Circumstances Of Death Research Articles

«Поступить по силе моего завещания»: второе завещание митрополита Платона (Левшина)

The article examines the circumstances of the peaceful death of Metropolitan Plato on October 11, 1812 and the fulfillment of the last will of the late hierarch. A sealed morocco case with two wills was taken to Vologda at the most dramatic moment of the Patriotic War of 1812. It contained two spiritual wills of Metropolitan Plato in 1801 and 1807 . Both wills were written with his own hand, in free form, without observing the form of this type of documents that had developed by that time. When they were written, there were no witnesses and they did not go through the usual procedures of appearance in the relevant authorities. One of them, written in 1801 in the form of a prayer of thanksgiving to the Lord, has been published and is well known. The second, of an administrative nature, written in 1807, demonstrates the hierarch's caring attitude about monastic monasteries, almshouses, established educational spiritual institutions, his successor, his circle of like-minded people, friends and students, as well as about his blood relatives and his own commemoration. There is only a brief mention of this second will in historiography. The author comes to the conclusion that the publication and full introduction into scientific circulation of the text of the testament of 1807 is an urgent necessity. A significant addition is the comments made, which relate both to the personalities mentioned in the text and explain the terminology used. In addition, some items named in the will were correlated with the inventory of the property of the Metropolitan of 1812 and the exhibits of the collection of the Sergiev Posad State Historical and Art Museum-Reserve (SPMZ).

Особливості підготовки окремих видів судово-медичних експертиз

Abstract. The article analyzes the important aspects of conducting forensic medical examinations in the context of the investigation of criminal cases and other offenses. The author determines that according to the object of examination, forensic medical examination can be divided into the following types: forensic medical examination, forensic medical examination of living persons, forensic medical examination of material evidence. The article analyzes the processes associated with the examination of a corpse, including the extraction of various biological materials and their further analysis. The methods of determining the time of death, establishing the causes and circumstances of death, as well as identifying the corpse are also considered in detail. It has been established that the forensic medical examination of living persons is the most common type of examination. The article describes the purpose, task and procedure of forensic medical examinations for living persons, including the collection of biological samples for comparison, analysis of injuries and other signs of violence. It is emphasized that the forensic medical expert does not have the right to provide the legal qualification of the examined injuries in the report, this is the prerogative of the investigation and the court. The author demonstrates how such examinations can be used to investigate criminal offenses, establish patterns, and resolve legal issues. In addition, the article examines in detail the specifics of physical evidence examination, such as blood, saliva, semen, tissues, and other materials that may be important in the investigation of criminal offenses. Methods of collection, storage and analysis of such evidence are highlighted, as well as their role in solving criminal cases. Summarizing, the article reveals the key aspects of forensic medical examinations of a corpse, living persons and physical evidence, which are important for judicial practice and the investigation of offenses. It helps to understand the processes and methods used by experts to obtain objective and reliable information necessary for justice and the protection of public safety.

Geographic origin, ancestry, and death circumstances at the Cornaux/Les Sauges Iron Age bridge, Switzerland

Cornaux/Les Sauges (Switzerland, Late Iron Age) revealed remnants of a wooden bridge, artifacts, and human and animal skeletal remains. The relationship between the collapsed structure and the skeletal material, whether it indicates a potential accident or cultural practices, remains elusive. We evaluate the most plausible scenario for Cornaux based on osteological, taphonomic, isotopic, and paleogenomic analysis of the recovered individuals. The latter amount to at least 20 individuals, mostly adult males. Perimortem lesions include only blunt force traumas. Radiocarbon data fall between the 3rd and 1st c. BCE, although in some cases predating available dendrochronological estimates from the bridge. Isotopic data highlight five to eight nonlocals. No close genetic relatedness links the analyzed skeletons. Paleogenomic results, the first for Iron Age Switzerland, point to a genetic affinity with other Central and Western European Iron Age groups. The type of skeletal lesions supports an accidental event as the more plausible explanation. Radiocarbon data and the demographic structure of the sample may suggest a sequence of different events possibly including executions and/or sacrifices. Isotopic and paleogenomic data, while not favoring one scenario over the other, do support earlier interpretations of the last centuries BCE in Europe as a dynamic period from a biocultural perspective.

