Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy

Worldwide, an estimated 15 million babies are born preterm (<37 weeks' gestation) every year. Despite significant improvements in survival rates, preterm infants often face a lifetime of neurodevelopmental disability including cognitive, behavioral, and motor impairments. Indeed, prematurity remains the largest risk factor for the development of cerebral palsy. The developing brain of the preterm infant is particularly fragile; preterm babies exhibit varying severities of cerebral palsy arising from reductions in both cerebral white and gray matter volumes, as well as altered brain microstructure and connectivity. Current intensive care therapies aim to optimize cardiovascular and respiratory function to protect the brain from injury by preserving oxygenation and blood flow. If a brain injury does occur, definitive diagnosis of cerebral palsy in the first few hours and weeks of life is difficult, especially when the lesions are subtle and not apparent on cranial ultrasound. However, early diagnosis of mildly affected infants is critical, because these are the patients most likely to respond to emergent treatments inducing neuroplasticity via high-intensity motor training programs and regenerative therapies involving stem cells. A current controversy is whether to test universal treatment in all infants at risk of brain injury, accepting that some patients never required treatment, because the perceived potential benefits outweigh the risk of harm. Versus, waiting for a diagnosis before commencing targeted treatment for infants with a brain injury, and potentially missing the therapeutic window. In this review, we discuss the emerging prophylactic, reparative, and restorative brain interventions for infants born preterm, who are at high risk of developing cerebral palsy. We examine the current evidence, considering the timing of the intervention with relation to the proposed mechanism/s of action. Finally, we consider the development of novel markers of preterm brain injury, which will undoubtedly lead to improved diagnostic and prognostic capability, and more accurate instruments to assess the efficacy of emerging interventions for this most vulnerable group of infants

Changing Gear: Delivering the Social Dividend

In December 2001, the Institute of Policy Studies and Business New Zealand co-hosted a one day symposium entitled ‘Changing Gear: Delivering the Social Dividend’. It was addressed and attended by members of academia, the public sector and the business sector. This IPS Policy Paper brings together a number of the presentations to that symposium. It includes papers delivered by Arthur Grimes, Colin Campbell-Hunt and Ross Wilson, plus a summary of key points raised in the address by Glenn Withers, and some concluding remarks by Rod Oram

Corticospinal tract integrity and motor function following neonatal stroke: a case study

Background: New MRI techniques enable visualisation of corticospinal tracts and cortical motor activity. The objective of this case study was to describe the magnetic resonance evidence of corticospinal pathway reorganisation following neonatal stroke. Case presentation: An 11 year old boy with a neonatal right middle cerebral artery territory ischaemic stroke was studied. Functional MRI was undertaken with a whole hand squeezing task, comparing areas of cortical activation between hands. White matter tracts, seeded from the area of peak activation in the cortex, were visualised using a diffusion weighted imaging probabilistic tractography method. Standardised evaluations of unilateral and bilateral motor function were undertaken. Clinically, the child presented with a left hemiparesis. Functional MRI demonstrated that movement of the hemiparetic hand resulted in activation in the ipsi-lesional (right) hemisphere only. Diffusion tractography revealed pathways in the right (lesioned) hemisphere tracked perilesionally to the cortical area identified by functional MRI. Conclusion: Our case demonstrates that neonatal stroke is associated with maintenance of organization of corticospinal pathways sufficient to maintain some degree of hand function in the affected hemisphere. Functional MRI and diffusion weighted imaging tractography may inform our understanding of recovery, organisation and reorganisation and have the potential to monitor responses to intervention following neonatal stroke

Addressing Nature-Deficit Disorder Using A Multi-program Area, Multi-State Approach

Youth are spending less time outdoors compared to previous generations. Because youth spend much of their time in school, teachers can provide the critical linkages that introduce students to nature. Unfortunately, teachers often lack access to standards-based STEAM curricula focused on natural resources, do not feel comfortable taking their students outside, and may not be knowledgeable about how to incorporate nature into the classroom. Addressing the nature deficit disorder facing today’s youth and the lack of professional development for teachers requires involvement from Extension (agriculture and natural resources specialists, health and human science educators) and natural resources professionals

The cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam over a one year period.

