Familial Vehicular Murder‐Suicide

A certain number of single‐vehicle crashes into stationary roadside objects such as trees are thought to be occult suicides. However, is it possible that some cases of multiple deaths within a family in similar crashes are due to unrecognized familial murder‐suicides? A 39‐year‐old woman and her 11‐year‐old daughter are reported who died of injuries following a vehicle impact with a tree. Unusual behavior of the mother leading up to the crash, and assessment at the scene, raised the possibility of this being a nonaccidental event. However, difficulties in retrospectively determining the intent of a driver in a vehicle crash, and the nonrecording of, or lack of separate coding for murder‐suicides on registers, make determination of the incidence of these types of events extremely difficult. It may be that this is a subcategory of murder‐suicide that is underdiagnosed and so is not being registered on central motor vehicle crash databases.     

Do juvenile curfew laws work? A time-series analysis of the New Orleans law

Juvenile curfew laws are one of the most recent weapons for combating delinquency, but little is known about their effectiveness. This study examines the impact of the juvenile curfew law in New Orleans, Louisiana on victimizations, juvenile victimizations, and juvenile arrests. Interrupted time-series analyses are used to compare victimizations and arrests before and after the curfew was implemented. The results show the ineffectiveness of the curfew. Victimizations, juvenile victimizations, and juvenile arrests during curfew hours did not decrease significantly after the law went into effect; some victimizations during non-curfew hours increased significantly after the law was implemented.     

The effect of a curfew law on juvenile crime in Washington,D.C.

Juvenile curfew laws were a popular intervention to combat juvenile crime during the 1980s and 1990s. An experimental replication design was used to examine the impact of the Washington, D.C. “Juvenile Curfew Act of 1995.” Juvenile arrest data were analyzed using a two-standard-deviation-band approach, t-test, and trend analysis. The results, consistent with previous studies, revealed that the curfew law did not reduce total juvenile arrests. Several flaws inherent in curfew laws, as well as implications for research and policy, are discussed.     

Teenage Drivers and Fatal Crash Responsibility

Data from national files on fatal crashes are analyzed to reveal that young drivers, especially sixteen and seventeen year olds, are more often responsible for fatal crashes than are older drivers. This is particularly the case for young males. Moreover, those killed in crashes for which teenagers are responsible are disproportionately people other than the teenaged drivers. A possible explanation for these facts lies in the "macho" culture of teenaged males. Potential countermeasures include those directed to limiting the driving exposure of teenagers as well as technological devices to moderate the injury-producing forces in crashes.     

Fatal Wrong‐Way Collisions on New Mexico’s Interstate Highways, 1990–2004

Abstract: Medical examiner files from 1990 through 2004 were reviewed to identify fatalities caused by drivers traveling the wrong direction on interstate highways and identify risk factors and prevention strategies. Other fatal nonpedestrian interstate motor vehicle crashes served as a comparison group. Data abstracted included decedent demographics, driver/passenger status, seatbelt use, blood alcohol concentration, weather and light at time of occurrence and types of vehicles involved. Of 1171, 79 (6.7%) interstate motor vehicle fatalities were because of drivers traveling against the posted direction in 49 crashes, with one to five fatalities per crash. Wrong‐way collisions were significantly more likely to occur during darkness (p < 0.0001) and involve legally intoxicated drivers (p < 0.0001). In 29/49 (60%) wrong‐way crashes, alcohol was a factor. Prevention strategies aimed at reducing the incidence of driving while intoxicated, as well as improved lighting and signage at ramps, could help reduce the occurrence of fatal wrong‐way collisions on interstates.     

Fatal positional asphyxia associated with rollover crashes

Motor vehicle rollover crashes result in complex occupant kinematics with the potential for severe injury. Five cases of fatal asphyxia in occupants suspended from their safety belt upside down after a rollover crash are presented. These fatalities accounted for 13.5% of all motor vehicle related asphyxia deaths in San Diego County over a 10-year period. This study supports previous research noting that incapacitation due to other injuries, alcohol, or obesity may be associated with fatal positional asphyxia due to inversion during rollovers. Safety belts are proven to prevent serious injury in motor vehicle crashes and should always be worn. However, redesign of the buckle could be considered to permit easier release by an occupant. We also suggest that pre-existing heart disease may contribute to the possibility of a fatal asphyxia outcome. Although this is a rare cause of motor vehicle related death, our results suggest that these are potentially preventable deaths.     

