Introduction ‘Procedural Response to Unexpected Deaths in Childhood (PRUDiC)’ was completed with Ministerial approval in Wales in March 2011 and all the principles described under SUDI were extended ...to include all unexpected childhood deaths up to 18 years of age. PRUDiC was formally implemented in our health board in Jan 2012. Aims 1. To look at all unexpected deaths in children and to ensure PRUDiC process was adhered to. 2. To identify any emerging themes. Methods Prospective analysis of all paediatric deaths in Aneurin Bevan Health Board from Jan 2012–Dec 2013. Deaths in Neonatal unit were excluded. Results There were 45 (30 in 2012 and 15 in 2013) paediatric deaths, out of which 35 were investigated as per PRUDiC protocol. PRUDiC deaths, n = 35 (Male – 20 and female –15): Majority of deaths – 40% (14/35) were in babies <1 year of age. 60% (21/35) of children had no previous underlying medical problems. 31/35 final Post Mortem (PM) reports were available. These were unascertained (including SUDI) – 42% (13), followed by sepsis–13% (4), pressure to neck–13% (4), exposure to fire–6.5% (2), congenital heart disease–6.5% (2) and road traffic accident–3%(1). Paediatric deaths not needing PRUDiC, n = 10 (Male – 5 and female – 5): There were 3 children in each of the following age groups – <1 year, 1–5 year & 10–17 years old. All children had underlying complex medical problems and a cause of death was identifiable. Discussion In 5 infants where PM findings were unascertained there were risk factors like co-sleeping, alcohol consumption and sleeping in prone position. One child where PRUDiC procedure was not followed was managed by adult medical team. Conclusions All unexpected deaths are being investigated appropriately as per PRUDiC. There are no obvious themes identified in our small sample size, however bed sharing/prone sleeping continues to be an ongoing risk factors in babies. There are ongoing delays in getting PM reports. Recommendations Analyse data on yearly basis to look at any emerging trends. Additional targeted education regarding bed sharing to be directed to vulnerable parent groups. The responsible paediatrician to actively chase the PM reports either through the police or directly from the coroner’s office.
Significance Cell death by regulated necrosis causes tremendous tissue damage in a wide variety of diseases, including myocardial infarction, stroke, sepsis, and ischemia–reperfusion injury upon ...solid organ transplantation. Here, we demonstrate that an iron-dependent form of regulated necrosis, referred to as ferroptosis, mediates regulated necrosis and synchronized death of functional units in diverse organs upon ischemia and other stimuli, thereby triggering a detrimental immune response. We developed a novel third-generation inhibitor of ferroptosis that is the first compound in this class that is stable in plasma and liver microsomes and that demonstrates high efficacy when supplied alone or in combination therapy.
Receptor-interacting protein kinase 3 (RIPK3)-mediated necroptosis is thought to be the pathophysiologically predominant pathway that leads to regulated necrosis of parenchymal cells in ischemia–reperfusion injury (IRI), and loss of either Fas-associated protein with death domain (FADD) or caspase-8 is known to sensitize tissues to undergo spontaneous necroptosis. Here, we demonstrate that renal tubules do not undergo sensitization to necroptosis upon genetic ablation of either FADD or caspase-8 and that the RIPK1 inhibitor necrostatin-1 (Nec-1) does not protect freshly isolated tubules from hypoxic injury. In contrast, iron-dependent ferroptosis directly causes synchronized necrosis of renal tubules, as demonstrated by intravital microscopy in models of IRI and oxalate crystal-induced acute kidney injury. To suppress ferroptosis in vivo, we generated a novel third-generation ferrostatin (termed 16-86), which we demonstrate to be more stable, to metabolism and plasma, and more potent, compared with the first-in-class compound ferrostatin-1 (Fer-1). Even in conditions with extraordinarily severe IRI, 16-86 exerts strong protection to an extent which has not previously allowed survival in any murine setting. In addition, 16-86 further potentiates the strong protective effect on IRI mediated by combination therapy with necrostatins and compounds that inhibit mitochondrial permeability transition. Renal tubules thus represent a tissue that is not sensitized to necroptosis by loss of FADD or caspase-8. Finally, ferroptosis mediates postischemic and toxic renal necrosis, which may be therapeutically targeted by ferrostatins and by combination therapy.
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IMPORTANCE: There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. OBJECTIVE: To ...formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. PROCESS: Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery. EVIDENCE SYNTHESIS: Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed. RECOMMENDATIONS: Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability. CONCLUSIONS AND RELEVANCE: This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.
Aim
This study reviewed cases of sudden unexpected child deaths in Norway to determine the significance of death‐scene investigations (DSIs) in establishing cause and manner of death, and thereby it ...is relevance to legal protection.
Methods
Data from forensic autopsy reports and DSIs were collected and analysed for cases of unexpected deaths in children below 4 years of age in Norway during 2010‐2016.
