Medical examiner response to the drug overdose epidemic in King County Washington: “Real-time” surveillance,data science,and applied forensic epidemiology

As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with “real-time” fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.     

“The old woman's wish”: widows by the family fire?: Widows' old age provisions in rural England, 1500–1700

This article considers the extent of changes between 1500 and 1700 in the provisions for widows in the wills from two villages in the east of England (Cratfield and Poslingford in Suffolk). Will-makers were by no means a homogeneous group but had more in common with each other than they did with the poor. The stage in life reached by both the testator and his widow helped determine the type of old-age provision received and the degree of involvement with the estate. The existence of young children proved to be not as an important factor in the decision-making process as either age or social status. Some widows received land from husbands who had been yeomen; other received goods. Older testators favored annuities and similar arrangements, while younger testators (under 60) preferred a division of property between the widow and at least one son. When there were minor children, the widow was more likely to be awarded all or part of the landed estate. Over time, greater reliance upon cash and credit created a more fluid and responsive range of old-age provisions but did not completely replace traditional forms of support.     

Forward,Gillick: Are competent children autonomous medical decision makers? New developments in Australia

Another chapter has opened in the tortured history of the status of Gillick competence. Never before has Gillick been extended to permit a mature child to make autonomous medical decisions over and above the curial ‘parens patriae’ power. In 2013, two judicial decisions promulgated from different Australian courts are in conflict over this most fundamental of questions. This Article situates the law of the ‘parens patriae’ power in Australia and, drawing on overseas conceptualizations of analogous doctrine, explores the bases for and potential consequences of this conflict.     

Could Innovations in Policing have Contributed to the New York City Crime Drop even in a Period of Declining Police Strength?: The Case of Stop,Question and Frisk as a Hot Spots Policing Strategy

Available data make it impossible to reach strong conclusions about the role of policing in the New York crime decline. Instead, we examine whether innovations implemented in New York fit with what is known about effective policing strategies. Our main analysis focuses on how the New York City Police Department (NYPD) could have continued to contribute to the crime drop over the last decade when the number of police declined significantly. We examine geographic data on crime and stop, question and frisks (SQFs) to show that SQFs are concentrated at crime hot spots. We also show that the NYPD increased these specific hot spots policing strategies despite declining numbers. In our discussion, we speculate on whether this “doing more with less” could be an explanation for the continued crime drop in New York, noting the limitations of drawing conclusions from existing data. We also raise concerns about possible backfire effects of SQF hot spots approaches.