Etiology of pulmonary thromboembolism in the absence of commonly recognized risk factors

Pulmonary thromboembolism is an often fatal complication of venous thrombosis. Any component or combination of the components composing Virchow's triad (venostasis, hypercoagulability, and endothelial damage) increases the propensity for a thrombophilic state. Hypercoagulable states may be inherited or acquired. While the etiology in many cases may be evident either on physical examination or on evaluation of the decedent's medical history, this is often not the case. We conducted a retrospective study of cases presenting to the Jefferson County Coroner/Medical Examiner's Office in Birmingham, Alabama, who were given a diagnosis of pulmonary embolism. A search of cases within the past 23 years yielded 81 cases. An underlying cause was determined in 70 cases (86%). The remaining 11 (14%) cases had no identifiable cause. We believe that a number of these cases may represent an underlying thrombophilic disorder. Since these disorders may be of an inherited or acquired nature, the determination of an etiology may be relevant to the decedent's family. Postmortem blood analyses may in selected cases be useful and appropriate for the detection of some of these disorders. However, such analyses are not practical in all cases, with each case having to be evaluated on its own merits.     

Terrorist Decision Making and the Deterrence Problem

An ongoing debate among policymakers and terrorism scholars concerns the effectiveness of deterrence as a counterterrorism tool. Absent from the debate is a discussion of the complex nature of terrorist decision making. Decisions are made at varying levels in a terrorist organization, often by actors having different motives, resulting in behavior that is not always fully rational. This article identifies several circumstances when terrorist behavior is not the product of an entirely unitary, rational decision-making process, and therefore highlights when deterrence policies will be least effective. It concludes with some policy implications for understanding when deterrence policies are most likely to succeed and how to address terrorism in other situations.