Investigating sudden unexpected deaths in infancy and childhood and caring for bereaved families : an integrated multiagency approach

The sudden unexpected death of an infant or child is one of the worst events to happen to any family. Bereaved parents expect and should receive appropriate, thorough, and sensitive investigations to identify the medical causes of such deaths. As a result, several parallel needs must be fulfilled. Firstly, the needs of the family must be recognised—including the need for information and support. Further, there is the need to identify any underlying medical causes of death that may have genetic or public health implications; the need for a thorough forensic investigation to exclude unnatural causes of death; and the need to protect siblings and subsequent children. Alongside this, families need to be protected from false or inappropriate accusations. Limitations in the present coronial system have led to delays or failures to detect deaths caused by relatives, carers, or health professionals. Several recent, highly publicised trials have highlighted the possibilities of parents facing such accusations. As a result of this the whole process of death certification has come under intense scrutiny. We review the medical, forensic, and sociological literature on the optimal investigation and care of families after the sudden death of a child. We describe the implementation in the former county of Avon of a structured multiagency approach and the potential benefits for families and professionals

Repo Market Microstructure in Unusual Monetary Policy Conditions

The financial turmoil that began in mid-2007 produced severe stress in interbank markets and prompted significant changes in central banks’ funding operations. We examine the changing characteristics of ECB official interventions through the crisis and assess how they affected the efficiency and reliability of the secondary repo market as a mechanism for the distribution of interbank funding. The limit orderbook from the BrokerTec electronic repo trading platform is reconstructed to provide a range of indicators of participating banks’ aversion to the risk of failing to fund their liquidity needs. These indicators anticipate similar variables from ECB reverse repo auctions and are also affected by surprise outcomes of auctions.Repo, Financial crisis, liquidity, market microstructure, monetary policy operations

‘Has anyone here seen Amos?’ – re-establishing ‘prophetic imagination’ at the centre of religious education and formation

In 1989 Australian author and illustrator Bob Graham published a children’s book entitled Has anyone here seen William? This article seeks to construct a parallel narrative in relation to the category of the prophet, with a particular focus on the need to engage in prophetic imagination within the twin contexts of religious education (hereafter R.E.) and formation. In doing so it also makes reference to one of the archetypical biblical prophets - Amos. The article’s primary interlocutor is scripture scholar Walter Brueggemann (1982, 2002a, 2002b) who has written on topics as diverse as scripture exegesis and the theology of pain and homecoming. He has also written prominently on prophetic imagination, understood as the capacity to stand outside the dominant discourse or power structure of one’s day and critique it. As we will demonstrate throughout the article, Brueggemann’s scholarship in this area is complemented and refined through contact with the African-American philosopher Cornel West’s (1999) approach to prophetic critique, along with other commentators. Held together, both thinkers impel us to consider why teaching ‘about prophets’ needs to be complemented by an explicit cultivation of prophetic imagination, and how this might be seeded in crucial contexts such as religious education and formation. Following a brief introduction (part one) the second part explores the nature of the prophetic challenge. Part three focuses on recovery of the prophetic imagination, while part four examines ways to cultivate the prophetic imagination today. The final section considers conclusions and future directions in relation to topics raised throughout the paper

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

Sustainability of Solar PV Institutions in Malawi

The sustainability challenges of off-grid community energy projects using solar photovoltaics in Malawi have been widely acknowledged. However, little formal evidence has been produced regarding the factors that affect the sustainability of these projects. Under the MREAP, a study was commissioned to generate more conclusive evidence around the sustainability challenges of the current stock of schools, health centres, and other rural public institutions. An original data set consisting of performance data from 5 sustainability ‘pillars’, consisting of economic, technical, social, organizational, and environmental has been captured for 43 systems in rural Malawi. The results confirm existing anecdotal evidence and suggest that the majority of installed projects can be considered ‘unsustainable’ and at risk of failure in the near future. Many projects are now unsupported, are partially or completely non-functional, and are without reliable and effective means to resuscitate performance. Projects are ranked (relatively) in terms of overall sustainability and factors for improved sustainability are discussed. Our analysis demonstrates the complicated interactions between sustainability pillars and highlights the need for a holistic approach to project design and implementation

Hotspots and Coldspots: Household and village-level variation in orphanhood prevalence in rural Malawi

We explore the spatial distribution of orphans in two areas of Malawi. We first review pertinent themes in qualitative data collected in our research sites. Then, using spatial analysis, we show how positive and negative clusters of orphans—which we term orphanhood "hotspots" and "coldspots"—can be found at the village and sub-village levels. In the third and longest section of the paper, and using multilevel analyses with both simple and complex variance structures, we evaluate the relationship between the presence of orphans and a range of individual, household and village-level characteristics, including households' spatial relationship to each other and to other local sites of significance. This series of analyses shows that the most important covariates of orphan presence are the density of settlement, household size, and religious characteristics, with the latter measured simultaneously at both household and village-level. Other characteristics like education, reported mortality levels and HIV infection, are wholly unrelated to orphan prevalence at all analytic levels. Wealth and various spatial characteristics are only marginally associated with orphan prevalence. We conclude by reviewing some difficulties in explaining causal mechanisms underlying these observed relationships, and discussing conceptual, theoretical and programmatic implications.Africa, AIDS/HIV, Malawi, multilevel model, orphan prevalence, orphans, spatial analysis

Site-Specific Effects of PECAM-1 on Atherosclerosis in LDL Receptor-Deficient Mice

Objective—Atherosclerosis is a vascular disease that involves lesion formation at sites of disturbed flow under the influence of genetic and environmental factors. Endothelial expression of adhesion molecules that enable infiltration of immune cells is important for lesion development. Platelet/endothelial cell adhesion molecule-1 (PECAM-1; CD31) is an adhesion and signaling receptor expressed by many cells involved in atherosclerotic lesion development. PECAM-1 transduces signals required for proinflammatory adhesion molecule expression at atherosusceptible sites; thus, it is predicted to be proatherosclerotic. PECAM-1 also inhibits inflammatory responses, on which basis it is predicted to be atheroprotective. Methods and Results—We evaluated herein the effect of PECAM-1 deficiency on development of atherosclerosis in LDL receptor– deficient mice. We found that PECAM-1 has both proatherosclerotic and atheroprotective effects, but that the former dominate in the inner curvature of the aortic arch whereas the latter dominate in the aortic sinus, branching arteries, and descending aorta. Endothelial cell expression of PECAM-1 was sufficient for its atheroprotective effects in the aortic sinus but not in the descending aorta, where the atheroprotective effects of PECAM-1 also required its expression on bone marrow–derived cells. Conclusion—We conclude that PECAM-1 influences initiation and progression of atherosclerosis both positively and negatively, and that it does so in a site-specific manner. (Arterioscler Thromb Vasc Biol. 2008;28:1996-2002