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Koehler SA Weiss HB Shakir A Shaeffer S Ladham S Rozin L Dominick J Lawrence BA Miller TR Wecht CH 《The American journal of forensic medicine and pathology》2006,27(1):30-35
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. 相似文献
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Price EA Schueler H Perper JA 《The American journal of forensic medicine and pathology》2006,27(2):97-102
Subcutaneous injections of inert or quasi-inert plastic material designed to smooth out wrinkled skin or to create a more esthetically sought appearance have become very popular with the American public in general, and, in particular, with certain groups highly focused on their physical image. The case of the injection procedure has attracted into the field of plastic medicine a substantial number of illegal, incompetent, and unscrupulous operators. Their ignorance of involved medical risks and procedures not uncommonly results in severe complications, disfigurement, and death of patients. We report the typical pathological and chemical findings of a systemic fatal silicone embolism in a 53-year-old heterosexual woman following illegal chronic injections of silicone in her hips and buttocks. The injected subcutaneous silicone apparently migrated rapidly from the interstitial subcutaneous tissue into the general blood stream resulting in a fatal systemic silicone embolism. An analysis of the presented case in conjunction with a review of the pertinent medical literature, including a recent article, revealed a marked similarity in the clinicopathologic findings between silicone embolism and fat embolism. 相似文献
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Harold D. Lasswell 《Policy Sciences》1971,2(4):439-446
The rapid emergence of the policy science conception is a consequence of profound changes in the modern world, and in turn is affecting public and private decision. In broad outline European civilization has passed from a high level of homogeneity to increasing fragmentation, and more recently toward a new and comprehensive configurative outlook.(1) The differentiation of the modern world fostered the fragmentation of intellectual life. It reduced the relative number of men of knowledge who gave attention to the map of knowledge as a whole, or to the social consequences and policy implications of science and scholarship.(2) At a later stage of differentiation specialists attain a high level of involvement in the policy processes of society. Increasingly they utilize a configurative approach to the advancement and application of knowledge.(3) At first, special and exclusive interests are multiplied by differentiation and fragmentation. As the aggregate impact of men of knowledge expands, particular demands are made more universal. This is a by-product of coalition formation.(4) Configurative ways of thinking do not necessarily result in effective control by champions of democratic and peaceful policy aims unless genuine freedom of access to knowledge—to data banks—is maintained, realistic common interests are unlikely to be defined either by policy scientists or decisionmakers.Distinguished Professor of Policy Sciences, John Jay College of Criminal Justice, City University of New York; Ford Foundation Professor Emeritus of the Social Sciences and Law, Yale University, New Haven, Connecticut. 相似文献
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Thomas J. Scotto Harold D. Clarke Allan Kornberg Jason Reifler David Sanders Marianne C. Stewart Paul Whiteley 《Electoral Studies》2010,29(4):545-556
In recent years, students of voting behavior have become increasingly interested in valence politics models of electoral choice. These models share the core assumption that key issues in electoral politicds typically are ones upon which there is a widespread public consensus on the goals of public policy. The present paper uses latent curve modeling procedures and data from a six-wave national panel survey of the American electorate to investigate the dynamic effects of voters’ concerns with the worsening economy—a valence issue par excellence—in the skein of causal forces at work in the 2008 presidential election campaign. As the campaign developed, the economy became the dominant issue. Although the massively negative public reaction to increasingly perilous economic conditions was not the only factor at work in 2008, dynamic multivariate analyses show that mounting worries about the economy played an important role in fueling Barack Obama’s successful run for the presidency. 相似文献