Blood alcohol in fatally injured drivers and the minimum legal drinking age

Although most research on the effect of minimum legal drinking age (LDA) laws on proxies for alcohol-related fatalities find effects of higher LDAs in reducing such fatalities, recent research that supposedly controls for drinking experience claims that higher LDAs have little or no effect. This study examines the actual amount of alcohol in the blood of fatally injured drivers per licensed driver in states where more than 80 percent of such drivers were tested for alcohol and where licensure data were available for the period 1982-1986. The involvement of alcohol in fatal crashes increases with age as the LDA is approached. A higher LDA is associated with fewer alcohol-related crashes among those younger than the LDA. No effect of drinking experience was evident, but this study finds an age-related bias in previously used proxies for alcohol involvement that results in overestimates of alcohol levels in younger drivers.     

The emergency petition process in Maryland

Maryland's Emergency Petition statute allows a violent or suicidal person with a mental disorder to be brought to an emergency facility for rapid evaluation regarding the need for emergency treatment. Although many states have similar laws, little has been written in the psychiatric literature about the emergency petition process. The investigators evaluated emergency petition documents, demographic data, and the adequacy of emergency room records for all patients brought to a large county hospital in Prince Georges County, Maryland, by emergency petition during a one-month period. All emergency petition patients in Prince Georges County are brought to this hospital site. Of 94 petitioned patients examined during the study period, 92 records were available for review. The emergency petition was found to meet appropriate legal criteria in 94 percent of cases. More than half of all patients evaluated were intoxicated on alcohol or illicit drugs, and the majority of these patients were released from the emergency room as no longer dangerous after their acute intoxication resolved. In contrast to previous studies most of the patients evaluated were affluent, had health insurance, and were employed.     

Delinquency and alcohol-impaired driving among young males: A longitudinal study

The present study assessed how the trajectory of delinquency affects the growth curve of alcohol-impaired driving using three-waves of data collected from the Buffalo Longitudinal Survey of Young Men (BLSYM). Using the structural equation modeling method, latent growth modeling was utilized to assess four age cohorts of sixteen, seventeen, eighteen, and nineteen years of age at the first wave. The data indicated that the growth rate of delinquency significantly and positively affects the growth rate of alcohol-impaired driving for the respondents who were sixteen at the first wave. The growth rate of drinking was also significantly and positively associated with the growth rate of alcohol-impaired driving for this age cohort. Although the growth rate of delinquency had no significant effect on the growth rate of alcohol-impaired driving for the age cohort which was seventeen at Wave 1, the growth rates of both drinking and drug use did affect for this age cohort. The data, however, showed that alcohol-impaired driving had a significant increase across the waves for the eighteen year old cohort, but there was no significant variation in the rate across respondents. Finally, for the nineteen year old cohort there was no significant increase in alcohol-impaired driving across the waves, and also no significant variation of the growth rate of alcohol-impaired driving across the respondents. These findings indicated that interventions focused on reducing delinquency, alcohol and drug use by sixteen and seventeen year old male adolescents will also reduce their alcohol-impaired driving.     

Motorcyclists’ fatalities in multiple crashes: Who is responsible for death? (three cases)

In Italy in 2007, 26% of two-wheeled motor vehicle injury/fatalities concerned motorcyclists. However, it is rare (4%) that a motorcycle (MC) crashes with two other road users and even more exceptional is a crash between a MC and three other vehicles. In general, in MC–vehicle crashes, the vehicle driver is at fault in more than 50% of the cases and the motorcyclist in 37%. The study concerns three MC lethal road accidents in which the culpability of the motorcyclist's death was questioned by the prosecutor because it was supposed that one or more vehicles ran over the motorcyclist after a fall. The crucial question in these three cases was if it was possible to assign injuries to a specific crash-aetiology and to assign/exclude the responsibility of motorcyclist's death to a defined subject (motorcyclist himself and/or car drivers) after a crash-dynamics study made by an engineer consultant or by the police authority. Case (1) A 56-year-old motorcyclist on a highway had a front–rear end collision with a car that suddenly stopped; he was therefore projected against a concrete traffic island, thrown on the soil and run over by another car. Case (2) A 29-year-old motorcyclist on the East ring road fell on the soil, perhaps by a supposed front–rear end contact with a car and was run over by two cars in rapid succession. Case (3) A 34-year-old motorcyclist on the North ring road fell suddenly on the soil for unknown reasons; during first aid, the medical team around him was run over by the ambulance which pushed after a rear-end collision with a car. A stepwise analysis of the indicated crash dynamics and an evaluation of all the injuries revealed at autopsy, the study proposed, when possible, injury aetiology for each case and the related responsibility assignments and exclusions.     

