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.     

Sex offender punishment and the persistence of penal harm in the U.S

The U.S. has dramatically revised its approach to punishment in the last several decades. In particular, people convicted of sex crimes have experienced a remarkable expansion in social control through a wide-range of post-conviction interventions. While this expansion may be largely explained by general punishment trends, there appear to be unique factors that have prevented other penal reforms from similarly modulating sex offender punishment. In part, this continuation of a “penal harm” approach to sex offenders relates to the past under-valuing of sexual victimization. In the “bad old days,” the law and its agents sent mixed messages about sexual violence and sexual offending. Some sexual offending was mere nuisance, some was treatable, and a fraction “deserved” punishment equivalent to other serious criminal offending. In contrast, today's sex offender punishment schemes rarely distinguish formally among gradations of harm or dangerousness. After examining incarceration trends, this article explores the historical context of the current broad brush approach and reviews the unintended consequences. Altogether, this article reinforces the need to return to differentiation among sex offenders, but differentiation based on science and on the experience-based, guided discretion of experts in law enforcement, corrections, and treatment.     

Nursing home deaths which fall under the jurisdiction of the coroner: an 11-year retrospective study

Twenty percent of deaths in the United States occur in nursing homes, yet less than 1% come to autopsy. The current study analyzed causes and manners of death in all nursing homes between 1993 and 2003, investigated by the coroner of Allegheny County, PA, which has the second highest elderly population in the United States. Two hundred eight decedents were identified, aged 19 to 91 years, 58% women and 42% men, 88% Caucasian and 22% African-American. Fifty-eight percent were accidental and 38.5% were natural manners of death, with 2 homicides, 2 suicides, and 3 undetermined cases. The manner of death was significantly different between Caucasians and African-Americans, with 92.6% of accidental deaths occurring in Caucasians and 6.6% in African-Americans (P < 0.1). Most common natural deaths were arteriosclerotic cardiovascular disease, nonarteriosclerotic cardiovascular disease, pneumonia, pulmonary thromboembolism, chronic obstructive pulmonary disease (COPD), seizure disorder, and atraumatic intracranial hemorrhage. Blunt force trauma was the single most commonly identified traumatic accidental death. Accidental deaths were more common in Caucasians than African-Americans. Homicides and suicides were rare events (<2%). Blunt force trauma is a major autopsy finding in accidental nursing home deaths, and a root-cause analysis may be helpful in developing policies and procedures to decrease the incidence of blunt force trauma.     

Where in the world is South Africa? Lecture by Ambassador Tony Leon 14 February 2013

Most of the current constructs which theoretically underpin foreign policy for this country are either overblown or incoherent; they do not appropriately define or advance or prioritise South Africa's national interests abroad, nor do they acknowledge the tensions embedded in the clash between normative policies and realpolitik. Drawing from ‘real time’ experiences in international diplomacy, this lecture explores some of the dilemmas that South Africa, as a middle-range power in the world, confronts in its international engagements. The cost-effectiveness of South Africa's global projection is also examined, and some practical reforms to achieve better results in the current age of austerity suggested.