Neuroforensomics: metabolites as valuable biomarkers in cerebrospinal fluid of lethal traumatic brain injuries

Traumatic brain injury (TBI) is a ubiquitous, common sequela of accidents with an annual prevalence of several million cases worldwide. In forensic pathology, structural proteins of the cellular compartments of the CNS in serum and cerebrospinal fluid (CSF) have been predominantly used so far as markers of an acute trauma reaction for the biochemical assessment of neuropathological changes after TBI. The analysis of endogenous metabolites offers an innovative approach that has not yet been considered widely in the assessment of causes and circumstances of death, for example after TBI. The present study, therefore, addresses the question whether the detection of metabolites by liquid-chromatography-mass spectrometry (LC/MS) analysis in post mortem CSF is suitable to identify TBI and to distinguish it from acute cardiovascular control fatalities (CVF). Metabolite analysis of 60 CSF samples collected during autopsies was performed using high resolution (HR)-LC/MS. Subsequent statistical and graphical evaluation as well as the calculation of a TBI/CVF quotient yielded promising results: numerous metabolites were identified that showed significant concentration differences in the post mortem CSF for lethal acute TBI (survival times up to 90 min) compared to CVF. For the first time, this forensic study provides an evaluation of a new generation of biomarkers for diagnosing TBI in the differentiation to other causes of death, here CVF, as surrogate markers for the post mortem assessment of complex neuropathological processes in the CNS (“neuroforensomics”).

Sex estimation from coxal bones using deep learning in a population balanced by sex and age.

In the field of forensic anthropology, researchers aim to identify anonymous human remains and determine the cause and circumstances of death from skeletonized human remains. Sex determination is a fundamental step of this procedure because it influences the estimation of other traits, such as age and stature. Pelvic bones are especially dimorphic, and are thus the most useful bones for sex identification. Sex estimation methods are usually based on morphologic traits, measurements, or landmarks on the bones. However, these methods are time-consuming and can be subject to inter- or intra-observer bias. Sex determination can be done using dry bones or CT scans. Recently, artificial neural networks (ANN) have attracted attention in forensic anthropology. Here we tested a fully automated and data-driven machine learning method for sex estimation using CT-scan reconstructions of coxal bones. We studied 580 CT scans of living individuals. Sex was predicted by two networks trained on an independent sample: a disentangled variational auto-encoder (DVAE) alone, and the same DVAE associated with another classifier (Crecon). The DVAE alone exhibited an accuracy of 97.9%, and the DVAE + Crecon showed an accuracy of 99.8%. Sensibility and precision were also high for both sexes. These results are better than those reported from previous studies. These data-driven algorithms are easy to implement, since the pre-processing step is also entirely automatic. Fully automated methods save time, as it only takes a few minutes to pre-process the images and predict sex, and does not require strong experience in forensic anthropology.

Forensic utility of carboxyhemoglobin levels in postmortem spleen specimens in South Korea

In order to determine whether CO poisoning was the definitive cause of death, the concentration of carboxyhemoglobin (COHb) in spleen specimens was analyzed using a gas chromatography-thermal conductivity detector. 125 cases of forensic autopsy reports containing COHb analysis requests were analyzed and subdivided into two groups, improbable and highly probable of CO intoxication. In the first group which consists of 100 cases, the results of COHb analysis were negative, and the circumstances of death, as well as the postmortem findings could not validate the exposure to CO. In the second group which consists of 25 cases, the results of COHb were positive, and both postmortem findings and circumstances of death confirmed the exposure to CO. In the cases of indoors and vehicle fires or those including the use of briquettes, COHb levels reached 43.1–97.5 %, whereas in individuals without any feature of CO poisoning had COHb level high as 29.8 %. However, certain cases without any connection to fire nor CO exposure also contained significant amount of CO based on post-mortem analysis. This study focuses on cases without any relationship to fire or CO and proves that COHb levels below 30 % may be considered as a contributing factor to but not exclusively as the cause of death.

