Deaths In New York Research Articles

Cocaine-Filled Capsule Detected after Firearm Injury: A Case Report

Emergency departments are facing increasing drug-related health problems with difficult medicolegal and social consequences. A 25-year-old male with no past medical history arrived at our emergency department. He was brought to the emergency room of our hospital by the security forces, as he suffered a gunshot wound while traveling to a place. The cocaine-filled capsule was seen on plain abdominal film. The plain abdominal film is the most commonly used radiological tool to detect 2-8 cm drug-filled packages within the gastrointestinal tract of body packers. In a study that analyzed the role of drugs in firearm deaths in New York between 1990 and 1998, more than half of firearm deaths had positive drug toxicology. Physicians working in the emergency unit should be prepared for secondary diagnoses. In addition, different examination and imaging findings should be kept in mind in suspicious cases.

Increased Inpatient Mortality for Cardiovascular Patients During the First Wave of the COVID-19 Epidemic in New York.

BackgroundThe acuity and magnitude of the first wave of the COVID‐19 epidemic in New York mandated a drastic change in healthcare access and delivery of care.Methods and ResultsWe retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID‐19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID‐19 positive) were admitted for an acute cardiovascular syndrome during the first COVID‐19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71–6.05] versus 2.87 [1.82–4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID‐19‐related admissions, all cause in‐hospital mortality, or incidence of out‐of‐hospital cardiac deaths in New York. Admission during the first COVID‐19 surge along with age and positive COVID‐19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001).ConclusionsA lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID‐19 pandemic, might have accounted for higher in‐hospital cardiovascular mortality during that period.

Prone during pandemic: development and implementation of a quality-based protocol for proning severe COVID-19 hypoxic lung failure patients in situationally or historically low resource hospitals

BackgroundIntermittent Prone Positioning (IPP) for Acute Respiratory Distress Syndrome (ARDS) decreases mortality. We present a program for IPP using expedient materials for settings of significant limitations in both overwhelmed established ICUs and particularly in low- and middle-income countries (LMICs) treating ARDS due to COVID-19 caused by SARS CoV-2.MethodsThe proning program evolved based on the principles of High Reliability Organizations (HROs) and Crew Resource Management (CRM). Patients with severe ARDS [PaO2:FiO2 ratio (PFr) ≤ 150 on FiO2 ≥ 0.6 and PEEP ≥ 5 cm H2O] received IPP. Patients were placed prone 16 h each day. When PFr was ≥ 200 for > 8 h supine IPP ceased. IPP used available materials without requiring additional work from the bedside team. Changes in PFr, PaCO2, and the SaO2:FiO2 ratio (SaFr) positionally were evaluated using t-statistics and ANOVA with Bonferroni correction (p < 0.017).ResultsBetween 14APR2020 and 09MAY2020, at the peak of deaths in New York, there were 202 IPPs in 29 patients. Patients were 58.5 ± 1.7 years of age (37, 73), 76% male and had a body mass index (BMI) of 27.8 ± 0.8 (21, 38). Pressor agents were used in 76% and 17% received dialysis. The PFr prior to IPP was 107.5 ± 5.6 and 1 h after IPP was 155.7 ± 11.2 (p < 0.001 compared to pre-prone). PFr after the patients were placed supine was 131.5 ± 9.1 (p = 0.02). Pre-prone PaCO2 was 60.0 ± 2.5 and the 1-h post-prone PaCO2 was 67.2 ± 3.1 (p = 0.02). Supine PaCO2 after IPP was 60.4 ± 3.4 (p = 0.90). The SaFr prior to IPP was 121.3 ± 4.2 and the SaFr 1 h after positioning was 131.5 ± 5.1 (p = 0.03). The post-IPP supine SaFr was 139.7 ± 5.9 (p < 0.001). With ANOVA and Bonferroni correction there were statistically significant changes in PFr (p < 0.001) and SaFr (p < 0.001) and no significant changes in PaCO2 over the four time points measured. Using regression coefficients, the SaFrs predicted by PFrs of 150 and 200 at baseline are 133.2 and 147.3, respectively.ConclusionsAn IPP program for patients with COVID-19 ARDS can be instituted rapidly, safely, and effectively during an overwhelming mass casualty scenario. This approach may be equally applicable in both traditionally austere environments in LMICs and in otherwise capable centers facing situational resource limitations.

