Conservative management of significant epidural haematomas in children

Objective: A significant epidural haematoma (EDH) is generally treated by craniotomy and evacuation. This is a report of conservative management following an EDH on computerized tomography (CT) in a paediatric population. The authors examined whether conservative treatment of radiologically significant EDH is a successful and safe therapeutic option. Methods: Retrospective data were collected from charts of patients with conservatively treated EDH in the Department of Surgery of the University Children's Hospital Zurich between September 1993 and January 2004. Included were patients without focal neurological deficits, with a Glasgow Coma Scale (GCS) of 15 and an initial CT demonstrating an EDH with a minimal thickness of 1cm. Mild clinical symptoms of raised intracranial pressure such as headache, nausea or vomiting were treated symptomatically. Follow-up included a standardized interview, a neuropaediatric examination and CT. Results: Thirteen children with EDH had successful conservative management. Only one 12-year-old female patient with a delayed diagnosed frontal EDH required surgical intervention 24h after admission and 5 days after the accident. Clinical follow-up showed patients without neurological deficits, a Glasgow Outcome Scale of 5 and no post-traumatic sequelae over an average of 4 4/12 years (range 4 months to 10 4/12 years). Follow-up CT showed complete resolution of the EDH within 2 to 3 months. Conclusions: Our results demonstrate that significant EDH can be treated non-operatively in neurologically normal children. We recommend that such treatment be performed in specialised paediatric centres under adequate neurological observation since prompt emergency operation in case of neurological deterioration should be provide

The corporate brand and strategic direction: Senior business school managers’ cognitions of corporate brand building and management

This revelatory study focuses on top Financial Times (FT) ranked British business school managers cognitions of corporate brand building and management. The study insinuates there is a prima facie bilateral link between corporate branding and strategic direction. Among this genus of business school, the data revealed corporate brand building entailed an on-going concern with strategic management, stakeholder management, corporate communications, service focus, leadership, and commitment. These empirical findings, chime with the early conceptual scholarship on corporate brand management dating back to the mid-1990s. These foundational articles stressed the multi-disciplinary and strategic nature of corporate brand management and stressed the significant role of the CEO. As such, this research adds further credence to the above in terms of best-practice vis-à-vis corporate brand management. Curiously, whilst senior managers espouse a corporate brand orientation, corporate brand management is seemingly not accorded a similar status in the curriculum. Drawing on general embedded case study methodological approach, data was collected within eight leading (FT-ranked) business schools in Great Britain at Oxford, Cambridge, Durham, Bradford, Cranfield, Warwick, Lancaster and City (London) Universities. Each of these eight British business schools can be deemed as ‘top’ business schools by virtue of their inclusion in the influential Financial Times (FT) worldwide list of top business schools. The primary mode of qualitative data collection was the 37 in-depth interviews with business school Deans, Associate Deans and other senior faculty members and other managers

The negotiating strategies determining coitus in stable heterosexual relationships

Heterosexual behaviour is a complex subject and one which is aggravated by confounding variables. Few studies have investigated the way in which one variable, namely coitus, is initiated and negotiated in stable marital relationships. As the HIV/AIDS pandemic spreads in sub-Saharan Africa, the subject of marital coitus becomes of increasing concern. This study tests a methodology of semi-structured interviews and diary-keeping techniques to investigate how the activity is initiated and negotiated. A research team monitored the study and evaluated the research techniques. The study concluded that the HIV/AIDS pandemic is affecting the initiation and negotiation of coitus between marital partners and that the partners wish to renegotiate the relationship, but the mechanisms for renegotiation are not at present available

Population Genetic Structure of Aldabra Giant Tortoises

Evolution of population structure on islands is the result of physical processes linked to volcanism, orogenic events, changes in sea level, as well as habitat variation. We assessed patterns of genetic structure in the giant tortoise of the Aldabra atoll, where previous ecological studies suggested population subdivisions as a result of landscape discontinuity due to unsuitable habitat and island separation. Analysis of mitochondrial DNA (mtDNA) control region sequences and allelic variation at 8 microsatellite loci were conducted on tortoises sampled in 3 locations on the 2 major islands of Aldabra. We found no variation in mtDNA sequences. This pattern corroborated earlier work supporting the occurrence of a founding event during the last interglacial period and a further reduction in genetic variability during historical time. On the other hand, significant population structure recorded at nuclear loci suggested allopatric divergence possibly due to geographical barriers among islands and ecological partitions hindering tortoise movements within islands. This is the first attempt to study the population genetics of Aldabra tortoises, which are now at carrying capacity in an isolated terrestrial ecosystem where ecological factors appear to have a strong influence on population dynamic

Plasma evolution in laser-irradiated hollow microcylinders

Hollow microcylinder targets, 200-300 μm in diameter, have been internally irradiated at up to 5 · 1014 W/cm2 with Nd:glass laser pulses directed through an axial entrance slit. The plasma evolution in the interior of the cavities was diagnosed with a pinhole imaging X-ray streak camera and a Nomarski-type interferometer. Plasma collision near the center of the cylinder is observed about 300 ps after the irradiating laser pulse. The experimental results are confirmed by a one-dimensional Eulerian fluid cod

Demographic drivers of decline and recovery in an Afro-Palaearctic migratory bird population

