“Not a death of that hospital”: the social production of maternity statistics in Freetown

This paper explores the social practices underlying the production of clinical statistics at Princess Christian Maternity Hospital in Freetown, Sierra Leone. Combining ethnographic and historical methods, it focuses on the contexts surrounding the point at which the raw data (on which country statistics are generated) are entered into the medical record. This focus sheds light on the hidden, elided, or otherwise unseen aspects of clinical practice that global health stakeholders risk missing when privileging statistical data over direct observation. Direct observation reveals not only how specious data comes to be part of the medical record, but why.     

The Toxicology of Methadone‐Related Death in Infants Under 1 Year: Three Case Series and Review of the Literature

Methadone‐related fatalities occur rarely in infants under 1 year, with five confirmed cases in the literature. The interpretation of pediatric postmortem toxicology relies on adult data; however, infants have crucial physiological differences that may impact interpretation of results. Retrospective case review included scene investigation, interviews, autopsy, and NIH/CDC Sudden Unexplained Infant Death Investigation Reporting Form. Methadone levels were confirmed by liquid chromatography/tandem mass spectrometry (LC‐MS/MS). The fatal blood methadone levels in this case series ranged from 69 to 700 ng/mL. This review of the literature adds toxicological findings of three methadone‐related infant fatalities and reviews the current literature on methadone‐related death in infants under 1 year. With opioid use on the rise in today's society, forensic experts should have a high index of suspicion for the possibility of intentional or unintentional poisoning in infants.     

Death of a 10‐Month‐Old Boy After Exposure to Ethylmorphine

Abstract: Ethylmorphine, an opiate that is partially metabolized to morphine, is a common ingredient in antitussive preparations. We present a case where a 10‐month‐old boy was administered ethylmorphine in the evening and found dead in bed the following morning. Postmortem toxicological analyses of heart blood by gas chromatography‐mass spectrometry and liquid chromatography‐mass spectrometry revealed the presence of ethylmorphine and morphine at concentrations of 0.17 μM (0.054 mg/L) and 0.090 μM (0.026 mg/L), respectively. CYP2D6 genotyping showed that the deceased had an extensive metabolizer genotype, signifying a “normal” capacity for metabolizing ethylmorphine to morphine. The autopsy report concluded that death was caused by a combination of opiate‐induced sedation and weakening of respiratory drive, a respiratory infection, and a sleeping position that could have impeded breathing. This is the first case report where the death of an infant has been linked to ethylmorphine ingestion.     

论限制民事行为能力人之缔约能力--兼论合同法第47条之不足

各国法律和学界对限制民事行为能力人的合法权益的保护问题都给予了充分的关注,而我国的现行法律对此无论在其概念的外延范围上还是缔约能力上均缺乏应有的规定。文章在结合比较法研究的基础上对我国现行法上限制民事行为能力人概念的外延范围和缔约能力进行分析,同时对我国合同法第47条之规定进行反思,希冀对我国限制民事行为能力人法律制度之完善有所裨益。     

Do multiparty elections improve human development in autocracies?

Improvements in human development under democratic institutions are often attributed to electoral contestation. We evaluate the effect of multiparty contestation on infant mortality in the authoritarian context. Contrary to what extant scholarship argues, we find no evidence that multiparty elections in authoritarian regimes reduce infant mortality. Specifically, we show that electoral autocracies do not produce better infant mortality outcomes compared to closed autocracies holding no multiparty elections. We also demonstrate a non-monotonic effect of electoral competition on infant mortality: Infant mortality increases in levels of electoral contestation common in electoral authoritarian regimes and decreases only at levels of contestation that are nearly exclusive to democracies. Finally, we show that increases in infant mortality in electoral authoritarian regimes operate partially through increased political violence and reduced state capacity.     