Excess mortality in the United States during the first three months of the COVID-19 pandemic.

Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013-127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338-6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095-3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646-6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341-3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562-7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170-16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538-39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125-6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.

The Fate of the Other in Tony Kushner's Angels in America

Before HBO first aired Mike Nichols's two-part television adaptation of Tony Kushner's Angels in America (Millennium Approaches and Perestroika) in December 2003, news of its production generated certain degree of skepticism as to whether the critical excitement it had generated during some of the most heated days of the AIDS crisis would be renewed.1 Moreover, many were immediately struck by the fact that this new incarnation curiously omitted the boldly provocative subtitle under which it once appeared: a Gay Fantasia on National Themes. Just what did this elision intimate in terms of Kushner's re-envisioned work?2 In this and other respects, it seemed natural to speculate on just what lasting cultural or moral relevance the 1993 drama might have for society facing what seemed altogether different challenges full decade later. On the journey to its star-studded incarnation could Angels in America still speak to the even greater social fragmentation, complex identity politics, and cultural ambiguities of the twenty-first century? On basic level, Angels in America concerns cluster of intersecting individuals whose lives are profoundly touched by the epidemic of AIDS deaths in New York in the mid-1980s.3 However, unlike its immediate predecessors, the epic scope of Angels can seem especially bewildering to those who encounter it for the first time and struggle to follow the sprawling narrative that ultimately encompasses such disparate matters as the historical migration of the Mormons, the McCarthy hearings, historical

Police deaths in New York and London during the twentieth century

Objectives: To describe the incidences and causes of occupational police deaths in New York City in the United States and Greater London in the United Kingdom during the twentieth century....

Crow deaths as a sentinel surveillance system for West Nile virus in the northeastern United States, 1999.

In addition to human encephalitis and meningitis cases, the West Nile (WN) virus outbreak in the summer and fall of 1999 in New York State resulted in bird deaths in New York, New Jersey, and Connecticut. From August to December 1999, 295 dead birds were laboratory-confirmed with WN virus infection; 262 (89%) were American Crows (Corvus brachyrhynchos). The New York State Department of Health received reports of 17,339 dead birds, including 5,697 (33%) crows; in Connecticut 1,040 dead crows were reported. Bird deaths were critical in identifying WN virus as the cause of the human outbreak and defining its geographic and temporal limits. If established before a WN virus outbreak, a surveillance system based on bird deaths may provide a sensitive method of detecting WN virus.

Crow Deaths as a Sentinel Surveillance System for West Nile Virus in the Northeastern United States, 1999

Abstract In addition to human encephalitis and meningitis cases, the West Nile (WN) virus outbreak in the summer and fall of 1999 in New York State resulted in bird deaths in New York, New Jersey, and Connecticut. From August to December 1999, 295 dead birds were laboratory-confirmed with WN virus infection; 262 (89%) were American Crows (Corvus brachyrhynchos). The New York State Department of Health received reports of 17,339 dead birds, including 5,697 (33%) crows; in Connecticut 1,040 dead crows were reported. Bird deaths were critical in identifying WN virus as the cause of the human outbreak and defining its geographic and temporal limits. If established before a WN virus outbreak, a surveillance system based on bird deaths may provide a sensitive method of detecting WN virus.

HIV Infection as Leading Cause of Death Among Young Adults in US Cities and States: 1991

To describe the extent to which human immunodeficiency virus (HIV) infection has become the leading cause of death among young adults (25 to 44 years of age) in US states and cities of at least 100,000 population.Analysis of underlying causes of death using national vital statistics for 1990 by state and city. Deaths caused by HIV were defined as those with underlying cause assigned a code number of 042, 043, or 044, as established by the National Center for Health Statistics.Infection with HIV was the leading cause of death among young men in five states, causing 29% of their deaths in New York, 28% in New Jersey, 24% in California and Florida, and 16% in Massachusetts. Among young women, HIV was not the leading cause of death in any state. Among young men, HIV infection was the leading cause of death in 64 cities, with the proportion of deaths due to HIV ranging from 16% in Bridgeport, Conn, to 61% in San Francisco, Calif. Among young women, HIV infection was the leading cause of death in nine cities, with the proportion of deaths due to HIV ranging from 15% in Baltimore, Md, to 43% in Newark, NJ.In many US communities, HIV infection is the leading cause of death among young men and women, causing a large proportion of deaths in this age group.

