A study on plea bargaining against theories of punishment and criminal justice / Abdul Hakeem Putra Abdul Rahman Putra, Ahmad Solehin Abd. Ghani, and Amee Asraaf Khairee Amin.

On December 13, 2010, it was reported that a change in the Malaysian Criminal Procedure Code to include the concept of formal plea bargaining in criminal cases would soon be implemented by the court. According to the former Chief Justice Yang Amat Arif Tun Tan Sri Dato' Sri Zaki Azmi, the plea bargaining have already put into practice now but this will become a more formal and standard procedure under the amendment. Plea bargaining will only be offered within 30 days after a person has been charged, and the case would go to a full trial after 90 days if no agreement has been reached. Plea bargains will be an option in cases involving first-time offenders including for offenses for which the maximum penalty is death. However, if there is a minimum sentence for the offense, a lesser term will not be available. The Deputy Public Prosecutor will be able to determine whether or not to offer plea bargains in each case. Plea bargaining may also involve a reduction of the charges. It will be the duty of the court to ensure that the plea bargain was entered into voluntarily by the parties. Judges will be able to call the accused in camera to ensure that this has occurred. Once a sentence has been determined neither the prosecution nor the defence will be able to appeal the decision, except on technical grounds. The Chief Justice said that the concept of formal plea bargaining would expedite the disposal of criminal cases and reduce the backlog in the courts. However, we also need to consider certain hidden danger on the application of the plea bargaining in Malaysia. This research will examine the issues pertaining whether the implementation of plea bargaining will fulfilled the theories of punishment and uphold criminal justice or it will be vice versa

Can Physician Champions Improve Kangaroo Care? Trends over 5 Years in Rural Western India

Introduction: In 2013, approximately 2.8 million children worldwide died within the neonatal period. India is at the epicenter of this tragedy, accounting for one-third of all neonatal mortalities. Prematurity and/or with low birth weight are the leading cause of neonatal mortality and India has the highest number of neonates born preterm and weighing less than 2,500 grams worldwide. It is estimated that Kangaroo Care can avert up to 48% of all neonatal deaths among premature babies by 2025. However, the promise of Kangaroo Care as a low-cost, safe, and efficacious intervention to reduce neonatal mortality in India has not been realized due to suboptimal implementation. Physician champions can improve Kangaroo Care implementation, but the magnitude of their impact is unknown. Methods: A retrospective cohort study of 648 infants identified using clinical data from a NICU located in rural western India. Physicians who led Kangaroo Care training sessions with neonates and coached peer healthcare professionals were considered champions. Two Kangaroo Care champions were on staff full-time from January 2010 through June 2011, part-time from July 2011 through June 2012, and absent thereafter. We examined the effect of the withdrawal of physician champions on overall use using logistic regression, time to initiation using competing risk cox regression, and intensity using linear regression models of the two main components of Kangaroo Care, skin-to-skin care and breastfeeding, separately. Findings: In comparison to when Kangaroo Care champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care (95% CI): 64% to 17%), 38% decrease in the rate of initiation of skin-to-skin care (95% CI: 53% to 82%), and on average, 1.47 less hours of skin-to-skin care (95% CI: -2.07 to -0.86). Breastfeeding practices were similar across different champion environments. Interpretation: Withdrawal of Kangaroo Care champions from neonatal intensive care unit in rural western India is associated with diminished administration, delayed initiation, and shorter duration of skin-to-skin care, but did not impact breastfeeding practices. Training healthcare workers and community stakeholders to become champions could help in scaling up and maintaining Kangaroo Care practices. Funding: This research was supported by TL1-TR001454 (to A.S.) from National Center for Advancing Translational Sciences, and P60-MD006912-05 (to J.A.) from National Institute on Minority Health and Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH

Integration of Digital-to-Analog converter and Sallen-Key biquad for future transmitters

Thesis presents the design of Digital-to-Analog (D/A) converter implemented in a standard 65nm CMOS technology with the active low-pass filter integrated at the output for future transmitters. The combination of binary weighted resistor ladder D/A converter and a 2nd order low-pass Sallen-Key filter with cut-off frequency 21MHz is chosen to support Long Term Evolution (LTE) communication systems. The sinusoidal dual tone signal (6MHz and 200MHz) is given as a digital input for the simulations. The filter architecture is differential based on the Sallen-Key biquad structures, where the miller-compensated differential amplifier is an active element and the resistors and capacitors are passive elements. The design work initializes with the study of various D/A converters and their applications. Next, the study of active filters is undertaken by comparing various architectures. Furthermore, the work is divided into several stages, starting with the implementation and simulation of ideal models followed by the transistor level simulations. Finally, the comparison between the ideal model simulations and schematic level simulations is presented for deeper insight

Do Not Huff, Puff, or Vape That Stuff: Interstitial Airspace Disease in a Teenager

A 17-year-old previously healthy male was admitted to the hospital for intractable and persistent vomiting, fever, cough, abdominal pain, and intermittent diarrhea and dehydration. He presented with severe chest pain and O2 desaturations up to 80% on room air. An infectious (including a nasopharyngeal swab), GI, and cardiac workup was completed and was negative except for elevated inflammatory markers with a C-reactive protein (CRP) level of 261 mg/L, erythrocyte sedimentation rate (ESR) of 53 mm/hr, and a D-dimer level of 0.93 mcg/ml. Chest X-ray showed diffuse multifocal infiltrates. The patient was treated with ceftriaxone and azithromycin initially for a suspected pneumonia. He was also started on 4L of nasal cannula O2 supplementation. Due to persistent hypoxic respiratory failure, worsening respiratory distress clinically, with tachypnea and retractions, and lab findings of elevated D-dimer, a chest CT was performed to rule out a pulmonary embolism (PE). Computed tomography (CT) findings were negative for PE but notable for diffuse airspace opacities, primarily within the lower lobes, with a ground-glass appearance concerning for ARDS. Upon further investigation of the social history, the patient admitted to vaping nicotine products for the past 4 years and tetrahydrocannabinol (THC) products within the last several months. He was immediately started on prednisone 30 mg BID for a diagnosis of e-cigarette or vaping product use-associated lung injury (EVALI) and started showing clinical improvement. The patient was able to be weaned off of supplemental oxygen to room air, and clinical symptoms of respiratory distress began to improve over the next 24 hours

