Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

Megaesophagus and Possible Mechanisms of Sudden Death

Abstract:  Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66-year-old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84-year-old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi-fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre-existing underlying disease.     

Pragmatism's contributions to international relations

This article examines the methodological and substantive contributions that pragmatism stands to make in the field of international relations (IR) theory. The methodological advantages that pragmatism offers have been described by many scholars in recent years, but the substantive contributions that classical American pragmatists (1870–1930) made to the study of international order have been largely overlooked. It suggests that a careful reading of this philosophical canon, particularly the writings of Charles Sanders Peirce and Josiah Royce, will provide important resources for today's IR theorist.     

Lessons learned from inter-laboratory studies of carbon isotope analysis of honey

Forensic application of carbon isotope ratio measurements of honey and honey protein to investigate the degree of adulteration with high fructose corn syrup or other C₄ plant sugars is well established. These measurements must use methods that exhibit suitable performance criteria, particularly with regard to measurement uncertainty and traceability – low levels of adulteration can only be detected by methods that result in suitably small measurement uncertainties such that differences of 1‰ or less can be reliably detected. Inter-laboratory exercises are invaluable to assess the state-of-the art of measurement capabilities of laboratories necessary to achieve such performance criteria. National and designated metrology institutes from a number of countries recently participated in an inter-laboratory assessment (CCQM-K140) of stable carbon isotope ratio determination of bulk honey. The same sample material was distributed to a number of forensic isotope analysis laboratories that could not participate directly in the metrological comparison. The results from these studies have demonstrated that the majority of participants provided isotope delta values with acceptable performance metrics; that all participants ensured traceability of their results; and that where measurement uncertainties were reported; these were fit-for-purpose. A number of the forensic laboratories only reported precision rather than full estimates of measurement uncertainty and this was the major cause of the few instances of questionable performance metrics. Reporting of standard deviations in place of measurement uncertainties is common practice outside metrology institutes and the implications for interpretations of small differences in isotopic compositions are discussed. The results have also highlighted a number of considerations that are useful for organisers of similar inter-laboratory studies in the future.     

How ‘Vulnerable’ young people describe their interactions with police: building positive pathways to drug diversion and treatment in Sydney and Melbourne,Australia

This article describes findings from an Australian mixed method study, and explores young people’s perceptions of police. We focus on the nature of positive experiences, and the potential for positive encounters to improve outcomes for young offenders affected by problematic alcohol and other drug use. Buber’s concept of dialogical interaction is used to articulate the components of a positive experience and how this increases police legitimacy. In doing so, we demonstrate that, despite negative experiences, young people can be sympathetic to the tensions of modern policing, and can envisage police as positive role models. As such, police can enhance outcomes for ‘vulnerable’ young people through more respectful interactions.     

A Multi-Level Conceptual Model to Examine Child Welfare Worker Turnover and Retention Decisions

There is little disagreement about the importance of a healthy stable workforce in promoting effective provision of child welfare services. This review proposes a multi-level conceptual model of child welfare workforce turnover combining traditional individual and organizational impacts with factors associated with community context. Identified gaps in the literature along with a related research agenda are reviewed. Also presented is an overview of the Florida Study of Professionals for Safe Families, a longitudinal study of new hires into the child welfare workforce across Florida, providing opportunities to address gaps and test model characteristics regarding turnover decisions and related outcomes.     

Slack resources,exploratory and exploitative innovation and the performance of small technology-based firms at incubators

This paper aims to contribute (1) to the understanding about how small technology-based firms in spite of being constrained by limited resources, can still perform exploratory and exploitative innovation and (2) to extend knowledge about the role of slack resources in the context of small technology-based firms in facilitating those innovation activities. Herein, we focus on two types of slack resources: internal slack, resources that are available within the firms and external slack, additional resources that are gathered through the facilitation of external sources such as business incubators. Using a sample of 141 small technology-based firms located at incubators, this study combined two streams of research on incubator studies and innovation to construct some hypotheses examining the role of slack resources and innovation activities in enhancing the performance of small technology-based firms operating in incubator setting. Our findings demonstrate that neither slack resources nor innovation activities alone explain firm performance. Instead, small technology-based firms fit their innovation activities to their slack resources. While the relationship between internal slack and performance is mediated by exploitative innovation, exploratory innovation plays a role as a mediator for the relationship between external slack and performance.     

