Rape or Homicide: Which Is Worse?

Some people believe rape is just as serious as homicide, or more serious, contrary to law. We examined the prevalence of this belief and whether it reflects an individual's political ideology and moral foundations. Analyses were based on a national YouGov survey of 1,125 US adults gathered in 2021. We found that only 26% of respondents believed rape was less serious than homicide. Most (61%) believed rape and homicide were equally serious, while 13% believed rape was more serious. Social progressives (particularly progressive women) were more likely than social conservatives to view rape as more serious or just as serious as homicide. However, this tendency was partially offset by the tendency of social progressives to view harm as a key factor in judging the morality of a behavior. We suggest that social progressives view rape more seriously than social conservatives because of their concern for gender inequality, but this concern is partially offset by their concern with harm.

Oral Albuterol Treatment in Three Pediatric Patients with Bradycardia: A Novel Therapy.

Clinically significant bradycardia is an uncommon problem in children, but one that can cause significant morbidity and sometimes necessitates implantation of a pacemaker. The most common causes of bradycardia are complete heart block (CHB), which can be congenital or acquired, and sinus node dysfunction, which is rare in children with structurally normal hearts. Pacemaker is indicated as therapy for the majority of children with CHB, and while early mortality is lower in postnatally diagnosed CHB than in fetal CHB, it is still up to 16%. In young children, less invasive transvenous pacemaker systems can be technically challenging to place and carry a high risk of complications, often necessitating surgical epicardial pacemaker placement, which usually entails a median sternotomy. We report three cases of pediatric patients referred for pacemaker implantation for different types of bradycardia, treated at our institution with oral albuterol with therapeutic results that avoided the need for surgical pacemaker implantation at that time.

Do moral intuitions influence judges' sentencing decisions? A multilevel study of criminal court sentencing in Pennsylvania.

The influence of judges' personal moral values on their sentencing decisions is of longstanding interest to researchers and the public. Few studies, however, have examined this influence empirically. Using a unique data set that combines a survey of 81 criminal court judges with archival data on their 40,385 criminal sentences over a 2-year period, and drawing on Moral Foundations Theory, we hypothesize that judges with strong care and fairness intuitions will sentence defendants less severely while judges with strong loyalty, authority, and sanctity intuitions will sentence defendants more severely. We further hypothesize that these effects will be heightened when the defendant is from a racial minority group. Results show that sentencing outcomes are largely independent of judges' moral intuitions, except that fairness intuitions tend to increase leniency, especially when the defendant is Black, and sanctity intuitions tend to decrease leniency. Implications for future research on sentencing are discussed.

Long-Term Follow-Up of Second-Degree Heart Block in Children.

Little is known about the outcomes of children with second-degree heart block. We aimed to determine whether children with structurally normal hearts and Mobitz 1, 2:1 block or Mobitz 2 are at increased risk for progressing to complete heart block (CHB) or requiring a pacemaker (PM) at long-term follow-up. We searched our institutional electrophysiology database for children with potentially concerning second-degree block on ambulatory rhythm monitoring between 2009 and 2021, defined as frequent episodes of Mobitz 1 or 2:1 block, episodes of Mobitz 1 or 2:1 block with additional evidence of conduction disease (i.e. first-degree heart block, bundle branch block), or episodes of Mobitz 2. Ambulatory rhythm monitor, ECG, and demographic data were reviewed. The primary composite outcome was CHB on follow-up rhythm monitor or PM placement. 20 patients were in the final analysis. Six (30%) patients either developed CHB but do not have a PM (4 = 20%) or have a PM (2 = 10%). Median follow-up was 5.8 years (IQR 4.4-7.0). Patients with CHB or PM were more likely to have second-degree block at maximum sinus rate (67% vs. 0%, p = 0.003), a below normal average heart rate (67% vs. 14%, p = 0.04), and 2:1 block on initial ECG (50% vs. 0%, p = 0.02). In this study of children with potentially concerning second-degree block, 30% of patients progressed to CHB or required a PM. Second-degree block at maximum sinus rate, a low average heart, and 2:1 block on initial ECG were associated with increased risk of disease progression.

