Fostering military diplomacy with America\u27s bilateral allies: The Philippine policy of linking spokes together

This chapter examines the Philippines’ efforts to foster closer security ties with the USA, and its other bilateral security partners, namely Japan, South Korea, and Australia. These moves are aimed at strengthening the territorial defense capabilities of the Armed Forces of the Philippines (AFP) in the face of the China challenge in the South China Sea. Consequently, these enhanced strategic relations with the Philippines also pursue the secondary goal of enabling the aforementioned allies to help the AFP overcome its inadequacies in conducting local humanitarian assistance and disaster relief (HADR) operations during and after natural calamities

Outcome after incomplete spinal cord injury: central cord versus Brown-Sequard syndrome

Study design : A retrospective analysis of prospectively collected data.Objective:A hemisection of the spinal cord is a frequently used animal model for spinal cord injury (SCI), the corresponding human condition, that is, the Brown-Sequard syndrome (BS), is relatively rare as compared with the central cord syndrome (CC). The time course of neurological deficit, functional recovery, impulse conductivity and rehabilitation length of stay in BS and CC subjects were compared.Setting:Nine European Spinal Cord Injury Rehabilitation Centers.Methods:Motor score, walking function, daily life activities, somatosensory evoked potentials and length of stay were evaluated 1 and 6 months after SCI, and were compared between age-matched groups of tetraparetic BS and CC subjects.Results:For all analyzed measures no difference in the time course of improvement was found in 15 matched pairs.Conclusion:In contrast to the assumption of a better outcome of subjects with BS, no difference was found between the two incomplete SCI groups. This is of interest with respect to the different potential mechanisms leading to a recovery of functions in these two SCI subgroups.Spinal Cord advance online publication, 10 November 2009; doi:10.1038/sc.2009.149

Diagnostic criteria of traumatic central cord syndrome. Part 3: Descriptive analyses of neurological and functional outcomes in a prospective cohort of traumatic motor incomplete tetraplegics

Objectives: To compare the neurological recovery and functional outcomes between traumatic central cord syndrome (TCCS) patients and motor incomplete tetraplegic patients. Setting: European Multicenter Study of human spinal cord injury. Methods: In 248 traumatic motor incomplete tetraplegics, initial phase (0–15 days) American Spinal Injury Association (ASIA) impairment grading, upper and lower extremity motor scores (UEMS and LEMS), upper and lower sensory scores and chronic phase (6 or 12 months) neurological outcomes were analyzed. In addition, chronic phase self-care and indoor mobility Spinal Cord Independence Measure (SCIM) items were studied. Tetraplegics were subdivided into three groups: (1) non-TCCS group (UEMSgreater than or equal toLEMS), (2) intermediate-TCCS group (UEMS=(1–9 points)<LEMS) and (3) TCCS group (UEMS=(greater than or equal to10 points)<LEMS). Student's t-tests and χ2-tests were applied. Results: A total of 89 non-TCCS subjects (AIS D, n=28), 62 int-TCCS (AIS D, n=43) and 97 TCCS (AIS D, n=80) subjects were analysed. Although minimal significant differences in chronic phase LEMS and UEMS outcomes were identified between TCCS and non-TCCS patients after stratification by the AIS grade, our data showed no significant differences in functional upper and lower extremity outcomes at 6 or 12 months post-injury. Conclusion: The AIS grading system, and not the diagnosis TCCS, continues to be the best available prognostic parameter for neurological and functional outcomes in motor incomplete tetraplegics. The authors recommend that for future outcome studies in motor incomplete tetraplegia, patients should not be selected based on, or stratified by, the diagnosis TCCS

Diagnostic criteria of traumatic central cord syndrome. Part 1: A systematic review of clinical descriptors and scores

STUDY DESIGN: Systematic review. BACKGROUND: The applied definition of traumatic central cord syndrome (TCCS) lacks specific quantified diagnostic criteria. OBJECTIVE: To review currently applied TCCS diagnostic criteria and quantitative data regarding the 'disproportionate weakness' between the upper and lower extremities described in original studies reporting on TCCS subjects. METHODS: A MEDLINE (1966 to 2008) literature search was conducted. The descriptors applied to define TCCS were extracted from all included articles. We included original studies that reported on the differences in motor score (based on the Medical Research Council scale) between the total upper extremity motor score (UEMS) and the total lower extremity motor score (LEMS), in a minimum of five TCCS patients at the time of hospital admission. The mean difference between the total UEMS and the total LEMS of the patients included in each study was calculated. Case reports were excluded. RESULTS: None of the identified studies on TCCS patients reported inclusion and/or exclusion criteria using a quantified difference between the UEMS and LEMS. Out of 30 retrieved studies, we identified seven different clinical descriptors that have been applied as TCCS diagnostic criteria. Nine studies reporting on a total of 312 TCCS patients were eligible for analysis. The mean total UEMS was 10.5 motor points lower than the mean total LEMS. CONCLUSIONS: There is no consensus on the diagnostic criteria for TCCS. Nevertheless, this review revealed an average of 10 motor points between the UEMS and LEMS as a possible TCCS diagnostic criterion. However, further discussion by an expert panel will be required to establish definitive diagnostic criteria