Laboratory investigation of deaths due to anaphylaxis.

To establish a useful laboratory protocol to investigate possible cases of fatal anaphylaxis, we measured mast-cell-derived tryptase levels and allergen-specific immunoglobulin E (IgE) antibody levels in sera obtained prior to or within 24 h after death from 19 anaphylaxis victims. Elevated serum tryptase levels (range = 12 ng/mL to 150 micrograms/mL) were found in nine of nine Hymenoptera sting fatalities, six of eight food-induced fatalities, and two of two reactions to diagnostic therapeutic agents. Tryptase levels were normal (less than 10 ng/mL) in 57 sequential sera obtained postmortem from six control patients. Tryptase could not be measured in pleural or pericardial fluids for technical reasons. Serum IgE antibodies were elevated in five of the nine Hymenoptera sting fatalities and in eight of the eight fatal food reactions; assays were unavailable for the two diagnostic/therapeutic agents. If elevated, the victim's serum IgE antibodies to food could be used to identify allergens in uneaten portions of foods consumed shortly before the anaphylactic event. IgE antibodies were moderately stable during storage in a variety of anticoagulants at room temperature for up to 11 weeks. Elevated mast-cell-derived tryptase levels in postmortem sera reflect antemortem mast cell activation and may be used as a marker for fatal anaphylaxis. If assays are available for IgE antibodies to relevant allergens, such assays provide evidence for antemortem sensitization; these assays may be modified to identify allergens in foods consumed by victims of food-induced anaphylaxis.     

A qualitative investigation into the U.S. Department of Agriculture 18‐item Household Food Security Survey Module: Variations in interpretation,understanding and report by gender

Food insecurity, or limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways, affects more than 10% of Americans. The U.S. Department of Agriculture's 18‐item Household Food Security Survey Module (HFSSM) is the most common measure used in the United States to assess food insecurity. This measure is to be completed by one adult who reports on the severity of disruptions in the quality and quantity of the household food supply. Recent work suggests that men and women might respond differently to some of the items in this measure. Therefore, the aim of the current study was to further explore how men and women interpret each of the items and specific concepts in this measure. Pairs (n = 25) of low‐income and food‐insecure mothers and fathers of children aged 2.5–10 years participated in one‐on‐one interviews to answer the HFSSM questions using the think‐aloud method. The data were analyzed using basic inductive qualitative methods, and the findings suggest that gender is related to interpretation of key concepts relevant to food insecurity including “household,” “balanced meal,” and “worry.” These findings have policy implications for the use of this measure as a national benchmark of food insecurity such as the potential need for an additional, complementary instrument to include several male reference questions with different terminology.     

The fiduciary duties of healthcare directors in the "zone of insolvency"

Directors of healthcare organizations normally owe fiduciary duties to their shareholders or, in the case of nonprofits, to the charitable mission of the organization. As an organization descends to bankruptcy, however, the board's duties may shift. At some point, the board may be imposed with different and often conflicting obligations to the corporate enterprise as a whole, with a primary criterion being the interests of creditors. In this article, the authors analyze the murky areas of the Zone and give guidance as to when the board's duty may shift-and as to how directors should proceed both in determining their duties and in working to fulfill them.     

Bioethical and legal considerations in increasing the supply of transplantable organs: from UAGA to "Baby Fae"

In the last 35 years, organ transplant technology has advanced greatly. The major problem associated with organ transplantation is organ availability, and not surgery-related mortality. This article examines current organ procurement procedures and technologies, legislative responses to the scarcity of transplantable organs, as well as the psychological barriers to organ donation. Issues of fairness in the allocation of scarce economic and social resources, the role of religion and ethics in organ donation and transplantation decision, and the impact of the media are also considered.     

Music Preferences,Personality Style,and Developmental Issues of Adolescents

The purpose of this study was to examine the personality characteristics and developmental issues of 3 groups of adolescent music listeners: those preferring light qualities of music, those preferring heavy qualities of music, and those who had eclectic preferences for music qualities. One hundred sixty-four adolescents completed an age-appropriate personality inventory and a systematic measure of music listening preference. The findings indicate that each of the 3 music preference groups is inclined to demonstrate a unique profile of personality dimensions and developmental issues. Those preferring heavy or light music qualities indicated at least moderate difficulty in negotiating several distinct domains of personality and/or developmental issues; those with more eclectic music preferences did not indicate similar difficulty. Thus, there was considerable support for the general hypothesis that adolescents prefer listening to music that reflects specific personalities and the developmental issues with which they are dealing.     

Sudden death in a patient with Von Recklinghausen's neurofibromatosis

Sudden death caused by tumors is uncommon. Death attributable to an unsuspected primary intracranial neoplasm is especially rare. An undiagnosed brain tumor is particularly unusual in a patient with Von Recklinghausen's neurofibromatosis (NF). A young man with known NF, with no manifest central nervous system involvement, died less than 24 hours after plastic surgery. A glioblastoma multiforme was discovered at autopsy.