HIV Infection as Leading Cause of Death Among Young Adults in US Cities and States

To describe the extent to which human immunodeficiency virus (HIV) infection has become the leading cause of death among young adults (25 to 44 years of age) in US states and cities of at least 100,000 population. Analysis of underlying causes of death using national vital statistics for 1990 by state and city. Deaths caused by HIV were defined as those with underlying cause assigned a code number of 042, 043, or 044, as established by the National Center for Health Statistics. Infection with HIV was the leading cause of death among young men in five states, causing 29% of their deaths in New York, 28% in New Jersey, 24% in California and Florida, and 16% in Massachusetts. Among young women, HIV was not the leading cause of death in any state. Among young men, HIV infection was the leading cause of death in 64 cities, with the proportion of deaths due to HIV ranging from 16% in Bridgeport, Conn, to 61% in San Francisco, Calif. Among young women, HIV infection was the leading cause of death in nine cities, with the proportion of deaths due to HIV ranging from 15% in Baltimore, Md, to 43% in Newark, NJ. In many US communities, HIV infection is the leading cause of death among young men and women, causing a large proportion of deaths in this age group.

The Economic Cost of Farm Tractor Rollover Deaths in New York

ABSTRACT:Farm tractor rollovers account for one quarter of all fatal farm injuries, but their economic impact has not been studied previously. This study surveyed surviving family members of people killed between 1985 and 1987 in New York farm tractor rollovers and found the average expected income lost by each death was $243,615 (response rate=46%, N=12). Fatal farm tractor rollovers may cost New York more than $2 million a year in lost income. Nonfarmers account for 33 percent of these rollover deaths. These nonfarmers were not on a farm and were not doing farm work at the time of the fatal injury. Policy responses to the dangers of farm tractors should consider the risks to nonfarmers and should be cognizant of the costs that could be averted.

Discrepancies in the Reported Frequency of Cocaine-Related Deaths, United States, 1983 Through 1988

--To assess the validity of cocaine-related mortality data available from the principal federal sources of information about the frequency of drug abuse deaths in the United States: the national vital statistics system and the Drug Abuse Warning Network (DAWN). --We compared the number of cocaine-related deaths reported to national vital statistics and DAWN from 25 metropolitan areas during the years 1983 through 1988. We also compared cocaine-related mortality data reported to national vital statistics with data from all published forensic case series of cocaine-related deaths that occurred during the mid-1980s. --During the 6-year study period, 75% more cocaine-related deaths were reported to DAWN (6057) than to national vital statistics (3466) from the 25 metropolitan areas that were studied. For individual metropolitan areas, the discrepancy between DAWN and vital statistics counts of cocaine-related deaths was as large as a sixfold difference. In six of the seven forensic case series identified in our literature search, the number of cocaine-related deaths exceeded the number of these deaths reported to vital statistics. The largest discrepancy was for cocaine-related deaths in New York, NY, during a 10-month period in 1986 for which 151 deaths were reported in a case series and seven deaths were reported to vital statistics. --Improvements in existing public health surveillance systems are needed for (1) full and accurate measurements of the lethal impact of drug abuse epidemics and (2) valid and comprehensive assessments of the effectiveness of national programs designed to prevent drug-related morbidity and mortality.