OBJECTIVE: To describe the cause-specific morbidity and mortality, and referral patterns of all neonates admitted to a tertiary referral hospital in the northern provinces of Vietnam. DESIGN: A prospective hospital based observational study. SETTING: The Neonatal Department, National Hospital of Pediatrics, Hanoi, Vietnam. PATIENTS: All admissions to the Neonatal Department over a 12 month period. MAIN OUTCOME MEASURES: Cause-specific morbidity and mortality; deaths. RESULTS: There were 5064 admissions with the commonest discharge diagnoses being infection (32%) and prematurity (29%). The case fatality ratio (CFR) was 13.9% (n = 703). Infection (38%), cardio/respiratory disorders (27%), congenital abnormalities (20%) and neurological conditions (10%) were the main causes of death. Of all the deaths, 38% had an admission weight ≥2500g. Higher CFR were associated with lower admission weights. Very few deaths (3%) occurred in the first 24 hours of life. Most referrals and deaths came from Hanoi and neighbouring provincial hospitals, with few from the most distant provinces. Two distant referral provinces had the highest CFR. CONCLUSIONS: The CFR was high and few deaths occurred in neonates <24 hours old. The high rates of infection call for an improvement in infection control practices and peripartum antibiotic use at provincial and tertiary level. Understanding provincial hospital capacity and referral pathways is crucial to improving the outcomes at tertiary centres. A quality of care audit tool would enable more targeted interventions and monitoring of health outcomes

Prognostic utility of magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy: substudy of a randomized trial

Objective: To investigate the effects of hypothermia treatment on magnetic resonance imaging (MRI) patterns of brain injury in newborns with hypoxic-ischemic encephalopathy compared with normothermia, including the prognostic utility of MRI for death and/or disability at a postnatal age of 2 years

Escape from the vicinity of fractal basin boundaries of a star cluster

The dissolution process of star clusters is rather intricate for theory. We investigate it in the context of chaotic dynamics. We use the simple Plummer model for the gravitational field of a star cluster and treat the tidal field of the Galaxy within the tidal approximation. That is, a linear approximation of tidal forces from the Galaxy based on epicyclic theory in a rotating reference frame. The Poincar\'e surfaces of section reveal the effect of a Coriolis asymmetry. The system is non-hyperbolic which has important consequences for the dynamics. We calculated the basins of escape with respect to the Lagrangian points $L_1$ and $L_2$. The longest escape times have been measured for initial conditions in the vicinity of the fractal basin boundaries. Furthermore, we computed the chaotic saddle for the system and its stable and unstable manifolds. The chaotic saddle is a fractal structure in phase space which has the form of a Cantor set and introduces chaos into the system.Comment: Accepted by MNRAS, Figures have lower qualit

Advanced EFL learners' beliefs about language learning and teaching: a comparison between grammar, pronunciation, and vocabulary

This paper reports on the results of a study exploring learners’ beliefs on the learning and teaching of English grammar, pronunciation and vocabulary at tertiary level. While the importance of learners’ beliefs on the acquisition process is generally recognized, few studies have focussed on and compared learners’ views on different components of the language system. A questionnaire containing semantic scale and Likert scale items probing learners’ views on grammar, pronunciation and vocabulary was designed and completed by 117 native speakers of Dutch in Flanders, who were studying English at university. The analysis of the responses revealed that (i) vocabulary was considered to be different from grammar and pronunciation, both in the extent to which an incorrect use could lead to communication breakdown and with respect to the learners’ language learning strategies, (ii) learners believed in the feasibility of achieving a native-like proficiency in all three components, and (iii) in-class grammar, pronunciation and vocabulary exercises were considered to be useful, even at tertiary level. The results are discussed in light of pedagogical approaches to language teaching