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.     

Characterisation of gunshot residue from three ammunition types using suppressed anion exchange chromatography

Gunshot residue (GSR) is commonly analysed in forensic casework using either scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) or gas chromatography-mass spectrometry (GC-MS). Relatively little work has been reported on the post-discharge GSR content of non-metallic inorganic or low molecular weight organic anions to distinguish between different ammunition types. The development of an analytical method using suppressed micro-bore anion exchange chromatography (IC) is presented for the analysis of GSR. A hydroxide gradient was optimised for the separation of 19 forensically relevant organic and inorganic anions in <23min and sensitivities of the order of 0.12-3.52ng of anion detected for all species were achieved. Along with an optimised extraction procedure, this method was applied to the analysis of post-ignition residues from three selected ammunition types. By profiling and comparing the anionic content in each ammunition residue, the possibility to distinguish between each type using their anionic profiles and absolute weight is presented. The potential for interference is also discussed with respect to sample types which are typically problematic in the analysis of GSR using SEM-EDX and GC-MS. To the best of our knowledge this represents the first study on the analysis of inorganic anions in GSR using suppressed ion chromatography.     

Wie wird bewertbar, ob ein Staat zu viele Schulden hat? Finanzexperten und ihr Bewertungswissen in der griechischen Schuldenkrise

This paper develops a sociology of knowledge of sovereign debt crises by studying expert cultures in the financial services industry. It is argued that the concept of calculative framing can capture the epistemic practices of analysts as well as the way their products are used by market participants and other stakeholders. The notion of calculative framing is empirically and conceptually extended: The article shows how sovereign debt is framed as a financial value and how calculative framing evolves in situations of crises. The central case is the evaluation of Greece government debt by analysts of international banks in the period from early 2010 until mid 2011. This case shows how crises frames are developed and how they consolidate the evaluation of sovereign default. In this crisis period, analysts inscribe their evaluations into contexts of official crisis management.     

Confronting catastrophe: norms,efficiency and the evolution of the AIDS battle in the UN

Social environments played a powerful role in the institutional adaptations of the AIDS fighting agencies within the United Nations system. Since its AIDS apparatus has become operational, the UN has undertaken two major strategic shifts. The first shift saw the dissolution of the GPA, a small subunit of the WHO in favour of UNAIDS, a dedicated agency engaged in global advocacy. This shift involved a controversial bureaucratic process that led, finally, to a more human rights-based approach to the disease. The second shift saw an increased emphasis on ground-level efficiency. What caused these changes? Contributions in the rationalist tradition expect the UN to act as a multilateral goal-seeker looking to optimally address a major gap in global governance. A sociological framework sees normative changes within the UN as catalysts for change in its goals and structure. A synthesis of these traditions conceptualizes the UN's strategic shifts more clearly, capturing the interactive process between the organization and its strategic environment. UN agencies were forced to rationally adapt to changing conditions in prevailing AIDS norms.