Trophoblastic microemboli as a marker for preeclampsia-eclampsia in sudden unexpected maternal death: a case report and review of the literature

The authors report the case of a 25-year-old white woman at 7 months' gestation who died suddenly and unexpectedly at home. Anatomic findings at autopsy included a tongue contusion, glomerulonephritis, changes indicative of systemic hypertension, and trophoblastic microemboli in the lungs. Review of the prenatal care record disclosed 3+ proteinuria 2 days before death. The features of the postmortem examination were consistent with clinically undiagnosed preeclampsia-eclampsia and glomerulonephritis. The authors discuss the rarity of fatal preeclampsia-eclampsia, the contribution of concomitant glomerulonephritis, and the significance of trophoblastic microemboli in the lungs.     

Lessons learned from large-scale comparative dental analysis following the South Asian tsunami of 2004

The aim of this study was to examine the quality of the ante-(AM) and postmortem (PM) dental data that were submitted for entry into the PLASS data system in Phuket, Thailand, following the Boxing Day (December 26) Tsunami, 2004. The investigators were two forensic odontologists who were part of the New Zealand Disaster Victim Identification team that worked at Wat Yang Yao morgue and at the Information Management Center in Phuket. Our findings underline the usefulness of dental data in human identification, but point to a number of significant sources of error. Of the 78 PM records received, only 68% of radiographs and 49% of photos confirmed the accompanying dental charting. This underlines the value, particularly of photographs of the dental arches, in quality control. It also points to a large error component, which may have been due to inexperience of the operators, fatigue, poor conditions in the temporary morgue, or the problem of tooth-colored fillings. Of the 106 AM records received, 62% were of unacceptable quality and 64% were either not accompanied by radiographs or had poor quality radiographs. These results indicate that AM data collection ideally needs to be collated and checked by a forensically trained dentist(s) in the country of origin.     

Combating child homicide: preventive policing for the new millennium

High-profile media coverage of crimes against children has heightened public awareness of critical child safety needs and issues. However, numerous research studies in the area of child homicide have illustrated the importance of the power of science to correct false perceptions and misinformation, improving how to best serve and protect our children. Age-based analyses of childhood crime patterns have vastly improved how law enforcement and social service practitioners identify, investigate, and resolve child victimization cases. Future protective efforts must involve multiagency and multidisciplinary collaboration. Law enforcement, social service clinicians, educators, and academicians should jointly develop and implement pragmatic and effective prevention, detection, and resolution programs and policies.     

Not Just Steering but Weaving: Relevant Knowledge and the Craft of Building Policy Capacity and Coherence

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Parents' Achievement Goals and Perfectionism in Their Academically Talented Children

Parents of academically talented students have been accused of pushing their children to attain high levels of achievement, as well as fostering performance anxiety and perfectionism in their children. Parents' achievement goals for their children, in terms of the focus on high performance or learning for understanding, were examined in relation to children's perfectionism. Parents (127 sets) and their sixth-grade academically talented children (56% boys) completed the Multidimensional Perfectionism Scale and parents reported their achievement goals for their children. Most parents reported learning goals, suggesting that emphasis on meeting external standards is not predominant among parents of talented students. Children of performance goal parents were significantly more likely to exhibit dysfunctional perfectionism than children of learning goal parents, reporting a combination of high concern about mistakes, doubts about actions, parental expectations, and parental criticism. Parents' achievement goals can help predict which students might be at risk for adjustment problems and future underachievement.     