Not by accident: An analytical approach to traffic crash harm reduction

Purpose

This study examines whether a problem-oriented approach used by police in Cincinnati, Ohio called the Crash Analysis Reduction Strategy (CARS) corresponded with a change in the number of traffic crashes that resulted in injuries after implementation onset. Under the CARS model, police developed tactics that focused on targeting high-risk driving behaviors, impaired drivers, and crash hotspot locations within the city.

Methods

Using a two-phase strategy we first assess local impact by examining injury-related traffic crash patterns at targeted locations. Second, we examine whether traffic crashes that resulted in injuries in Cincinnati significantly diverged relative to similar outcomes across a number of comparison sites.

Results

Difference-in-difference negative binomial regression analyses indicates that traffic crashes were significantly lower in Cincinnati - down roughly 5.7% to 10.3% in the post-intervention period - when contrasted with comparison sites.

Conclusions

Our findings suggest that comprehensive problem solving approaches can significantly reduce the risk of life changing events such as automobile crashes that result in injuries beyond traditional policing efforts that explicitly focus on crime and violence.     

About the authors

In recent years, afterschool programs have received support for their potential to reduce juvenile delinquency and victimization. This support stems largely from reports based on police incident data indicating that juvenile crime and victimization peak during the afterschool hours. However, prior studies of victimization surveys and self‐reports of crime suggest that delinquency is more elevated during school hours. Utilizing self‐report data from a sample of juveniles participating in an evaluation of afterschool programs in Maryland, this study shows that juvenile victimization and delinquency peak during the school hours, while substance use peaks during the weekend. Disaggregating by offense reveals, however, that the more serious violent offenses are elevated during the afterschool hours, while simple assault offenses are most elevated during school hours. Implications for research and practice are discussed.     

The impact of state community benefit laws on the community health orientation and health promotion services of hospitals

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levene's test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.     

A comparison of curfew and noncurfew violators using a self-report delinquency survey

The present study examines one city’s experience with a juvenile curfew ordinance. It compares characteristics of youths detained by the police for curfew violation with teenagers who did not have such police contact. Selfreport data reveal curfew violators admit committing more minor and serious delinquency, as well as status offenses, than noncurfew violators. Curfew violators also disclose higher victimization levels. Implications deriving from these observations are discussed.     

The sensitivity and specificity of control surface injuries in aircraft accident fatalities

Among the important determinations that aircraft crash investigators try to make is which occupant of an aircraft was attempting to control the aircraft at the time of the crash. The presence or absence of certain injuries of the extremities is used to help make this determination. These "control surface injuries" reportedly occur when crash forces are applied to a pilot's hands and feet through the aircraft's controls. We sought to clarify the significance of these injuries and the frequency with which their presence indicates that the decedent was the person that might have been trying to control the aircraft, questions that are frequently asked of the examining pathologist. We studied sequential fatalities of airplane and helicopter crashes in which autopsies were performed by the Office of the Armed Forces Medical Examiner, excluding those that were known to have been incapacitated before the crash and those that were known to have attempted to escape from the aircraft, collecting 100 "qualified" crash decedents. The incidence of control surface injuries was determined for both pilots and passengers. The sensitivity and specificity of control surface injuries were calculated by classifying the decedents into a 4-cell diagnostic matrix. The positive and negative predictive values for control surface injuries were also calculated. Injuries that met the published definitions of control surface injuries had high incidences in passengers, as well as pilots, giving the term control surface injury a diagnostically unacceptable sensitivity and specificity for indicating "a pilot attempting to control an aircraft." We offer caveats and refinements to the definition of these injuries that help to increase the sensitivity and specificity of this term.     

