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.     

Validation of a microchip electrophoresis system as a DNA amplification control

As part of the normal procedure in a forensic DNA laboratory, a quality control step of the amplified DNA is often implemented to ensure the correct amplification of the sample before it is analysed in downstream applications. A validation study was undertaken to investigate a new microchip electrophoresis system (MultiNa, Shimadzu Corporation) claiming high resolution and sensitivity compared to routine polyacrylamide gel electrophoresis (PAGE). An array of STR multiplexes (AmpFISTR™ SGM+, GenePrint^® FFFL, PowerPlex™ 16, PowerPlex™ Y, an in-house Y-STR multiplex and AmpFISTR™ Profiler) was tested under both standard and low copy number PCR parameters to evaluate the accuracy, reproducibility and sensitivity of this technique. These tests showed that the microchip system did not have improved sensitivity compared to PAGE though had increased resolution and high reproducibility between samples.     

Dating violence and girls in the juvenile justice system

The purpose of this study is to explore the prevalence and associated behaviors of dating violence among a population of girls in the juvenile justice system. A sample of 590 girls from an urban juvenile justice system completed a questionnaire assessing attitudes and self-efficacy about and occurrence of dating violence. The analysis developed a random effect model to determine a risk profile for dating violence. The strongest predictors of dating violence were (a) initial sexual experience at age 13 or earlier, (b) unwillingness of initial sexual experience, (c) drug use, and (d) low self-efficacy about preventing dating violence. The high prevalence of dating violence and associated behaviors among participants suggests the importance of implementing primary prevention programs to assist preteen girls in delaying initial sexual intercourse and in learning techniques to prevent dating violence.     

The fallacy of perfect regulatory controls: Lessons from database surveillance of migration in West Germany from the 1950s to the 1970s

Surveillance studies have long argued that electronic databases are designed to maximize state surveillance as a “superpanopticon” or “surveillant assemblage.” But how are databases being implemented in practice, and do they actually enhance control? This article addresses these questions by examining the case of the German Central Foreigners Register (Ausländerzentralregister [AZR]). Established in 1953, the AZR was one of the first databases on migrants in the western liberal world, and remains a pillar of Germany's migration control system today. By analyzing internal ministerial records from the 1950s to the 1970s – the time when this database was introduced, expanded, and automatized while still relatively free from legal or public constraints – this article examines whether, or how, databases enhance state control. I argue that the AZR did not provide the “perfect surveillance” it was intended to deliver; rather, it produced major bureaucratic and political challenges and a series of malfunctions. This case study confirms that database surveillance, such as the German AZR in the 1970s and European databases today, depends on three basic conditions: shared expectations regarding data usages, cooperation in data supply, and capacities of data storage and maintenance. Moreover, databases serve the additional symbolic function of reassuring the self-imagination of sovereign, modern state power.     

MEDICALLY ASSISTED HUMAN REPRODUCTIVE TECHNOLOGIES (ART) AND HUMAN RIGHTS — THE EUROPEAN PERSPECTIVE

The present article examines how the progress of science, and in particular, medically assisted human reproductive technologies (ART) have provoked a revolution in the sphere of family relations, generating a series of ethical and legal conflicts. The article focuses on the European perspective, without ignoring the international sphere, given the globalization of the phenomenon. The emerging legal issues are analyzed through the filter of international human rights, not only an important aspect to take into consideration in the context of bioethics in general, but a “passage obligé” given that certain concepts find their explanation and coordinates in international human rights law. It is from this perspective that the relationship between ART and human rights is presented. The applicable international and European legal instruments and principles shall be mentioned, as well as a brief comparison of national legal frameworks in Europe. The emerging bioethical and legal issues are examined in correlation with the response of the European Court of Human Rights through its case law aimed at balancing conflicting rights when faced with issues pertaining to ART. Lastly, the article presents in more detail the particular legal issues under debate in France and Italy, two European countries with specific legislation in the field.     

Hair analysis of opiates in mothers and newborns for evaluating opiate exposure during pregnancy

The increasing interest in toxicological hair analysis as a marker of human exposure to xenobiotics such as illicit substances or therapeutic drugs, has been made feasible by the extension of mass spectrometry, a highly sensitive method of detection. A newborn exposed to drugs in utero can suffer from a varying degree of withdrawal syndrome, a few days after birth. If of opiate origin, the withdrawal syndrome can be treated with morphine, among other therapeutics, but it is not easy to diagnose because of atypical symptoms presented by neonates and especially when maternal drug addiction has not been revealed. To assess and measure toxicological factors linked with the appearance and the severity of this syndrome, maternal and neonatal matrices such as urine, meconium and hair were collected during a protocol approved by the ethical committee. Opiates in particular were measured with GC-MS and potential combined dependences (cannabis, cocaine, amphetamine, LSD and benzodiazepines) and/or substitutive therapeutics (methadone or buprenorphine) were also assessed in 17 mother/neonate couples. Gestational opiate exposure profiles were drawn up and linked with the observed withdrawal syndromes. A withdrawal syndrome seems to appear more frequently after foetal exposure to an association of opiates/substitutive molecules (8 out of 10 withdrawal syndromes observed in this study), although the impact of cocaine and benzodiazepines must also be taken into account. The results obtained in neonatal hair make it possible to affirm foetal drug exposure and are in accordance, for the majority, with the appearance of a neonatal withdrawal syndrome (NWS). Neonatal hair analysis could contribute to assess in utero exposure to opiates, particularly when results in urine and meconium are negative or when these matrices are not available.     

Vehicle-assisted suicide resulting in complete decapitation

A rare case of vehicle-assisted suicide in a 43-year-old man is presented. The man had tied a rope between a fence and his neck and, while seated on the driver's seat, accelerated the vehicle, which resulted in complete decapitation. Earlier that day, the man had tried to bleed himself to death by bottling his own blood in his flat, thus defining the case as secondary complex suicide.     

'Good Faith' in the WTO Jurisprudence - Necessary Balancing Element or an Open Door to Judicial Activism?

The purpose of the article is two-fold: first, it seeks to clarifyand structure those contexts in which the principle of goodfaith has entered the WTO jurisprudence; and second, it presentsan analysis of the potential effects and risks accompanyingthis entrance, such as the allegation of judicial activism onthe part of the panels or the Appellate Body and the viabilityof a distinction between violation and non-violation cases.It attempts to define the framework within which a suitableconcept for the application of good faith must be found andexplores the conclusion that thus far the Appellate Body hasapplied good faith with the necessary caution. However, it cautionsthe necessity of avoiding an overbroad use of the concept andmandates the requirement for the judicial bodies to articulatemore clearly the content attributed to the concept in a particularcase and the legal consequences thereof than it has done thusfar. Finally this article urges the judicial bodies to avoidthe idea of an abstract obligation of good faith that adds somethingto the obligation under the WTO Agreements. This would accordwith the traditional international law understanding of whatthe application of the good faith principle implies.