Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

Inaction,under-reaction action and incapacity: communication breakdown in Italy’s vaccination governance

This article explores why governments do not respond to public compliance problems in a timely manner with appropriate instruments, and the consequences of their failure to do so. Utilising a case study of Italian vaccination policy, the article considers counterfactuals and the challenges of governing health policy in an age of disinformation. It counterposes two methods of governing vaccination compliance: discipline, which uses public institutions to inculcate the population with favourable attitudes and practices, and modulation, which uses access to public institutions as a form of control. The Italian government ineffectively employed discipline for a number of years. Epistemological and organisational constraints stymied its efforts to tackle a significant childhood vaccination compliance problem. With a loss of control over the information environment, vaccinations were not served well by exogenous crises, the sensationalism of the news cycle and online misinformation. Hampered by austerity, lack of capacity and epistemic shortcomings, the Italian government did not protect the public legitimacy of the vaccination programme. Instead of employing communications to reassure a hesitant population, they focused on systemic and delivery issues, until it was too late to do anything except make vaccinations mandatory (using modulation). The apparent short-term success of this measure in generating population compliance does not foreclose the need for ongoing governance of vaccine confidence through effective discipline. This is evident for the COVID-19 vaccination campaign, with many Italians still indicating that they would not accept a vaccine despite the devastation that the disease has wrought throughout their country.

     

Passive Drip Stain Formation Dynamics of Blood onto Hard Surfaces and Comparison with Simple Fluids for Blood Substitute Development and Assessment,

The spreading dynamics of blood dripping onto hard surfaces is compared to two spreading models. Samples of human blood, porcine blood, and Millipore^® water were dripped onto cardboard, foamcore, and glass surfaces in low velocity passive drip simulations. Final stain diameter, the total number of spines and scallops, and angle of impact were measured and analyzed. Spreading is best predicted by applying the concept of effective viscosity to the Scheller and Bousfield (R² = 0.91) and Roisman (R² = 0.89) spreading models. In the tested conditions, blood spreads with Newtonian tendencies; however, has quantifiable differences in stain appearance to Newtonian fluids like water. This is encouraging for the development of water‐based fluids as synthetic blood substitutes (SBSs). The work presents an assessment platform to quantify and score the performance of simple water‐based fluids using final stain diameter (6 points) and number of spines and scallops (6 points) at six dripping heights between 20 and 120 cm. The angle of impact of a stain alone is not a sensitive measure of SBS performance, but stain formation scores the SBS's performance with another 1 point. Together these features generate a quantitative relative ranking system, of a maximum possible 13 points, that can be used to support the use of a particular fluid for the creation of a drip stain. The performance of twenty simple fluids in the simulated dripping assessment test is described.     

Reflections on a course on ‘women and literature’

The authors outline the place of their course in a Polytechnic Humanities Degree and show how, concentrating primarily upon the novel and a line of women novelists from Jane Austen to Doris Lessing, new perspectives upon literary criticism and literary history in relation to society and culture are opened up. Teaching methods and attitudes are discussed in relation to the re-evaluation of the role of women as readers and critics, as well as authors. The success of the course, in terms of the interest it has aroused among students in women authors and feminist criticism is discussed, together with the effects of open recognition of differences of emphasis and point of view between the two tutors responsible for it. The authors express their confidence in the course as undermining a harmful acceptance of the idea of a single established literary tradition, which ‘happens’ to be dominated by white, male authors and critics, thus opening the way for students to appreciate how, as Adrienne Rich puts it, ‘there is another story to be told’.