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.     

Effects of prior knowledge and expert statement on belief in recovered memories: an international perspective

We tested the hypothesis that beliefs in the purported attributes of recovered memories of child sexual abuse (CSA) are associated with knowledge of the "recovered/false memory debate", and that such beliefs will be related to assessments of the credibility of statements made by participants in a vignette about CSA. Participants from five countries (the United States, Canada, New Zealand, the United Kingdom and Israel) responded to a questionnaire regarding beliefs about recovered memory as well as self-reported exposure to and knowledge of the debate. In addition, they assessed the credibility of statements made by a daughter (reporting recovery of memories of sexual abuse by her father), her father (denying the allegation and accusing the daughter's therapist of implanting in her false "memories" of abuse), and two experts (each supporting one of the two protagonists). We found that prior knowledge of the debate across countries was linked to beliefs in specific attributes of recovered memories and to a subset of the credibility assessments of statements made by the protagonists and their experts. For individuals, however, credibility assessments were unrelated to knowledge of the debate, but they were related to beliefs about memory recovery. Finally, credibility of the protagonists' statements was differentially associated with those made by the daughter's and the father's experts. The results suggest that whereas familiarity with the debate does not affect the credibility of the statements made by the complainant and the accused, expert testimony does, as has been found in prior research. The psycholegal implications of this conclusion are discussed.     

Adult perspectives on growing up following uxoricide

The purpose of this article is to provide an overview of the state of the science on uxoricide, including qualitative findings on 47 survivors. Two qualitative interviews were conducted between January 2004 and January 2005 with 47 convenience sample adult survivors of uxoricide. Data were analyzed using hermeneutic analysis. A number of themes emerge, such as later experiences with violence, including sexual abuse as a child; family difficulties in speaking about the death; the need to learn about the homicide as an adult as well as a need to reconnect with and forgive the assailant; and the importance of a caring adult to provide stability.     

A Preliminary Theory of Informal Accountability among Network Organizational Actors

Widespread government contracting for nonprofit social service delivery has resulted in extensive reliance on networks of service providers, which involve complicated accountability dynamics. The literature has tended to emphasize formal aspects of accountability in contract relationships, focusing on the specification of contract terms, performance measures, reporting relationships, and stipulated consequences. Far less attention has been focused on the interorganizational and interpersonal behaviors that reflect informal accountability. This article examines the informal norms, expectations, and behaviors that facilitate collective action and promote informal accountability among nonprofit network actors. The data are based on in‐depth interviews with nonprofit senior administrators in four major metropolitan areas. Based on this research, the authors propose a preliminary theory of informal accountability that links (1) the shared norms and facilitative behaviors that foster informal accountability for collective outcomes, (2) the informal system of rewards and sanctions used to promote and reinforce behavioral expectations, and (3) the challenges that may undermine informal accountability.     

Are Green Vehicles Worth the Extra Cost? The Case of Diesel‐Electric Hybrid Technology for Urban Delivery Vehicles

A central question for environmental policy is whether the long‐term benefits of energy‐saving technologies are sufficient to justify their short‐term costs, and if so, whether financial incentives are needed to stimulate adoption. The fiscal effects of incentivizing new technologies, and the revenue effects of using the technology, are also policy relevant, given current fiscal constraints. This study evaluates the economic and fiscal effects of promoting diesel‐electric hybrid technology in urban delivery vehicles, an application supported by U.S. policymakers. An economic model is used to simulate the conditional probability density functions of the net present values (NPVs) of diesel electric hybrids annually from 2012 to 2030. The NPV time paths, which reflect fuel price, environmental, and technology trends, show the expected dates that hybrids become economically viable, and allow an evaluation of the net benefits of hybrid technology as an investment over the entire simulation horizon. The NPV distributions are computed for five stakeholder classes, including transportation firms, parties benefiting from reduced externality damages, state and local governments, and the larger society. The analysis shows that hybrid technology investment does not appear to be justified from a societal perspective at a 7 percent discount rate, but the probability for positive net returns increases substantially at a 3 percent rate.     

Method validation of a survey of thevetia cardiac glycosides in serum samples

A sensitive and specific liquid chromatography tandem mass spectrometry (HPLC-ESI(+)-MS/MS) procedure was developed and validated for the identification and quantification of thevetin B and further cardiac glycosides in human serum. The seeds of Yellow Oleander (Thevetia peruviana) contain cardiac glycosides that can cause serious intoxication. A mixture of six thevetia glycosides was extracted from these seeds and characterized. Thevetin B, isolated and efficiently purified from that mixture, is the main component and can be used as evidence. Solid phase extraction (SPE) proved to be an effective sample preparation method. Digoxin-d3 was used as the internal standard. Although ion suppression occurs, the limit of detection (LOD) is 0.27 ng/ml serum for thevetin B. Recovery is higher than 94%, and accuracy and precision were proficient. Method refinement was carried out with regard to developing a general screening method for cardiac glycosides. The assay is linear over the range of 0.5-8 ng/ml serum. Finally, the method was applied to a case of thevetia seed ingestion.     

Ignitable liquid identification using gas chromatography/mass spectrometry data by projected difference resolution mapping and fuzzy rule-building expert system classification

The gasoline and kerosene collected from different locations in the United States were identified by gas chromatography/mass spectrometry (GC/MS) followed by chemometric analysis. Classifications based on two-way profiles and target component ratios were compared. The projected difference resolution (PDR) mapping was applied to measure the differences among the ignitable liquid (IL) samples by their GC/MS profiles quantitatively. Fuzzy rule-building expert systems (FuRESs) were applied to classify individual ILs. The FuRES models yielded correct classification rates greater than 90% for discriminating between samples. PDR mapping, a new method for characterizing complex data sets was consistent with the FuRES classification result.     

Risk for Partner Victimization and Marital Dissatisfaction Among Chronically Depressed Patients

The link between marital dysfunction and depressive symptoms has been well established, but the link between partner violence and depressive symptoms is less clear. Further, little is known about partner violence and marital satisfaction in chronically depressed patients. In this multi-site treatment sample of chronically depressed patients (N = 316), approximately 17% of men and 12% of women reported experiencing physical victimization from their partner in the past year. However, physical victimization was not associated with the severity of depression for men or women. Cross-sectional path analyses indicated that depressive symptoms predicted marital dissatisfaction, which in turn, predicted psychological victimization. Further, psychological victimization predicted physical victimization. With chronically depressed individuals, interventions that address both depression and marital dissatisfaction may prevent psychological and physical victimization.