Results
Out of 141 cases, the death scene was investigated as a voluntary procedure in 75 cases and by the police in 41 cases. The cause of death remained unexplained in 81/141 (57%) of the cases, of which 46/141 (33%) met the criteria for sudden infant death syndrome (SIDS) or sudden unexplained death in early childhood (SUDC). The manner of death was determined in 102/141 (72%). Voluntary DSI increased the ability to rule out accidental suffocation, facilitated evaluations of environmental risk factors and enabled detection of possible neglect.
Conclusion
Death‐scene investigations illuminate uncertainty about the cause of death, especially in grey‐area cases where accidental suffocation, neglect or abuse is suspected. Knowledge about the course of events and the cause of death enhances both the child's and the caregiver's legal protection. Death‐scene investigations should therefore be mandatory.
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Previous research on the impact of parental loss on labor market outcomes in adulthood has often suffered from low sample sizes. To generate further insights into the longterm consequences of ...parental death, I use the Historical Sample of the Netherlands (HSN). The HSN contains occupational information on life courses of a sample of more than 8,000 males and almost 7,000 females born between 1850 and 1922, a period of important labor market transformations. Roughly 20 % of the sample population experienced parental death before age 16. Linear regression models show that maternal loss is significantly associated with lower occupational position in adulthood for both men and women, which points to the crucial importance of maternal care in childhood for socioeconomic outcomes in later life. This interpretation is supported by the finding that a stepmother's entry into the family is positively related with sons' occupational position later in life. In contrast to expectations, the loss of economic resources related to the father's death is generally not associated with lower status attainment in adulthood for men or for women. The results indicate, however, that the negative consequences of paternal death on men's socioeconomic outcomes decreased over time, illustrating the complex interaction between individual life courses and surrounding labor market transformations.
Sudden death is a leading cause of deaths nationally. Definitions of sudden death vary greatly, resulting in imprecise estimates of its frequency and incomplete knowledge of its risk factors. The ...degree to which time-based and coronary artery disease (CAD) criteria impacts estimates of sudden death frequency and risk factors is unknown. Here, we apply these criteria to a registry of all-cause sudden death to assess its impact on sudden death frequency and risk factors. The sudden unexpected death in North Carolina (SUDDEN) project is a registry of out of-hospital, adjudicated, sudden unexpected deaths attended by Emergency Medical Services. Deaths were not excluded by time since last seen or alive or by prior symptoms or diagnosis of CAD. Common criteria for sudden death based on time since last seen alive (both 24 hours and 1 hour) and prior diagnosis of CAD were applied to the SUDDEN case registry. The proportion of cases satisfying each of the 4 criteria was calculated. Characteristics of victims within each restrictive set of criteria were measured and compared to the SUDDEN registry. There were 296 qualifying sudden deaths. Application of 24 hour and 1 hour timing criteria compared to no timing criteria reduced cases by 25.0% and 69.6%, respectively. Addition of CAD criteria to each timing criterion further reduced qualifying cases, for a total reduction of 81.8% and 90.5%, respectively. However, characteristics among victims meeting restrictive criteria remained similar to the unrestricted population. Timing and CAD criteria dramatically reduces estimates of the number of sudden deaths without significantly impacting victim characteristics.
Parting Ways explores the emergence of new end-of-life rituals in America that celebrate the dying and reinvent the roles of family and community at the deathbed. Denise Carson contrasts her father's ...passing in the 1980s, governed by the structures of institutionalized death, with her mother's death some two decades later. Carson's moving account of her mother's dying at home vividly portrays a ceremonial farewell known as a living wake, showing how it closed the gap between social and biological death while opening the door for family and friends to reminisce with her mother. Carson also investigates a variety of solutions--living funerals, oral ethical wills, and home funerals--that revise the impending death scenario. Integrating the profoundly personal with the objectively historical, Parting Ways calls for an "end of life revolution" to change the way of death in America.
BackgroundComparing rates of sudden unexpected death in infancy (SUDI) in different countries and over time is difficult, as these deaths are certified differently in different countries, and, even ...within the same jurisdiction, changes in this death certification process have occurred over time.AimsTo identify if International Classification of Diseases-10 (ICD-10) codes are being applied differently in different countries, and to develop a more robust tool for international comparison of these types of deaths.MethodsUsage of six ICD-10 codes, which code for the majority of SUDI, was compared for the years 2002–2010 in eight high-income countries.ResultsThere was a great variability in how each country codes SUDI. For example, the proportion of SUDI coded as sudden infant death syndrome (R95) ranged from 32.6% in Japan to 72.5% in Germany. The proportion of deaths coded as accidental suffocation and strangulation in bed (W75) ranged from 1.1% in Germany to 31.7% in New Zealand. Japan was the only country to consistently use the R96 code, with 44.8% of SUDI attributed to that code. The lowest, overall, SUDI rate was seen in the Netherlands (0.19/1000 live births (LB)), and the highest in New Zealand (1.00/1000 LB). SUDI accounted for one-third to half of postneonatal mortality in 2002–2010 for all of the countries except for the Netherlands.ConclusionsThe proposed set of ICD-10 codes encompasses the codes used in different countries for most SUDI cases. Use of these codes will allow for better international comparisons and tracking of trends over time.
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