Gas dispersal potential of bedding as a cause for sudden infant death

We assessed the gas dispersal potential of bedding articles used by 14 infants diagnosed with sudden unexpected infant death at autopsy. Of these cases, eight exhibited FiCO₂ values greater than 10% within 2.5 min, six of which were found prone and two supine. The results demonstrated that these eight beddings had a high rebreathing potential if they covered the babies’ faces. We did not, however, take into account in our model the large tissue stores of CO₂. As some bicarbonate pools will delay or suppress the increase of FiCO₂, the time–FiCO₂ graphs of this study are not true for living infants. This model, however, demonstrated the potential gas dispersal ability of bedding. The higher the FiCO₂ values, the more dangerous the situation for rebreathing infants. In addition, FiO₂ in the potential space around the model's face can be estimated mathematically using FiCO₂ values. The FiO₂ graph pattern for each bedding item corresponded roughly to the inverse of the FiCO₂ time course. The FiO₂ of the above eight cases decreased by 8.5% within 2.5 min. Recent studies using living infants placed prone to sleep reported that some babies exhibited larger decreases in FiO₂ than increases observed in FiCO₂. While the decrease of FiO₂ in our model is still theoretical, CO₂ accumulation and O₂ deprivation are closely related. If a striking O₂ deficiency occurs in a short period, babies can lose consciousness before an arousal response is evoked and all infants could be influenced by the poor gas dispersal of bedding; the main cause of sudden death in infancy would thus be asphyxia. When the bedding is soft, the potential for trapping CO₂ seems to be high; however, it is impossible to assess it by appearance alone. We sought to provide some objective indices for the assessment of respiratory compromise in relation to bedding using our model. When a baby is found unresponsive with his/her face covered with poor gas dispersal bedding, we should consider the possibility of asphyxia.     

A comparison of pulmonary intra-alveolar hemorrhage in cases of sudden infant death due to SIDS in a safe sleep environment or to suffocation

The differentiation of SIDS from accidental or inflicted suffocation may be impossible without corroborating findings from the death scene or autopsy or in the absence of a confession from a perpetrator. Pulmonary intra-alveolar hemorrhage (PH) has been proposed as a potential clue to suffocation, but none of the previous studies on this topic have limited SIDS cases to those who were in a safe sleep environment, in which all were found supine and alone on a firm surface with their heads uncovered. Our aims are to: (1) compare PH in SIDS cases found in a safe sleep environment to a control group comprised of infants whose deaths were attributed to accidental or inflicted suffocation and (2) assess the effect of age, CPR, and postmortem interval (PMI), with regard to the severity of PH in this subset of safe-sleeping SIDS cases. We conducted a retrospective study of all postneonatal cases accessioned by the Office of the Medical Examiner in San Diego County, California who died of SIDS or suffocation between 1999 and 2004. A total of 74 cases of sudden infant death caused by SIDS (34 cases as defined above, comprising 8% of the total SIDS cases), accidental suffocation (37), and inflicted suffocation (3) from the San Diego SIDS/SUDC Research Project database were compared using a semiquantitative measure of pulmonary intra-alveolar hemorrhage. The most severe (grade 3 or 4) PH occurred in 35% of deaths attributed to suffocation, but in only 9% of the SIDS cases. Age, duration of CPR attempts and PMI had no effect on the severity of PH in SIDS. Our results indicate that the severity of PH cannot be used independently to differentiate SIDS from suffocation deaths. Each case must be evaluated on its own merits after thorough review of the medical history, circumstances of death, and postmortem findings.     

The predictive and convergent validity of a psychometric battery used to assess sexual offenders in a treatment programme: an 18-year follow-up

Abstract

This study examined sex offender risk and treatment change based on a battery of psychometric assessment measures administered to 267 treated adult Canadian federal sex offenders followed up an average 18 years post release. Several significant pre–post changes that were frequently moderate in magnitude (d>.50) were observed across these measures. A factor analysis of the psychometric battery generated three broad need domains consistent with the extant literature that were labelled Socioemotional Functioning, Anger/Hostility, and Misogynist Attitudes. The three need domains and a Need Total, created by their summation, converged with the Violence Risk Scale—Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003) in conceptually meaningful ways and predicted sexual and violent recidivism to varying degrees. Raw measurements of change obtained from pre-to posttreatment frequently bore weak and non-significant relationships to outcome. However, after creating standardised residual change scores to control for pre-treatment score, treatment changes in the individual measures, need domains and Need Total improved significantly in their prediction of reductions in general and sexual violence.