Accurately assessing elderly fall deaths using hospital discharge and vital statistics data

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deaths. However, studies have shown that discrepancies between the HDD and the corresponding DC often exist. This discrepancy was especially evident when comparing HDD to the vital statistics data (VSD) for deaths by falls among those aged 65 and over in 19 states.This was a retrospective forensic review of elderly (age 65 and over) fall-associated fatalities (E880-E888) identified from HDD and VSD in Allegheny County, Pennsylvania, between 1997 and 1998. Seventy-seven cases were identified, with the original manner of death listed as natural (34), suicide (1), and accidental (42) on the DC. Following a forensic review of the cases, the manner of the death on the DC should have been changed from natural to accidental in 28% (n = 12) of the cases, representing an undercount in the VSD. Undercounts were due to a failure of clinicians to account for the significance of a fall event that contributed to subsequent pathology and death. In addition, in that 22% (n = 17) of the HDD fall-associated deaths, the fall did not contribute directly or sequentially to the underlying cause of death, thereby representing an overcount in the HDD.Based on these findings we recommend (1) elderly fall surveillance systems should only count HDD E-coded falls that demonstrate a serious traumatic injury which directly or subsequently results in death, (2) all in-hospital fall-associated deaths should be reported to and reviewed by coroner/Medical Examiner offices for determination of the cause and manner of death, and (3) physicians should be better educated in properly completing death certificates.     

The Rise of Citizen Groups within the Administration and Parliament in Switzerland

This research note presents three newly interconnected and expanded datasets on interest groups’ (IGs) access to the Swiss political decision‐making process: (1) extra‐parliamentary committee seats occupied by IGs (1980, 2000, 2010), (2) parliamentary (committee) seats occupied by IG representatives (1992‐2015), and (3) consultation replies submitted by IGs (2008‐11). We show that the Swiss system of interest intermediation adapted to the multiplication and organizational consolidation of citizen groups, which defend non‐producer interests and do not provide selective benefits to their members (e.g. environmental groups). The share of access granted to citizen groups has increased in both the administration and parliament, across all federal departments and most legislative committees. Moreover, citizen groups benefit from a larger share of access in the recently revitalized parliament, compared to the administration. This suggests that economic groups’ decline in power is also related to the rise of citizen groups.     

Strategic Challenger Entry in a Federal System: The Role of Economic and Political Conditions in State Legislative Competition

Over a third of state legislators do not face challengers when seeking reelection. Existing analyses of state legislative contestation almost exclusively focus on the stable institutional features surrounding elections and ignore conditions that change between elections. I remedy this oversight by investigating how political contexts influence challenger entry. State legislators—particularly members of the governor's party—more often face opposition during weak state economies, but the president's copartisans are even more likely to receive a challenger when the president is unpopular. My findings suggest that both national‐ and state‐level political conditions have an important impact on challengers' entry strategies.     

The Relationship Between Crime Reporting and Police: Implications for the Use of Uniform Crime Reports

Empirical studies that use reported crime data to evaluate policies for reducing crime will understate the true effectiveness of these policies if crime reporting/recording behavior is also affected by the policies. For instance, when the size of the police force increases, changes in the perceived likelihood that a crime will be solved may lead a higher fraction of victimizations to be reported to the police. In this paper, three data sets are employed to measure the magnitude of this reporting bias. While each of these analyses is subject to individual criticisms, all of the approaches yield similar estimates. Reporting bias appears to be present but relatively small in magnitude: each additional officer is associated with an increase of roughly five Index crimes that previously would have gone unreported. Taking reporting bias into account makes the hiring of additional police substantially more attractive from a cost–benefit perspective but cannot explain the frequent inability of past studies to uncover a systematic negative relationship between the size of the police force and crime rates.     

Polydrug fatality involving metaxalone

A 29-year old female with a history of depression was found dead in a hotel room. The death scene investigation found empty pill bottles and an empty liter bottle of wine. Metaxalone, a centrally acting muscle relaxant, along with citalopram, ethanol, and chlorpheniramine were identified in the postmortem samples and quantitated by gas chromatography-mass spectrometry. The concentration of metaxalone in femoral vein blood was 39 mg/L. The heart blood concentration was 54 mg/L. Femoral vein blood concentrations of citalopram and chlorpheniramine were 0.77 mg/L and 0.04 mg/L, respectively. Ethanol levels were 0.13 g/dL in vitreous and 0.08 g/dL in heart blood. Other tissue samples were also analyzed. The authors consider the metaxalone concentrations toxic and potentially fatal. The citalopram concentrations were lower than those reported in fatal cases for this drug alone. Death was ascribed to polydrug abuse/overdose with metaxalone a major contributor. This represents the first reported case to our knowledge in which a metaxalone overdose significantly contributed to death.     

Death by chainsaw: fatal kickback injuries to the neck

Each year over 3 million new chainsaws are sold in the United States. The operation of these newer saws combined with the millions of older chainsaws in circulation results in over 28,000 chainsaw-related injures annually. The majority of the injuries involve the hands and lower extremities with less than 10% involving injuries to the head and neck regions. Deaths while operating a chainsaw are extremely rare. The most common hazards associated with chainsaws are injuries caused by kickback, pushback, and pull-in. Kickback is the most common and poses the greatest hazard. Kickback occurs when the rotating chain is stopped suddenly by contact with a more solid area throwing the saw rapidly backward toward the operator. The cause of most injuries can be traced to improper use of the saw or poor judgment on part of the operator. We present two fatal chainsaw deaths; one with an older style saw, and the other with a modern type. In both cases the victims died from fatal injuries received to the neck region from a chainsaw kickback. The first case involved a 49-year-old white male operating an older style chainsaw with limited safety features. The second case involved a 38-year old white male who was operating a newer model chainsaw equipped with a low kickback chain in an unsafe manner.     

Cardiac concussion: definition, differential diagnosis, and cases presentation and the legal ramification of a misdiagnosis

A cardiac concussion is caused by a sudden, nonpenetrating, localized impact to the chest that is theorized to result in almost simultaneous sudden death from a disruption to the conductive system. The detailed external/internal forensic examination of the body reveals no evidence of structural, pathologic, or histologic signs of trauma to the heart. A cardiac concussion is a rare and often overlooked cause of sudden death. This type of sudden death is typically seen among younger individuals participating in sports involving projectiles and, to a lesser degree, where collisions occur. Cardiac concussions are clinically, pathologically, and chemically different from a cardiac contusion. The objective of this paper will be to define cardiac concussion, differentiate between cardiac concussion and cardiac contusion, and describe the clinical and pathologic features of a 32-year-old white male who died of a cardiac concussion following a collision with a catcher during a softball game. The civil ramification of incorrectly diagnosing the manner of death in cases of death involving a cardiac concussion will also be addressed.     

Pitfalls in the Use of Time Series Methods to Study Deterrence and Capital Punishment

Objectives

Evaluate the use of various time series methods to measure the deterrence effect of capital punishment.

Methods

The analysis of the time series approach to deterrence is conducted at two levels. First, the mathematical foundations of time series methods are described and the link between the time series properties of aggregate homicide and execution series and individual decision making is developed. Second, individual studies are examined for logical consistency.

Results

The analysis concludes that time series methods used to study the deterrence effects of capital punishment suffer from fundamental limitations and fail to provide credible evidence. The common limitation of these studies is their lack of attention to identification problems. Suggestions are made as to directions for future work that may be able to mitigate the weaknesses of the current literature.

Conclusions

Time series studies of capital punishment suffer from sufficiently serious identification problems that existing empirical findings are compatible with either the presence or the absence of a deterrent effect.