Inequities in naloxone administration among fatal overdose decedents by race and ethnicity in Pennsylvania, 2019-21.

The aim of this study was to characterize the circumstances of drug overdose deaths and determine whether naloxone administration differed by overdose decedent race and ethnicity. Analysis of data on unintentional and undetermined intent drug overdose deaths in Pennsylvania (2019-21) was collected from death certificates and the State Unintentional Drug Overdose Reporting System. Multivariable logistic regression models were adjusted for overdose death circumstances and the odds of naloxone administration were estimated by race/ethnicity and year. The analytical sample included 3386 fatal overdose decedents in 2019, 3864 in 2020 and 3816 in 2021. Evidence of naloxone administration (yes/no) was defined using scene evidence and toxicology reports from coroner and medical examiner records, while race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) was based on the death certificate. In the analytic sample, overdose death rates were the highest among Black people and increased over time (rate per 10 000 population, 2019: 4.3; 2020: 6.1; 2021: 6.5); rates were lowest among White people and remained constant over time (rate per 10 000 population, 2019: 2.6; 2020: 2.7; 2021: 2.6). Throughout all years, Black decedents had approximately 40-50% lower odds of naloxone administration compared with White decedents as referent [2019: odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5-0.9; 2020: OR = 0.5, 95% CI = 0.4-0.7; 2021: OR = 0.6, 95% CI = 0.5-0.8], while Hispanic decedents had similar odds of naloxone administration to that of White decedents. After controlling for overdose circumstances in drug overdose deaths in Pennsylvania, USA, from 2019 to 2021, Black people had lower odds of naloxone administration compared with White people, while there were no differences between Hispanic and White people.

A retrospective study of the characteristics and toxicology of cases of lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia.

Lysergic acid diethylamide (LSD) and psilocybin are used as recreational drugs, and there is renewed interest in their clinical use. The current study aimed to (1) determine the circumstances of death and case characteristics of LSD- and psilocybin-related death in Australia, 2000-23; and (2) determine the toxicological profile and major autopsy findings of these cases. This was a retrospective exploratory study of all cases of LSD- and psilocybin-related death in Australia, 2000-23, retrieved from the National Coronial Information System. A total of 43 cases were identified: 33 LSD and 10 psilocybin. The median ages were 24 years [interquartile range (IQR) = 13, range = 16-53] (LSD) and 26 years (IQR = 18.5, range = 20-58) (psilocybin), and fewer than five cases were female. The most common circumstance of death among both groups was traumatic accident (LSD 36.4%, psilocybin 40.0%). There were 12 cases of self-harm, all of which involved LSD, all by physical means. In a fifth, death was attributed to multiple drug toxicity (LSD 18.2%, psilocybin 20.0%). In one case, death was attributed solely to LSD toxicity, while in a further two cases death was attributed to a cardiovascular event following LSD consumption (one LSD only, one multiple drug toxicity). In four psilocybin cases, the cause of death was undetermined. The most common clinical presentation was severe agitation (LSD 27.3%, psilocybin 20.0%). Median blood concentrations were LSD 0.8μg/l (IQR = 1.7, range = 0.1-3), psilocin 20 μg/l (IQR = 53.5, range = 6-83). LSD was the only drug present in 25.0% of LSD cases and psilocybin in 20.0% of psilocybin cases. Pre-existing organ pathology was uncommon. Lysergic acid diethylamide (LSD)- and psilocybin-related death in Australia from 2000 to 2023 was primarily due to traumatic injury, whether through accident or self-harm. Cases of acute toxic reactions that were attributed solely to LSD were rare.

