Responding to unexpected infant deaths : experience in one English region

New national procedures for responding to the unexpected death of a child in England require a joint agency approach to investigate each death and support the bereaved family. As part of a wider population-based study of sudden unexpected deaths in infancy (SUDI) we evaluated the implementation of this approach. Methods: A process evaluation using a population-based study of all unexpected deaths from birth to 2 years in the South West of England between January 2003 and December 2006. Local police and health professionals followed a standardised approach to the investigation of each death, supported by the research team set up to facilitate this joint approach as well as collect data for a wider research project. Results: We were notified of 155/157 SUDI, with a median time to notification of 2 hours. Initial multi-agency discussions took place in 93.5% of cases. A joint home visit by police officers with health professionals was carried out in 117 cases, 75% within 24 hours of the death. Time to notification and interview reduced during the 4 years of the study. Autopsies were conducted on all cases, the median time to autopsy being 3 days. At the conclusion of the investigation, a local multi-agency case discussion was held in 88% of cases. The median time for the whole process (including family support) was 5 months. Conclusions: This study has demonstrated that with appropriate protocols and support, the joint agency approach to the investigation of unexpected infant deaths can be successfully implemented

Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England

Objectives: To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child). Design: Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups. Setting: South west region of England (population 4.9 million, 184 800 births). Participants: 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked). Results: The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant’s head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%). Conclusions: Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa

Targeted genetic testing for familial hypercholesterolaemia using next generation sequencing:a population-based study

Background<p></p> Familial hypercholesterolaemia (FH) is a common Mendelian condition which, untreated, results in premature coronary heart disease. An estimated 88% of FH cases are undiagnosed in the UK. We previously validated a method for FH mutation detection in a lipid clinic population using next generation sequencing (NGS), but this did not address the challenge of identifying index cases in primary care where most undiagnosed patients receive healthcare. Here, we evaluate the targeted use of NGS as a potential route to diagnosis of FH in a primary care population subset selected for hypercholesterolaemia.<p></p> Methods<p></p> We used microfluidics-based PCR amplification coupled with NGS and multiplex ligation-dependent probe amplification (MLPA) to detect mutations in LDLR, APOB and PCSK9 in three phenotypic groups within the Generation Scotland: Scottish Family Health Study including 193 individuals with high total cholesterol, 232 with moderately high total cholesterol despite cholesterol-lowering therapy, and 192 normocholesterolaemic controls.<p></p> Results<p></p> Pathogenic mutations were found in 2.1% of hypercholesterolaemic individuals, in 2.2% of subjects on cholesterol-lowering therapy and in 42% of their available first-degree relatives. In addition, variants of uncertain clinical significance (VUCS) were detected in 1.4% of the hypercholesterolaemic and cholesterol-lowering therapy groups. No pathogenic variants or VUCS were detected in controls.<p></p> Conclusions<p></p> We demonstrated that population-based genetic testing using these protocols is able to deliver definitive molecular diagnoses of FH in individuals with high cholesterol or on cholesterol-lowering therapy. The lower cost and labour associated with NGS-based testing may increase the attractiveness of a population-based approach to FH detection compared to genetic testing with conventional sequencing. This could provide one route to increasing the present low percentage of FH cases with a genetic diagnosis

The Vehicle, 1961, Vol. 3 no. 2

Vol. 3, No. 2 Table of Contents The Voting CattleLinda Kay Campbellpage 5 But For the Passage of TimeDon Shepardsonpage 14 LoveJon Woodspage 16 Infinite JourneyJames E. Martinpage 19 The Clover ChainRichard W. Blairpage 20 SnowballSusan Daughertypage 24 Sureness Is NeverDon Shepardsonpage 26 ConceptionChristine McCollpage 34 Comedy: Relief and GriefTom McPeakpage 35 The Unspoken WordChristine McCollpage 35 CharmBenjamin Polkpage 36 Screaming SpiderTom McPeakpage 39 Just Once in an Early SpringE.J.B.page 39 HummingbirdPauline B. Smithpage 40 Willow TreesPauline B. Smithpage 40 MaturityChristine McCollpage 41 The New YearLinda Campbellpage 41 The StormMary-Jean Pitratpage 42 Ebony IvoryJean Danenbargerpage 42 The Fireball MailAllen Engelbrightpage 43 ExpectationChristine McCollpage 44 CatastropheChristine McCollpage 44 SophisticationBenjamin Polkpage 45 On Playing BridgeMyrna Jo Handleypage 46 SonnetMignon Stricklandpage 48https://thekeep.eiu.edu/vehicle/1009/thumbnail.jp

