Vertebral artery dissection complicating occipital injection of heparin for treatment of thoracic outlet syndrome

A 38-year-old woman with a 2-year history of chronic neck pain radiating down her right arm underwent radiological and neurological evaluations, which revealed no anatomical cause for her pain. She sought alternative therapies including intramuscular heparin injections. Following a right occipital injection of heparin, cyanocobalamin, and lidocaine, she had a sudden cardiorespiratory arrest and was successfully resuscitated, but did not regain consciousness.Computed tomography of the head and neck and subsequent autopsy revealed a right vertebral artery dissection, but at autopsy, no significant subarachnoid hemorrhage was noted at the base of the brain. This is the first case report where heparin (a potent anticoagulant) used in an occipital injection was documented to cause a vertebral artery dissection. It is also the first reported case where radiographically and histologically documented vertebral artery dissection did not present with overwhelming subarachnoid hemorrhage at the base of the brain. The subtle gross anatomical findings in this case highlight the importance of evaluating the cervical spinal cord in any case of sudden cardiorespiratory arrest following even apparently minor neck injury.     

S—s—U— phenotype in the coloured population of Cape Town: Problems encountered in paternity tests

Two Cape Coloured persons of mixed White, Khoikhoi, Malay, Black parentage in Cape Town whose red cells were found to be S—s—U— establish that the rare S^u allele is present in this population group. The most likely source of the S^u allele in them is the non-indigenous Black slaves who were brought to the Cape in the early years of White settlement there. In two paternity suits involving Cape Coloured persons, maternal and paternal exclusions were present unless the inheritance of an MS^u or an NS^u chromosome was postulated, and MS, NS and Ns chromosomes were seen to accompany He+ alleles in them.     

Regulation of technology transfer: The Mexican experience

Beginning some 20 years ago, regulation of technology transfer became common-place in a number of developing countries. Whether such regulation could prove beneficial was often questioned, particularly in the industrialized world. But with a 15–20 year history to study, we can now look at the impact that regulation has had. Mexico presents a good case study, as its original law was one of the earliest, and the country's political continuity has led to a detectable evolvement of the technology-transfer process that allows analysis of various factors over time.     

Predicting batterer recidivism five years after community intervention

The purpose of this study was to examine batterer recidivism rates 5 years after community intervention and to determine differences that discriminate between recidivists and nonrecidivists. Of the 100 men included in the sample, 40% were identified as recidivists because they were either convicted of domestic assault, the subject of an order for protection, or a police suspect for domestic assault. A discriminant analysis was conducted using a variety of background and intervention variables. Five variables were selected that significantly discriminated between recidivists and nonrecidivists and correctly classified 60.6% of the cases. Men who had been abusive for a shorter duration prior to the program, court ordered to have a chemical dependency evaluation, in chemical dependency treatment, abused as children, and previously convicted for nonassault crimes were more likely to be recidivists. Variables relating to intervention did not significantly predict recidivism. Implications for community intervention programs are discussed.     

Public Leadership in Times of Crisis: Mission Impossible?

Crisis management (prevention, preparedness, response, and reconstruction) is a tough task for political and bureaucratic leaders. This article documents the persistent tensions between the expectations and realities of crisis leadership. It explores the popular notion that crises provide key opportunities for reform. The very occurrence of a crisis is then thought to expose the status quo as problematic, making it easier to gain momentum for alternative policies and institutions. We argue that the opportunities for reform in the wake of crisis are smaller than often thought. The prime reason is that the requisites of crisis leadership are at odds with the requirements of effective reform.     

Expert Approaches to Communicating Violence Risk

There has been virtually no empirical study of the way in which evaluating clinicians communicate their conclusions about the risk of violence toward others. Risk communication has become particularly important in recent years, serving as the link between empirical data from recent studies and the understanding and use of such data by evaluators and decision makers. The present study considered how psychologists and psychiatrists, identified as experts in violence risk assessment, responded to eight vignettes that systematically measured preferences for risk communication. The vignettes involved the presentation of the following factors in a 2 × 2 × 2 within-subjects design, counterbalanced for order: (1) risk model (prediction vs. management), (2) risk level (high vs. low risk of the individual being assessed), and (3) risk factors (the predominance of static vs. dynamic risk factors). A total of 71 individuals (41 psychologists, 2 sociologists, and 28 psychiatrists) responded to a survey mailed to 100 individuals, for a response rate of 71%. Participants were asked to rate the value of six forms of risk communication for each of the eight vignettes. There were few significant differences between the ratings assigned by psychologists and those assigned by psychiatrists. The most highly valued form of risk communication involved identifying risk factors applicable to the individual and specifying interventions to reduce risk. A repeated-measures multivariate analysis of variance yielded a main effect for risk level and an interaction between risk level and risk factors. The implications of these findings for research and practice are discussed.     

The Spousal Assault Risk Assessment (SARA) Guide: Reliability and Validity in Adult Male Offenders

We evaluated the reliability and validity of judgments concerning risk for violence made using the Spousal Assault Risk Assessment Guide (SARA; Kropp, Hart, Webster, & Eaves, 1994, 1995, 1998). We analyzed SARA ratings in six samples of adult male offenders (total N = 2681). The distribution of ratings indicated that offenders were quite heterogeneous with respect to the presence of individual risk factors and to overall perceived risk. Structural analyses of the risk factors indicated moderate levels of internal consistency and item homogeneity. Interrater reliability was high for judgments concerning the presence of individual risk factors and for overall perceived risk. SARA ratings significantly discriminated between offenders with and without a history of spousal violence in one sample, and between recidivistic and nonrecidivistic spousal assaulters in another. Finally, SARA ratings showed good convergent and discriminant validity with respect to other measures related to risk for general and violent criminality.     

Reducing Variability in Civil Jury Awards

The purpose of the present study was to test several procedures that could be adopted for reducing unwanted variability in civil damage awards. Four methods for providing guidance to jurors (and judges) about the distribution of awards in comparable cases were compared to each other, to a no-guidance control, and to the capping of awards at a specified maximum, which has been the most commonly legislated solution. The findings of this study suggest several alternative solutions that are better able than caps to solve the problem of unwanted variability in awards.