Cortical activity evoked by inoculation needle prick in infants up to one-year old

Inoculation is one of the first and most common experiences of procedural pain in infancy. However, little is known about how needle puncture pain is processed by the central nervous system in children. In this study, we describe for the first time the event-related activity in the infant brain during routine inoculation using electroencephalography. Fifteen healthy term-born infants aged 1 to 2 months (n = 12) or 12 months (n = 5) were studied in an outpatient clinic. Pain behavior was scored using the Modified Behavioral Pain Scale. A distinct inoculation event-related vertex potential, consisting of 2 late negative-positive complexes, was observable in single trials after needle contact with the skin. The amplitude of both negative-positive components was significantly greater in the 12-month group. Both inoculation event-related potential amplitude and behavioral pain scores increased with age but the 2 measures were not correlated with each other. These components are the first recordings of brain activity in response to real-life needle pain in infants up to a year old. They provide new evidence of postnatal nociceptive processing and, combined with more traditional behavioral pain scores, offer a potentially more sensitive measure for testing the efficacy of analgesic protocols in this age group

Cortical pain responses in human infants

Despite the recent increase in our understanding of the development of pain processing, it is still not known whether premature infants are capable of processing pain at a cortical level. In this study, changes in cerebral oxygenation over the somatosensory cortex were measured in response to noxious stimulation using real-time near-infrared spectroscopy in 18 infants aged between 25 and 45 weeks postmenstrual age. The noxious stimuli were heel lances performed for routine blood sampling; no blood tests were performed solely for the purpose of the study. Noxious stimulation produced a clear cortical response, measured as an increase in total hemoglobin concentration [HbT] in the contralateral somatosensory cortex, from 25 weeks (mean Delta[HbT] = 7.74 mu mol/L; SE, 1.10). Cortical responses were significantly greater in awake compared with sleeping infants, with a mean difference of 6.63 mu mol/L [95% confidence interval (CI) limits: 2.35, 10.91 mu mol/L; mean age, 35.2 weeks]. In awake infants, the response in the contralateral somatosensory cortex increased with age ( regression coefficient, 0.698 mu mol/L/week; 95% CI limits: 0.132, 1.265 mu mol/L/week) and the latency decreased with age (regression coefficient, -0.9861 mu mol/L/week; 95% CI limits: -1.5361, -0.4361 mu mol/L/week; age range, 25-38 weeks). The response was modality specific because no response was detected after non-noxious stimulation of the heel, even when accompanied by reflex withdrawal of the foot. We conclude that noxious information is transmitted to the preterm infant cortex from 25 weeks, highlighting the potential for both higher-level pain processing and pain-induced plasticity in the human brain from a very early age

Direct to consumer advertising via the Internet, a study of hip resurfacing

With increased use of the internet for health information and direct to consumer advertising from medical companies, there is a concern about the quality of the information available for patients. The aim of this study was to examine the quality of health information on the internet for hip resurfacing. An assessment tool was designed to measure quality of information. Websites were measured on credibility of source; usability; currentness of the information; content relevance; content accuracy/completeness and disclosure/bias. Each website assessed was given a total score, based on number of scores achieved from the above categories websites were further analysed on author, geographical origin and possession of an independent credibility check. There was positive correlation between the overall score for the website and the score of each website in each assessment category. Websites by implant companies, doctors and hospitals scored poorly. Websites with an independent credibility check such as Health on the Net (HoN) scored twice the total scores of websites without. Like other internet health websites, the quality of information on hip resurfacing websites is variable. This study highlights methods by which to assess the quality of health information on the internet and advocates that patients should look for a statement of an "independent credibility check" when searching for information on hip resurfacing

Gelatine backing affects the performance of single-layer ballistic-resistant materials against blast fragments

Penetrating trauma by energized fragments is the most common injury from explosive devices, the main threat in the contemporary battlefield. Such devices produce projectiles dependent upon their design, including preformed fragments, casings, glass, or stones; these are subsequently energized to high velocities and cause serious injuries to the body. Current body armor focuses on the essential coverage, which is mainly the thoracic and abdominal area, and can be heavy and cumbersome. In addition, there may be coverage gaps that can benefit from the additional protection provided by one or more layers of lightweight ballistic fabrics. This study assessed the performance of single layers of commercially available ballistic protective fabrics such as Kevlar®, Twaron®, and Dyneema®, in both woven and knitted configurations. Experiments were carried out using a custom-built gas-gun system, with a 0.78-g cylindrical steel fragment simulating projectile (FSP) as the impactor, and ballistic gelatine as the backing material. FSP velocity at 50% risk of material perforation, gelatine penetration, and high-risk wounding to soft tissue, as well as the depth of penetration (DoP) against impact velocity and the normalized energy absorption were used as metrics to rank the performance of the materials tested. Additional tests were performed to investigate the effect of not including a soft-tissue simulant backing material on the performance of the fabrics. The results show that a thin layer of ballistic material may offer meaningful protection against the penetration of this FSP. Additionally, it is essential to ensure a biofidelic boundary condition as the protective efficacy of fabrics was markedly altered by a gelatine backing