Assessing the utility of atrial fibrillation induction to risk stratify children with Wolff-Parkinson-White syndrome.

BACKGROUND: Wolff-Parkinson-White syndrome is associated with sudden cardiac death from rapid conduction through the accessory pathway in atrial fibrillation. Adult patients are at higher risk for sudden cardiac death if the shortest-pre-excited-RR-interval in atrial fibrillation (SPERRI) is ≤250 milliseconds (msec) during electrophysiologic study. Exclusive conduction through the atrioventricular node in atrial fibrillation is presumed to convey lower risk. The shortest-pre-excited-paced-cycle-length with atrial pacing has also served as a marker for risk stratification. OBJECTIVE: To determine accessory pathway characteristic of patients undergoing induction of atrial fibrillation during electrophysiologic study. METHODS: We reviewed 321 pediatric patients that underwent electrophysiologic study between 2010 and 2019. Induction of atrial fibrillation was attempted on patients while on isoproterenol and SPERRI was measured if atrial fibrillation was induced. Shortest-pre-excited-paced-cycle-length (SPPCL) was determined while on isoproterenol. RESULTS: Atrial fibrillation was induced in 233 (73%) patients. Of those, 104 (45%) patients conducted exclusively through the atrioventricular node during atrial fibrillation (Group A). The remaining 129 (55%) patients had some conduction through the accessory pathway (Group B). In Group A, SPPCL was 260 msec with 48 (46%) conducting through the accessory pathway at ≤250 msec. In Group B, SPPCL was 240 msec with 92 patients (71%) conducting at ≤250 msec (p < 0.05). In Group B, SPERRI was 250 msec and had a positive correlation with SPPCL (p < 0.001, R2 = 0.28). Almost half (46%) of those with exclusive conduction through the atrioventricular node in atrial fibrillation had rapid accessory pathway conduction with atrial pacing. CONCLUSION: Conduction in atrial fibrillation during electrophysiologic study on isoproterenol via the atrioventricular node may not exclude high-risk accessory pathways in pediatric patients.

For whom is patriotism blind? Examining the roles of moral intuitions and system justification.

Patriotism defines one's attachment and identification to a broad political community. We examine how levels of patriotism are shaped by beliefs about the fairness of institutions, termed system justification, and people's moral intuitions. Using data from a 2021 YouGov survey, we find that system justification and "binding" moral intuitions that prioritize the cohesion of social groups both lead to greater patriotism. Notably, we found a moderating effect of moral intuitions on system justification. Strong binding intuitions reduced the effect of system justification, indicative of blind patriotism, where some people are patriotic even if they perceive the system as unfair. Strong "individualizing" intuitions, which prioritize fairness and protection from harm, increased the effect of system justification. This is consistent with the notion of constructive patriotism, where patriotism among people with strong individualizing intuitions is affected by whether they believe the country is living up to its fairness ideals. We extend prior research on patriotism and system justification by showing the vitally important way that moral intuitions moderate the effects of system justification.

Moral Reactions to Sexual Relationships that Violate Age Norms.

We examined whether Moral Foundations Theory helps explain Americans' reactions to violations of age-related sexual norms. Attitudes toward sexual relationships between two adolescents, an adolescent and a young adult, and two adults of highly discrepant ages were obtained from a nationally representative sample of 1,117 adults in the United States. The sex of the older person was manipulated in the age-discrepant scenarios. We found that respondents for whom purity was an important value were generally more likely to be bothered by these sexual activities. The reaction to sexual relationships between adolescent girls and young men was an exception. For this type of relationship, the negative reaction was related to the fairness foundation, suggesting that respondents thought the relationship involved exploitation. Reactions to violations of age norms were unrelated to whether respondents had a strong harm foundation, suggesting that their reactions were not motivated by concern that such relationships are harmful to participants. Finally, we found that male respondents were less likely to react negatively to age violations than female respondents, particularly when the sexual relationship involved an adolescent boy and a young woman.

Moral intuitions and attitudes towards affirmative action in college admissions.

Affirmative action has long been a contentious issue in the United States. Using data from a 2021 national YouGov sample of 1125 U.S. adults, we are the first to examine the effect of moral intuitions on people's support for affirmative action in college admissions. We find that those with strong individualizing moral intuitions-a heightened general concern with avoiding harm and mistreatment of people-are more likely to support affirmative action. We find that its effect is mediated in large part by beliefs in the extent of systemic racism, as those with strong individualizing moral intuitions are more likely to also believe that systemic racism is pervasive, and also partly by low levels of racial resentment. Conversely, those with strong binding moral intuitions-a heightened concern with the cohesion of social groups-are less likely to support affirmative action. This effect is also mediated by belief in the extent of systemic racism and racial resentment, as those with strong binding moral intuitions are more likely to believe both that the system is fair and have higher levels of racial resentment. Our study suggests that future work should consider the role of moral intuitions in shaping people's views of contentious social policies.

Comparison of AliveCor KardiaMobile Six-Lead ECG with Standard ECG in Pediatric Patients.

The AliveCor KardiaMobile (ACKM) is a remote electrocardiogram (ECG) monitoring device. Little research has been conducted on its accuracy with pediatric patients. This prospective study aims to compare the ACKM six-lead device with a standard fifteen-lead ECG in measuring the QTc, QRS, and axis in pediatric patients. Pediatric patients ages 5 to 21 years were enrolled prospectively to have their ECG recorded using an ACKM six-lead device following a recording with the standard 15-lead ECG. A pediatric electrophysiologist measured the QTc, QRS interval, and QRS axis for both ECGs. Bland-Altman analysis was performed to assess agreement among measurements. The study included 141 patients. The mean age was 12.3 ± 4.4 years. Average heart rate was 79 ± 16 bpm. The mean difference in the QTc measurements for a paired standard ECG and ACKM was - 0.6 ms [95% confidence interval - 48 to 47 ms]. Of the ACKM QTc measurements, 117 (83%) were within 30 ms of the standard ECG. The mean difference in paired QRS measurements was - 1.3 ms [95% confidence interval - 23 to 21 ms]. Of the ACKM QRS measurements, 134 (95%) were within 20 ms of the standard ECG. The measured axis was the same for 84% of ACKM and standard ECGs. Over 80% of the ACKM six-lead ECGs produced QTc, QRS, and axis deviation measurements within a clinically useful range of the standard ECG. However, it is not accurate enough to be used consistently in place of a standard ECG for QTc and QRS measurement for pediatric patients.

Descending Necrotizing Mediastinitis Resulting From Sialadenitis Without Sialolithiasis.

Descending necrotizing mediastinitis (DNM) is an uncommon and life-threatening condition that arises from an oropharyngeal infection and descends along the cervical fascial planes into the mediastinum. Without aggressive surgical management, a high mortality rate exists. We report a case of an otherwise healthy 49-year-old male who presented with an abscess formation of the right submandibular gland secondary to sialadenitis without sialolithiasis. Computed tomography revealed fluid collection around the right submandibular gland suggestive of sialadenitis without sialolithiasis with severe inflammation and leftward deviation of the aerodigestive tract. Despite multiple drainages, the infection eventually progressed inferiorly into the mediastinum, resulting in DNM. After multiple takebacks to the operating room for exploration and washout of the neck and chest, intensive care unit management, and aggressive IV antibiotic therapy, the patient eventually had a successful recovery and was discharged home. In this paper, the etiology, anatomy, pathophysiology, and management of DNM are discussed. To our knowledge, this is the first report in the literature of DNM developing from sialadenitis without sialolithiasis in the submandibular gland.

Relation of Norwood Shunt Type and Frequency of Arrhythmias at 6 Years (from the Single Ventricle Reconstruction Trial).

