Sickle cell trait-associated deaths: a case series with a review of the literature

This study presents a series of 16 carriers of hemoglobin S (HbS) who died during various circumstances. Many of the cases were associated with mild to moderate exertion. The onset and/or duration of symptoms varied from a few minutes to several hours with many displaying a prolonged lucid interval with stable vital signs. Despite seeking medical treatment, sickle cell trait-related micro-occlusive crisis was never considered in the differential diagnosis. Several cases were associated with sudden death. In those deaths which were delayed, high anion gap and uncompensated metabolic acidosis were typical and were not heat related. Also characteristic were large increases in creatine kinase, alanine aminotransferase, and aspartate aminotransferase along with myoglobinemia. Although the antemortem diagnosis of rhabdomyolysis was made, the underlying cause was never deduced by the clinicians. The sickling found at autopsy is not always a postmortem artifact, and in the right circumstances can be diagnostic.     

People must change before institutions can: a model addressing the challenge from administering to managing the maltese public service

The Maltese public service is currently undergoing major organisational changes to enhance its efficiency and effectiveness in its service delivery. The great majority of these changes have focussed on re‐organising the macro‐level, namely strategy, processes and structures. This is not an easy feat as local external power forces leave their impact in the process. It is argued, however, that one way to circumvent these resisting forces is to empower the real agents of change: the administrators of the public service. For some reason, the micro‐level has been neglected and has been generally absent from the agenda of the major change programme with a few exceptions. This article throws light on this level by proposing an intrapersonal, psychological and pedagogical model for change that may complement and accompany the larger macro changes. The authors suggest that the model can be developed in a practical way to motivate change from within the person and not just push change around the person. Copyright © 2005 John Wiley & Sons, Ltd.     

Assessing Readiness to Change among Perpetrators of Intimate Partner Violence: Analysis of Two Self-report Measures

Recent interest in the construct of motivation to change among male perpetrators of intimate partner violence (IPV) has led to development of two self-report measures of this construct: the University of Rhode Island Change Assessment for Domestic Violence (URICA-DV; Levesque et al. 2000) and the Safe at Home Inventory (SAH; Begun et al. 2003). We examined the internal structure of these instruments using confirmatory and exploratory factor analyses in a sample of 199 male IPV perpetrators waiting to begin court-mandated batterer intervention programs. Results indicated that the scales had adequate internal consistency. However, using confirmatory factor analyses, the hypothesized structural models of each instrument fit the data poorly. Subsequent models suggested by a series of exploratory factor analyses failed to improve model fit substantially for both scales. For the URICA-DV, a 3-factor model including items from the Precontemplation, Contemplation, and Action subscales fit the data adequately. No acceptable model fit could be found for the SAH. Intercorrelations among similar subscales across the two inventories suggested only a modest degree of intercorrelation (r’s = 0.16–0.52), and a factor structure more dependent on scale of origin than item latent content, suggesting that the scales assess different facets of the readiness to change construct. These results suggest that before the stages of change construct can be fully applied to the IPV area, more research and evaluation are needed on how to accurately assess abuser readiness to change.     

Inequality,democracy and taxation: Lessons from the post-communist transition

Using data for the period 1989 – 2002, we examine the determinants of income inequality in post-communist economies. We find a strong positive association between equality and tax collection but note that this relationship is significantly stronger under authoritarian regimes than under democracies. We also discover that countries introducing sustainable democratic institutions early are characterised by lower inequality. We also confirm that education fosters equality and find that larger countries are prone to higher levels of inequality.