Development of a neonatal incubator with phototherapy,biometric fingerprint reader,remote monitoring,and heart rate control adapted for developing countries hospitals

This paper aims to develop an automatic neonatal incubator equipped with phototherapy, biometric fingerprint reader, remote monitoring and heart rate control modules for developing countries due to the lack of neonatal incubators. The proposed device consists of an acquisition module that senses temperatures (of the enclosure and the baby) and humidity, a biometric fingerprint reader to identify the user, a remote monitoring module in charge of supervising the temperature and the heart rate of the baby, a video surveillance module which allows filming and transmitting the images to the web server in order to give parents and nurses the possibility of being able to visualize whatever their location the newborn baby, a phototherapy module used to treat newborn jaundice by lowering the bilirubin levels in the baby's blood, a digital control module from a pulse width modulation (PWM) signal generated by a microcontroller of Arduino Nano type for system operation monitoring, and a human machine interface module for setting parameters. The equations describing the energy balance and heat transfer for newborn baby (Ostrowski and Rojczyk, 2018) are taken into account for the implementation of power supply and the choice of the heating resistor. The desired temperature of 37 °C was obtained after only a few minutes inside the incubator.     

广东省3个城市大气污染物二氧化氮对居民的死亡效应研究

目的 探讨广东省广州、佛山及珠海3个城市的大气污染二氧化氮（NO₂）对居民每日死亡效应的影响。方法 收集2013—2016年广州、佛山及珠海3个城市的每日大气污染物浓度、气象资料数据和居民的每日总死亡数据,对数据基本特征进行统计描述,并通过Spearman分析其相关关系,最后利用广义相加模型（GAM）分别对3个城市的NO₂日均浓度及每日总死亡数据进行分析。结果 2013—2016年广州、佛山及珠海市的大气污染物NO₂日均浓度分别为46.4、48.4、33.1 μg/m³,均符合国家二级标准（80 μg/m³）。广州市大气中NO₂日均浓度对当天、滞后1、2 d的每日总死亡人数、循环系统疾病死亡人数的影响有统计学意义（均P<0.05）,佛山市滞后1、2 d的NO₂日均浓度对居民每日总死亡人数及循环系统疾病每日死亡人数的影响有统计学意义（均P<0.05）,广州和佛山市均表现出滞后1 d时效应最大。滞后2 d的NO₂日均浓度对广州市居民的呼吸系统疾病每日死亡人数有影响（ER=1.38）。结论 大气污染物NO₂浓度的上升会引起居民死亡风险的增加,应引起重视。     

SUDEP classification: Discordances between forensic investigators and epileptologists

We compared sudden unexpected death in epilepsy (SUDEP) diagnosis rates between North American SUDEP Registry (NASR) epileptologists and original death investigators, to determine degree and causes of discordance. In 220 SUDEP cases with post-mortem examination, we recorded the epileptologist adjudications and medical examiner- and coroner- (ME/C) listed causes of death (CODs). COD diagnosis concordance decreased with NASR’s uncertainty in the SUDEP diagnosis: highest for Definite SUDEP (84%, n = 158), lower in Definite Plus (50%, n = 36), and lowest in Possible (0%, n = 18). Rates of psychiatric comorbidity, substance abuse, and toxicology findings for drugs of abuse were all higher in discordant cases than concordant cases. Possible SUDEP cases, an understudied group, were significantly older, and had higher rates of cardiac, drug, or toxicology findings than more certain SUDEP cases. With a potentially contributing or competing COD, ME/Cs favored non–epilepsy-related diagnoses, suggesting a bias toward listing CODs with structural or toxicological findings; SUDEP has no pathognomonic features. A history of epilepsy should always be listed on death certificates and autopsy reports. Even without an alternate COD, ME/Cs infrequently classified COD as “SUDEP.” Improved collaboration and communication between epilepsy and ME/C communities improve diagnostic accuracy, as well as bereavement and research opportunities.     

Safety evaluation of adverse events following vaccination with Havrix,Engerix-B or Twinrix during pregnancy

