Naval Power. London: Macmillan, 1994, 246pp.

Evans R, Deng Xiaoping and the Making of Modern China. London: Hamish Hamilton, 1993, 339pp.

Gaddis JL, The United States and the End of the Cold War: Implications, Reconsiderations, Provocations. New York: Oxford University Press, 1992, 301pp.

Jeffrey R, What's Happening to India? Punjab, Ethnic Conflict, and the Test for Federalism. London: Macmillan, Second Edition, 1994, pp. ii &; 252pp.

Mazrui AA &; C Wondji (eds), Africa since 1935. Paris: UNESCO; Oxford: Heinemann Educational; Berkeley: University of California Press, 1993. (UNESCO General History of Africa Series, Vol. VIII) xxiii, 1025 pp. Illustrated, maps, plates, bibliography and index.