Physician homicide: Reports in the National Violent Death Reporting System (2003–2018)

ObjectiveTo explore the occurrence, demographics, and circumstances of homicides of physicians. MethodAuthors interrogated the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention's surveillance system tracking violent deaths between 2003 and 2018 which integrates data from law enforcement and coroner/medical examiner reports. Authors identified cases of homicide decedents whose profession was physician, surgeon, or psychiatrist. Data collected included decedents' demographics as well as circumstances of death. ResultsData were provided by 7–41 states as participating states increased over time. Fifty-six homicides were reported, most were male (73.2%) and white (76.8%). Most (67.9%) identified assailants reportedly knew decedents: 23.2% were perpetrated by partners/ex-partners; 10.7% by patients/patients' family members. Deaths were mainly due to gunshot wounds (44.6%), stabbing (16.1%), and blunt force trauma (16.1%). More (58.9%) homicides occurred at victims' homes than work (16.1%). ConclusionsPhysician homicides are relatively rare and occur at lower rates than in the general population. Physicians were more frequently killed by partners or ex-partners than by patients. Most homicides occurred away from the workplace. Broader efforts are needed to promote interventions throughout America's violent society to reduce domestic/partner violence and gun violence.

The role of radiology in provenance research - experiences from the collaboration between radiology and anatomy at the University of Rostock and future perspectives.

Worldwide, the study and examination of human remains and the circumstances of their acquisition for anatomical collection have received great interest. As part of provenance research projects, a large number of collections are being investigated to determine whether the human remains have been acquired in a correct or unlawful way because the people could have been killed in order to be used as "anthropological objects" for research purposes and to become so-called "specimens". These topics have also been addressed by the Institute of Anatomy at the University Medical Center Rostock. The role of radiology in this interdisciplinary project will be presented using selected examples.The anatomical collection at the University of Rostock includes 40 human skulls, 14 plaster casts, 6 Egyptian mummy heads, and 1 full-body mummy. In addition to the examination by a historian, an anthropologist, and forensic pathologists, additional computed tomography was carried out on nine skulls and the full-body mummy. Micro-computed tomography was also carried out on seven skulls in order to enable a look behind the mummification material and tissue remains.(Micro-)computed tomography was able to close diagnostic gaps and the results presented some rather unexpected findings.Due to interdisciplinary collaboration, individual fates could be determined, which provided information about the individual's life and death circumstances. None of the examined individuals showed evidence of colonial-era injustice or the use of violence that would have led to their inclusion in the collection. (Micro-)computed tomography was a valuable addition to this provenance research project. · Computed tomography enhances interdisciplinary provenance research projects.. · Computed tomography enables a non-destructive examination of human remains.. · The future of research and presentation of human remains will increasingly be virtual.. · Steinhagen I, Brinker U, Kolbe V et al. The role of radiology in provenance research - experiences from the collaboration between radiology and anatomy at the University of Rostock and future perspectives. Fortschr Röntgenstr 2024; DOI 10.1055/a-2303-0312.

ИЗМЕНЕНИЕ СТРУКТУРЫ И ФОРМ УЧЕТА ФАКТОВ ДЕТСКОЙ И МЛАДЕНЧЕСКОЙ СМЕРТНОСТИ В ЕЖЕГОДНОЙ ДЕМОГРАФИЧЕСКОЙ ОТЧЕТНОСТИ КРАСНОЯРСКОГО КРАЯ В 1959–1985 гг.

The paper examines the change in the forms and structure of recording infant and child mortality in the Krasnoyarsk Region in the period 1959–1985 based on annual reports on vital statistics in the context of changes in the demographic policy of the USSR. The hypothesis is that the problem of child and infant mortality was quite acute for the Soviet state, and in certain periods unsatisfactory indicators were perceived painfully, as a result of which the question of the accuracy and depth of accounting for demographic processes developing in the age group of children under one year old will be reflected in the forms and the structure of annual demographic reporting. A retrospective analysis of accounting forms clearly shows that over time, the development of medicine, methods and systems for recording demographic facts, statistical accounting of various aspects relating to the facts of child and infant mortality becomes more and more detailed and deep. Separate forms appear, devoted only to the issue of the circumstances of death of children under the age of one year or under the age of one month, and their share in the total volume of annual demographic reporting only grows over the years, which indicates the correctness of the initial hypothesis. It was also discovered that statistical authorities focused their attention on the demographic processes that took place among the indigenous peoples of the Far North, Siberia and the Far East, especially in the short period of 1963–1964. The author of the article presents his own conclusions based on what is presented in the main part of the material in relation to the theory of epidemiological transition.

