BACKGROUND AND OBJECTIVES:In 2019, the Consumer Product Safety Commission (CPSC) recalled inclined sleepers following reports of infant deaths. In 2023, recalls were reannounced after additional reports of infant deaths. This study used child death review (CDR) data to describe sudden unexpected infant deaths (SUIDs) that occurred in inclined sleepers. METHODS:We identified SUIDs that occurred in inclined sleepers from 2009 to 2023 from the Pediatric National Fatality Review-Case Reporting System (Pediatric NFR-CRS). Frequencies and proportions were calculated to describe demographic, incident, and supervisor characteristics. RESULTS:From 2009 to 2023, 158 SUIDs occurred in inclined sleepers. One hundred and eight deaths (68%) occurred from 2009 to 2019; 50 deaths (32%) occurred after 2019. Most infants were younger than 4 months (67%). Most incidents occurred at the infant's home (86%) under the supervision of a parent (83%). Nearly 30% were reported as placed supine to sleep and subsequently found unresponsive nonsupine. In 51 deaths (32%), the CDR team indicated the infant's airway was obstructed when found: 55% by the inclined sleeper material and 35% by other soft bedding in the sleep environment (not mutually exclusive). CONCLUSIONS:Infant deaths occurred in inclined sleepers even after the CPSC issued manufacturer recalls in 2019. Health care providers, home visitors, health insurers, and family-serving organizations should continue advising caregivers on the importance of a safe infant sleep environment, including use of a firm, noninclined surface, and avoidance of soft bedding. Improved dissemination of recalls of infant products that represent unsafe sleep environments may reduce the risk of sleep-related deaths.
The 2026 opening of the Gordie Howe International Bridge between Windsor, Ontario, Canada and Detroit, Michigan, USA, with its multi-use trail for cyclists and pedestrians, is projected to catalyze cross-border trail tourism and help further revitalize these two border cities. Both Windsor and Detroit have unique, extensive trail systems with compelling destinations. However, cross-border trail tourism institutionalization needs improvement. Tourism, greenway, and destination partners should explore creating a boundary organization to foster and market cross-border trail tourism. Recommendations from a 2024 cross-border trail tourism conference include: develop strategies for community engagement and storytelling to enhance cultural connections between regions; strengthen ties between trail groups and environmental organizations to provide trail experiences that reconnect people with the river and other natural resources; support the region’s efforts to obtain a UNESCO World Heritage Site designation for the Underground Railroad and support the Canadian federal designation of Windsor’s Ojibway National Urban Park; strengthen collaborations between tourism and cycling partners to promote and market cross-border trail tourism; institutionalize greenway assessments (every 5–10 years) to evaluate trail segment completions, gaps, potential route improvements, safety improvements, equity considerations, etc., and to keep greenways in the public consciousness; and measure and broadly communicate the economic impact of cross-border trail tourism resulting from the bridge.
Background Sudden unexpected death in children is a tragic event. Understanding the genetics of sudden death in the young (SDY) enables family counseling and cascade screening. The objective of this study was to characterize genetic variation in an SDY cohort using whole genome sequencing. Methods The SDY Case Registry is a National Institutes of Health/Centers for Disease Control and Prevention surveillance effort to discern the prevalence, causes, and risk factors for SDY. The SDY Case Registry prospectively collected clinical data and DNA biospecimens from SDY cases < 20 years of age. SDY cases were collected from medical examiner and coroner offices spanning 13 US jurisdictions from 2015 to 2019. The cohort included 211 children (median age 0.33 year; range 0–20 years), determined to have died suddenly and unexpectedly and from whom DNA biospecimens for DNA extractions and next-of-kin consent were ascertained. A control cohort consisted of 211 randomly sampled, sex- and ancestry-matched individuals from the 1000 Genomes Project. Genetic variation was evaluated in epilepsy, cardiomyopathy, and arrhythmia genes in the SDY and control cohorts. American College of Medical Genetics/Genomics guidelines were used to classify variants as pathogenic or likely pathogenic. Additionally, pathogenic and likely pathogenic genetic variation was identified using a Bayesian-based artificial intelligence (AI) tool. Results The SDY cohort was 43% European, 29% African, 3% Asian, 16% Hispanic, and 9% with mixed ancestries and 39% female. Six percent of the cohort was found to harbor a pathogenic or likely pathogenic genetic variant in an epilepsy, cardiomyopathy, or arrhythmia gene. The genomes of SDY cases, but not controls, were enriched for rare, potentially damaging variants in epilepsy, cardiomyopathy, and arrhythmia-related genes. A greater number of rare epilepsy genetic variants correlated with younger age at death. Conclusions While damaging cardiomyopathy and arrhythmia genes are recognized contributors to SDY, we also observed an enrichment in epilepsy-related genes in the SDY cohort and a correlation between rare epilepsy variation and younger age at death. These findings emphasize the importance of considering epilepsy genes when evaluating SDY.
Earned Income Tax Credit (EITC) is a promising anti-poverty strategy in the United States (Hoynes Patel, 2018). It has protective effects against adverse childhood experiences including child maltreatment (Berger et al., 2017; Biehl Hill, 2018; Klevens et al., 2017; Rostad et al., 2020), intimate partner violence (Spencer et al., 2020), and parental mental health problems (Boyd-Swan et al., 2016; Evans Garthwaite, 2014). Despite these positive impacts, approximately one in five families eligible for EITC does not receive it (Internal Revenue Service, 2019). The EITC Access Project involves intensive, one-on-one home visiting (delivered in conjunction with Parents As Teachers) that includes financial empowerment and education surrounding EITC across nine counties in the State of Michigan. Using paired t-tests, this study examines the outcomes of the EITC Access Project including knowledge of, application for, receipt of, and barriers to applying the EITC, and finds initial evidence that it may increase knowledge and uptake of EITC while decreasing neglect.