BackgroundVaccination of pregnant women against hepatitis A virus (HAV) or hepatitis B virus (HBV) may benefit the mother and the fetus but is not routinely recommended. However, the risk associated with vaccination should be weighed against the risk of HAV or HBV infection. Data on safety profiles after hepatitis A, B or combined AB immunization during pregnancy are limited.MethodsWe searched the GSK Worldwide Safety Database for adverse events (AEs) following immunization of pregnant women with HAV (Havrix, GSK), HBV (Engerix-B, GSK) or the combined hepatitis AB (Twinrix, GSK) vaccine since market authorization through 31 January 2018, covering at least 25 years. AE reports (spontaneous, post-marketing surveillance and clinical trial cases) in the GSK Worldwide Safety Database were identified using a systematic search and were reviewed by clinicians to ascertain pregnancy status at time of vaccination and characterize adverse pregnancy outcomes, including pregnancy-related AEs and AEs in infants regardless of the causality assessment.ResultsOverall, 613, 700 and 363 pregnancies with exposure to Havrix, Engerix-B and Twinrix, respectively, were reported. Of these, 378, 339 and 194 were analyzed. The most frequently identified pregnancy outcomes were live infants (288, 223 and 151), spontaneous abortions (43, 57 and 26) and elective terminations (25, 24 and 9). A total of 19, 29 and 10 cases of congenital anomalies were reported. Of these, 17, 20 and 7 were major birth defects. The most commonly reported pregnancy-related AE and AE in infants were premature delivery (28) and jaundice (11), respectively. No maternal deaths were reported. Congenital anomalies were reported in all recorded infant deaths.ConclusionsThis review did not indicate any concerning pattern of adverse pregnancy outcomes following exposure to any of the 3 vaccines during pregnancy.     

End-of-life practices in patients admitted to pediatric intensive care units in Brazil: A retrospective study

ObjectiveTo determine the prevalence of life support limitation (LSL) in patients who died after at least 24 h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered.MethodsRetrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24 h of admission.Results53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a do-not-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support.ConclusionsLSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.     

Defunciones por COVID-19: no están todas las que son y no son todas las que están

The death counts from COVID-19 have generated public controversy. The regional health councils’ need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.     

Jouer avec la mort : prise de risque dans le sport et deuils impossibles

AimAlthough death seems to be increasingly dissimulated in our Western society, “death-dodger” behaviors, on the contrary, are constantly on the rise. The study of those who practice high-risk sports allows us to clearly see their game with/around/against death. Through the case of Kevin, who engages in tremendously risky behavior in his practice of sport, we propose to show how continued traumaphilia and flirting with death is an attempt to deal with multiple griefs, as well as an illusory attempt to restore a frail narcissism, weakened by losses and mournings that remain unresolved.MethodThe authors conducted a case study, with exemplary value, combining two unstructured-type research interviews as well as the administration of the Rorschach and TAT tests, with a retest one month later. These tests were analyzed according to the principles of the French school.ResultsIn addition to an identification with masculinity and virility, lethal risk-taking in sports can also be understood, in our case study, as a fight against the effects of multiple bereavements and the associated depression. This is the anti-depressive struggle that is at the forefront of psychological functioning and that becomes part of the masochism expressed in “traumaphilia,” constituting the last defense against the risk of an otherwise more disruptive collapse.DiscussionThe authors propose the notion of “sepulcher work” – borrowing R. Gori's and M.-J. Del Volgo's use of the expression, with reference to M. de M’Uzan's formula on the work of passing over – to define the stage of mourning in which it is recognized that the object has indeed been definitively lost. Sepulcher work, for us, consists in a psychological movement in which the subject who has lost her/his object admits that this loss is final: the first recognition of the principle of reality prior to the work of mourning.ConclusionsThe risk-taking in sports reported in the case studied here illustrates unique clinical situations in which the process of mourning could not begin, leading to depression. These psychopathological configurations do not constitute a homogeneous clinical picture, but illustrate, in their own way, psychological strategies to avoid facing the suffering of loss.     

Can deaths in police cells be prevented? Experience from Norway and death rates in other countries

PurposeTo describe the changes in death rates and causes of deaths in Norwegian police cells during the last 2 decades. To review reports on death rates in police cells that have been published in medical journals and elsewhere, and discuss the difficulties of comparing death rates between countries.MethodsData on deaths in Norwegian police cells were collected retrospectively in 2002 and 2012 for two time periods: 1993–2001 (period 1) and 2003–2012 (period 2). Several databases were searched to find reports on deaths in police cells from as many countries as possible.ResultsThe death rates in Norwegian police cells reduced significantly from 0.83 deaths per year per million inhabitants (DYM) in period 1 to 0.22 DYM in period 2 (p < 0.05). The most common cause of death in period 1 was alcohol intoxication including intracranial bleeding in persons with high blood alcohol levels, and the number declined from 16 persons in period 1 to 1 person in period 2 (p = 0.032). The median death rate in the surveyed Western countries was 0.44 DYM (range: 0.14–1.46 DYM).ConclusionThe number of deaths in Norwegian police cells reduced by about 75% over a period of approximately 10 years. This is probably mainly due to individuals with severe alcohol intoxication no longer being placed in police cells. However, there remain large methodology difficulties in comparing deaths rates between countries.