Bioprinting in cardiovascular medicine: Possibilities, challenges, and future perspectives for low and middle-income countries.

Cardiovascular diseases (CVD) stemming from various factors significantly impact the quality of life (QoL) and are prevalent with high mortality rates in both developed and developing countries. In cases where pharmacotherapy proves insufficient and end-stage disease ensues, a heart transplant/surgical repair becomes the only feasible treatment option. However, challenges such as a limited supply of heart donors, complications associated with rejection, and issues related to medication compliance introduce an additional burden to healthcare services and adversely affect patient outcomes. The emergence of bioprinting has facilitated advancements in creating structures, including ventricles, valves, and blood vessels. Notably, the development of myocardial/cardiac patches through bioprinting has offered a promising avenue for revascularizing, strengthening, and regenerating ventricles. Employment loss in developing countries as a circumstance of disability or death can severely impact a family's well-being and means for sustainable living. Innovations by means of life sustaining treatment options can provide hope for the impoverished and help reduce disability burden on the economy of low- to middle-income countries (LMICs). Such developments can have a significant impact that can last for generations, especially in developing countries. In this review, the authors delve into various types of bioprinting techniques, exploring their possibilities, challenges, and potential future applications in treating various end-stage cardiovascular conditions in LMICs.

Military Widows’ Experiences of Social Isolation, Loneliness and Unmet Social Needs

Military widow/ers can experience spousal death suddenly and in traumatic circumstances. Evidence shows that this experience often has a long-term effect on surviving family members, highlighting the unique experiences of loneliness and social isolation in the armed forces community. This study aimed to explore military widow/ers’ lived experiences of social isolation and loneliness and unmet needs relating to social participation. This paper presents the qualitative findings of a sequential study in which Phase One utilized an online survey (N = 165) and Phase Two employed semi-structured interviews (N = 26). Almost all participants across both Phases discussed feeling lonely, socially isolated, or both. Findings highlight the complexity in transition from military spouse to military widow/er through the loss of a military community and geographical location. This was further compounded by language barriers and perceived hierarchy (through service life or circumstances of death) which created obstacles to help seeking. However, individuals who did join military widow/ers’ associations valued peer support through shared connection and understanding. Peer support was particularly valued as, for many, existing relationships with friends or family members were often negatively impacted following bereavement. These changed relationships led to feelings of both vulnerability and loss. Consideration needs to be given to how access to appropriate support is gained and what provision needs to be in place. This study recommends the use of more inclusive language for the military bereaved to promote inclusive practices and broaden the availability of support, including that which would increase social participation, across the sector.

Cases of homicide in Senegal in medicolegal autopsies during the period from 2017 to 2021

Introduction: In case of death by homicide or suspicious death, unidentified deceased bodies, a judicial procedure is opened and a requisition for an autopsy is systematically requested from the medical examiner, whose purpose is to identify the causes and circumstances of death. The objective of this study is to determine the epidemiological and medico-legal aspects of violent deaths by homicides involving a medico-legal obstacle in Senegal. Methodology: Our study was carried out in public hospital structures in Senegal. This is a retrospective study based on data collected in judicial requisitions, autopsy reports and in registers from January 2017 to December 2021. It concerned all cases of death that have benefited from a forensic autopsy following a judicial requisition. Results: During the study period, violent deaths constituted the most represented forensic form with 53.4% of autopsies performed, ahead of natural deaths with 42.4%. The average age of the deceased subjects was 37 years with a male predominance in 242 cases (78%).The place of death or discovery of the corpse was in Rural Dakar .Violent deaths by homicides accounted for 12.5% of cases. Thus, in the cases of homicides, intentional assault and wounding by a knife were in the foreground with 71.2% followed by infanticide 15%. Conclusion: Homicide deaths are violent deaths that represent a public health problem due to unemployment, poverty and economic crises. Thus, the information collected from forensic sources provides information about the victims, the causes and circumstances of death. Improving the collection of data on the perpetrators of homicides requires detailed databases on homicides during investigations and after judicial sanctions , to have a more complete overview of homicide profiles and homicide prevention strategies at national level.