The Norwood procedure with a right ventricular to pulmonary artery shunt (RVPAS) decreases early mortality, but requires a ventriculotomy, possibly increasing risk of ventricular arrhythmias (VAs) compared with the modified Blalock-Taussig shunt (MBTS). The effect of shunt and Fontan type on arrhythmias by 6 years of age in the SVRII (Single Ventricle Reconstruction Extension Study) was assessed. SVRII data collected on 324 patients pre-/post-Fontan and annually at 2 to 6 years included antiarrhythmic medications, electrocardiography (ECG) at Fontan, and Holter/ECG at 6 years. ECGs and Holters were reviewed for morphology, intervals, atrioventricular conduction, and arrhythmias. Isolated VA were seen on 6-year Holter in >50% of both cohorts (MBTS 54% vs RVPAS 60%), whereas nonsustained ventricular tachycardia was rare and observed in RVPAS only (2.7%). First-degree atrioventricular block was more common in RVPAS than MBTS (21% vs 8%, p = 0.01), whereas right bundle branch block, QRS duration, and QTc were similar. Antiarrhythmic medication usage was common in both groups, but most agents also supported ventricular function (e.g., digoxin, carvedilol). Of the 7 patients with death or transplant between 2 and 6 years, none had documented VAs, but compared with transplant-free survivors, they had somewhat longer QRS (106 vs 93 ms, p = 0.05). Atrial tachyarrhythmias varied little between MBTS and RVPAS but did vary by Fontan type (lateral tunnel 41% vs extracardiac conduit 29%). VAs did not vary by Fontan type. In conclusion, at 6-year follow-up, benign VAs were common in the SVRII population. However, despite the potential for increased VAs and sudden death in the RVPAS cohort, these data do not support significant differences or increased risk at 6 years. The findings highlight the need for ongoing surveillance for arrhythmias in the SVR population.

Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes.

OBJECTIVES: This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT). BACKGROUND: Although catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure. METHODS: An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT. RESULTS: Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range: 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11). CONCLUSIONS: T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.

Secretory Carcinoma of the Salivary Gland - Systematic Review of the Literature and Report of 2 Cases.

PURPOSE: Secretory carcinoma (SC) of the salivary gland, formerly known as mammary analogue secretory carcinoma, is an uncommon and fairly newly described low grade malignant neoplasm of the salivary gland. Given the small number of cases reported in the literature to date, treatment guidelines are scarce. This study aimed to describe the clinical characteristics of SC, discuss prior management strategies, and provide recommendations for future treatment. METHODS: We performed a systematic review of all the cases of SC reported in the literature since it was first recognized in 2010. Using Pubmed, Crossref, and Google Scholar, we identified all articles reporting cases of SC. RESULTS: We identified 657 cases of SC in 109 articles. In addition, we provided 2 new cases, for a total of 659 cases in 110 articles. To our knowledge, this is the largest review of cases of SC in the literature to date. We summarized the clinical characteristics of SC, as well as the nodal status, clinical management, recurrence rate, and death rate. CONCLUSIONS: SC occurs on average in middle age (with a large age range), presents most often initially as localized disease without metastasis, and has a low but not insignificant recurrence rate. Deaths have been reported. The generalized recommendations for treatment of SC are in line with those of other low-grade salivary gland malignancies.

The Influence of Moral Intuitions on Americans' Divergent Reactions to Reports of Sexual Assault and Harassment.

Drawing on insights from moral psychology, we examine the influence of moral intuitions on Americans' divergent reactions to reports of sexual assault and harassment. We hypothesize that Americans whose moral intuitions emphasize care and protection of the vulnerable will show a greater willingness to believe reports of sexual assault and harassment, while those whose moral intuitions emphasize social order and cohesion will show greater skepticism toward such reports. Using data from a nationally representative sample of USA adults (N =1050), we find strong support for both hypotheses. We also find that the influence of moral intuitions on reactions to reports of sexual assault and harassment is partially mediated by respondents' willingness to attribute responsibility to victims of sex crimes. Our results hold when females and males are examined separately. The study provides compelling evidence that a moral intuitionist approach is useful for understanding Americans' divergent reactions to reports of sexual assault and harassment.

