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.     

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.     

Special report on patient care. HCFA finally issues patient-dumping regulations

EMTALA has always been an especially worrisome law for providers because its requirements are both sweeping and vague, with potentially drastic penalties for violations. The new regulations remove only some of the law's vagueness. As with previous EMTALA amendments, all United States hospitals, as well as emergency department physicians and other doctors who see patients in the emergency department, should carefully review their internal policies regarding patient ++ transfers in light of the new regulations. For example, hospitals must have an internal policy for following up on suspicious transfers, as failure to detect an inappropriate transfer can now potentially result in a Medicare decertification action. Also, hospitals with specialized services (e.g., burn units or shock-trauma units) should review their policies on receiving transfer patients in light of the greater specificity of the new regulations. Finally, because of the confusing new requirements regarding ambulance services, all hospitals should review their relationships with and policies regarding, ambulance services and ambulance diversion.     

Differences in perceived seriousness of overt and covert road traffic offenses

Attitudes towards the perceived seriousness of road traffic offenses were studied as a function of the age and sex of drivers. Ratings of seriousness of 31 verbalized offenses were analyzed using detection theory parameters to study sensitivity and bias effects in the discrimination of “overt” and “covert” offenses. Overt offenses were defined as those which are immediately obvious to a casual observer, such as jumping red traffic lights. Covert offenses are those not so easily observable, such as driving a defective vehicle. The latter are inherently more hazardous, because they do not allow other road users to adopt appropriate margins of safety. The results indicated that young male drivers were relatively insensitive in discriminating between overt and covert offenses compared with other subgroups of drivers tested. Instructions which directed drivers to judge the offenses from the standpoints of personal responsibility, or involvement in, or the social consequences of, any accidental outcome, increased sensitivity relative to no such instructions being given. Analysis of the rating data itself showed that, overall, overtly offensive driving was considered less serious than covertly offensive driving. This was particularly the case for male and younger drivers. Possible implications of the results for legal sanctioning and other accident countermeasures are discussed.     

Assessing Integrity Systems: Introduction to the Symposium

The following Symposium on Australia's national integrity systems, drawn from an Australian Research Council‐funded project conducted in 2002‐2004 by researchers from Griffith University, Charles Sturt University, University of Sydney, RMIT University, Monash University and the Australian National University, together with Transparency International Australia. The first three papers examine the public integrity regimes at federal, state (NSW) and local levels. The remaining four papers develop three themes as a framework for assessing strengths and weaknesses in Australia's major integrity regimes: consequences, capacity and coherence. The papers were originally presented in sessions of the Australasian Political Studies Association (University of Adelaide, September 2004) and the 5th National Investigation Symposium (NSW Ombudsman, Independent Commission Against Corruption and Institute of Public Administration Australia NSW, Sydney, November 2004).     

From Greek Temple to Bird's Nest: Towards A Theory of Coherence and Mutual Accountability for National Integrity Systems

Since the 1990s, recognition has grown that the answer to corruption–political, bureaucratic or corporate–does not lie in a single institution, let alone a single law. Rather the institutionalisation of integrity through a number of agencies, laws, practices and ethical codes is increasingly recognised as the best option for limiting corruption in many societies. This article addresses the key issue of coherence between these various institutions, picking up on the third and final theme of the Australian national integrity system assessment. The assessment has shown, firstly, that concepts of ‘horizontal’ or ‘mutual’ accountability are important but also need to be developed and better contextualised as a framework for designing integrity systems; secondly, that integrity system coherence can be usefully measured and mapped using standard network analysis approaches, helping more clearly identify the need for more deliberate strategies for coordination of integrity policies; and thirdly, that new metaphors can and should be developed for communicating the nature and significance of the institutional interactions that constitute integrity systems. The new metaphor suggested here is that of a bird's nest, in which a multitude of often weak institutions and relationships can combine to more effectively protect and promote the fragile goal of public integrity.     

‘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.