Promise and peril

The size of the federal budget tells only one part of the tale of government's presence in the market economy. The enormous amounts of non-tax dollars government requires to be spent on regulation – estimated at $647 billion per year – powerfully argue for some sort of regulatory scorekeeping. Regulatory costs are equivalent to over one-third of the level of government spending. A regulatory budget can be an effective tool both for spurring reform and monitoring regulatory activity.At bottom, today's rulemaking process is plagued by the fact that agency bureaucrats are not accountable to voters. And Congress – though responsible for the underlying statutes that usually propel those unanswerable agencies – nevertheless can conveniently blame agencies for regulatory excesses. Indeed, Americans live under a regime of Regulation Without Representation.A regulatory budget could promote greater accountability by limiting the regulatory costs agencies could impose on the private sector. Congress could either specify a limit on compliance costs for each newly enacted law or reauthorization of existing law, or Congress could enact a more ambitious full-scale budget paralleling the fiscal budget, a riskier approach. A comprehensive budget would require Congress to divide to a total budget among agencies. Agencies' responsibility would be to rank hazards serially, from most to least severe, and address them within their budget constraint. In either version of a regulatory budget, any agency desiring to exceed its budget would need to seek congressional approval.Regulatory costs imposed on the private sector by federal agencies can never be precisely measured, and a budget cannot achieve absolute precision. Nonetheless, a regulatory budget is a valuable tool. The real innovation of regulatory budgeting is its potential to impose the consequences of regulatory decisionmaking on agencies rather than on the regulated parties alone. Agencies that today rarely admit a rule provides negligible benefit would be forced to compete for the right to regulate. While agencies would be free to regulate as unwisely as they do now, the consequences could be transfer of the squandered budgetary allocation to a rival agency that saves more lives.Budgeting could fundamentally change incentives. Under a budget, adopting a costly, but marginally beneficial, regulation will suddenly be irrational. Congress would weigh an agency's claimed benefits against alternative means of protecting public health and safety, giving agencies incentives to compete and expose one another's bogus benefits. Budgeting could encourage greater recognition of the fact that some risks are far more remote than those we undertake daily. In the long run, a regulatory budget would force agencies to compete with one another on the most important bottom line of all: that their least-effective rules save more lives per dollar spent (or correct some alleged market imperfection better) than those of other agencies.There are clear benefits to regulatory budgeting, but there are also pitfalls. For instance, under a budget, agencies have incentives to underestimate compliance costs while regulated parties have the opposite incentive. Self-correcting techniques that may force opposing cost calculations to converge are only at the thought- experiment stage. However, limitations on the delegation of regulatory power and enhancing congressional accountability can help.Certain principles and antecedents can help ensure that a regulatory budgeting effort succeeds. Explicitly recognizing that an agency's basic impulse is to overstate the benefits of its activities, a budget would relieve agencies of benefit calculation responsibilities altogether. Agencies would concentrate on properly assessing only the costs of their initiatives. Since an agency must try to maximize benefits within its budget constraint or risk losing its budget allocation, it would be rational for agencies to monitor benefits, but Congress need not require it.Other ways to promote the success of a budget are to: establish an incremental rather than total budget; collect and summarize annual report card data on the numbers of regulations in each agency; establish a regulatory cost freeze; implement a Regulatory Reduction Commission; employ separate budgets for economic and environmental/social regulation; and control indirect costs by limiting the regulatory methods that most often generate them.A regulatory budget is not a magic device alone capable of reducing the current $647 billion regulatory burden. Yet a cautious one deserve consideration. Having good information is an aid in grappling with the regulatory state just as compiling the federal fiscal budget is indispensable to any effort to plan and control government spending.     

Sexual risk behavior,knowledge, and condom use among adolescents in juvenile detention

This paper reports on sexual behavior, knowledge of sexually transmitted diseases (including AIDS) and condoms, and condom use among African-American and white incarcerated adolescents in Seattle, Washington. One hundred nineteen adolescents in a juvenile detention facility completed questionnaires that assessed their lifetime and recent sexual behaviors, an objective test of disease and condom knowledge, attitudes and norms regarding condom use with steady and casual partners, prior condom use, and intentions to use condoms. The results indicate that these adolescents are at high risk by a number of indicators: They have a high average number of partners, have unprotected vaginal and anal sex, and many have sex with known or suspected drug users. Their overall knowledge of condoms and sexual transmitted diseases risks is high, but high knowledge is not correlated with positive attitudes; for one attitude measure, high knowledge is significantly correlated with negative attitudes toward condom use. These findings suggest that programs designed solely to increase knowledge are unlikely to effect behavior change.This research presented in this paper was supported by a research grant from the National Institute of Allergy and Infectious Diseases.Received Ph.D. in social psychology from the University of Washington. Research interests are in sexual decision making and attitude-behavior relationships.Received Ph.D. in educational psychology from the University of Washington. Research interests are in sexual behavior and health.Received Ph.D. in sociology from the University of Washington. Research interests are in problem behaviors of adolescence.