The Vehicle, 1961, Vol. 3 no. 2

Vol. 3, No. 2 Table of Contents The Voting CattleLinda Kay Campbellpage 5 But For the Passage of TimeDon Shepardsonpage 14 LoveJon Woodspage 16 Infinite JourneyJames E. Martinpage 19 The Clover ChainRichard W. Blairpage 20 SnowballSusan Daughertypage 24 Sureness Is NeverDon Shepardsonpage 26 ConceptionChristine McCollpage 34 Comedy: Relief and GriefTom McPeakpage 35 The Unspoken WordChristine McCollpage 35 CharmBenjamin Polkpage 36 Screaming SpiderTom McPeakpage 39 Just Once in an Early SpringE.J.B.page 39 HummingbirdPauline B. Smithpage 40 Willow TreesPauline B. Smithpage 40 MaturityChristine McCollpage 41 The New YearLinda Campbellpage 41 The StormMary-Jean Pitratpage 42 Ebony IvoryJean Danenbargerpage 42 The Fireball MailAllen Engelbrightpage 43 ExpectationChristine McCollpage 44 CatastropheChristine McCollpage 44 SophisticationBenjamin Polkpage 45 On Playing BridgeMyrna Jo Handleypage 46 SonnetMignon Stricklandpage 48https://thekeep.eiu.edu/vehicle/1009/thumbnail.jp

Transport of organic carbon from the California coast to the slope region : a study of Δ14C and δ13C signatures of organic compound classes

Author Posting. © American Geophysical Union, 2005. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Global Biogeochemical Cycles 19 (2005): GB2018, doi:10.1029/2004GB002422.Surface sediments along a transect from an abyssal site in the northeastern Pacific (Station M, 34°50′N, 123°00′W) to a small mountainous river on the California coast (Santa Clara River) were studied to investigate the sources and cycling of organic matter on the continental margin. Sediment samples were separated into organic compound fractions (extractable lipids, amino acids (THAA), carbohydrates (TCHO), and the acid-insoluble fraction), and their carbon isotope ratios were measured. The Δ14C values of all the THAA and TCHO fractions were greater than −100‰, indicating relatively modern organic carbon (OC) source(s), and rapid cycling of these fractions. In contrast, the Δ14C values of extractable lipids and the acid-insoluble fraction were distinctly lower than those of the THAA and TCHO fractions. The Δ14C values of source OC to the sediments were estimated using a simple mixed layer model. These values were lower than the Δ14C signatures of pre-industrial plankton suggesting input of both old OC and contemporary plankton to the margin sediments. The source of old OC at the 2000-m site was likely from laterally transported coastal sediment. The estimated low Δ14C value of the transported OC suggests that old lipids and acid-insoluble material were selectively transported to the 2000-m site. The contribution of riverine POC to the margin sediments were estimated from Δ14C and δ13C values and indicate that relict OC exported by rivers was an important source of old lipids and acid-insoluble material to sedimentary OC on the shelf.This research was supported by NSF OCE Chemical Oceanography Program and ACS Petroleum Research Fund (to E. R. M. D.), the UCOP Marine Science Fellowship Program (to J. H.), and the Dreyfus Foundation for an Environmental Science Postdoctoral Fellowship grant (to T. K.)

Including Front-Line Workers as Primary Stakeholders in Public-Space HRI

When a robot is deployed in a public space, that space is almost always an existing workspace, with front-line workers who will need to work alongside the robot when it is deployed and who are crucial to the success of the overall project. We show how these front-line workers have been included alongside other stakeholders in three recent social robotics projects: a socially assistive robot for use in paediatric emergency departments, a guidance robot for visitors to a large university building, and a robot social worker designed to help international students and other new arrivals to navigate processes in a new country. We argue that the contributions of these front-line workers are crucial to the success of any such public-space and should always be taken into account at all stages of the project life cycle

The Ups and Downs in Women's Employment: Shifting Composition or Behavior from 1970 to 2010?

