Exploring Cold Case Homicide Survivors' Perceptions of and Relationships With Law Enforcement.

Given the nature of unsolved homicide, a complicated dynamic exists between survivors of cold case homicides and law enforcement personnel. The current study utilizes interviews with 24 survivors to explore the perceptions associated with this relationship. Employing a grounded theory framework, we find several themes depicted within these narratives that guide survivors' overall perceptions of their relationship with law enforcement, including investigative and communication efforts. Results indicate that the survivors universally perceive original detectives were incompetent or ineffective in their original investigation, thus leading to the unsolved status of their case. Over time, secondary and current investigators were also perceived as unable to properly investigate, due to challenges such as insufficient evidence or simply not conducting a comprehensive examination of the case. Regardless of this negative view of police activity on the case, relationships were defined by the level and nature of communication survivors had with their detective. Families who felt listened to, included, and/or valued reported a positive relationship with police that allowed them to trust their case was in good hands. Participants who perceived communication to be secretive, misleading, or completely absent noted strained relationships and further disappointment. Survivors may adopt roles, such as investigator, spokesperson, or advocate, to help compensate for their perception that the case is not properly cared for by police. With regard to grief progress and health of cold case homicide survivors, it is possible treatment by law enforcement outweighs the significant of case resolution years after the homicide. Recommendations for more productive survivor/police interactions are included.

Metabolic Shock in Elderly Pertrochanteric or Intertrochanteric Surgery. Comparison of Three Surgical Methods. Is there a Much Safer?

INTRODUCTION: Trochanteric fractures are a major trauma in the elderly population and represent a significant part of public health spending. Various fixation devices are used as treatment for these fractures. This study aimed to evaluate three surgical methods in the treatment of pertrochanteric femoral fractures. MATERIALS AND METHODS: From January 1, 2013, to December 31, 2014, 86 patients were divided into 3 groups. Fifteen patients were treated with osteosynthesis by reamed intramedullary nailing (RIMN), 15 patients were treated with unreamed intramedullary nailing (UIMN), and 13 patients were treated with dynamic hip screw (DHS) plate osteosynthesis. All patients were >75 years of age. They were evaluated with a clinical radiological follow-up and laboratory examination (LDH, CPK, IL-1-B, IL-8, TNF-α, alpha-1-acid glycoprotein, D-dimer, fibrinogen, ESR, CRP, and procalcitonin). RESULTS: IL-8, TNF-α, fibrinogen, D-dimer and alpha-1-acid glycoprotein levels were higher in the DHS group compared with the other two groups at 1 month after surgery (P<0.05). LDH, IL-1ß, and IL-6 levels were higher in the DHS group compared with the other two groups at 3 months after surgery (P<0.05). From 3 to 6 months after surgery, the TNF-α level was high in the DHS and RIMN groups (P<0.05). Infection markers did not demonstrate a difference among the 3 groups. Twelve patients died during the 12-month follow-up. Regardless of the method used, morbidity and mortality are linked to enticement and comorbidities rather than surgery within 48 hours after the trauma. CONCLUSIONS: From our study, we can affirm that the values of cytokines and interleukins observed remain high during the 12-month follow up, regardless of whatever fixation devices or surgery type was performed within 48 hours of injury. Inflammatory markers are higher in patients in the DHS group. This can probably be explained by the fact that DHS technique is performed by open surgery, and this can create a higher inflammation of soft tissue. Mortality is reduced in the first 30 days after surgery if patients are mobilized early. Therefore, mortality in our study population of patients aged >75 years is linked more to the chronic inflammatory state and comorbidities, rather than fixation device or surgical type used.However, future studies are needed to answer further questions that go beyond the scope of our study.