Sudden cardiac death in young adults: environmental risk factors and genetic aspects of premature atherosclerosis

Familial hypercholesterolemia (FH) is a genetic disorder that may lead to premature coronary heart disease (CHD) and sudden cardiac death (SCD). Mutations in the LDLR or APOB genes cause FH. We have screened the LDLR and the ligand-binding region of APOB genes in 52 cases of SCD. Deceased patients were younger than 40 years of age and were suspected of having FH. The LDLR and APOB genes were examined via PCR, high-resolution melting, and DNA sequencing. Therein, it was observed that 7.7% of the screened patients exhibited a rare sequence variant in the LDLR gene, with 5.7% suspected of being pathogenic mutations. Lipid profiles and genetic testing for FH could be considered when autopsy reveals significant atherosclerosis of the coronary arteries in young adults. First-degree family members are advised to seek medical advice and testing to determine their own risks of atherosclerosis to prevent premature CHD and SCD.     

Toxicological and pathological findings in a series of buprenorphine related deaths. Possible risk factors for fatal outcome

Buprenorphine is considered to have little respiratory side effects at therapeutic doses and the partial agonistic properties should produce a "ceiling effect" for respiratory depression at higher doses. Still, there are several reports on buprenorphine related deaths. Most deaths involve drug users and the co-administration of other CNS depressant drugs as well as reduced tolerance have been suggested to be risk factors. The primary aims were to investigate if lack of tolerance and/or co-ingestion of other psychotropic drugs are significant risk factors in buprenorphine fatalities. From July 2005 to September 2009, all autopsy cases where buprenorphine or norbuprenorphine had been detected in femoral blood and where analysis of buprenorphine had been performed in urine were selected. Results from the postmortem examination and toxicology were compiled. Postmortem toxicology was performed using the routine methodology at the laboratory. In total, 97 subjects were included in the study. These were divided into four groups; Intoxication with buprenorphine (N=41), Possible intoxication with buprenorphine (N=24), Control cases where buprenorphine was not the cause of death (N=14), and Unclear (N=18). The metabolite to parent compound ratios in both blood and urine in the Intoxication group were significantly different from those in the Control and Unclear groups. An extensive poly-drug use was seen in all groups with several additional opioids in the Possible group (54%) and in the Unclear group (78%) and hypnotics or sedatives in more than 75% of the Intoxication, Possible, and Unclear cases. Illicit drugs were present in all groups but not to a great extent with amphetamine and tetrahydrocannabinol as the main findings. Interestingly, 4 cases in the Intoxication group presented with no other significant drugs in blood other than buprenorphine. We conclude that a lethal concentration of buprenorphine in blood cannot be defined. Instead the analysis of blood as well as urine can be an important tool to show that the drug was taken shortly before death and to rule out a continuous use of buprenorphine supporting the notion that abstinence is an important risk factor. The presence of alprazolam in more than 40% of the Intoxications and the presence of hypnotics and sedatives in 75% of the Intoxications suggests that these drugs interact with buprenorphine producing toxic effects that buprenorphine alone would not have produced. Still, in 10% of the Intoxications no other drugs were found indicating that under certain circumstances buprenorphine alone may produce respiratory depression resulting in death.     

Post-mortem stability and redistribution of carbohydrate-deficient transferrin (CDT)

Post-mortem diagnosis of chronic alcohol abuse is a challenge for forensic experts due to the lack of pathognomonic morphological findings and often also inadequate background information. Objective methods demonstrating chronic excessive alcohol consumption would therefore be a useful tool for forensic pathologists. In clinical practice, several markers of chronic alcohol abuse have recently been introduced, among which carbohydrate-deficient transferrin (CDT) is the most accepted, but the use of these markers in autopsy has not yet been established. We examined post-mortem stability and possible post-mortem redistribution of CDT and compared two analytical methods, capillary zone electrophoresis and high-performance liquid chromatography. According to our results, CDT remains stable for an appreciable time after death. The results further indicate that CDT is not subject to major post-mortem redistribution.     

Does the three-factor model of psychopathy identify a problematic subgroup of young offenders?