This paper tracks factors contributing to the ups and downs in women’s employment from 1970 to 2010 using regression decompositions focusing on whether changes are due to shifts in the means (composition of women) or due to shifts in coefficients (inclinations of women to work for pay). Compositional shifts in education exerted a positive effect on women’s employment across all decades, while shifts in the composition of other family income, particularly at the highest deciles, depressed married women’s employment over the 1990s contributing to the slowdown in this decade. A positive coefficient effect of education was found in all decades, except the 1990s, when the effect was negative, depressing women’s employment. Further, positive coefficient results for other family income at the highest deciles bolstered married women’s employment over the 1990s. Models are run separately for married and single women demonstrating the varying results of other family income by marital status. This research was supported in part by an Upjohn Institute Early Career Research Award

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Sources and cycling of dissolved and particulate organic radiocarbon in the northwest Atlantic continental margin

Continental shelves and slopes are productive and dynamic ocean margin systems that also regulate the fluxes of terrestrial, riverine, and estuarine materials between the continents and oceans. In order to evaluate the ages, potential sources, and transformations of organic matter in an ocean margin system, we measured the radiocarbon (Delta (14)C and delta (13)C distributions of total dissolved organic carbon (DOC), suspended particulate organic carbon (POC), and dissolved inorganic carbon (DIC) in waters of the Middle Atlantic Bight (MAB) continental shelf and slope in April-May 1994. The Delta (14)C of DOC was greatest (as high as -39 parts per thousand) in surface waters of the shelf, decreasing rapidly offshore and with depth, even in relatively shallow (25-50 in depth) shelf waters. The lowest Delta (14)C-DOC values were observed in deep slope waters, where they were significantly lower than values measured previously for the deep Sargasso Sea. There was a strong inverse relationship between Delta (14)C-DOC and delta (-13)C-DOC in all shelf and surface slope waters of the MAB, which is likely attributable to varying contributions of young, (14)C-enriched organic matter of terrestrial and/or riverine origin. The more highly (14)C-depleted DOC in deep : slope waters (as low as -442 parts per thousand) generally had a correspondingly lower delta (13)C (as low as -22.3 parts per thousand) component. However, this must originate from relic terrestrial material either in the MAB itself or be discharged to the MAB from rivers and estuaries. The isotopic signatures of POC were clearly differentiable from DOC and indicate that this pool also contained a broad range of both old and young material of terrestrial (delta (13)C as low as -24.9 parts per thousand) and marine (delta (13)C as high as -19.9 parts per thousand) origin throughout the MAB shelf and slope. The highest Delta (14)C-POC values (up to 78 parts per thousand) were observed in shallow shelf waters of the southern MAR Conversely, the lowest Delta (14)C-POC values (as low as -394 parts per thousand) were found in MAB deep slope waters and were also significantly more depleted in (14)C than POC from the central north Atlantic (Sargasso Sea). A multiple-source isotopic mass balance model employing both (14)C and (13)C was used to evaluate the relative contributions of both young and old terrigenous versus marine organic matter to DOC and POC in the MAR The results indicate that shelf and slope DOC is comprised of an old marine fraction (represented by offshore Sargasso Sea material) and either a young terrestrial/riverine/estuarine (TRE) component (in shelf and shallow slope waters) or a relic TRE component (in deep and some shallow slope waters). In contrast, suspended POC from the MAB appears to originate predominantly from a mixture of recent MAB primary production and an old, TRE component, similar to that observed in one of the major subestuaries of the Chesapeake Bay. These results suggest that both young and old sources of terrestrial and riverine organic matter can comprise a significant fraction of the DOC and POC in ocean margins. Preliminary calculations indicate that the export of this compositionally unique DOC and suspended POC may be significant terms in the organic carbon budgets of the MAB and other margin systems