Supraventricular Tachycardia Without Preexcitation as a Cause of Sudden Cardiac Arrest in Pediatric Patients.

Sudden cardiac arrest in pediatric patients is a rare occurrence. Supraventricular tachycardia without the presence of ventricular preexcitation in pediatric patients with a structurally normal heart is generally considered benign. Previous literature in adults reported a subset of patients in whom SVT was suspected to be the primary trigger of sudden cardiac arrest. We performed a single-center, retrospective cohort study of pediatric patients without known heart disease, 1-21 years of age, presenting with aborted SCA between 2009 and 2019. We collected diagnostic studies in all patients to identify the etiology of the aborted SCA. Thirty patients met the inclusion criteria. The median age at the time of SCA was 15.2 years. The etiology of SCA was identified in 23 (77%) patients. Of the seven patients with unknown diagnosis after initial diagnostic studies, three patients subsequently developed fast SVT that was presumed to be the etiology of the initial SCA. These three patients had varying diagnoses of atrioventricular nodal reentry tachycardia, ectopic atrial tachycardia, and a concealed accessory pathway with atrioventricular reentrant tachycardia. After ablation or medical treatment of the SVT substrate, no further tachyarrhythmias were observed. Pediatric patients presenting with an aborted SCA of unknown etiology ought to be considered for electrophysiology testing to elicit occult SVT substrates that may lead to a malignant ventricular tachyarrhythmia.

Anodal stimulation in pediatric patients with permanent epicardial ventricular pacemakers.

OBJECTIVES: We aimed to measure the frequency and factors associated with anodal stimulation in a pediatric population with epicardial pacing leads. BACKGROUND: In bipolar pacemakers, capture of the myocardium typically occurs at the cathode. However, AS with capture at the anode has been described. This has not been described in epicardial pacemakers. METHODS: Retrospective data were collected from patients ≤ 21 years of age with permanent bipolar epicardial ventricular pacemakers from 1/2017 to 1/2018. AS was defined as a clear change on surface ECG in at least one of the 12 leads assessed by two blinded pediatric electrophysiologists. RESULTS: Twenty-four bipolar leads in 23 patients were included in the study. One patient had both biventricular leads tested. Median age was 7.1 years (IQR 5.0-10.9), weight was 20.9 kg (IQR 16.5-33.5), and 65% were male. Testing was performed at a median of 2.8 years (IQR 1.6-6.1) after implant. Congenital heart disease was present in 57%. Complete heart block was the pacemaker indication in 78%. AS was identified in 16/24 (67%) of leads tested. Identification of AS was associated with presence of congenital heart disease (p = 0.004) and 3DD between electrodes (p = 0.04). CONCLUSIONS: AS is common in pediatric patients and was associated with a history of congenital heart disease and greater estimated 3DD between electrodes. The prevalent nature of AS may allow clinicians to utilize existing pacemakers as multisite pacing systems.

Conduction Properties and Ablation of Adenosine Sensitive Accessory Pathways in Children.

Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs

Cutaneous Metastasis of Renal Cell Carcinoma to the Cheek: A Case Report and Literature Review.

BACKGROUND Cutaneous metastasis of renal cell carcinoma is exceedingly rare, and there are few described cases of metastasis to the skin of the head and neck region. Most of these cases describe metastases to the scalp, but some cases of metastases to the face and neck have been reported. CASE REPORT A 72-year-old man presented to the Surgery Clinic with a chief complaint of a lesion that had grown on his left cheek over a period of about 3 months. A punch biopsy revealed the mass to be metastatic renal cell carcinoma, clear-cell subtype. The patient had already had a nephrectomy for primary tumor control. Due to the advanced disease process, the patient elected for palliative care. CONCLUSIONS Cutaneous presentations of renal cell carcinoma in the head and neck are exceptionally rare, and metastases to the face are less common than metastases to the scalp. When this disease process does occur, it often presents as a raised mass of between 1 and 3 cm with a red, red-purple, or red-blue color. Patient history often reveals a relatively rapid growth process of their facial lesion. This case highlights the fact that malignancies may manifest several years after initial primary resection.