Clinical case management: a strategy to coordinate detection, reporting, and prosecution of elder abuse

Despite civil and criminal sanctions, elder abuse is a prevalent, underreported, and underprosecuted event in the United States. Traditional reporting legislation and common law remedies have had minimal effect on the incidence and prevalence of elder abuse. The epidemic nature of elder abuse is projected to increase exponentially as the elderly population grows disproportionately over the next several decades. The fragmented system of detecting, reporting, and prosecuting this abuse across a wide range of medical and legal settings creates a poor structure to effectively allow a potentially abused patient to have his/her abuse circumstance communicated to the relevant parties to protect the patient, have his/her situation reported and investigated, and, if necessary, have the perpetrator brought to justice. Emergency rooms and other facilities where elders present for care should be staffed by clinically trained persons who have familiarity interacting with patients and providers across settings of care, and who are trained to detect and report abuse. Nursing case managers fill this role well because they are able to coordinate efforts among acute and long-term care facilities while also being able to supply patients with legal and clinical information about elder abuse. In addition they may support prosecution efforts through their clinical observations and expertise. Hence, clinical case managers are able to coordinate efforts lacking in the current system to effectively evaluate, report, protect, and arrange for relevant services for the patient. Through clinical and special training in elder abuse, nursing case managers can provide support to prosecution efforts against the perpetrators of this most egregious crime.     

Reforming residency: modernizing resident education and training to promote quality and safety in healthcare

The goal of medical residency is to provide the best clinical education for future practice, while increasing quality and safety in current and future healthcare. This goal is not being met. Traditional residency programs often continue to utilize individually oriented, shame-and-blame approaches that do not recognize the systems nature of outcomes, care, and patient safety. Appropriate substantive methods, content, and training tools are also lacking, while residents continue to labor in a poor working environment. All these factors create a system that serves no one-not the resident, the patient, or the system in which both interact. Residency reforms are proposed to address these imperative concerns.     

How do voters form positive economic beliefs? Evidence from the Survey of Americans and Economists on the Economy

Beliefs about normative economics appear to be primarily determined by sociotropic rather than egocentric variables. (Sears & Funk, 1990; Citrin & Green, 1990) Using the Survey of Americans and Economists on the Economy, the current paper finds that the same holds for positiveeconomic beliefs in most – but not all – cases. This hinges on whether a question is “causal” or “non-causal”: Causal beliefs depend on sociotropic variables, especially education and ideology; non-causal beliefs, in contrast, depend on egocentric variables, with income growth playing the leading role. This is consistent with a cognitive model where actors answer easier questions using personal experience, and harder ones with ``off-the-shelf" theories.     

Forensic handwriting examiners' expertise for signature comparison

This paper reports on the performance of forensic document examiners (FDEs) in a signature comparison task that was designed to address the issue of expertise. The opinions of FDEs regarding 150 genuine and simulated questioned signatures were compared with a control group of non-examiners' opinions. On the question of expertise, results showed that FDEs were statistically better than the control group at accurately determining the genuineness or non-genuineness of questioned signatures. The FDE group made errors (by calling a genuine signature simulated or by calling a simulated signature genuine) in 3.4% of their opinions while 19.3% of the control group's opinions were erroneous. The FDE group gave significantly more inconclusive opinions than the control group. Analysis of FDEs' responses showed that more correct opinions were expressed regarding simulated signatures and more inconclusive opinions were made on genuine signatures. Further, when the complexity of a signature was taken into account, FDEs made more correct opinions on high complexity signatures than on signatures of lower complexity. There was a wide range of skill amongst FDEs and no significant relationship was found between the number of years FDEs had been practicing and their correct, inconclusive and error rates.     

Injuries of the Head from Backface Deformation of Ballistic Protective Helmets Under Ballistic Impact

Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed “behind armor blunt trauma” (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400–460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear.