Medical negligence in drug associated deaths

According to epidemiological studies adverse drug events are one of the most frequently encountered complications during medical treatment, a leading cause of hospitalisation and frequent cause of death. However, medical malpractice claims due to medication errors seem to be relatively rare. Based on a retrospective multicentre study on medical malpractice cases with lethal outcome (n = 4450), drug related cases (n = 575) were further evaluated. In 50% of cases a causal connection between drug therapy and death could be ruled out already after autopsy. In 232 cases a causal connection between drug therapy and death could be approved (drug allergies, relative overdose, wrong application, mix-up of drugs and sepsis after injection abscess). However, within the legal context only in 70 cases a medication error was approved which was in 42 cases causal for death, in 28 not. Administration of contraindicated drugs, incorrect application and relative overdose in renal insufficiency are the prevalent mistakes. Concerning the frequency of ADE in epidemiological studies medication errors are underreported in all data sources on medical malpractice; this seems to be due to the fact that even doctors and attending physicians rarely recognize an ADE; furthermore approving the connection between drug effect and death is extremely difficult for the expert witness.     

数额认识错误初论

数额认识错误,是指行为人对表现为货币或财物的行为对象的经济价值量的认识错误,即行为人主观上认识到的行为对象的经济价值与实际经济价值的不一致。从本质上看,它并不是一种独立的错误类型,而是属于事实错误中的对象认识错误。是否属于数额认识错误,应当依据法定符合说进行判断。行为人对行为对象数额的认识错误超出构成要件所要求的限度,就会影响到故意的成立以及行为人的刑事责任。     

The use of error rates to predict and characterize the efficacy of presumptive field tests

From a forensic perspective, a presumptive test, one which indicates the presence or absence of a certain target material such as blood, is an invaluable tool. Among these tests, there are different specificities, sensitivities, and shelf lives. The accuracy of a test is an algebraic combination of the specificity and sensitivity of the test. Each test has limitations as given by its false positive and false negative rates. The aim of this study was to illustrate how the false positive and false negative rates are to be properly determined using a simulation study for the phenolphthalein test. New presumptive tests must be properly evaluated/validated through testing of commonly encountered household items and other potentially probative items usually found at crime scenes, however, the makeup of test sets must appropriately capture all error rates. In order to correctly use these results when the test is applied to an unknown sample recovered at a crime scene, the error rates cannot be applied directly to estimate whether or not the sample is actually the analyte of interest. In a validation study, the forensic scientist calculates the false positive rate as the p(Positive Reaction|Blood), whereas at the scene, the crime scene investigator wishes to determine the p(Blood|Positive Reaction). All crime scene investigators need to ensure that the conditional is not transposed when interpreting such results. Furthermore, this work provides a model for the assessment of a multiple test diagnostic system intended for investigators.     

Analysis of histomorphometric variables: Proposal and validation of osteon definitions

Histological analysis of bone tissue has been used to explore a variety of questions relating to age-at-death, habitual behaviors, health, and nutritional stress. Identification of intact and fragmentary osteons is of key interest to many researchers in these studies, yet the definitions of these features vary between researchers making cross-study comparisons problematic. Furthermore, histological variable definitions are often ambiguous or require subjective classifications by the observer. As a result, and as indicated by previous studies, observer error and misclassification of certain variables, namely intact and fragmentary osteons, can be significant. This study proposes new definitions for intact and fragmentary osteons that are designed to limit observer subjectivity and also explore efficacy of combining osteon types into one variable. A sample of 30 6th rib cross-sections from a modern forensic population was used to test the validity of the proposed definitions. Observations of intact osteon population density (OPD(I)) and fragmentary osteon population density (OPD(F)) were made by three observers for each cross-section. These observations were used to explore the interobserver error associated with the proposed definitions and determine if combining variables into one variable (OPD) mitigates persisting classification difficulties. Results indicate that the proposed definitions significantly reduce interobserver error and misclassification of intact and fragmentary osteons. However, the interobserver error associated with fragmentary osteons is still high. Evaluation of the variables independently indicates that combining variables has potential to reduce the predictive strength of an age estimation model and the ability to interpret age-related bone remodeling.     

