The use of rapid diagnostic test of procalcitonin serum levels for the postmortem diagnosis of sepsis

Because serum Procalcitonin is reported to be a valid postmortem marker of sepsis, this prospective study was carried out to determine whether the semi-quantitative PCT-Q((R))-Test (B.R.A.H.M.S., Germany) is a reliable indicator of postmortem Procalcitonin (PCT) serum levels, thus enabling a quick "tableside" diagnosis of sepsis. Postmortem PCT-levels of 70 forensic and 78 clinical-pathological autopsy cases (n=148) were examined using the B.R.A.H.M.S-PCT-Q-Test during autopsy. 27 cases were categorized as the cases of sepsis according to the ACCP/SCCM Consensus Conference criteria. 121 cases were assigned to the non-sepsis group. Among the 148 cases, 18 samples could not be analyzed by the reason of strong hemolysis. Using a cut-off point of 2 ng/ml, 20 cases of sepsis were identified (true positive) whereas 3 cases of sepsis were not detected (false negative). In the non-sepsis group (107 cases) 6 cases showed a positive testing (false positive). When applied within 48 h postmortem, the PCT-Q-Test showed a sensitivity of 86.96% and a specificity of 94.39% (at cut-off 2 ng/ml). Likelihood ratios and positive predictive values proved to be lower in the forensic autopsy group (PPV: 59.3% in forensic case vs. 85.1% in clinicopathological cases; NPV: 98.73% in forensic cases vs. 95.2% in clinicopathological cases). The PPVs using a cut-off point of 10 ng/ml were 100% in both groups independent of sepsis prevalences. The results show, that a high NPV for prevalences ranging from 3% to 30% can be reached using a 2 ng/ml cut-off point, whereas a cut-off of 10 ng/ml ensures a high PPV for the respective prevalences in the absence of exclusion criteria. The study provides strong evidence that the introduction of rapid diagnostic test (RDTs) of postmortem PCT serum levels may be useful in achieving rapid distinction between sepsis and non-sepsis-related causes of death, especially in conjunction with the medical case history and further autopsy results. In addition, the use of RDTs enables clinicians to conduct an evidence-based validation of clinical diagnosis, thus facilitating future clinical decision-making.     

The New Public Management, Homeland Security, and the Politics of Civil Service Reform

This article examines the George W. Bush administration's efforts to apply New Public Management reforms to the Department of Homeland Security. The primary focus is the administration's attempt to implement the law. The managerial strategy that Department of Homeland Security and Office of Personnel Management executives used to carry out the law in the massive new department receives attention, with a special focus on the approach used in dealing with the federal courts. The article suggests five general lessons concerning civil service deregulation at the federal level. The case reaffirms the notion that successful administrative reform requires a keen appreciation for the politics that shape it.     

Political liberty and social development: An empirical investigation

Liberty is not only economic; it is political. Whether the economic system promotes social development is one question. Whether the political system promotes social development is another question. The empirical investigations indicate that for the world political liberty has a small, though significant relationship with the level of social development.By investigating groupings of alternative economic systems, it is clear that global policies to increase political liberty will not necessarily bring about desired results. In the Socialist, Mixed Socialist, and Capitalist-Statist countries political liberty appears to have virtually no relationship with social development. An increase in political liberty without an increase in economic liberty is even associated with lower levels of social development.     

Voting rules in insolvency law: a simple-game theoretic approach

A chief characteristic of modern insolvency law in Canada, Germany, the UK, and the US is the provision for ‘workouts’ or ‘schemes of arrangement’ by which insolvent companies can attempt to rehabilitate the business. If reorganization is chosen, the debtor has to devise a plan of action which will be voted upon by claimants. The voting rules, however, differ in each jurisdiction to a greater or lesser extent and as yet have not been analyzed in any rigorous manner. This paper provides an approach based upon the theory of simple games to analyze the rules in terms of the ease which each of these regimes can pass (or hinder) plans and how these rules distribute value among claimants. We pay particular attention to the role of classification and the effect of coalition formation.