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.     

‘God Wanted Diversity’: Alawite Pluralist Ideals and their Integration into Syrian Society 1832–1973

The Alawites are often linked to the interests and fate of the al-Asad regime in Syria, yet a much broader context needs to be analysed to gain any meaningful impression of this community's politics. This article suggests that pluralism and diversity lie at the core of Alawite political preferences and what's more, according to Alawite perspectives, this is what God intended. Between 1832 and 1973 Alawites made gradual progress towards genuine integration into Syrian society, however, the confluence of two factors marked a turning point in this process: the mobilisation of Alawite ‘asabiyya by the al-Asad regime and a renewed perception of Sunni Muslim intolerance. Thereafter a different trajectory was set towards the current crisis in Syria. The final analysis suggests that the longstanding political aspirations of Alawites are not dissimilar to those demanded in anti- regime protests that began in Syria in early 2011.     

A practical model for the management of resistance to change: An analysis of political resistance in South Africa

Change is usually accompanied by resistance -- a neglected and not well understood facet of applied O.D. and large social system change efforts. The management of resistance, just as the rest of the change intervention, should be a planned, systematic, continuous and actively managed process.

The model described in this paper supplies an approach to actively manage resistance according to a systematic and methodological plan. In South Africa this model has been used for two purposes: as a practical management strategy for dealing with resistance during O.D.-projects in business, industry and also in other social settings; and for purposes such as research and as a framework to come to grips with resistance of political parties and other interes groups in these times of major political and social changes. This model is explained and then applied to analyse the resistance of various groups to political changes in South Africa.     

Measures of opportunity and the calculation of the arson rate: The connection between operationalization and association

The crime of arson is complicated in part because of the motives associated with the offense and the vast assortment of combustible objects or targets deliberately burned in urban areas. This research attempts to conceptualize the crime in light of criminal law and demonstrates that arson occupies a rather unique position. Although classified as a property crime, the legislative intent appears to focus on the protection of human life. Moreover, legislative developments have brought us to the point where burning almost any property is designated arson. There is a growing concern over the incidence of arson, but there has been little discussion of how to calculate the arson rate when the targets of opportunity are not known. The exploratory research presented here addresses the structure of arson rates by using an assortment of indirect and direct measures of opportunity as denominators in the calculation of the arson rate. Factor analysis reduces a 27×27 correlation matrix to six significant factors and demonstrates that some measures share the same underlying rate structure. By using a factorbase scale (dependent variable) for each factor and a set of independent variables, regression analysis reveals that there are differences in the direction of association, the degree of association, and the types of independent variables that associate with different measures of the arson rate.     

Carcass mass can influence rate of decomposition and release of ninhydrin-reactive nitrogen into gravesoil

To investigate the use of ninhydrin-reactive nitrogen (NRN) in gravesoil to estimate early postmortem interval (PMI), we conducted an experiment to decompose swine (Sus scrofa) carcasses of contrasting mass (～1 kg, ～20 kg, ～40 kg, ～50 kg). Carcasses were placed on the soil surface during June 2007 to monitor mass loss and the concentration of gravesoil NRN over an interval of 15 days. Carcasses of a mass ≤ 20 kg decomposed more rapidly than larger carcasses. However, 1 kg carcasses were associated with a slower release of NRN into gravesoil but a greater concentration of NRN per kg carcass (NRN(C)). We conclude that carcass mass can affect the rate of decomposition and release of NRN into gravesoil, which reflects an interaction between carcass volume and blow fly colonization. Furthermore, we conclude that neonatal carcasses require a different equation than larger carcasses when using gravesoil chemistry to estimate PMI.     

Family influences,school behaviors,and risk for the later development of an eating disorder

Interviews were conducted with parents of 136 female and 45 male adolescents categorized into risk groups for the later development of an eating disorder. The family and school concomitants of risk status in females were demonstrated to be different from that in males. Risk group female adolescents rated family cohesion, parent-adolescent communication processes, and overall family satisfaction more negatively than the comparison group. Mothers of moderate risk group females reported lower family cohesion than the comparison group; there were no group differences for adolescent females in fathers' ratings of family measures. However, no group differences were found on any of the family measures between male risk and comparison males. For both females and males, there were no significant group differences in family history of eating and mood disorders, or alcohol dependence. Teacher ratings indicated relatively greater internalizing tendencies in the high-risk female group.This investigation was supported by NICHD Grant Number 1R01-HD24700 awarded to Gloria R. Leon.Received Ph.D. from University at Maryla. Research interests include precursors of eating disorders and stress and coping in extreme environments. To whom correspondence should be addressed.Received M.A. from San Diego State University. Research interests include precursors of eating disorders, substance abuse, and personality.Received Ph.D. from Stanford University. Research interests include psychosocial aspects of health promotion and disease prevention.Received B.A. from University of Maine. Research interests life span development and family issues.     

Postbariatric surgery deaths, which fall under the jurisdiction of the coroner

Obesity has attained epidemic proportions in the United States, with more than 50% of adults classified as overweight or obese. If untreated, morbidly obese patients have a 1 in 7 chance of reaching normal life expectancy. The surgical treatment of obesity has emerged as the most effective treatment modality in long-term weight control and has become increasingly popular, with attendant postoperative complications and death. We performed a cross-sectional, coroner based, 2-year retrospective review of archival case records for decedents who died following bariatric surgery for the treatment of obesity to identify underlying causes of death and forensic characteristics of this cohort. Fifteen (0.5%) out of 3097 archival cases died following bariatric surgery, with approximately 73% of decedents dying within 6 months of surgery. The underlying causes of death in 80% of decedents were natural comorbidities of obesity, with cardiovascular diseases (33%) being the most frequent causes of death, followed by gastrointestinal diseases (20%), acute pulmonary thromboembolism (13%), and acute bacterial pneumonia (13%). The majority of decedents were white females who remained morbidly obese after bariatric surgery. Only 2 decedents died of direct inadvertent/accidental surgical complications.