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This multicenter study evaluated the Biosite Triage® Cardiac Panel as a quantitative, multimarker, whole blood system for the detection of acute myocardial infarction (MI). Optimum cutoffs for the discrimination of acute MI (n = 192 patients, 59 with MI) as determined by ROC curve analyses were as follows: 0.4 μg/L for cardiac troponin I (cTnI); 4.3 μg/L for the creatine kinase MB isoenzyme (CK-MB); and 107 μg/L for myoglobin. The Triage Panel showed the following concordances for detection or rule-out of MI compared with established devices: cTnI >89%; CK-MB >81%; myoglobin >69%. No significant differences were present between methods for the same marker. Diagnostic efficiencies demonstrated comparable sensitivities and specificities for the diagnosis of MI in patients presenting with symptoms compared with the Dade, Beckman, and Behring CK-MB, cTnI, and myoglobin assays; the ratio of sensitivity to specificity for each marker was as follows: cTnI, 98%:100%; CK-MB, 95%:91%; myoglobin, 81%:92%. The areas under the ROC curves for the Biosite myoglobin, CK-MB, and cTnI were 0.818, 0.905, and 0.970, respectively; the areas were significantly different, P <0.05. In patients with skeletal muscle injury and renal disease, the Triage cTnI showed 94% and 100% specificity, respectively. The Triage panel offers clinicians a whole blood, point-of-care analysis of multiple cardiac markers that provides excellent clinical sensitivity and specificity for the detection of acute MI.

What is the best way to make sustained societal progress over time? Non-ideal theory done on its own faces the problem of second best, but ideal theory seems unable to cope with disagreement about how to make progress. If ideal theory gives up its claims to completeness, then we can use the method of incompletely theorized agreements to make progress over time.

When we can’t live up to the ultimate standards of morality, how can moral theory give us guidance? We can distinguish between ideal and non‐ideal theory to see that there are different versions of the voluntarist constraint, ‘ought implies can.’ Ideal moral theory identifies the best standard, so its demands are constrained by one version. Non‐ideal theory tells us what to do given our psychological and motivational shortcomings and so is constrained by others. Moral theory can now both provide an ultimate standard and give us guidance; this view also gives us new insights into demandingness and blame.

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