Repeat Coronary Artery Dissection in Pregnancy: A Case Report and Review of the Literature

Non‐atherosclerotic spontaneous coronary artery dissection (NA‐SCAD) is a rare cause of morbidity and mortality with a propensity for young, healthy, and often peripartum women. NA‐SCAD etiology is poorly understood, with possible hormonal and hereditary mechanisms. Current treatment strategies range from conservative management (often showing resolution on angiographic follow‐up) to invasive angiographic procedures. Rarely, NA‐SCAD has recurred in another coronary artery, ranging hours to years later. We report NA‐SCAD of the right coronary artery (RCA) in a 30‐year old, 3‐month postpartum female with an additional autopsy finding of remote myocardial infarction (MI) in the left anterior descending (LAD) coronary artery territory. The remote MI is consistent with prior NA‐SCAD of the LAD and, given the medical history, may have occurred in the peripartum period of the decedent first pregnancy 3 years earlier. As such, to the best of our knowledge, this may represent the first reported case of NA‐SCAD recurrence in a subsequent pregnancy.     

The Will to Change: Lessons from Canada's Successful Decarceration of Youth

In 1997, Canada's youth custodial facilities held 3825 sentenced youths. Eighteen years later, this number was 527—an 86 percent reduction. Overall youth imprisonment (sentenced + pretrial detention) decreased by approximately 73 percent. This paper uses Canada's successful decarceration of youths to understand what might be learned about decarceration more broadly. By examining the reforms that transpired in Canada's treatment of young offenders since the 1960s and the political/cultural shifts that occurred since the 1990s, we demonstrate that the decline resulted from changes occurring in various parts of the system. Finally, we contrast this decarceration with more than 60 years of relative stability of Canadian adult imprisonment rates as well as Canada's failure to substantially decrease youth pretrial detention in order to identify those factors seemingly necessary to reduce imprisonment more generally.     

Factors influencing state progress in the implementation of Public Law 99-457, Part H

Policy implementation has been an infrequently studied process although it has become increasingly evident that the implementation processes of policy development, policy approval, and policy application can shape and delay prospective implementation of legislation. The current study analyzes the implementation of P.L. 99–457 (Part H) the Education for the Handicapped Amendments of 1986. This law provides the states with planning money from the federal government to design a comprehensive interagency, multidisciplinary program of services for children with handicapping conditions and their families. Ratings were taken from key administrators and citizens knowledgeable about the law on state progress in implementing the fourteen requirements of the law and also on proposed influential conditions that might affect that implementation. Additional demographic information was obtained for the fifty states. The factor that seemed to be most influential in a subset of 35 states was the prior presence in the state of systems for interagency planning and development. Neither prior history of early childhood services, available resources, wealth of the state, or geographic region appeared to have a significant influence on policy development. There was some indication that different factors might become influential in the next phase of implementation, policy approval. It appears that progress in state policy development may be linked to the special requirements of the legislation itself and to prior availability of institutional structures that make mandated collaborative efforts more possible.     

Feminist literary studies

Elaine Showalter (ed), The New Feminist Criticism: Essays on women, literature and theory (Virago) London, 1985.

Gayle Green and Coppélia Kahn (eds), Making a Difference: Feminist literary criticism (Methuen: New Accents) London, 1985.

Toril Moi, Sexual/Textual Politics: Feminist Theory (Methuen: New Accents) London, 1985.