Fatal bupivacaine intoxication following unusual erotic practices

A fatal drug overdose is described which involved unusual erotic practices. A 54-year-old male was discovered supine on the floor surrounded by sexual paraphernalia, syringes, and medications including three empty bottles of bupivacaine. Acute and chronic injection sites of the external genitalia with contusions, scarring, focal necrosis, and calcification were present at autopsy. Toxicology revealed femoral blood, heart blood, and vitreous bupivacaine concentrations of 3.8, 2.8 and 1.3 mg/L, respectively. The urine bupivacaine concentration was 11.4 mg/L. The cause of death was attributed to bupivacaine intoxication and the manner of death was accidental.     

Human herpesvirus-6 and sudden death in infancy: report of a case and review of the literature

Investigation of sudden death in infancy is a vital function of the medical examiner's office. Surveillance of these cases may lead to recognition of new diseases or new manifestations of previously described diseases. Human herpesvirus-6 (HHV-6) is a relatively newly described virus that has been recognized as a cause of acute febrile illness in early childhood. While most cases are apparently self-limited, seven fatal cases have been reported. We present a case of a seven-month-old Latin American male with recent otitis media and vomiting who was found dead in bed. Autopsy revealed interstitial pneumonitis with an atypical polymorphous lymphocytic infiltrate in the liver, kidney, heart, spleen, lymph nodes, and bone marrow, associated with erythrophagocytosis. Polymerase chain reaction (PCR) analysis of formalin-fixed paraffin-embedded tissue was positive for HHV-6 and negative for Epstein-Barr virus (EBV) and cytomegalovirus (CMV). HHV-6 was also detected in the atypical lymphoid infiltrate by in-situ hybridization.     

Social Security Amendments of 1977: legislative history and summary of provisions

This article describes the legislative history of the Social Security Amendments of 1977 and contains a summary of the amendments. The major provisions revise the benefit structure so that future replacement rates--initial benefits as a percent of previous earnings--will be relatively stable and revise the tax structure to restore the financial soundness of the program in the short range and into the 21st century. Other significant provisions include: An increased special minimum benefit for long-term workers with future automatic adjustment to prices; a minimum benefit frozen at the December 1978 level (roughly $121) with automatic adjustment only for those on the rolls; a higher retirement test exempt amount of beneficiaries aged 65 and over; an annual measure of "quarter of coverage" and other changes in annual wage reporting provisions; and authorization for agreements with foreign countries for limited coordination between social security systems.     

Better than Raw: A Guide to Measuring Organizational Performance with Adjusted Performance Measures

Like oysters on the half shell, some things are better when they're raw. In evaluating the performance of organizations and providing guidance for improving performance, however, raw performance measures, such as test scores or success rates, are often inferior to performance measures adjusted for client and environmental characteristics, or adjusted performance measures (APMs). Using examples from a variety of public services and data on public schools in Georgia, we compare the performance data generated by raw scores and by APMs. We conclude with guidance for constructing and using adjusted performance measures.     

The Purpose and Perception of Learning Objectives

Much of existing assessment and instructional design strategies revolve around the use of learning objectives. Learning objectives are used by faculty, by instructional designers, by accreditors, by assessment offices, and by students. But even as the use of learning objectives becomes more widespread, the definition and purpose have remained unclear. Instructional designers argue that learning objectives exist to provide a focused mindset for students engaging in the content, while faculty often view learning objectives as an administrative requirement that has little impact on teaching or student performance. Existing research on the subject is primarily normative and/or qualitative in nature (Harden 2002 Harden, Ronald M. 2002. “Learning Outcomes and Instructional Objectives: Is There a Difference?” Medical Teacher 24 (2):151–155.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]; Torrance 2007 Torrance, Harry. 2007. “Assessment as Learning? How the Use of Explicit Learning Objectives, Assessment Criteria and Feedback in Post-Secondary Education and Training Can Come to Dominate Learning.” Assessment in Education 14 (3):281–94. doi:10.1080/09695940701591867.[Taylor &; Francis Online] , [Google Scholar]). In this article, the researchers seek to use empirical evidence to examine the definitions, purpose, and impact of learning objectives on student performance. We find that there is no shared understanding of definitions and purpose, and using an experimental design, we find that learning objective wording and use in the classroom does not affect student performance.     

Federalism and democratization in Russia

The scholarly literature on democratic transitions has largely ignored developments at the local level and the relationship between federalism and democracy. In this work I examine the development of federalism in Russia and I assess the impact of Russia's highly asymmetrical form of federalism on democratisation. The study shows that federalism far from promoting democracy has allowed authoritarianism to flourish in many of Russia's eighty nine regions and republics. Federalism and democratization in Russia exist in contradiction rather than harmony. In a vicious circle, authoritarianism at the centre has been nourished by authoritarianism in the region and vice versa. “Elective dictatorships” and “delegative democracies” are now well entrenched in many republics, and mini-presidential systems are firmly established in a majority of the regions.