THE IMPACT OF ENHANCED PRISON TERMS FOR FELONIES COMMITTED WITH GUNS*

Legislation mandating minimum sentences or additions to sentences for crimes committed with guns is a frequent response to gun problems. We compiled these state laws and estimated their impact on state prison populations, prison admissions, UCR crime rates, and gun use in homicides, assaults and robberies. We employed a multiple time series research design, with data for nearly all states over the past 16 to 24 years, such that for any one state the remaining states operated as controls. Several small-scale studies have suggested that the laws might reduce some types of gun crime. We found that the laws produced such an impact in no more than a few states and that there is little evidence that the laws generally reduce crime or increase prison populations.     

Differential effectiveness in patient protection laws: what are the causes? An example from the drive-through delivery laws

In the mid-1990s, many states as well as the federal government began to regulate early postpartum hospital discharge. Length-of-stay patterns changed markedly in response, but effects were much greater in some states than others. In particular, laws directly empowering patients appeared more effective than laws requiring providers to follow practice guidelines. In addition, the effectiveness of regulation could potentially be influenced by state environment, such as managed care penetration as well as exposure to media attention and public pressure on the issue, though these factors alone were insufficient to cause general behavior change. Furthermore, the 1996 federal law had little effect beyond state laws, suggesting that it did not provide substantial benefits to women in self-insured plans exempted from state law regulation by the Employee Retirement Income Security Act. Findings from this study could provide lessons for similar patient protection initiatives.     

机动车外后视镜对人体损伤的研究

目的探讨机动车外后视镜对人体损伤的特点。方法对10例于1990-2005年间在华西医科大学法医学院鉴定的案例进行回顾性的调查,所有研究对象均为机动车外后视镜损伤患者。结果在车内驾驶员为左眼损伤,前排乘客为右眼损伤,均被同则外后视镜碎片所致,而在车外分为两类,一类为骑自行车的中学生,被外后视镜撞伤,以颅脑损伤居多,另一类为行走老年人,被后视镜撞伤,表现为四肢骨折。结论根据其受伤特征,提出相应的预防措施。     

Any-Willing-Provider laws: their financial effect on HMOs

Any-Willing-Provider (AWP) legislation requires that health plans accept any health care provider who agrees to conform to the plan's conditions, terms, and reimbursement rates. Many states have adopted such legislation, raising questions about its effect on the managed care market. Those favoring this legislation argue that it will reduce restrictions on choice of provider, while opponents argue that it will reduce competition by increasing administrative and medical costs for managed care plans. Using cross-sectional time-series data for the period 1992-1995 (the period during which many of these laws were enacted), this study investigates the effect that these laws have on HMO financial performance. Our results show that "all-provider" AWP laws have a very limited effect on the financial performance measures we examine. "Pharmacy" AWP laws have a more significant effect, but neither type of law appears to affect the overall profitability of HMOs.     

Serious head and neck injury as a predictor of occupant position in fatal rollover crashes

Serious head and neck injuries are a common finding in fatalities associated with rollover crashes. In some fatal rollover crashes, particularly when ejection occurs, the determination of which occupant was driving at the time of the crash may be uncertain. In the present investigation, we describe the analysis of rollover crash data from the National Automotive Sampling System-Crashworthiness Data System for the years 1997 through 2007 in which we examined the relationship between a serious head and neck injury in an occupant and a specified degree of roof deformation at the occupant's seating position. We found 960 occupants who qualified for the analysis, with 142 deaths among the subjects. Using a ranked composite head and neck injury score (the HNISS) we found a strong relationship between HNISS and the degree of roof crush. As a result of the analysis, we arrived at a predictive model, in which each additional unit increase in HNISS equated to an increased odds of roof crush as follows: for ≥8cm of roof crush compared with <8cm by 4%, for ≥15cm of roof crush compared to <8cm by 6% and for ≥30cm of roof crush compared to <8cm by 11%. We describe two hypothetical scenarios in which the model could be applied to the real world investigation of occupant position in a rollover crash-related fatality.