Medium-chain acyl CoA dehydrogenase deficiency: Its relationship to SIDS and the impact on genetic counseling

Sudden infant death syndrome (SIDS) is defined as the sudden and unexpected death of an apparently healthy infant under 1 year of age. Routine autopsies often provide few clues as to the cause of death and rarely include a biochemical evaluation. Genetic counseling for SIDS can be difficult as recurrence risks vary depending on the age at death and the number of deaths which have occurred in the family. Biochemical disorders may account for up to 5% of SIDS. Of the metabolic disorders known to be involved in SIDS, the most commonly found is medium-chain acyl CoA dehydrogenase deficiency (MCAD). MCAD is an autosomal recessive disorder of fatty acid oxidation which accounts for up to 1% of SIDS. For some families, the addition of a postmortem biochemical investigation can identify an unsuspected metabolic disorder as the cause of death. Once the diagnosis is established, accurate genetic counseling can then be provided. Metabolic testing of the surviving siblings of victims of sudden death, and the subsequent identification of those due to MCAD can prevent the tragedy of recurrent SIDS in some families. In addition, screening the survivors of an acute life threatening event (ALTE) may also prevent a recurrence.     

On the dynamics of dying

This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the “dying” stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying—an accelerating disintegration terminating in death. A medical case history is analyzed.     

Intersections of personal vs. collective trauma during the COVID-19 pandemic: the hijacking of the human imagination

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or ‘triggers’ un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear – leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways – leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker’s analysis of our ‘denial of death’ and his urgency to embrace our common human vulnerability is explored in relation to Jung’s early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the ‘Black Lives Matter’ movement that swept the world in the aftermath of the COVID-19 outbreak.     

Back to sleep: Teaching adults to arrange safe infant sleep environments

There are over 3,000 sleep related infant deaths each year in the United States. Attempts to teach medical personnel and parents safe infant sleep practices in the infant sleep training literature have demonstrated mixed results. Thus, strategies to teach arrangements of safe infant sleep environments warrant further investigation. Behavioral skills training (BST) is an evidence-based teaching strategy shown to successfully teach various safety skills to children and adults. The current study evaluated the effectiveness of behavioral skills training to teach safe infant sleep practices to typically developing adults. Specifically, differential responding was assessed across multiple environmental arrangements typical of contexts parents may be exposed to when putting an infant to sleep. BST significantly improved appropriate arrangement of a safe sleep environment for infants for all 8 participants.     

L’annonce d’un décès en milieu hospitalier

Announcing a death is always a delicate moment for close familial members but also for caregivers. Law gives some precisions about how this information must be delivered. Recently the state council judged that the lack of empathy from caregivers and the late of the death announcement can create a damage. This judgement gives more precisions about how a death announcement must be in a hospital. This topic is pretty similar with the information which must be given to close familial members about organ donation. This latter is definitely more exceptional and the procedure is a way more regulated. There are much rules which explain how this information must be delivered.     

From agape to organs: religious difference between Japan and America in judging the ethics of transplant

This essay argues that Japan's resistance to the practice of transplanting organs from persons deemed "brain dead" may not be the result, as some claim, of that society's religions being not yet sufficiently expressive of love and altruism. The violence to the body necessary for the excision of transplantable organs seems to have been made acceptable to American Christians at a unique historical "window of opportunity" for acceptance of that new form of medical technology. Traditional reserve about corpse mutilation had weakened and, especially as presented by the theologian Joseph Fletcher, organ donation was touted as both expressive of agape and a way of "updating" Christianity via the ethics of Utilitarianism. Many Japanese, largely Buddhist and Confucian in their orientation, view these changed valorizations as neither necessary nor patently more ethical than those of their own traditions.     

Touching Mortality, Touching Strength: Clinical Work with Dying Patients

This paper outlines some of the special stresses that must be shouldered by clinicians—physicians, nurses, chaplains, social workers, pastoral staff, and others—whose work focuses on dying and extremely vulnerable patients. The utility of a theory of generative death anxiety as a framework for interpreting the nature of these special stresses is suggested. Three common burnout reactions are examined. The paper concludes that positive acceptance of personal mortality may help clinicians avoid burnout and lead to better therapeutic practice. This framework for interpreting therapeutic practice demonstrates the integral role spirituality plays in work with this particular patient group.     

A case study of borderline anxiety andthe process of analytic transformation

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extratransference. This acting-out is often followed by the self-destructive, antichange attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.