The Infant Injury Database: A Tool for the Study of Injury Patterns in Medicolegal Investigations of Child Abuse

In 2012, the Harris County Institute of Forensic Sciences began prospectively collecting injury data from pediatric autopsies. These data and associated case information from 635 pediatric cases are archived in the Infant Injury Database (IID). This paper introduces the IID to the forensic community and demonstrates its potential utility for child abuse and infant fatality investigations. The database is intended to be a source of evidence‐based research for coroners/medical examiners and clinicians in the recognition and diagnosis of child abuse. RR estimates were employed to quantify the relationship between individual autopsy findings to trauma‐related and nontrauma‐related causes of death. For example, unsurprisingly, the RR of trauma cases with multiple injury types is significantly greater than other causes of death, but the RR results provide a quantitative representation of the relationship. ROC curve modeling of the presence/absence of various injury types performed well at discriminating trauma from other causes of death (AUC = 0.96).     

桂林风电如何较快有序发展

风力发电是一门新兴产业。桂林大力发展风电,符合桂林市的城市定位。应尽快编制桂林风电发展规划、合理签订风电开发协议、优化程序加快推进项目前期工作、出台鼓励政策推动风电发展、加强与电网建设的协调,以促进桂林风电较快有序发展。     

从中国古代律法和一些国家相关刑法看现行刑法中的“嫖宿幼女罪”

嫖宿幼女罪从设立以来，一直存在争议。从比较法的视角来看，嫖宿幼女罪乃是世界刑事立法的另类：其原因不仅在于这一罪名本身存在着法律上悖论，逻辑上的混乱.更为重要的是，这一罪名的设立违背社会基本的道德良知．     

Infant death scene investigation and the assessment of potential risk factors for asphyxia: a review of 209 sudden unexpected infant deaths

At the Wayne County Medical Examiner Office (WCMEO) in Detroit, Michigan, from 2001 to 2004, thorough scene investigations were performed on 209 sudden and unexpected infant deaths, ages 3 days to 12 months. The 209 cases were reviewed to assess the position of the infant at the time of discovery and identify potential risk factors for asphyxia including bed sharing, witnessed overlay, wedging, strangulation, prone position, obstruction of the nose and mouth, coverage of the head by bedding and sleeping on a couch. Overall, one or more potential risk factors were identified in 178 of 209 cases (85.2%). The increasing awareness of infant positions at death has led to a dramatic reduction in the diagnosis of sudden infant death syndrome at the WCMEO. This study suggests that asphyxia plays a greater role in many sudden infant deaths than has been historically attributed to it.     

Possible role of pseudoephedrine and other over-the-counter cold medications in the deaths of very young children

The Philadelphia Medical Examiners Office has reported a series of 15 deaths between February 1999 and June 2005 of infants and toddlers 16 months and younger in which drugs commonly found in over-the-counter (OTC) cold medications were present. A total of 10 different drugs were detected: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine and the anticonvulsants, phenobarbital, and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry, with the exception of ethanol, which was analyzed by headspace GC and of phenobarbital and phenytoin that were quantified by GC with a nitrogen phosphorus detector. The most predominant drug was pseudoephedrine, which was found in all of the cases (blood concentration, n=14, range=0.10-17.0 mg/L, mean=3.34 mg/L) and was the sole drug detected in three cases. Acetaminophen was detected in blood from each of the five cases with sufficient sample. Other drugs (with frequency of detection) were dextromethorphan (five cases), carbinoxamine (four cases), chlorpheniramine (two cases) and brompheniramine, doxylamine, and ethanol (one case each). In the majority of the cases, toxicity from drugs found in easily available OTC medications was listed either as the direct cause of death or as a contributory factor. The manner of death was determined to be natural in only two of the cases. This postmortem study supports previous evidence that the administration of OTC cold medications to infants may, under some circumstances, be an unsafe practice and in some cases may even be fatal. The treating physicians and the general public need to be made more aware of the dangers of using OTC cold medications to treat very young children so that these types of tragedies might be avoided.