Regional initiatives and the UN 2001 Conference: Building Mutual Support and Complementarity.

yesAs the agenda for the United Nations (UN) 2001 Conference on The Illicit Trade in Small Arms and Light Weapons in All Its Aspects takes shape, governments should begin to identify a set of standards, mechanisms and specific agreements that will help consolidate, reinforce and co-ordinate regional and national measures to address the problem of the proliferation and misuse of small arms. An important element of this approach will be to build upon the wealth of regional and national experiences and perspectives that illustrate the different contexts in which efforts to combat the proliferation and misuse of small arms and light weapons have occurred. At the same time, agreements reached at the UN 2001 Conference should be substantial, establishing an agreed comprehensive `international action programme¿ f o r sustained global effort on this complex problem. However there remain issues and concerns that are common to all regions: these should be identified and addressed internationally within the context of the UN 2001 Conference. This briefing, the second in the Biting the Bullet series, reviews some of the current regional e fforts on small arms and light weapons. It identifies common approaches that have been used in different regions to counter the proliferation and misuse of small arms and light weapons, these include: law enforcement and crime control; supplier restraint and transparency; national legislation and regulation of arms; and arms reduction and control. The briefing analyses initiatives using these approaches that are moving forward in West Africa, Eastern and Southern Africa, the European Union (EU), and the development of cooperation between EU Member States and other countries and regional organizations, including Cambodia and the Southern African Development Community. The briefing identifies the impact and priorities of these initiatives, suggesting ways in which the UN 2001 Conference is both relevant to the region and what the region can contribute to the outcomes of the Conference. The briefing concludes with recommendations on the ways in which regional processes can be reinforced and further developed by the international community, focusing especially on the contribution of the UN 2001 Conference. Experience is showing that much of what happens nationally and regionally needs reinforcement and further development with assistance from the international community. The UN 2001 Conference comes at an important time for providing the framework ¿ through the international action programme ¿ to develop, reinforce and c o-ordinate these national and regional processes, through developing appropriate international norms, standards, programmes and mechanisms. Using the illustration of combating illicit arms trafficking, this briefing outlines some of the processes that could be taken forward through the UN 2001 Conference which would build upon and strengthen national and regional eff o r t s . The briefing contains an annex, which provides background information on many current regional and international initiatives, including those in Africa, the Americas, Asia, Europe and inter-regionally, such as the Organisation for Security and Co-operation in Europe and the North Atlantic Treaty Organisation

Implementing the UN Action Programme for Combating the Illicit Trafficking in Small Arms and Light Weapons in All Its Aspects.

