Human immunodeficiency virus infection in cases presenting to the Philadelphia Medical Examiner's Office.

Serum samples were available from 492 of 1,058 cadavers seen at the Philadelphia Medical Examiner's Office between August 4 and December 15, 1989. These sera were tested for the presence of antibodies to human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA) and Western blot. The overall prevalence of HIV in the autopsy population was 2.24%. The following populations showed increased prevalence as compared to the total sampled population: blacks (3.60%, p less than 0.01), males (2.51%, n.s.), and homicide victims (3.74%, n.s.). Seroprevalence data from this study are compared with those from earlier studies of other related populations, with regard to overall prevalence and risk factor analysis.     

From Development to Empowerment: The Self-Employed Women's Association in India

Since the 1970s, development experts have increasingly focused on how development policies and strategies affect women in developing countries. In recent years, the emphasis has included empowerment, which increases women's decision-making capability and well-being. This essay is an account of the Self-Employed Women's Association (SEWA) in India, a trade union for self-employed women since 1972. It analyzes the strategies that SEWA has used to mobilize and empower self-employed women in India, using materials and data collected on a field visit in 1998.     

Commotio cordis, revisited

Nonpenetrating cardiac injuries due to direct precordial blunt impacts are a commonly encountered phenomenon in medicolegal offices. These injuries vary from contusions to valvular lacerations, or papillary muscle rupture to coronary arterial injury with resulting infarction. A less commonly occurring manifestation of nonpenetrating injury is a concussion of the heart (commotio cordis), often with dramatic physiological consequences but no morphologic cardiac injury. We describe four case reports of this entity. The cases were collected over a 5-year period (1978-1983) from the Wayne County Medical Examiner's Office in Detroit, Michigan.     

Hypernatremia due to amniotic fluid embolism during a saline-induced abortion

A case of fatal amniotic fluid embolism leading to hypernatremia during a hypertonic saline-induced abortion is reported. This sequence of events has not, to our knowledge, been previously reported. Hypernatremia as a diagnostic aid for amniotic fluid embolism is discussed.     

Local Government Responses to Fiscal Stress: Evidence from the Public Education Sector

This article investigates local government responses to fiscal stress through the lens of the K–12 public education sector, examining two major policy options available to school districts for managing fiscal hardship: (1) cutting costs, especially through layoffs, and (2) raising revenues locally through voter referenda. The article employs district‐level administrative and survey data from California and Indiana to examine whether school districts exhibit features of a rational or natural system—in which their behaviors largely reflect fiscal pressures only—or whether they exhibit features of an open system in which nonfinancial factors also shape responses. In Indiana, district fiscal characteristics explain differences in cost‐cutting and revenue‐raising behaviors; there is little empirical evidence that school districts exhibit features of an open system. In California, both fiscal and environmental attributes, including poverty characteristics, average student achievement levels, and the enrollment of English learner students, explain school district behaviors.     

Rethinking central planning: A federal critique of the Planning Commission

ABSTRACT

This article critically assesses the impact of the Planning Commission on center-state relations in India. It argues that the Planning Commission had a centralizing effect due to its role in overseeing five year and annual planning, its contribution to designing and overseeing Centrally Sponsored Schemes (CSS), and its involvement in discretionary grant-making. Central policy priorities and inter-state disagreements prevented the Planning Commission from acquiring the role of a shared rule institution, capable of offsetting the centralizing implications of the aforementioned policies. The article then speculates on what prompted the recent replacement of the Planning Commission with the NITI Aayog and what this may mean for shared rule and the nature of collaborative federalism in India more in general.     

Death as a result of asthma in Wayne County Medical Examiner cases, 1975-1987

All deaths ascribed to asthma in the 5-to-40-year age group at the Wayne County Medical Examiners' Office were reviewed from 1975 to 1987 inclusive. Fifty-eight deaths were attributed solely to asthma, and the annual number increased fivefold in the 1980s to a rate of approximately 0.5 per 100,000 per year when extrapolated to the Wayne County population. Blacks were overrepresented to double their proportion in the general population. Almost all cases were known asthmatics, and many had received previous emergency care. Most fatalities occurred at night and did not demonstrate any seasonal variation. The onset of the fatal attack was apparently very rapid in most cases, with many engaged in routine activities and few surviving any length of time in hospital or having sought treatment earlier. Our data reveal a significant increase in sudden death in previously well asthmatics in Wayne County in the 1980s. Similar increases in deaths as a result of asthma have been noted previously in other countries for reasons that remain unclear.     

Fatal malignant hyperthermia as a result of ingestion of tranylcypromine (Parnate) combined with white wine and cheese

Fatal malignant hyperthermia occurred in a patient who was taking tranylcypromine (Parnate) and ingested wine and cheese. The case findings are presented along with a review of the literature concerning adverse interactions between monoamine oxidase (MAO) inhibitors and certain foods and beverages. Hyperthermia and its possible causative mechanisms and treatments are discussed. The facts suggest that the complicated dietary restrictions attending the use of MAO inhibitors and the possibility of severe and even catastrophic reactions resulting from violations of these restrictions make the use of these drugs fraught with danger and therefore not a first choice for the treatment of depression.