Overturned abusive head trauma and shaken baby syndrome convictions in the United States: Prevalence, legal basis, and medical evidence.

BACKGROUND: Media reports and the Innocence Network assert that wrongful Abusive Head Trauma (AHT)/Shaken Baby Syndrome (SBS) convictions pervade the United States (U.S.) criminal justice system. Yet, no empirical evaluation of overturned AHT/SBS convictions has been conducted. OBJECTIVE: To evaluate the prevalence, legal basis, and characteristics of appellate rulings of AHT/SBS convictions. PARTICIPANTS AND SETTING: U.S. appellate cases in a legal database, Westlaw. METHODS: Retrospective review of AHT/SBS convictions that had appellate rulings from January 2008 through December 2018. Multiple search terms ensured all potential AHT/SBS cases were included. A mixed-methods analysis was conducted on overturned AHT/SBS convictions. RESULTS: We identified a total of 1431 unique AHT/SBS criminal convictions that had appellate rulings since 2008. Of those, 49 convictions (3%) were overturned, and 1382 (97%) were affirmed/upheld. Of those overturned, 20 cases (1% overall) were overturned on medical evidence-related grounds. The most common themes from the medical evidence-related reversals were controversy over the AHT/SBS diagnosis (n = 12) and accidental injury mechanism (n = 11). After being overturned on appeal, upon retrial, 42% of defendants either re-plead guilty to or were convicted again of the same offense. CONCLUSION(S): AHT/SBS convictions are rarely overturned on medical evidence-related grounds. When overturned, medical evidence-related themes seldom reflect new scientific or clinical discoveries, but rather are alternative or differing medical opinions from those offered at the original trial. Our data tends to support the concerns of other authors regarding irresponsible communication of medical information in AHT/SBS cases.

Fabrication of LaFeO3 and rGO-LaFeO3 microspheres based gas sensors for detection of NO2 and CO.

In the present report, gas sensing devices based on LaFeO3 and rGO-LaFeO3 were fabricated by a photolithography technique. The X-ray diffraction, Raman spectra and FT-IR results confirm the formation of a perovskite phase and composite. XPS and TEM give the chemical compositions for both products. The higher roughness, greater surface area (62.1 m2 g-1), larger pore size (16.4 nm) and lower band gap (1.94 eV) of rGO-LaFeO3 make it a suitable candidate to obtain high sensitivity. The gas sensing performance of the devices was investigated for various concentrations of NO2 and CO gases at temperatures of 200 and 250 °C. It was observed that the rGO-LaFeO3 based device exhibited a high relative response (183.4%) for a 3 ppm concentration of NO2 at a 250 °C operating temperature. This higher response is attributed to the large surface area, greater surface roughness, and numerous active sites of rGO-LaFeO3. The gas sensing properties investigated show that rGO-LaFeO3 is an excellent candidate for an NO2 sensor.

Guidelines for the peri-operative care of people with dementia: Guidelines from the Association of Anaesthetists.

Ageing populations have greater incidences of dementia. People with dementia present for emergency and, increasingly, elective surgery, but are poorly served by the lack of available guidance on their peri-operative management, particularly relating to pharmacological, medico-legal, environmental and attitudinal considerations. These guidelines seek to deliver such guidance, by providing information for peri-operative care providers about dementia pathophysiology, specific difficulties anaesthetising patients with dementia, medication interactions, organisational and medico-legal factors, pre-, intra- and postoperative care considerations, training, sources of further information and care quality improvement tools.

Emergency medicine and air rescue in India: future perspectives.

76.7% of Indian population lives in rural areas. About 160,000 primary health care centres and subcentres, established all over the country, are responsible for the emergency care in the countryside. A centre, manned by a qualified doctor, a nurse/midwife and paramedics, with basic equipment and facilities has to manage all types of medical emergencies in a population of 3000 - 5000. A patient who survives this emergency care has to be transferred to higher secondary / tertiary centre. In metropolitan areas there are larger hospitals some of them having well equipped casualty departments supervised by specialists, but the number of patients are so large that the management of emergency goes often haywire. Patient transport system is very inadequate. The ambulances are scarce and mostly not well equipped. Air rescue which is the most desired, because of the distances and road conditions, is only in a rudimentary state. Existing infrastructure more than 400 airports, airstrips and many helipads, well qualified flying personnel and well maintained small and large aircrafts is sufficient to have a well functioning Air Rescue system. But it is prohibitively expensive. Most individuals are neither able to afford Air Rescue on their own cost nor they are insured. With the growth of economy and ever increasing awareness of medical facilities, the demand of better standards of emergency medicine is going up. In next 20 years a different scenario is expected. Availability of information technology, privatization of insurance system and medical facilities and better transport system and roads in the coming years will facilitate a well functioning emergency medicine and air rescue in India.

Structure of pescaproside E, a fatty acid glycoside from Ipomoea pescaprae.

Three fatty acid glycosides, designated pescaprosides A, B, and E, have been isolated from Ipomoea pescaprae (family Convolvulaceae). Chemical studies on pescaproside E, the major product, led to its characterisation as a pentaglycoside of 11-hydroxyhexadecanoic acid. Its sugar chain was esterified with 2-methylbutanoic and lauric acids. The structure of the pentaglycoside has been established as O-alpha-L-rhamnopyranosyl-(1----3)-O-[alpha-L-rhamnopyranosyl- (1----4)]-O-alpha-L-rhamnopyranosyl-(1----4)-O-beta-D-fucopyranosyl-(1-- --2)- O-alpha-L-rhamnopyranosyl-(1----11)-oxyhexadecanoic acid.

