a child's trauma was caused by abuse, has been questioned. a proposed clinical prediction rule with high sensitivity and low specificity, to rule out abusive head trauma, has been published. in july 2005, the court of appeals in the united kingdom heard four appeals of sbs convictions: one case was dropped, the sentence was reduced for one, and two convictions were upheld. the court found that the classic triad of retinal bleeding, subdural hematoma, and acute encephalopathy are not 100% diagnostic of sbs and that clinical history is also important. in the court's ruling, they upheld the clinical concept of sbs but dismissed one case and reduced another from murder to manslaughter. in their words: "whilst a strong pointer to nahi on its own we do not think it possible to find that it must automatically and necessarily lead to a diagnosis of nahi. all the circumstances, including the clinical picture, must be taken into account." the court did not believe the "unified hypothesis", proposed by british physician j. f. geddes and colleagues, as an alternative mechanism for the subdural and retinal bleeding found in suspected cases of sbs. the unified hypothesis proposed that the bleeding was not caused by shearing of subdural and retinal veins but rather by cerebral hypoxia, increased intracranial pressure, and increased pressure in the brain's blood vessels. the court reported that "the unified hypothesis no longer be regarded as a credible or alternative cause of the triad of injuries": subdural haemorrhage, retinal bleeding and encephalopathy due to hypoxemia (low blood oxygen) found in suspected sbs. on 31 january 2008, the wisconsin court of appeals granted audrey a. edmunds a new trial based on "competing credible medical opinions in determining whether there is a reasonable doubt as to edmunds's guilt." specifically, the appeals court found that "edmunds presented evidence that was not discovered until after her conviction, in the form of expert medical testimony, that a significant and legitimate debate in the medical community has developed in the past ten years over whether infants can be fatally injured through shaking alone, whether an infant may suffer head trauma and yet experience a significant lucid interval prior to death, and whether other causes may mimic the symptoms traditionally viewed as indicating shaken baby or shaken impact syndrome." in 2012, a. norman guthkelch, the neurosurgeon often credited with "discovering" the diagnosis of sbs, published an article "after 40 years of consideration," which is harshly critical of shaken baby prosecutions based solely on the triad of injuries. again, in 2012, guthkelch stated in an interview, "i think we need to go back to the drawing board and make a more thorough assessment of these fatal cases, and i am going to bet ... that we are going to find in every – or at least the large majority of cases, the child had another severe illness of some sort which was missed until too late." furthermore, in 2015, guthkelch went so far as to say, "i was against defining this thing as a syndrome in the first instance. to go on and say every time you see it, it's a crime... it became an easy way to go into jail." on the other hand, teri covington, who runs the national center for child death review policy and practice, worries that such caution has led to a growing number of cases of child abuse in which the abuser is not punished. in march 2016, waney squier, a paediatric neuropathologist who has served as an expert witness in many shaken baby trials, was struck off the medical register for misconduct. shortly after her conviction, squier was given the "champion of justice" award by the international innocence network for her efforts to free those wrongfully convicted of shaken baby syndrome. squier denied the allegations and appealed the decision to strike her off the medical register. as her case was heard by the high court of england and wales in october 2016, an open letter to the british medical journal questioning the decision to strike off squier, was signed by 350 doctors, scientists, and attorneys. on 3 november 2016, the court published a judgment which concluded that "the determination of the mpt is in many significant respects flawed". the judge found that she had committed serious professional misconduct but was not dishonest. she was reinstated to the medical register but prohibited from giving expert evidence in court for the next three years. the louise woodward case relied on the "shaken baby syndrome".