Sudden death resulting from lesions of the cardiac conduction system

Sudden unexpected deaths in young persons with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. As part of the evaluation of such cases, the cardiac conduction system (CCS) should be studied. To determine the type and incidence of lethal CCS lesions, the authors reviewed their files of sudden unexpected cardiac deaths with particular attention to cases with causes of death in the conduction system. Cases of sudden cardiac death in patients aged < or=40 years during a 10-year period (Michigan) and a 4 year-period (Spain) were selected from the files. From this group, cases were identified in which the cause of death was a lethal change in the CCS. The portions of the heart containing the CCS were excised, and at least one hematoxylin and eosin slide and at least one trichrome or elastic trichrome slide per block were studied. In the two centers, 381 cases of sudden cardiac death were identified. The most common causes of sudden cardiac death were arteriosclerotic narrowing of the coronary arteries, cardiomyopathy, and myocarditis. In 82 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed, a medical history was obtained, and a drug screen was performed. In 11 cases, the CCS contained lesions that were considered lethal: narrowing of the atrioventricular node artery by fibromuscular hyperplasia (7 cases) and atrioventricular node tumors (4 cases). The 11 cases accounted for 2.9% of the 381 cases of sudden cardiac death and 11.8% of the indeterminable cases. It was concluded that examination of the CCS in deaths in which the gross and microscopic autopsy, history, and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases. If heart block was not documented during life and no explanatory lesions were found during routine cardiac examination, examination of the CCS can yield valuable information.     

Slouching Towards New ‘Just’ Wars: International Law and the Use of Force After September 11th

Netherlands International Law Review -     

PROGRAM COORDINATION IN THE EMPLOYMENT SERVICE: A STATE AND LOCAL POLICY PERSPECTIVE

This paper analyzes the role of coordination criteria in employment and training service delivery within the Job Training Partnership Act system. The evolution of coordination criteria is related to current initiatives in the Employment Service at the state and local levels. An operational set of program outcome measures for monitoring coordination efforts is discussed. This set of outcome measures is formulated in the broad context of stabilizing employment and averting the "structuralization" of unemployment impacts wrought by fundamental economic change in the labor market. The assessment and monitoring of such coordination efforts is discussed.     

Poetry in Review: Robert Lowell

Book reviewed in this article:
Robert Lowell (edited by Frank Bidart and David Gewanter), Collected Poems     

Institutional sustainability: at what price? UNDP and the new cost‐sharing model in Brazil

By the turn of the twenty‐first century, UNDP had embraced a new form of funding based on ‘cost sharing’, with this source accounting for 51 per cent of the organisation's total expenditure worldwide in 2000. Unlike the traditional donor–recipient relationship so common with development projects, the new cost‐sharing modality has created a situation whereby UNDP local offices become ‘subcontractors’ and agencies of the recipient countries become ‘clients’. This paper explores this transition in the context of Brazil, focusing on how the new modality may have compromised UNDP's ability to promote Sustainable Human Development, as established in its mandate. The great enthusiasm for this modality within the UN system and its potential application to other developing countries increase the importance of a systematic assessment of its impact and developmental consequences.