“Kind of Natural,Kind of Wrong”: Young People's Beliefs about the Morality,Legality, and Normalcy of Sexual Aggression in Public Drinking Settings

Unwelcome touching, groping, and kissing are illegal, but widely tolerated in public drinking settings. This contingency in the law's response means that patrons routinely negotiate the moral boundaries of nonconsensual sexual contact. We use 197 interviews with college‐age individuals to examine the discursive strategies young people employ when negotiating those boundaries. We find that most interviewees have experiences with sexual aggression, do not categorize it as aggression, but advocate for stronger legal punishments against offenders. In accounting for this paradox, they draw on contradictory legal and cultural narratives that both normalize and condemn men's sexual aggression. We build on legal consciousness theories and gender theories by highlighting the complex ways that gender stereotypes enshrined in law are implicated in the construction of a social problem. We also contribute to the sociology of culture by explicating the often unconscious link between culture and action revealed in young people's narratives about sexual aggression.     

Dispositional Mindfulness Moderates the Relationship Between Occupational Stressors and Perceived Stress Among Law Enforcement Personnel

Law enforcement personnel (LEPs) experience occupational stressors that can result in poor health outcomes and have a negative impact on the communities they serve. Dispositional mindfulness, or receptive awareness and attention to present moment experience, has been shown to negatively predict perceived stress and to moderate the relationship between stressors and negative stress-related outcomes. The current study is an investigation of the moderating role of specific facets of dispositional mindfulness (i.e., nonreactivity, nonjudging, and acting with awareness) in the relationship between occupational stressors and perceived stress in a sample of LEPs. As hypothesized, nonreactivity significantly moderated the relationship between operational stressors and perceived stress, such that LEPs low in nonreactivity exhibited a significant relationship between stressors and perceived stress, whereas those high in nonreactivity did not. Nonjudging also moderated the relationship between organizational stressors and perceived stress; however, unexpectedly, LEPs high in nonjudging evidenced a significant relationship between stressors and perceived stress, whereas those low in nonjudging did not. Potential implications of these findings for LEP stress reduction interventions are discussed.     

Impact of Common Mental Health Disorders on Cognition: Depression and Posttraumatic Stress Disorder in Forensic Neuropsychology Context

The assessment and diagnosis of posttraumatic stress disorder (PTSD) and depression in forensic evaluations may lack an acknowledgement of the neurocognitive impact of these disorders and how they interact with other causative factors, such as traumatic brain injury (TBI), pain or fatigue. Both PTSD and depression have a complex, growing and consolidating neuroscientific and neuropsychological evidence base, and both can affect neuropsychological test results. In forensic neuropsychological assessments, they are often considered to be confounding factors in evaluating TBI and neurodegenerative disorders but not a source of cognitive impairment in their own right. Yet, an accurate neuropsychological assessment of both cognition and affect is vital to causality determination, prognosis and treatment planning. To complicate matters, selective brain injuries, contingent on the location of injury, can produce symptoms of depression that also affect the neurocognitive profile. Therefore, behavior can overlap not only due to overlapping or comorbid diagnoses, but also due to similar neuroanatomical correlates of both conditions. This paper focuses on reviewing and integrating the available empirical evidence from neuroscience and neuropsychology regarding the cognitive impact of PTSD and depression. Our critical review will emphasize the implications of the more recent evidence for forensic assessment determinations regarding causality, diagnosis, and the impact on function, prognosis and treatment. Hence, electronic search engines, PubMed, PsycINFO, and Google Scholar (up to January 2018) were screened and reviewed both for the neuroscience and neuropsychological literature related to depression and PTSD.