Across Europe, rapid population declines are ongoing in many Afro-Palaearctic migratory bird species, but the development of appropriate conservation actions across such large migratory ranges is severely constrained by lack of understanding of the demographic drivers of these declines. By constructing regional integrated population models (IPMs) for one of the suite of migratory species that is declining in the south-east of Britain but increasing in the north-west, we show that, while annual population growth rates in both regions vary with adult survival, the divergent regional trajectories are primarily a consequence of differences in productivity. Between 1994 and 2012, annual survival and productivity rates ranged over similar levels in both regions, but high productivity rates were rarer in the declining south-east population and never coincided with high survival rates. By contrast, population growth in the north-west was fuelled by several years in which higher productivity coincided with high survival rates. Simulated population trajectories suggest that realistic improvements in productivity could have reversed the decline (i.e. recovery of the population index to ≥ 1) in the south-east. Consequently, actions to improve productivity on European breeding grounds are likely to be a more fruitful and achievable means of reversing migrant declines than actions to improve survival on breeding, passage or sub-Saharan wintering grounds

Electrocardiographic changes during continuous intravenous application of bupivacaine in neonatal pigs

Background It is controversial as to whether T-wave elevation is caused by local anaesthetics, epinephrine, or their combination. It has been shown that T-elevation after intravascular injection of a small bupivacaine test dose is caused by epinephrine and not by bupivacaine. The aim of this study was to investigate ECG changes with higher doses of i.v. bupivacaine. Methods Thirty neonatal pigs were anaesthetized with sevoflurane and their tracheas intubated and artificially ventilated. Under steady-state conditions, bupivacaine was continuously infused (flow rate 3.2 ml kg−1 min−1) by a syringe infusion pump through a central venous catheter. Group 1 received bupivacaine 0.125%, Group 2 bupivacaine 0.5%. The ECG was continuously printed and subsequently analysed for alterations in heart rate, ventricular de- and repolarization, and arrhythmias at 1.25, 2.5, and 5 mg kg−1 bupivacaine infused. Results Sinus rhythm persisted in all pigs. Heart rate decreased progressively in both groups, but this was significantly more pronounced in Group 1. T-wave elevation occurred in 40% and 0% (Groups 1 and 2) at 1.25 mg kg−1, in 80% and 0% at 2.5 mg kg−1, and in 93% and 80% at 5 mg kg−1 bupivacaine infused. There were significant differences between the two groups at 1.25 and 2.5 mg kg−1 infused. Conclusions Higher doses of i.v. infused bupivacaine can cause T-elevation. With slower injection technique, T-elevation can already be detected at lower bupivacaine doses administere

Trypanosoma brucei gambiense group 1 is distinguished by a unique amino acid substitution in the HpHb receptor implicated in human serum resistance

Trypanosoma brucei rhodesiense (Tbr) and T. b. gambiense (Tbg), causative agents of Human African Trypanosomiasis (sleeping sickness) in Africa, have evolved alternative mechanisms of resisting the activity of trypanosome lytic factors (TLFs), components of innate immunity in human serum that protect against infection by other African trypanosomes. In Tbr, lytic activity is suppressed by the Tbr-specific serum-resistance associated (SRA) protein. The mechanism in Tbg is less well understood but has been hypothesized to involve altered activity and expression of haptoglobin haemoglobin receptor (HpHbR). HpHbR has been shown to facilitate internalization of TLF-1 in T.b. brucei (Tbb), a member of the T. brucei species complex that is susceptible to human serum. By evaluating the genetic variability of HpHbR in a comprehensive geographical and taxonomic context, we show that a single substitution that replaces leucine with serine at position 210 is conserved in the most widespread form of Tbg (Tbg group 1) and not found in related taxa, which are either human serum susceptible (Tbb) or known to resist lysis via an alternative mechanism (Tbr and Tbg group 2). We hypothesize that this single substitution contributes to reduced uptake of TLF and thus may play a key role in conferring serum resistance to Tbg group 1. In contrast, similarity in HpHbR sequence among isolates of Tbg group 2 and Tbb/Tbr provides further evidence that human serum resistance in Tbg group 2 is likely independent of HpHbR functio

Bis-Retinoid A2E Induces an Increase of Basic Fibroblast Growth Factor via Inhibition of Extracellular Signal-Regulated Kinases 1/2 Pathway in Retinal Pigment Epithelium Cells and Facilitates Phagocytosis.

Age-related macular degeneration (ARMD) is the leading cause of vision loss in developed countries. Hallmarks of the disease are well known; indeed, this pathology is characterized by lipofuscin accumulation, is principally composed of lipid-containing residues of lysosomal digestion. The N-retinyl-N-retinylidene ethanolamine (A2E) retinoid which is thought to be a cytotoxic component for RPE is the best-characterized component of lipofuscin so far. Even if no direct correlation between A2E spatial distribution and lipofuscin fluorescence has been established in aged human RPE, modified forms or metabolites of A2E could be involved in ARMD pathology. Mitogen-activated protein kinase (MAPK) pathways have been involved in many pathologies, but not in ARMD. Therefore, we wanted to analyze the effects of A2E on MAPKs in polarized ARPE19 and isolated mouse RPE cells. We showed that long-term exposure of polarized ARPE19 cells to low A2E dose induces a strong decrease of the extracellular signal-regulated kinases' (ERK1/2) activity. In addition, we showed that A2E, via ERK1/2 decrease, induces a significant decrease of the retinal pigment epithelium-specific protein 65 kDa (RPE65) expression in ARPE19 cells and isolated mouse RPE. In the meantime, we showed that the decrease of ERK1/2 activity mediates an increase of basic fibroblast growth factor (bFGF) mRNA expression and secretion that induces an increase in phagocytosis via a paracrine effect. We suggest that the accumulation of deposits coming from outer segments (OS) could be explained by both an increase of bFGF-induced phagocytosis and by the decrease of clearance by A2E. The bFGF angiogenic protein may therefore be an attractive target to treat ARMD