Cause and preventability of in-hospital mortality after PCI: A statewide root-cause analysis of 1,163 deaths.

Mortality is the most devastating complication of percutaneous coronary interventions (PCI). Identifying the most common causes and mechanisms of death after PCI in contemporary practice is an important step in further reducing periprocedural mortality. To systematically analyze the cause and circumstances of in-hospital mortality in a large, multi-center, statewide cohort. In-hospital deaths after PCI occurring at 39 hospitals included in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) between 2012 and 2014 were retrospectively reviewed using validated methods. A priori PCI-related mortality risk was estimated using the validated BMC2 model. A total of 1,163 deaths after PCI were included in the study. Mean age was 71±13 years, and 507 (44%) were women. Left ventricular failure was the most common cause of death (52% of cases). The circumstance of death was most commonly related to prior acute cardiovascular condition (61% of cases). Procedural complications were considered contributing to mortality in 235 (20%) cases. Death was rated as not preventable or slightly preventable in 1,045 (89.9%) cases. The majority of the deaths occurred in intermediate or high-risk patients, but 328 (28.2%) deaths occurred in low-risk patients (<5% predicted risk of mortality). PCI was considered rarely appropriate in 30% of preventable deaths. In-hospital mortality after PCI is rare, and primarily related to pre-existing critical acute cardiovascular condition. However, approximately 10% of deaths were preventable. Further research is needed to characterize preventable deaths, in order to develop strategies to improve procedural safety.

Varying circumstances surrounding opioid toxicity deaths across ethno-racial groups in Ontario, Canada: a population-based descriptive cross-sectional study

IntroductionThe North American toxic drug crisis has been framed as an epidemic primarily affecting white people. However, evidence suggests that deaths are rising among racialised people. Accordingly, we sought to...

Utility and limitations of postmortem computed tomography in animal abuse suspected cases: A case series study of cats

ObjectivesInjuries caused by animal abuse are termed non-accidental injuries, and should be distinguished from accidental injuries. We compared postmortem computed tomography (PMCT) and necropsy findings in deceased cat bodies suspected of having been abused to determine whether findings previously reported to be associated with abuse or accident could be ascertained by necropsy or PMCT. Materials and methodsSeven deceased cat bodies requested by the police for necropsy because of suspicion of animal abuse were used to compare necropsy and PMCT findings. ResultsPMCT revealed gas distribution abnormalities, such as pneumocephalus and pneumothorax, and bone lesions findings, such as cervical and pelvic fracture; however, several of these were not confirmed at necropsy. Findings such as liver contusion and injury to the posterior vena cava were confirmed only by necropsy and not by PMCT. Findings related to animal abuse, i.e., ocular injuries, skull, bilateral rib, and femoral fractures were confirmed by both PMCT and necropsy in 3, 5, 2, and 2 cats, respectively. Pneumothorax, pelvic fracture, and sacroiliac luxation, related to accidents, were confirmed only by CT in 6 of 6, 1 of 4, and 2 of 2 bodies. ConclusionPMCT revealed gas- and some bone-related findings more efficiently than necropsy, and a combination of PMCT and necropsy is recommended to perform, particularly if the death circumstances is unknown.