yesHistorically, UN conferences have been criticised for resulting more in compromises than in commitments to real change, which is also a charge that has been levelled against the UN Conference on the Illicit Trade in Small Arms and Light Weapons in All Its Aspects (UN Small Arms Conference). The consensus-based approach adopted throughout the negotiations had the advantage of binding all participating States to all aspects of the agreed Programme of Action (PoA), but it also ensured that it would be difficult to achieve a sufficiently rigorous and comprehensive agreement on all of the measures required to tackle the trafficking, proliferation and misuse of small arms and light weapons (SALW). Therefore, in spite of the efforts of many governments and NGOs, the UN Small Arms Conference did not agree sufficiently robust agreements in several areas. Nonetheless, it was a valuable and productive process. The resulting PoA includes a reasonably comprehensive set of key principles and commitments, which provide a basis for taking forward action at national, regional and global levels. The PoAwas agreed by all of the participating States, amounting to more than 100, and each are politically bound to adopt and implement it. Given that the UN Small Arms Conference was the first of its kind, its achievement in generating political will and momentum for efforts to control SALW is important. Although many of the commitments are weaker and less comprehensive than hoped for by many governments and organisations, it is significant that the PoAcontains at least some important commitments in all but two of the `core¿ issue areas raised by States. The two exceptions relate to transfers to non-State actors and to civilian trade, possession and use of SALW, restrictions which were strongly opposed by the USA. Equally, human rights related issues were noteworthy by their absence in the PoA. Whilst the process of reaching agreement began with a far-reaching draft PoA in December 2000 (A/Conf.192/L.4), most of the comments that were tabled on this text during the second Preparatory Committee in January 2001 came from countries that sought to weaken its commitments. The subsequent draft (A/Conf.192/L.4/Rev.1) was therefore weaker, with the result that progressive States faced an uphill task in seeking to strengthen its provisions. The next draft PoA emerged at the UN Small Arms Conference itself in the form of a third draft (A/Conf.192/L.5). Although still limited in a number of key areas ¿ such as export criteria and transparency ¿ this document went further than L.4/Rev.1 in a number of respects and included specific international commitments, including on brokering and tracing lines of supply. This, however, proved too ambitious an agenda for a small group of States and in the end the document that was adopted by consensus (A/Conf.192/L.5/Rev.1) represented a lower-level compromise. Despite the difficulties of agreeing the consensus-based PoA, the process culminating in the agreement was perhaps as important as the agreement itself. UN Small Arms Conference represented the first time that all UN Member States had met to discuss the illicit trade in SALW in all its aspects with a view to agreeing a comprehensive set of measures to address the problem. Although many of the commitments contained in the PoAare couched in equivocal language that will allow States to do as much or as little as they like, it is clear that the UN Small Arms Conference has contributed to a much better understanding, amongst all stakeholders, of the nature of the illicit trade in SALW and of the particular concerns and priorities of different countries and sub-regions. It is also clear that although the Programme of Action provides a set of minimum standards and commitments which all states should adopt, it also encourages further action from all States willing to adopt more stringent commitments and stronger programmes. There is a willingness among a number of States to build upon the PoAand take more concrete and far-reaching measures at national, sub-regional, regional and international levels, such as specific arrangements for tracing co-operation, or mechanisms to co-ordinate e fforts to improve stockpile security or weapons destruction. This briefing provides a critical assessment of key provisions in the UN Small Arms Conference PoA. Section 1 measures the overall outcomes of the conference against those that the Biting the Bullet (BtB) project proposed as optimal conclusions, and suggests ways to put the commitments contained in the PoA into practice. Section 2 assesses the implementation and follow-up commitments contained in the PoA, and identifies ways of promoting the implementation of Sections III and IV, as well as options for making the most of the Biennial Meetings of States and the Review Conference in 2006. Section 3 examines funding and resourcing possibilities for the PoA including identifying needs, mobilising resources and matching needs with resources. The final section of the briefing focuses on the way forward, and in particular on how implementation of the PoA could build on existing regional initiatives and develop common international approaches to controlling SALW proliferation, availability and misuse. It also examines how action to prevent and combat the illicit trade in SALW in all its aspects can be taken forward at sub-regional and regional levels in conjunction with all major stakeholders, including civil society, in the period leading up to the first Review Conference

Teleological Essentialism

Placeholder essentialism is the view that there is a causal essence that holds category members together, though we may not know what the essence is. Sometimes the placeholder can be filled in by scientific essences, such as when we acquire scientific knowledge that the atomic weight of gold is 79. We challenge the view that placeholders are elaborated by scientific essences. On our view, if placeholders are elaborated, they are elaborated Aristotelian essences, a telos. Utilizing the same kinds of experiments used by traditional essentialists—involving superficial change (study 1), transformation of insides (study 2), acquired traits (study 3) and inferences about offspring (study 4)—we find support for the view that essences are elaborated by a telos. And we find evidence (study 5) that teleological essences may generate category judgments

Cerebral Near Infrared Spectroscopy Monitoring in Term Infants With Hypoxic Ischemic Encephalopathy—A Systematic Review

BACKGROUND: Neonatal hypoxic ischemic encephalopathy (HIE) remains a significant cause of mortality and morbidity worldwide. Cerebral near infrared spectroscopy (NIRS) can provide cot side continuous information about changes in brain hemodynamics, oxygenation and metabolism in real time. OBJECTIVE: To perform a systematic review of cerebral NIRS monitoring in term and near-term infants with HIE. SEARCH METHODS: A systematic search was performed in Ovid EMBASE and Medline database from inception to November 2019. The search combined three broad categories: measurement (NIRS monitoring), disease condition [hypoxic ischemic encephalopathy (HIE)] and subject category (newborn infants) using a stepwise approach as per PRISMA guidance. SELECTION CRITERIA: Only human studies published in English were included. DATA COLLECTION AND ANALYSIS: Two authors independently selected, assessed the quality, and extracted data from the studies for this review. RESULTS: Forty-seven studies on term and near-term infants following HIE were identified. Most studies measured multi-distance NIRS based cerebral tissue saturation using monitors that are referred to as cerebral oximeters. Thirty-nine studies were published since 2010; eight studies were published before this. Fifteen studies reviewed the neurodevelopmental outcome in relation to NIRS findings. No randomized study was identified. CONCLUSION: Commercial NIRS cerebral oximeters can provide important information regarding changes in cerebral oxygenation and hemodynamics following HIE and can be particularly helpful when used in combination with other neuromonitoring tools. Optical measurements of brain metabolism using broadband NIRS and cerebral blood flow using diffuse correlation spectroscopy add additional pathophysiological information. Further randomized clinical trials and large observational studies are necessary with proper study design to assess the utility of NIRS in predicting neurodevelopmental outcome and guiding therapeutic interventions

Guidelines and the adoption of ‘lipid rescue’ therapy for local anaesthetic toxicity

Accepted versio