Patterns of urban heat-wave deaths and implications for prevention: Data from New York and St. Louis during July, 1966

Patterns of urban heat wave deaths in New York and St. Louis during July 1966 indicate not only the impact of environmental stress on heat-susceptible segments of the population but provide clues to the possible prevention of such deaths. While mortality from all causes increased by 36% in New York and by 56% in St. Louis certain subgroups were at substantially higher risk (persons over age 65; censustract residents with low income, crowding, or poor housing; those with hypertensive, arteriosclerotic, cardiovascular, or other circulatory disease, diabetes, or chronic respiratory disease). The oppressiveness of heat waves in cities is emphasized by increased rates of homicide and by clashes with police in the streets. On the brighter side, pediatric deaths were controlled during heat episodes in both cities, suggesting that medical, social, and environmental measures can intervene. Unless the general approach to urban heat waves becomes prospective rather than retrospective, one can anticipate episodes of excess mortality during the summers of the 1970's with a human cost of about 136 excess deaths per million per week of heat stress.

Schistosoma mansoni infection in children. Treatment with lucanthone hydrochloride (Nilodin).

Schistosomiasis is a problem of increasing importance when viewed on a world-wide scale. It is a serious problem in Africa and South America, especially in Brazil where the expanding population carries the disease with it into previously unsettled territory. In certain cities of the continental United States, such as New York, schistosomiasis has become important even though transmission does not occur. This is so because of the large number of inhabitants who come from the Caribbean Islands, especially Puerto Rico. Since approximately 10% of the people of Puerto Rico are infected with Schistosoma mansoni1,2and since more than 500,000 persons born in Puerto Rico reside in New York, it is estimated that there are more than 50,000 individuals with S. mansoni infection in that city alone. There were 8 deaths in New York from advanced schistosomiasis in the 3-year period from 1956-1958. Schistosoma mansoni is a blood fluke, the definitive

A plea for conscientious prenatal care

P RENATAL care has been given considerable attention in the Iiterature during the Iast severa years. However, no portion of medicine is more negIected than the care of the expectant mother. Because of oId traditions and superstitions, our immediate ancestors sought the services of the physician probabIy a month before the expected deIivery, just to Iet the doctor know that he might expect a caI1. Examination of the patient, if the physician arrived before the deIivery, was done first and Iast, when the stork was on the way. In this sort of practice there were many compIications that often became tragedies. In modern communities the situation has markedIy improved, and in recent years the mortaIity rate has been greatIy decreased. However, the first eIeven months of ‘933, Kansas Iost 139 mothers in 27,526 deIiveries. This number of deaths is appaIIing when one stops to consider that most of the cases were handled by Iicensed physicians, who are supposed to be we11 trained, and to practice aseptic conservatism. The situation is not IocaI. In 1930, the New York Academy of Medicine organized a committee to study materna1 mortality in New York City. In the three years, 1930, 1931, and 1932, there were 2041 materna1 deaths in New York. Of this number, the committee estimated that 1343 or 65 per cent wouId have been preventable, if the women had been given proper care during pregnancy and Iabor. On the other hand it is quite gratifying to the obstetrician, to read statistics from the Chicago Lying-In HospitaI, reporting 23,136 deIiveries with onIy 57 deaths, and part of these were cases that had been mis-managed before the patient entered the hospita1 for deIivery. PrenataI care is routine in this hospita1. Since medicine has made such definite advances in other fieIds, it is high time that a11 medica societies demand better obstetrics in their own communities. This can be done by every physician, whether ocuIist or pediatrician, urging that their patient seek competent obstetrica care. PrenataI care shouId begin as soon as a positive diagnosis of pregnancy has been made. At the Iirst visit a careful history, and physica examination shouId be made. It is important to know something of the famiIy history. Are there any cases of tubercuIosis, nephritis, syphiIis, or bIeeders in the famiIy? Has the patient’s mother or sister had any abnorma1 pregnancies or Iabors, and why ? In her persona1 history do not overIook the diseases of childhood, that may have Ieft chronic heart or kidney disease. The history of any nervous disorders and the patient’s reaction to physica stress and worry may be of great vaIue to the physician in assisting the patient to adjust herseIf to the pregnancy and prevent an impending psychosis. Do not fail to inquire about chronic infections, for many a case of pyeIitis has been caused by an infected tooth. If a foca1 infection is discovered, insist that it be cIeared up as soon as possibIe. If there has been a former pregnancy, a detaiIed history shouId be elicited for often symptoms that may be passed over IightIy by the patient may have