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791.
Four unrelated hanging deaths involving young white males, all in enlisted status in the United States military, are presented. Taken in a military context, one scene served as a suicide note equivalent with the unmistakable message of extreme defiance toward military regulations. In two cases, the elaborate attire of the decedents could have lead to the misclassification of the manner of death if investigative information had not been considered. Extensive background investigation and review of medical records in the fourth case disclosed that the victim had an eight- to ten-year history of compressing his neck to cause unconsciousness. He left an extensive suicide note in which he concluded that "hanging would be good." Each case has certain unique features, as a group, the cases all demonstrate a continuum from obvious suicide to cases where the manner of death is, at first, equivocal. 相似文献
792.
The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul 总被引:1,自引:0,他引:1
The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates. 相似文献
793.
794.
A 19-year-old school boy suffered from fluctuating uncharacteristic chest pain in the last 20 h before his death. He died unexpectedly within a few minutes of a hemopericardium, which resulted from an aneurysmal rupture of the ascending aorta. The patient's past history as well as the autopsy and ultrastructural findings led to the diagnosis of Marfan's syndrome with alterations of the cardiovascular skeletal system but no ophthalmological involvement ("oligosymptomatic" form of Marfan's syndrome). Appraisal of the cause of death is made more difficult by the fact that medical treatment was undertaken on the same day, whereby subtotal liver crushing was established that had resulted from attempts at resuscitation. 相似文献
795.
A R Copeland 《Zeitschrift für Rechtsmedizin》1986,96(4):291-296
A study of non-commercial accidental water transport (boating) fatalities was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Fla., during the years 1980-1984. A total of 23 cases were collected and analyzed as to the age, race, sex, and the cause of death of the victim along with the blood alcohol content and the Urine EMIT drug screen at autopsy. Furthermore, the type of boat involved, the geographic locale, the time of the incident, the reason or risk factor for the incident, and the scene circumstances were also noted. Commonly, one is dealing with a male population below the age of 30 years who die of drowning. In approximately half of the cases alcohol is detected. The scenario involves "small" boats or canoes in the Atlantic Ocean or in canals in the afternoon or evening. Inexperience in boating/or stupidity plays a key role. A discussion ensues concerning recommendations designed to avoid such tragedies. 相似文献
796.
Legislative and educational alternatives to a judicial remedy for the transfer trauma dilemma 总被引:1,自引:0,他引:1
E S Cohen 《American journal of law & medicine》1986,11(4):405-432
Transfer trauma is alleged to be an increase in morbidity and mortality in institutionally relocated chronically ill elderly. Efforts by the legal profession to persuade courts that transfer trauma should be a legally recognized phenomenon invoking judicial protections against transfer (the "transfer trauma argument") have been unproductive. In O'Bannon v. Town Court Nursing Center, Inc., the United States Supreme Court denied standing to elderly persons claiming a property interest in remaining in alleged substandard facilities. The Court rejected the argument that the possibility of transfer trauma constituted a deprivation of life or liberty that would have required due process protections of notice and hearing. Despite the Court's preclusion of transfer trauma litigation in a constitutional context and the general unwillingness of lower courts to recognize the phenomenon, attorneys continue to burden the judicial system with frivolous transfer trauma arguments. The unfruitful pursuit of a judicial remedy for the ethical and social problems that arise with relocation of the elderly continues, in part, because of a misguided belief that this distressing social phenomenon is best remedied by the courts. Judicial unwillingness to recognize the transfer trauma argument, however, does not preclude legislative consideration of the humanitarian issues concerning the institutional relocation of elderly persons. This Article examines gerontological research in order to understand the judicial rejection of the transfer trauma argument and argues in support of legislative and educational solutions for the ethical and social problems attending transfer. 相似文献
797.
Judith V. Becker Meg S. Kaplan Jerry Cunningham-Rathner Richard Kavoussi 《Journal of family violence》1986,1(1):85-97
Adolescent incest sexual perpetrators seen at an out-patient clinic were interviewed regarding demographic characteristics and occurrence of deviant and nondeviant sexual behaviors. Results indicate that subjects (1) committed more sexual crimes than they had been arrested for, (2) reported a very early onset of sexual behavior, (3) had additional DSM-III psychiatric disorders, and (4) reported previous sexual victimization. Recommendations for future research are made. 相似文献
798.
P S Appelbaum A Meisel 《The Bulletin of the American Academy of Psychiatry and the Law》1986,14(3):221-230
The law governing the obligation of therapists to report their patients' previous criminal acts was reviewed. Most often, discussions of this subject fall under the general category of "misprison of a felony," that is, the presumed general obligation of all citizens to report felonies that come to their attention. Review of federal law revealed that the courts have consistently interpreted the federal misprision statute as requiring active concealment of a crime, not a mere failure to report, in order to convict for the offense. State law is more diverse. Only one state has a general misprison statute labeled as such, and several states have recently repealed such statutes. The strong trend in states without statutes is to reject misprison as a common law crime, because of its incompatibility with modern notions of justice. Most states, however, have limited reporting statutes, such as for child abuse or gunshot wounds, that impose similar obligations. Therapists' reporting of past crimes may be affected by clinical and ethical concerns, as well as by obligations to protect future victims. In almost all jurisdictions, however, the fear of prosecution for failure to report a past crime should not be a factor in deciding on a course of action. 相似文献
799.
Approximately 15% of victims of instantly lethal central nervous system trauma have an empty or nearly empty heart at autopsy. This article defines and discusses the "empty heart" sign. 相似文献
800.
Upon coming to office, President Ronald Reagan proposed a numberof programs collectively referred to as the New Federalism.These programs were designed to alleviate some of the problemswhich the president saw as plaguing the intergovernmental systemand to accomplish Reagan's goal of decentralizing authority.One of the most highly publicized and debated indeed,probably the most controversialaspect of the President'sNew Federalism package was the "Big Swap" plan. Both versionsof this plan, however, were bad deals for the states and theircommunities, and it would appear that several interrelated economicconcerns played a role in the opposition of many state and localofficials to these proposals. To demonstrate just how bad theseproposals were, the article documents the effect that inflationand recession had had on the fiscal health of state and localgovernments, and the projected impact that these plans wouldhave had on state and local revenue and tax systems. 相似文献