Apnea of prematurity: from cause to treatment

Apnea of prematurity (AOP) is a common problem affecting premature infants, likely secondary to a “physiologic” immaturity of respiratory control that may be exacerbated by neonatal disease. These include altered ventilatory responses to hypoxia, hypercapnia, and altered sleep states, while the roles of gastroesophageal reflux and anemia remain controversial. Standard clinical management of the obstructive subtype of AOP includes prone positioning and continuous positive or nasal intermittent positive pressure ventilation to prevent pharyngeal collapse and alveolar atelectasis, while methylxanthine therapy is a mainstay of treatment of central apnea by stimulating the central nervous system and respiratory muscle function. Other therapies, including kangaroo care, red blood cell transfusions, and CO2 inhalation, require further study. The physiology and pathophysiology behind AOP are discussed, including the laryngeal chemoreflex and sensitivity to inhibitory neurotransmitters, as are the mechanisms by which different therapies may work and the potential long-term neurodevelopmental consequences of AOP and its treatment

Caffeine for the management of apnea in preterm infants.

Considerable uncertainty persists regarding the efficacy and safety of methylxanthines (caffeine, theophylline - in intravenous form named aminophylline) for the prevention and treatment of infant apnea. To help inform national guideline development in Kenya we undertook structured literature searches to identify current evidence on caffeine therapy for infant apnea. Available evidence shows that caffeine is as effective as intravenous theophylline (aminophylline), but is safer and easier to give and has better therapeutic properties. It is therefore recommended for the treatment of apnea of prematurity. Caffeine is also the preferred drug if clinicians plan to provide apnea prophylaxis. As prematurity is likely to result in more than 1 million deaths a year, mostly in resource-poor settings, greater efforts need to be made to ensure interventions such as caffeine, currently unavailable in countries such as Kenya, are made more widely available

Modeling the emergence of migratory corridors and foraging hot spots of the green sea turtle

Environmental factors shape the spatial distribution and dynamics of populations. Understanding how these factors interact with movement behavior is critical for efficient conservation, in particular for migratory species. Adult female green sea turtles, Chelonia mydas, migrate between foraging and nesting sites that are generally separated by thousands of kilometers. As an emblematic endangered species, green turtles have been intensively studied, with a focus on nesting, migration, and foraging. Nevertheless, few attempts integrated these behaviors and their trade‐offs by considering the spatial configurations of foraging and nesting grounds as well as environmental heterogeneity like oceanic currents and food distribution. We developed an individual‐based model to investigate the impact of local environmental conditions on emerging migratory corridors and reproductive output and to thereby identify conservation priority sites. The model integrates movement, nesting, and foraging behavior. Despite being largely conceptual, the model captured realistic movement patterns which confirm field studies. The spatial distribution of migratory corridors and foraging hot spots was mostly constrained by features of the regional landscape, such as nesting site locations, distribution of feeding patches, and oceanic currents. These constraints also explained the mixing patterns in regional forager communities. By implementing alternative decision strategies of the turtles, we found that foraging site fidelity and nesting investment, two characteristics of green turtles' biology, are favorable strategies under unpredictable environmental conditions affecting their habitats. Based on our results, we propose specific guidelines for the regional conservation of green turtles as well as future research suggestions advancing spatial ecology of sea turtles. Being implemented in an easy to learn open‐source software, our model can coevolve with the collection and analysis of new data on energy budget and movement into a generic tool for sea turtle research and conservation. Our modeling approach could also be useful for supporting the conservation of other migratory marine animals

Building research capacity for African institutions: confronting the research leadership gap and lessons from African research leaders

This study explores the meaning and competencies of ‘research leadership’ in the African context and investigates strategies for developing it. Data for the study were gathered through an online survey that targeted recipients of research grants/support from key research funders to selected African institutions. The recipients of these grants were either research leaders or team members. The study employs a mixed methodology approach with empirical data drawn from focus group discussions and online surveys of English-speaking research leaders and research teams whose research work was supported by the selected funding institutions. In line with literature of leadership styles in Africa, our results suggest that preferred research leadership style for African researchers is different in some ways, especially with its attention to the ‘human touch’. Respondents preferred ‘people/relationship orientated’, ‘task-orientated’ and ‘democratic/participative’ styles of leadership, all of which have strong elements of Ubuntu (humaneness). The study also showed that leadership development for many in Africa involves mostly ‘learning by doing’ and informal mentoring, and less formal training opportunities. We explore policy implications of our findings with reference to research leadership development in African institutions, paying particular attention to challenges faced by female research leaders, and stress that research leadership develop- ment in Africa must be seen as a long-term and continuous activity and calls for more formal leadership development opportunities to complement the existing informal approaches.This article is published as Building research capacity for African institutions: confronting the research leadership gap and lessons from African research leaders”, International Journal of Leadership in Education: Theory and Practice, (2015) 1046497. (with Ezekiel Kalipeni, Nicholas Awortwi & Joy Mueni Maina Kiiru).Doi: 10.1080/13603124.2015.1046497 Posted with permission.</p