Knowledge of umbilical cord blood banking among obstetricians and mothers in Anand and Kheda District, India

Background: To assess the knowledge of obstetricians and expectant mothers towards UCB banking and their awareness regarding pros and cons of the process. Methods: Questionnaires from a previously published study were modified contextually and translated into vernacular language (Gujarati). The questionnaires were distributed among 200 obstetricians, of which 100 responded and 100 mothers were in Anand and Kheda districts of India. Informed consent was taken for both. Results: Mean (SD) age of obstetricians was 47.5 years (11.14) with mean (SD) work experience of 19.72 years (9.94). Almost all were aware of collection procedure for UCB and felt that UCB banking is useful. Thirty obstetricians thought that stored blood can be used in conditions of Autism, Duchenne Muscular Dystrophy and all genetic conditions. Sixty-three were aware of the procedure technique. Majority felt that the process was feasible and would do it for their own child. All the 100 mothers approached consented for the study with average age (SD) of 26.88 (4.17). Many were not aware of such a procedure and were not certain about the usefulness of the procedure. Seventy-six did not know the conditions in which the stored blood can be used. Only 4 mothers/family members had opted for UCB banking, whereas 27 expressed their willingness to recommend UCB to another mother. Five Muslim women wanted UCB but could not pursue it due to religious norms. Conclusion: The level of understanding among obstetricians was not commensurate with the amount of faith with which they promoted UCB banking

The presence of physician champions improved Kangaroo mother care in rural western India

AIM: This study determined the effect of physician champions on the two main components of Kangaroo mother care (KMC): skin-to-skin care and breastfeeding. METHODS: KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between 5 January 2011 and 7 October 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. RESULTS: In comparison to when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% Confidence Interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53% to 82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environments. CONCLUSION: Withdrawing physician champions from the NICU setting was associated with a decline in skin-to-skin care, but not breastfeeding. Training healthcare workers and community stakeholders to become champions could help to scale up and maintain KMC practices

Efficacy and Safety of COVID-19 Convalescent Plasma in Hospitalized Patients: A Randomized Clinical Trial

There is clinical equipoise for COVID-19 convalescent plasma (CCP) use in patients hospitalized with COVID-19. To determine the safety and efficacy of CCP compared with placebo in hospitalized patients with COVID-19 receiving noninvasive supplemental oxygen. CONTAIN COVID-19, a randomized, double-blind, placebo-controlled trial of CCP in hospitalized adults with COVID-19, was conducted at 21 US hospitals from April 17, 2020, to March 15, 2021. The trial enrolled 941 participants who were hospitalized for 3 or less days or presented 7 or less days after symptom onset and required noninvasive oxygen supplementation. A unit of approximately 250 mL of CCP or equivalent volume of placebo (normal saline). The primary outcome was participant scores on the 11-point World Health Organization (WHO) Ordinal Scale for Clinical Improvement on day 14 after randomization; the secondary outcome was WHO scores determined on day 28. Subgroups were analyzed with respect to age, baseline WHO score, concomitant medications, symptom duration, CCP SARS-CoV-2 titer, baseline SARS-CoV-2 serostatus, and enrollment quarter. Outcomes were analyzed using a bayesian proportional cumulative odds model. Efficacy of CCP was defined as a cumulative adjusted odds ratio (cOR) less than 1 and a clinically meaningful effect as cOR less than 0.8. Of 941 participants randomized (473 to placebo and 468 to CCP), 556 were men (59.1%); median age was 63 years (IQR, 52-73); 373 (39.6%) were Hispanic and 132 (14.0%) were non-Hispanic Black. The cOR for the primary outcome adjusted for site, baseline risk, WHO score, age, sex, and symptom duration was 0.94 (95% credible interval [CrI], 0.75-1.18) with posterior probability (P[cOR<1] = 72%); the cOR for the secondary adjusted outcome was 0.92 (95% CrI, 0.74-1.16; P[cOR<1] = 76%). Exploratory subgroup analyses suggested heterogeneity of treatment effect: at day 28, cORs were 0.72 (95% CrI, 0.46-1.13; P[cOR<1] = 93%) for participants enrolled in April-June 2020 and 0.65 (95% CrI, 0.41 to 1.02; P[cOR<1] = 97%) for those not receiving remdesivir and not receiving corticosteroids at randomization. Median CCP SARS-CoV-2 neutralizing titer used in April to June 2020 was 1:175 (IQR, 76-379). Any adverse events (excluding transfusion reactions) were reported for 39 (8.2%) placebo recipients and 44 (9.4%) CCP recipients (P = .57). Transfusion reactions occurred in 2 (0.4) placebo recipients and 8 (1.7) CCP recipients (P = .06). In this trial, CCP did not meet the prespecified primary and secondary outcomes for CCP efficacy. However, high-titer CCP may have benefited participants early in the pandemic when remdesivir and corticosteroids were not in use. ClinicalTrials.gov Identifier: NCT04364737

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease