A study of various morphologic variables and troponin I in pericardial fluid as possible discriminators of sudden cardiac death

Pathologists frequently examine victims of sudden cardiac death. In some cases, a firm diagnosis of cardiac-related death can be made based on conclusive gross and histologic findings. In many other cases, we find evidence supportive of, but not diagnostic of, cardiac death (e.g., atherosclerotic coronary artery disease, cardiomegaly, myocardial scarring). A final cohort consists of cases of sudden death with minimal to mild cardiac disease, no other significant pathology, and negative toxicologic studies. This prospective study compared 38 cardiac-related deaths with 52 control cases with respect to concentrations of pericardial cardiac troponin I (cTnI), heart weight, evidence of old and/or recent myocardial injury, and presence of significant coronary artery disease. The influence of documented chest trauma and/or perimortem cardiopulmonary resuscitation (CPR) on levels of cTnI was also analyzed. Even though median cTnI levels were significantly higher in cardiac deaths than in controls (p = .003), cTnI was not found to be a significant predictor of cardiac deaths, as determined by discriminant analysis (p = .52). Heart weight >500 g, evidence of old and recent myocardial injury, and significant coronary artery disease were seen statistically more often in cardiac deaths than in controls (p < or = .005 in each case), and median age was significantly higher in cardiac deaths than in controls (p = .001). Based on a stepwise logistic regression model, significant coronary artery disease, old and recent myocardial injury, and heart weight >500 g were found to contribute significantly to the prediction of cardiac death. Finally, neither chest injury nor CPR significantly affected concentrations of cTnI in pericardial fluid. These data confirm that the presence of acute and remote myocardial injury, significant coronary artery disease, and cardiomegaly (heart weight >500 g) strongly supports the diagnosis of a cardiac-related death. In contrast to a recently published report, we do not find that elevated concentrations of cTnI in pericardial fluid are strong indicators of cardiac-related deaths using our methodology.     

The Comparability of Male Violent Substance Abusers in Violence or Substance Abuse Treatment

The abuse of alcohol is strongly associated with violent behavior in general and domestic violence in particular. The present study examined the compara-bility of dual-problem (i.e., substance abuse and conjugal violence) men in substance abuse and violence treatment milieus. Thirty males in substance abuse treatment and 33 men in violence treatment were identified as being dual-problematic and were administered the Addiction Severity Index (ASI) to assess psychosocial and substance abuse status, the Conflict Tactics Scale (CTS) for the frequency and type of abusive behavior, the Symptoms Checklist-90 (SCL-90) for psychological distress, and the 16 Personality Factor (16PF) for personality attributes. When dual-problem men from each milieu were compared on these measures, men in the substance abuse-milieu reported not only significantly more severe substance abuse problems, but also more frequent partner sexual abuse. Few other differences emerged. Thus, while current referral procedures may be appropriate in identifying and directing more severe substance abuse problems to the appropriate treatment setting, violent men with difficulties comparable to those seen in violence treatment may also be found in substance abuse treatment. These findings emphasize the need for: (1) routine objective screening for family violence and substance abuse in these two treatment milieus; (2) informed and up-to-date staff in both settings who are sufficiently prepared for the therapeutic challenges such men may present, and (3) more study of how treatment for dual-problem men may be coordinated by the violence and substance abuse treatment communities to optimize their outcome.     

Image analysis of gunshot residue on entry wounds. I--The technique and preliminary study.

An automated image analysis (IA) technique has been developed to obtain a measure of the amount (i.e. number and area) of gunshot residue (GSR) particles within and around a gunshot wound. Sample preparation and IA procedures were standardised to improve the reproducibility of the IA measurements of GSR. Measurements of GSR from test firings into goat hide were enhanced by staining the barium and lead components present on the skin sections with Alizarin Red S. The amount of GSR detected on the stained skin sections was compared with backscatter electron micrographs of the same sections. The differences were deemed to be insignificant when the variability in the repeated test firings were taken into consideration. Preliminary results indicated that the decreasing relationship between firing range and the amount of GSR deposited was non-linear, and that for firing ranges of up to 20 cm the amount of GSR deposited from repeated shots fired from the same distance was highly variable.     

‘What is to be done?’ Anticipating the future and mobilizing prudence

Various social and political factors often block the emergence of good ideas — e.g., the presence of an overbearing leader, the loquaciousness of some actors and the shyness of others, conventional and doctrinal thinking, the political climate, etc. — and devices have been invented to overcome some of these obstacles in decisionmaking settings: the Delphi technique, idea writing, and the nominal group technique are all front-end operations designed to encourage the blossoming of possible solutions to problems. Devices for generating ideas have not been helpful in coping with the volumes of ideas produced, however, and this had led some theorists to give up on the human mind as a solver of problems. Following a summary of the factors impeding rationality in decisional settings, the advantages of Q methodology are presented, and a case study is described in which Q, in conjunction with front-end operations, has been used to assist groups in clarifying their own perspectives and in gaining access to collective wisdom (political prudence) for purposes of problem solving.

(Aristotle,Metaphysics)

Revised from a paper read at a meeting of the Policy Sciences Annual Institute, School of Law, Yale University, October 16–18, 1992, and at a meeting of the International Society for the Scientific Study of Subjectivity, University of Missouri, Columbia, October 7–9, 1993. We are grateful for the helpful comments from reviewers for this journal.     

Competition and health care policy: experience and expectations

Since 1970 federal policymakers have tried to strengthen competition and incentive-based market forces as alternatives to regulation in containing health costs. The effort to stimulate the growth of health maintenance organizations (HMOs) throughout the country has had limited results, and federal plans to promote competition by enacting changes in the health insurance market have so far come to little. Coalitions in some localities have shown growing interest in flexible HMO variants, however, and the intellectual force of the HMO critique of mainstream practices remains strong. Moreover, the federal government has shown new interest in prospective reimbursement of hospitals--a proposal that draws from both HMOs--competition--and hospital rate-setting programs--regulation--the element of prospectivity.     

Environmental Commitment among the States: Integrating Alternative Approaches to State Environmental Policy

This article examines variation in state commitment to protectingthe natural environment. We contribute to theoretical and empiricalresearch in this area in two primary ways. First, our dependentvariable consists of a general measure of state commitment tothe environment. Second, we develop a causal model that integratessix major explanatory approaches to state environmental policy.Our results show that stales with liberal public opinion, strongenvironmental interest groups, liberal legislatures, and professionalizedlegislatures are the most committed to environmental protection.States' manufacturing interests and economic resources playa relatively minor role, and slates' environmental conditionsand the influence of the federal government play virtually norole in explaining variation in general state commitment toenvironmental protection.     

Teenage pregnancy and neonatal behavior: Effects in Puerto Rico and Florida

The purpose of this study was to examine the relationship between neonatal behavior and prenatal and perinatal risk factors in infants of teenage and older mothers in Puerto Rico and Mainland United States. The sample included approximately 300 newborn infants;half were examined in Puerto Rico, the other half in Florida, using the Brazelton Neonatal Behavioral Assessment Scale. Comparisons by maternal age and the number of obstetrical complications showed that for the Puerto Rican group, infants with fewer obstetrical complications were better able to regulate their crying and active states. Infants of teenage mothers with fewer complications had a higher level of arousal than infants of older mothers with fewer complications. Infant behavior in the Mainland sample did not vary by maternal age or complications. Multiple regression analysis indicated that the combination of biomedical variables significantly predicted neonatal behavior in both cultures. Mother's age was not separately correlated with neonatal behavior, but was repeatedly combined with other variables in the significant regressions. The findings suggest that infants of teenage mothers may differ from infants of older mothers, particularly in the organization of state behavior, and that the effects of maternal age on neonatal behavior are increased in the presence of biological outcome factors.This article is based on a final report to the NICHD Center for Population Research, Contract N01-HD-7283.Received Ph.D. from Michigan State University. Main research interests are determinants of neonatal and infant development, assessment of preterm and at risk infant.Received Ph.D. from Harvard University. Main research interests are sociocultural aspects of development, teenage pregnancy, infant temperament and psychophysiology.Received M.A. from University of Florida. Main research interests are prenatal and prenatal factors on development, maternal obstetric medication, and behavioral teratology.