Dodonic Acid, A New Diterpenoid from Dodonaea viscosa1.

The aerial parts of DODONAEA VISCOSA afforded a new diterpenoid, dodonic acid, the structure and stereochemistry of which have been established by chemical and spectroscopic means.

Anorectic effect of SK & F 38393, a new dopamine agonist in rats.

Anorectics are clinically used in the management of obesity to accept dietary restriction through decreased desire of food intake. The present study, indicates that the drug SK & F 38393 a dopamine agonist given to albino rats at the doses of 1 mg/kg and 5 mg/kg caused decreased food intake. Central side effects observed with amphetamine and other related drugs were not observed with this drug. The drug thus may be used as an anorectic agent without central side effects.

Trigeminal nerve stimulation: short latency somatosensory evoked potentials.

We have devised a technique to measure trigeminal somatosensory evoked potentials, stimulating the mentalis nerve at the mandibular foramen and recording the evoked early potential on the scalp at 3.2 msec. The early potential was easily recognized in all normal subjects and on the asymptomatic side of patients with facial pain. The latency of the early potential in normals was 1 to 2 msec less than half the latency of the mechanically induced jaw jerk. The early potential appeared simultaneously on both sides after stimulation of either the right or left mentalis nerve and may have its origin in deep brainstem structures, the Gasserian ganglion, or the trigeminal nerve. The technique is useful in documenting the functional integrity of peripheral and central afferent pathways of the trigeminal nerve.

Generalized, bilaterally synchronous bursts of slow waves in the EEG.

Forty-two patients who had bursts of spontaneous, bilaterally synchronous slow waves during the waking state in an otherwise normal EEG were compared with 42 age-matched control subjects with normal EEGs. The study group had a significantly higher incidence of diffuse encephalopathy than did the control group. They also had a higher incidence of alterations of consciousness. None of the patients in the study group had focal, deep midline lesions. This study indicates that generalized, bilaterally synchronous slow bursts in the EEG are significant abnormalities that in the majority of cases are associated with a mild to moderate diffuse encephalopathy rather than with a lesion limited to deep midline structures.

Effect of mepyramine on the histaminase release induced by heparin injection and anaphylaxis in guinea pigs.

Injection of heparin as well as antigenic challenge in sensitized guinea pigs are known to produce a release of histaminase into the plasma. In the present study, tissue histaminase estimation was done by Spencer's method (17) and plasma estimation by Kapellar Adler's (7) method. Mepyramine pretreatment considerably decreased the histaminase release by both heparin and anaphylaxis. Mepyramine did not antagonise the anticoagulant action of heparin in vitro.

Status of circulating "T" lymphocyte population in leprosy.

'T' lymphocyte population was estimated in 40 cases of various types of leprosy by E-rosette formation. The mean percentage value of T-lymphocyte was significantly low in lepromatous group as compared to tuberculoid and borderline leprosy. The mean percentage population of 'T' lymphocyte was also compared with 24 normal healthy control cases and significantly low levels were observed in all types of leprosy. The population of 'T' lymphocytes was also co-related with tuberculin tests in leprosy patients and healthy control cases. Lowest count of 'T; lymphocyte population and smallest diameter of erythema was observed in lepromatous leprosy, suggesting impaired cell mediated immunity in this group.

Juvenile muscular atrophy localized to arms.

Twenty-four patients from India, had juvenile muscular atrophy localized to the upper extremities. The condition characteristically affects young men and is not familial. Atrophy is limited to the hand and forearm muscles, with slow progression for two to three years after which it seems to be stationary. The condition is associated with "tremor-like" movements out of proportion to the weakness. Examination of muscle biopsy specimens shows group 2 fiber atrophy. This syndrome, for which no cause has been described, is benign and self-limiting, unlike most motor neuron diseases, and is distal in upper extremities, unlike Kugelberg-Welander disease. Asymmetrical muscle wasting and preceding febrile illness in some patients suggests an atypical poliomyelitis-like viral disease.

A simple implantable system for delivery of halothane.

A capsule for regulated halothane delivery after abdominal implantation in experimental animals is described. The capsule is constructed of readily available medical-grade polyethylene and Teflon tubing. At 37 C linear halothane release rates of 0.4 to 15 mg/hour may be obtained.

Antagonism of some contractile responses to prostaglandins by cyproheptadine.

In the present study antagonism of the contractile responses to PGE1 and PGF2 alpha, by cyproheptadine on isolated rat stomach strip, rabbit uterus, guinea-pig ileum and rabbit jejunum is documented. Cyproheptadine blocks the responses to PGE1, PGF2 alpha, acetylcholine, 5-hydroxytryptamine in extremely small concentrations varying from 10 ng to 1 microgram/ml. The blockade is persistant, provided the exposure is prolonged. However, it does not antagonise the responses of adrenaline on guinea-pig seminal vesicle. Polyphloretine phosphate was used in the concentration of 2.5 to 100 micrograms/ml on the rat stomach strip, rabbit jejunum and rabbit uterus; it failed to produce any blockade of contractile responses to prostaglandins. It is concluded that cyproheptadine nonspecifically antagonised the responses to acetylcholine, 5-hydroxytryptamine, PGE1 and PGF2 alpha in extremely small concentrations.

Juvenile parkinsonism treated with levodopa.

We describe three patients with early onset of parkinsonism. Two of these were sisters and showed a reduction in homovanillic acid (HVA), 5-hydroxytryptamine (5-HT), and 5-hydroxyindole acetic acid (5-HIAA) levels in the CSF. In the third patient, parkinsonism developed, which was probably related to chickenpox encephalitis. All three patients responed favorably to levodopa therapy.