Development as a buzzword

Despite its widespread usage, the meaning of the term ‘development’ remains vague, tending to refer to a set of beliefs and assumptions about the nature of social progress rather than to anything more precise. After presenting a brief history of the term, the author argues that not only will development fail to address poverty or to narrow the gap between rich and poor, but in fact it both widens and deepens this division and ultimately creates poverty, as natural resources and human beings alike are increasingly harnessed to the pursuit of consumption and profit. The survival of the planet will depend upon abandoning the deep-rooted belief that economic growth can deliver social justice, the rational use of environment, or human well-being, and embracing the notion that there would be a better life for all if we moved beyond ‘development’.     

“We’re in it to win it”- negotiating successful outsourcing transactions Introduction

Much emphasis has been placed on the continuing growth of the outsourcing sector in the recent recessionary times. However, whilst much of this growth has undeniably been due to the budget-driven imperative to lower costs, the long term advantages of lower cost, guaranteed service levels and access to best practice/latest technology marks out the outsourcing sector as one which is set for sustained growth. In this context, the importance of establishing sound foundations for what are invariably long term deals is clear. This paper will accordingly establish the key stages involved in establishing the foundations for a successful outsource project, and the pitfalls to avoid.     

Epithelial cell mitotic arrest--a useful postmortem histologic marker in cases of possible colchicine toxicity

Following ingestion of 30 mg of presumed benztropine (Cogentin) a 39-year-old male developed nausea, vomiting and diarrhea. His admission to hospital was soon followed by collapse and death. Histological examination, however, revealed increased numbers of mitotic figures in otherwise normal epithelial cells of the esophagus and bronchioles, a feature characteristic of colchicine toxicity. Subsequent toxicological analyses confirmed the presence of colchicine in the urine, but not in the blood. A dispensing error had resulted in substitution of colchicine for Cogentin. Histological findings had, therefore, provided evidence of colchicine toxicity and had guided subsequent toxicological evaluation. In suspected cases of colchicine toxicity, histological samples should, therefore, be taken from multiple sites along the gastrointestinal and respiratory tract in addition to other organs and tissues so that diagnostic morphological changes can be looked for.     

Sleeping accidents in the elderly

Two cases of dangerous sleeping environments in the elderly are reported to demonstrate similarities and differences of these "sleeping accidents" to similar episodes that occur in infants and children. CASE REPORTS: An 87-year-old wheelchair-bound man with a history of dementia was found in his nursing home room hanging off the side of the bed from a vertical metal bar, and an 87-year-old woman with epilepsy, ischemic heart disease, and insulin-dependent diabetes mellitus was found in hospital wedged between an inflatable mattress and the bars of her bed. These cases demonstrate that, as in the very young, relatively poor coordination and strength in the elderly often with limited comprehension and ability to deal with dangerous environments may predispose to sleeping accidents. Significant underlying organic disease may, however, make determination of the precise lethal mechanisms difficult. Modification of beds should only be undertaken when safety issues have been carefully evaluated.     

Potentially lethal complications of tracheostomy: autopsy considerations

Tracheostomy is widely used to facilitate respiration by protecting the airways. It may be performed to relieve upper airway obstruction from congenital stenoses or from acquired conditions such as foreign body impaction, swelling from neck trauma or anaphylaxis, benign or malignant tumors, and infection. Tracheostomy may also be performed in individuals with respiratory impairment who require suctioning for accumulated mucoid secretions and in those with obstructive sleep apnea. Review of autopsy files and the literature was undertaken to demonstrate the range of lethal circumstances that may involve tracheostomy. Unexpected death may result from incorrect positioning of an endotracheal tube with failure of oxygenation, tracheal perforation with pneumothorax, mucus plugging, accidental extubation, and hemorrhage from tracheovascular fistulas. Lethal tracheovascular fistulas usually involve the innominate artery and result from mural perforation by the tip of a tracheostomy tube, mural necrosis from a high-pressure cuff, prolonged intubation, radiotherapy, and low tracheal incisions. Increased movement of tubes in patients with impaired consciousness and excessive head movements may also increase the chances of hemorrhage, as may infiltrating tumors. Given the wide range of potential fatal mechanisms that may be found in such cases, careful autopsy evaluation and dissection will be required to demonstrate the exact nature and site of the lethal lesion in individuals who underwent tracheostomy and die unexpectedly.     

Urinary incontinence, hyperthermia, and sudden death

An 84-year-old woman is reported whose death was associated with strenuous exercise on an extremely hot day (maximum temperature=43.1 °C, 109.6 °F). At autopsy there was evidence of exposure to high environmental temperatures with early putrefactive changes and mummification. There was underlying cardiomegaly with mild pulmonary emphysema. No significant injuries were detected. Toxicology revealed therapeutic levels of oxybutynin prescribed for urinary stress incontinence. Death was considered to be heat related, exacerbated by oxybutynin therapy, exercise, and cardiomegaly. Given that it has been predicted that there may be an increase in the number of heatwaves and in their intensity and duration, it is possible that such cases may be encountered more often in future. The assessment of all deaths occurring during conditions of extreme heat will require consideration of postmortem toxicology, particularly if there are underlying conditions such as stress incontinence that may be associated with anticholinergic drug therapy.