The present study tests the utility of the personality-based three-factor model of psychopathy according to the Hare Psychopathy Checklist: Screening Version (PCL:SV). This model of psychopathy excludes aspects of criminal behavior as opposed to other models of psychopathy. The main research question was to what extent the three-factor model of psychopathy can identify a problematic subgroup of young offenders. The sample consisted of 148 incarcerated young male criminal offenders, between 15 and 25 years of age (mean=19.07, SD=2.11) who were recruited from a central detention center for young offenders in a northern German county. Model-based cluster analysis of the three psychopathy factors showed that three different clusters labeled: (i) Unemotional/Impulsive-Irresponsible, (ii) Low traits, and (iii) Psychopathic personality, had the best fit to the data. The psychopathic personality cluster with high scores on all three factors of the PCL:SV exhibited, as expected, a significantly higher prevalence of conduct disorder and substance use problems, but was not significantly different from the other clusters on past criminality and previous incarcerations. In conclusion, the results showed that the three-factor model of psychopathy can be useful in identifying a problematic subgroup of young offenders.     

Converging Markets

The crucible in this scenario for the international climate regime is the emergence of an effective and liquid international carbon market with participation of private entities. In order to make the carbon market effective a bilateral negotiation track will develop, operating in parallel with the multilateral track under the UNFCCC. The purpose of the bilateral track is to integrate the various emissions trading schemes involving private actors. This bilateral track feeds into the UNFCCC negotiations, which still represents the main arena for the international climate negotiations. Through the bilateral, bottom-up negotiations, a multistage system develops, with differentiated rights and duties, complemented by a package of coordinated support mechanisms. The advantages of such a bottom-up approach prove to be, inter alia, fewer negotiating parties, new negotiation arenas, and a new set of selective incentives. The result is a continuously evolving agreement with the potential to gradually broaden participation and deepen the reduction commitments of the international climate regime. Moreover, the bilateral agreements for linking schemes with private actors also represent a fallback in the event of a collapse in the multilateral negotiations.The article has been written by funding from the Central Research Institute for the Electric Power Industry in Tokyo and the Norwegian Ministry of Foreign Affairs. It also represents an output of research financed by the Research Council of Norway, project no. 144768/520. The authors thank all three institutions for the funding, as well as the many participants at the workshops where the ideas in the paper have been presented. Their criticism and suggestions have been very stimulating, indeed.     

THE CRISIS IN DOMESTIC LAW

The author proposes some measures for dealing with unmarried parents, who in all Western countries form an ever-increasing percentage of parents. The author suggests the adoption of an administrative system similar to the one used in Scandinavian countries for the dissolution of marriage and traces the excessive costs of the family law system in other countries to the insistence that divorce be granted by court order.     

The Impact of Economic Performance on Electoral Support in Sweden, 1967–1978*

This article investigates the impact of macroeconomic conditions on aggregate political support for governing parties in Sweden over the period 1967–1978. After reviewing survey evidence on the relative salience of economic and fiscal issues to the Swedish electorate, a novel, dynamic model of political support is presented. The model incorporates the ideas that voters evaluate economic performance relatively rather than absolutely, and that governments' mass political support is based on their cumulative performance records. The empirical results supply estimates of the impact of unemployment, inflation, the real income growth rate and the income effects of direct tax and transfer policies on political support. The evidence suggests that the responses of political support to reasonable movements in macroeconomic conditions are large enough to give economic management a pivotal role in electoral shifts.     

‘Nothing but Survival?’ On David Easton's Concept of Political Persistence

How do you catch the fish you are after in a text-analysis, and what are the effects of your world-view upon your abilities to fish? Although the analytic positivists can indeed help us to answer these questions, their world-view has nevertheless functioned as a constraint upon the development of political theory by ignoring (more or less) the methods of the understanding traditions. Because, if you fail to understand the complex of problems in a given text-system, you are also in danger of analysing and criticizing nothing but your own misunderstandings - of kidding no-one but yourself. In the case of David Easton's concept of political persistence, such analytic misunderstandings have helped to produce a one-dimensional picture of the systems model, which, however, can be dissolved by uniting world-view, metascience, and science of respectively the analysts and the interpreters within the framework of the critical traditions.