Delayed death in sudden infant death syndrome: a San Diego SIDS/SUDC Research Project 15-year population-based report

A fraction of SIDS cases have death delayed by successful CPR, yet they have not been compared to SIDS cases which were found dead or not successfully resuscitated. Our aims were to: (1) determine the percent of SIDS cases in the San Diego SIDS Research Project database for whom death was delayed by CPR and subsequent life support; (2) compare demographics, circumstances of death and autopsy findings of delayed death SIDS cases (delayed SIDS) with those whose deaths were not delayed (non-delayed SIDS); (3) examine the evolution of pathologic changes in delayed SIDS as a function of survival interval. A retrospective 15-year population-based study of 454 infant deaths attributed to SIDS revealed 29 delayed SIDS cases (Group I) and 425 non-delayed SIDS cases (Group II). Group I cases were significantly older than Group II cases (mean age 132 days vs. 102 days and p<0.0001). Eighty-nine percent of the Group I cases were discovered between 08.00 and 19.59 h; none were found between 00.00 and 07.59 h, compared to 38% of the Group II cases. Group I infants were found significantly more often away from home (at daycare, or at the home of a relative, friend, or baby sitter) than Group II infants (45% vs. 25%, p<0.05). There were no differences between groups with regard to gender, gestational age, type of delivery, bed sharing, URI within 48 h of death, ALTEs, a history of referral to child protective services, body position when placed or found, or face position when found. Pathologic changes were semiquantitatively evaluated; findings were characteristic of anoxic-ischemic injury that generally became more severe with increasing survival intervals. Anoxic-ischemic brain injury was the immediate cause of death in all delayed SIDS cases. Aspiration of gastric contents was identified in Group I cases surviving less than 48 h and was the likely etiology of acute bronchopneumonia occurring in 83% of the Group I cases. We did not identify factors that would reliably predict which SIDS cases might be discovered soon enough to allow earlier and more effective CPR and survival without permanent brain injury.     

Characterization of Undigested Particulate Material Following Microwave Digestion of Recycled Document Papers

Abstract:  Recycled document paper was microwave digested in a solution of HNO₃ and H₂O₂ prior to analysis by inductively coupled plasma mass spectrometry (ICP-MS) to determine the trace elemental concentrations within the paper. Undigested particulate material was observed and subsequently characterized as a mixture of kaolin (clay) and TiO₂ by Fourier transform infrared spectroscopy and X-ray diffraction spectroscopy. The effect of the particulate material on the elemental concentrations was then investigated. Paper samples were completely digested in hydrofluoric acid (HF) and element concentrations determined in the HF and HNO₃/H₂O digests were statistically compared using Student's t -test (95% confidence limit). Statistical differences in element concentrations between the two digests were observed for only four elements and there was no evidence of element adsorption by the particulate material. Hence, the HNO₃/H₂O₂ digestion proved sufficient to digest paper for ICP-MS analysis, eliminating the need to use the hazardous and corrosive HF matrix.     

Verbandsklagen zur Geltendmachung von Naturschutzbelangen bei immissionsschutzrechtlichen Genehmigungen

Zusammenfassung  Eine Verletzung der Belange von Natur und Landschaft ist in der Vergangenheit bei immissionsschutzrechtlichen Genehmigungen nur in Ausnahmef?llen durch die Verwaltungsgerichte überprüft worden. Weder gelten diese Belange als drittschützend, noch zielen die bisherigen naturschutzrechtlichen Verbandsklagen prim?r auf immissionsschutzrechtliche Genehmigungen. Im Umweltrechtsbehelfsgesetz (UmwRG) hat der deutsche Gesetzgeber die Klagerechte der Verb?nde an eine Verletzung subjektiver Rechte gekoppelt und damit ebenfalls die Geltendmachung von Naturschutzbelangen ausgeschlossen. Durch den Vorlagebeschluss des OVG Münster vom 5. M?rz 2009 im Verfahren gegen das Steinkohlekraftwerk Lünen ist nun der EuGH aufgefordert, sich dazu zu ?u?ern, ob das deutsche Recht den Vorgaben des Gemeinschaftsrechts entspricht.     

Effect of Gas Chromatography Temperature Program on the Association and Discrimination of Diesel Samples*†

Abstract: Five diesel samples were analyzed by gas chromatography–mass spectrometry (GC‐MS) using six GC temperature programs, aiming to investigate the effect of temperature program on association and discrimination of the samples. Temperature programs varied by ramp rate and incorporated one‐ or two‐step temperature ramps. Pearson product moment correlation coefficients and principal components analysis were used to evaluate differences in discrimination among the diesel samples afforded by each temperature program, based on the total ion chromatogram (TIC) and selected extracted ion profiles (EIPs). Association of diesel replicates and discrimination among samples based on the TIC and aromatic EIP were similar for all temperature programs based on scores plots. The alkane EIP was not useful in discriminating samples regardless of temperature program, because of similar alkane content of the diesel samples. The association and discrimination of diesel samples was largely unaffected by temperature programs that incorporated one‐ or two‐step temperature ramps.     

Detection of Gunshot Residue in Blowfly Larvae and Decomposing Porcine Tissue Using Inductively Coupled Plasma Mass Spectrometry (ICP‐MS)*

Abstract: Blowfly larvae and porcine tissue contaminated with gunshot residue (GSR) were collected during summer and winter months, over a 37‐day and a 60‐day sampling period, respectively. Wound samples were microwave‐digested and analyzed by inductively coupled plasma mass spectrometry (ICP‐MS) for the detection of antimony, barium, and lead. During summer, the 37‐day sampling period encompassed all stages of decomposition, except skeletonization. The three elements were detected in larvae only on days 3 and 4 after death but were detected at significant levels in tissue samples throughout the entire sampling period. In winter, no significant decomposition was observed throughout the 60‐day sampling. Although temperatures were too low for blowfly activity, the three elements were detected in the tissue samples at relatively constant, significant levels. Hence, GSR determination in tissue was more dependent on decomposition stage rather than time since death.     

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: A Litany of Fundamental Flaws?

This article argues that the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are fatally flawed notwithstanding the apparent rigour of the process which produced them. These Regulations were the product of considerable deliberation following a sensitively executed public inquiry yet, it is argued, they rely too heavily on the rhetoric of criminal law while failing to take into account the competing norms for compliance and the impact of NHS budget constraints. Further, they push the CQC towards a heavy‐handed deterrence approach to enforcement, which will increase hostility between regulatees and the inspectorate, and ultimately reduce the scope for developing the transparency about failures which is sorely needed in the NHS. This article challenges the contemporary wisdom that it is primarily knee‐jerk regulatory responses that suffer from fatal flaws of this nature.     

Abortion Needs or Abortion Rights? Claiming State Accountability for Women’s Reproductive Welfare

The Family Planning Association Northern Ireland (F.P.A.N.I.) has recently been successful in holding the state accountable for its duty to safeguard women’s reproductive health and welfare, and clarify the circumstances in which abortion is lawful. By demanding that the Minister for Health investigate abortion provision and produce abortion guidance, F.P.A.N.I. hope to improve the quality of abortion services and alleviate the situation of those women who are legally entitled to abortion in Northern Ireland but cannot access it there. This action has challenged a public failure which impacts most negatively on those women who cannot easily escape its effects. Although the case succeeded in shaming the state for such a failure, the judicial review strategy could not challenge the legal ethos which denies women a say over their reproductive lives. This case commentary argues that pro-choice strategic litigation needs to positively and generally assert women’s reproductive rights at the same time as it seeks to accommodate the needs of the most vulnerable.