Measuring Exposure to Political Advertising in Surveys

Research on the influence of negative political advertising in America is characterized by fundamentally conflicting findings. In recent years, however, survey research using estimates of exposure based on a combination of self-reported television viewing habits and Campaign Media Analysis Group data (a database of all advertisements broadcast on national and cable television in the top 75 media markets) has argued that exposure to negative political advertising boosts interest in the campaign and turnout. This paper examines the measurement properties of self-reports of television viewing. I argue that the errors from common survey formats may both be nonrandom and larger than previously acknowledged. The nonrandom error is due to the tendency of politically knowledgeable individuals to be more sensitive to question format. Thus the inferences drawn about the relationship between political knowledge, exposure to negative ads, and political behavior are also sensitive to the measures used to estimate exposure. I demonstrate, however, that one commonly used measure of exposure—the log of estimated exposure—is not only more theoretically defensible but also alleviates some of the more serious problems due to measurement error.

论法律认识错误对刑事责任的影响

随着社会的发展和时代的进步,关于法律认识错误与刑事责任关系的传统观点开始受到人们的质疑.应本着立足于现实社会,尊重历史的精神,坚持客观、全面的观点,从理论与实践相结合的角度重新审视法律认识错误与刑事责任的关系问题.     

The Contribution of Body Mass and Volume of Distribution to the Estimated Uncertainty Associated with the Widmark Equation

The Widmark equation is used forensically for the determination of the amount of ethanol (alcohol) that may have been consumed and also to determine the blood alcohol concentration (BAC) of an individual at a specific time. It is important to be able to estimate the uncertainty associated with Widmark equations. To date, there has been no detailed determination of contribution to the final uncertainty of Widmark calculations of the volume of distribution of ethanol (V_d), using anthropometric equations, or the contribution of an individual’s body mass. Using published data, published literature, and freedom of information data, we determined that the variability (%CV) associated with V_d was ~10% (Watson et al. and Forrest anthropometric equations) and that the %CV associated with estimated body mass was ~15% compared to ~3% when body mass was directly measured. These data allow an estimation of the overall uncertainty of Widmark calculations using general error propagation. The estimated total uncertainty for BAC calculations increased from ~11% (volume consumed) and ~22% (BAC) to ~19% (volume consumed) and ~37% (BAC) when using measured body mass compared to estimated body mass. These results demonstrate that forensic practitioners should be mindful of the increase in estimated uncertainty in calculated Widmark equation results when estimated body mass is used rather than measured body mass. These data further improve the knowledge around the uncertainty of results calculated with the Widmark equation.     

Heresies’ Heresies: Collaboration and Dispute in a Feminist Publication on Art and Politics

Abstract

In the 1970s magazines, journals and periodicals constituted an alternative public sphere for second wave feminism. These publications provide an index—and at times the only documentation—of the activities of the women’s art movement as well as its many iterations and divisions. This article addresses this imbalance, arguing that Heresies: A Feminist Publication on Art and Politics (1977–1992) was exemplar of the radical political challenge feminism posed to the art world and culture more broadly. Launched in 1977 by the Heresies mother collective, which included Joan Braderman, Mary Beth Edelson, Lucy R. Lippard, Harmony Hammond and May Stevens among others, the magazine had thematic issues edited by different collectives and was comprised of material from an open call. Content ranged from poetry, to academic essays, to artworks both original and reproduced. This article considers the collaborative process of producing the magazine, which attempted to be inclusive, but in fact came to mirror the divisions—as well as political investments—of the broader women’s movement, alongside the dissensus the publication provoked and attempted to confront.     

Human Factors Effecting Forensic Decision Making: Workplace Stress and Well‐being

Over the past decade, there has been a growing openness about the importance of human factors in forensic work. However, most of it focused on cognitive bias, and neglected issues of workplace wellness and stress. Forensic scientists work in a dynamic environment that includes common workplace pressures such as workload volume, tight deadlines, lack of advancement, number of working hours, low salary, technology distractions, and fluctuating priorities. However, in addition, forensic scientists also encounter a number of industry‐specific pressures, such as technique criticism, repeated exposure to crime scenes or horrific case details, access to funding, working in an adversarial legal system, and zero tolerance for “errors”. Thus, stress is an important human factor to mitigate for overall error management, productivity and decision quality (not to mention the well‐being of the examiners themselves). Techniques such as mindfulness can become powerful tools to enhance work and decision quality.