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A definite diagnosis of anterior myocardial infarction is often difficult to make in patients when a pattern of poor R wave progression in the precordial leads is present on the electrocardiogram. The purpose of this study was to determine whether a mathematical model could be devised to identify patients with anterior infarction among 102 consecutive patients with poor R wave progression. Each patient underwent exercise testing with thallium scanning. The diagnosis of anterior infarction was established in 20 (20%) of the 102 patients by the presence of fixed thallium-201 perfusion defects in the anterior wall or septum, or both. With the use of a multivariate stepwise discriminant analysis of clinical and electrocardiographic variables, five variables (sex, ST-T changes, S wave amplitude in leads V2 and V3 and the sum of the R wave amplitude in leads V3 and V4) that were statistically significant by univariate analysis were selected by the model to identify patients with anterior infarction (sensitivity 85%, specificity 71%). The discriminant model was subsequently applied prospectively to an additional 21 patients with poor R wave progression and provided a sensitivity of 85% and a specificity of 88%. Thus, anterior infarction (fixed thallium-201 defects in the anteroseptal segments) was present in 20% of patients with poor R wave progression in the precordial leads; and a mathematical model can be used to identify a subset of patients with anterior infarction in a group of patients with poor R wave progression.

Today, public school accountability depends mostly on compliance. This accountability-via-regulation will only make charter public schools like district public schools. A different approach to charter accountability is envisioned, designed to help these schools succeed as genuine education alternatives. This accountability-via-transparency is based on giving charter schools operational, financial, and program autonomy in exchange for holding them accountable for results. Furthermore, rather than bureaucratic control from higher levels within the system, charter accountability is propelled mostly by public marketplaces in which a school’s clients and stakeholders reward its successes, punish its failures, and send it signals about what must change. In what follows, approaches to accountability in today’s charter world are reviewed; how a transparent charter accountability system following Generally Accepted Accountability Principles for Education (GAAPE) would work for charter schools, their sponsors, and statewide programs is described; and three accountability dilemmas that charter schools face are discussed in the conclusion.

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