Characteristics and circumstances of rail suicides in England 2019–2021: A cluster analysis and autopsy study

BackgroundAround 4 % of all suicide deaths in Great Britain occur on the railways. This exploratory study was designed to increase understanding of the individuals that take their lives in this way, and the circumstances of their death. MethodData were obtained from fatality investigation files compiled by the British Transport Police (BTP) relating to suspected suicides on the mainline railway in England from April 2019 to March 2021. Cluster analysis was carried out to identify grouped associations of characteristics and circumstances relating to rail suicide. ResultsA total of 436 files were analysed, representing 93 % of all suspected railway suicides during this period. Cluster analysis identified four groups of almost equal size, distinguished principally by age, living arrangements, employment status and location of death. The study is novel in the way it integrates individual characteristics and circumstances of death. The identified clusters may provide a multidimensional way of conceptualising suicide risk that could inform more targeted interventions at rail locations. LimitationsA high proportion of missing data means that the findings need to be interpreted with caution. It also restricted the multivariate analysis to those categories of information for which sufficient information was available. ConclusionThe characteristics and circumstances of suicide deaths on the railways are complex and multifaceted. The typology identified in this study may help to target preventative strategies prior to the incident as well as at different location types.

Accidental substance-related acute toxicity deaths in older adults in 2016 and 2017: a national chart review study.

Limited research exists on substance-related acute toxicity deaths (ATDs) in older adults (≥60 years) in Canada. This study aims to examine and describe the sociodemographic characteristics, health histories and circumstances of death for accidental ATDs among older adults. Following a retrospective descriptive analysis of all coroner and medical examiner files on accidental substance-related ATDs in older adults in Canada from 2016 to 2017, proportions and mortality rates for coroner and medical examiner data were compared with general population data on older adults from the 2016 Census. Chisquare tests were conducted for categorical variables where possible. From 2016 to 2017, there were 705 documented accidental ATDs in older adults. Multiple substances contributed to 61% of these deaths. Fentanyl, cocaine and ethanol (alcohol) were the most common substances contributing to death. Heart disease (33%), chronic pain (27%) and depression (26%) were commonly documented. Approximately 84% of older adults had contact with health care services in the year preceding their death. Only 14% were confirmed as having their deaths witnessed. Findings provide insight into the demographic, contextual and medical history factors that may influence substance-related ATDs in older adults and suggest key areas for prevention.

Adoption of ride share services associated with decreased organ donor availability

IntroductionRecent single center studies have shown an association between the introduction and adoption of ride sharing services and a significant reduction in alcohol-related motor vehicle collisions and fatalities at urban trauma centers. There is a lack of studies that have evaluated the effect of the introduction and widespread adoption of ride sharing services on the number of organ donors available from motor vehicle accidents (MVAs) and the effect on the overall donor pool. We hypothesize that the number of deceased donors from MVAs has decreased with the introduction of ride sharing. MethodsThe United Network for Organ Sharing (UNOs) database was retrospectively reviewed from September 29,1987 to June 30, 2022 for deceased donors. Only pediatric donors were excluded (age<15). Donors were analyzed by circumstance of death, which included: MVA, suicide, homicide, non-MVA accidents, natural causes, and other. The launch of the major ride sharing service in the United States occurred on July 15, 2010. This service was available in 100 cities in April 2014 and in 500 cities in December 2016. Data were analyzed in a continuous manner and then 4 major adoption periods were considered: pre-launch, launch to narrow adoption, narrow to wide adoption, and post wide adoption. Results218,606 deceased donors had the circumstance of death data available and were included in our analysis. The mean deceased donor age was 42 years, 60% of donors were male, and 71% were white. MVA proportion of death decreased 5% (p<0.001) from the launch to narrow adoption period (16%) compared to pre-launch (21%). Another 2% (p<0.001) decrease occurred during the narrow to wide adoption period (14%). An additional 2% (p<0.001) drop occurred after wide adoption (12%). Figure 1 shows stacked percentages of the various circumstances of death in a continuous manner. Of note: homicides, suicides, and non-MVA accidents were not consistently recorded until 1994, and natural causes until 2001. This graph demonstrates a notable drop in MVA percentages beginning after the launch of ride sharing with steady declines continuing to the period of wide adoption. While absolute numbers of MVA donors have steadily increased since 2014 and had steady numbers before, the other deceased donor categories have increased at a higher rate. ConclusionThe invention and adoption of ride sharing services has decreased the proportion of organ donors from MVAs. The overall number of donors from MVAs, donors from all other causes, and the total number of deceased donors increases each year.