Operationalizing Social Capital: A Strategy to Enhance Communities'"Capacity to Concert"

This article addresses a concern increasingly being voiced in the donor establishment: fifty years of development assistance programs have failed to produce conclusive evidence that they can foster sustainable economic and social development in poor countries. The nature of donor programs is such that it emphasizes economic remedies and orients aid to finite projects. Yet recent evidence suggests that sustained development may be more a continued civic process whereby communities form their capacity to come to their own understandings about public ways of behaving and relating, whereby they develop their capacity to concert . This translates into a practical capability to pinpoint underlying problems, assess alternative approaches, and devise solutions most likely to be sustained. This micro capability may also have important macroeconomic implications in terms of institutional predictability and—through it—in terms of scale economies, transaction costs, transparency, incentive to innovate, and climate to implement public policies. The article suggests an alternative approach to development assistance and offers concrete recommendations to donors.     

Super Tuesday 1988: Regional Results and National Implications

Fourteen southern and border states established a same-day presidentialprimary on 8 March 1988. This analysis shows that this SuperTuesday, in several senses, was less than super. The resultsturned out to be less satisfying than its Democratic founderspreferred but less upsetting than its critics anticipated. DespiteSuper Tuesday, Iowa and New Hampshire remained dominant in the1988 presidential primaries. Although voter turnout increasedslightly over 1984 and the results contributed mightily towardsettling the nomination in the Republican party, Super Tuesdayneither settled the Democratic nomination nor gave meaningfulmomentum to the more moderate Democratic candidates.     

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.     

Massive systemic silicone embolism: a case report and review of literature

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.