The Role of Postmortem Cardiac Markers in the Diagnosis of Acute Myocardial Infarction*

Abstract: Sudden cardiac deaths because of acute myocardial infarction (MI) constitute a significant percentage of the caseload for death investigators, coroners, and forensic pathologists. Clinicians use cardiac markers, highly sensitive and specific for myocardial damage, to screen living patients for acute MI; however, to this point, the utility of these markers in the autopsy setting has not been fully established. The current study included 10 decedents, five who died of acute MI, and five subjects who died of noncardiac disease. Samples of pericardial fluid and blood from multiple sites were tested for creatine kinase, creatinine kinase MB, and troponin‐I. Three main conclusions were drawn: the levels of cardiac markers from all patients are significantly higher than the reference range for living patients, there are significant differences in cardiac marker levels between samples from different anatomic locations, and only three cardiac marker/anatomic site combinations were significantly different between the control and study groups.     

Defining sustainable development: environmental and investment perspectives and implications for administrative reform

The current catchphrase of “sustainable development” reflects two primary issues: increased concern with the environment and natural resource management, and heightened frustration with the meager staying power of many development investments once external support has ceased. Achieving and measuring sustainable benefits has been exceedingly difficult, however, and considerable confusion exists regarding the definitions and contexts in which the term is used. This paper outlines the similarities and differences between the environmental perspective and the development investment perspective, and discusses the lessons for administrative reform. The concept of development investment sustainability emphasizes that successful administrative reform must enhance the ability of the government to continually respond to change in the external environment. An important lesson from the environmentalists is that reforms must be approached in an integrative manner – all elements of the system must work together rather than in isolation for sustainable results.     

Directed Patrol for Preventing City Centre Street Violence in Sweden — A Hot Spot Policing Intervention

This study examines a hot spot policing intervention where private security guards patrolled a specific area in the city centre of a mid-sized Swedish town during summer weekend evenings and nights, aiming to reduce the number of reported street violence incidents. A follow-up of the intervention, using previous years as a control was conducted to measure changes in the number of street violence rates before and during the intervention. The results show non-significant decreases in the number of reported street violence incidents during the intervention. The results can be interpreted in at least two ways: that the intervention had no effects; or that the small, but non-significant decreases observed, are indeed small effects that can be strengthened by modifying the implementation of the intervention. An additional analysis shows that the changes in crime rates are larger at times when the guards adapted a stricter hot spot policing approach, which indicates that with a more structured implementation of the intervention it might be possible to see larger effects.     

International relations in China and Europe: the case for interregional dialogue in a hegemonic discipline

Abstract

The international relations (IR) discipline is known as an ‘American Social Science’ dominated by scholars and theories from the US core. This paper compares IR in two noncore settings, China and Europe. It shows that there is a growing institutional and intellectual integration into global Anglophone, mostly American, IR in both Europe and China. Both Chinese and European IR communities have established top Anglophone journals like the European Journal of International Relations and the Chinese Journal of International Politics to spearhead their integration into mainstream Anglophone IR and carve out a space for regional thinking. Yet, the analysis of their publication and citation patterns shows that IR outside the American core communicates through a hub-and-spokes system where there is always a connection to the American core but rarely very strong linkages to other peripheral regions. The two journals studied thus function as outlets for ‘local’ and American scholars, rely on ‘local’ and American sources, and there is very little integration and exchange between Chinese and European IR. Chinese and European IR would benefit from such a dialogue, especially regarding ‘schools’ of IR at the margins of an ‘American social science’.     

Entomological and Cardiologic Evidence of Time Since Death in Short Postmortem Intervals

Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78‐year‐old woman, found dead in a small forest with broad‐leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.     

Ancillary studies in amniotic fluid embolism: a case report and review of the literature

The incidence of amniotic fluid embolism during pregnancy is approximately 1/50,000 and has a mortality rate in excess of 80%. The postmortem diagnosis of amniotic fluid embolism can be challenging for forensic investigators and pathologists. At autopsy, usually signs of disseminated intravascular coagulation suggest an amniotic fluid embolism. A definitive diagnosis of amniotic fluid embolism cannot be made until ancillary studies are performed on the decedent's tissues. We report a case of a 37-year-old G3P2 white female who was 36 weeks gestation when her membranes spontaneously ruptured. She suddenly became breathless, went into cardiogenic shock, and died. The autopsy revealed gross and microscopic findings of amniotic fluid embolism, which was confirmed with ancillary studies consisting of special stains, immunohistochemistry, and a serum tryptase level. The authors hope this case report, including gross and microscopic autopsy findings with procedural and ancillary studies, and review of the literature will help investigators and pathologists in the diagnosis of amniotic fluid embolism.     

Youth violence in everyday life

What we now know about violence in the United States is that it is a common occurrence and recurrence for youth. Self-report methods have greatly enhanced our understanding of interpersonal violence. Specifically, from the 1980s to the present the age group most vulnerable to violence is youth. In addition, and in any given year, one third will physically fight with peers, more than one third physically fight with dating partners, and a majority of those who fight with either peers or partners will repeat this at least one more time.