Treatment of Post Dural Puncture Headaches in The Obstetric Population

Post dural puncture headache (PDPH) is a headache associated with orthostatic symptoms in which the headache increases with standing and is relieved with supine position. This type of headache arises as a result of a dural puncture either intentionally such as occurs with a subarachnoid block, or inadvertently during placement of an epidural. These symptoms can be of varying severity and usually appears within 1-3 days post dural puncture. In many cases patients are incapacitated and unable to carry out activities of daily living until treatment is received. If left untreated, 85% of PDPH resolve within six weeks, however, most new mothers are unwilling to wait that long (Sprigge, 2008). The risk factors for developing a post dural puncture headache include the size and type of needle used to make the dural puncture, female gender, patient age between 18-50, and a history of chronic or recurrent headaches. According to Sprigge & Harper (2008), the incidence of accidental dural puncture during the initiation of epidural analgesia in the obstetric population is between 0.5% and 2.5%. With these risk factors in mind one can understand why the incidence of post dural puncture headache is elevated in the obstetric population. Following accidental dural puncture for a labor epidurals 80-86% of these patients will develop a post dural puncture headache (Sprigge, 2008). While there are a variety of treatment and prevention options used in healthcare for post dural puncture headache, this evidence based review seeks to identify the most effective interventions. A review of literature found the administration of an epidural blood patch to have the best results in the treatment of post dural puncture headaches, although rarely used as a first line treatment due to the invasiveness of the procedure (Safa-Tisseront, 200 I). Many healthcare found in this literature review did not support this practice as changing the incidence or severity of post dural puncture headache (Cook, 1989, Dietrich, 1988 & Spriggs, 1992). While the benefit of the administration of sumatriptan was not supported by the research (Connelly, 2000), caffeine administration did show a statistical significant improvement with the symptoms associated with post dural puncture headache (Camann, 1990). Other preventative measures such as the injection of normal saline or morphine into the epidural space following a dural puncture are also explored within the context of this independent projec

Environmental drivers of the composition and diversity of the herb layer in mixed temperate forests in Hungary

Herbaceous understory vegetation is an important part of temperate forested ecosystems, the diversity and composition of which are strongly dependent on the conditions of the forest stand and the landscape. The aim of this study was to find the most important environmental drivers influencing understory herb layer species composition (explored with multivariate analysis), and richness and cover (analysed by linear modelling) in managed mixed forests in West Hungary. Our detailed inventory showed that the most important factors increasing the diversity and cover of the understory are light, tree species richness, and landscape diversity. Composition is also mainly influenced by light conditions and tree species richness, with minor effects of tree species composition, soil texture, and moss cover. As the strongest influencing factors are closely linked to stand structure and tree species composition, they can either directly or indirectly be altered by forest management. In the studied region, heterogeneous light conditions and canopy structure, the maintenance of tree species richness and forest continuity are key elements for the conservation of forest herbs. Forestry that maintains continuous forest cover and the tree selection management system can better provide these conditions than the presently widely used shelterwood management system. © 2016 Springer Science+Business Media Dordrech

Transferts, erreurs et alternance codique : Les caractéristiques de la langue finnoise chez les enfants bilingues français-finnois

Cette étude vise à connaitre les principales caractéristiques de la langue finnoise chez les enfants bilingues en français et en finnois. Nous nous intéressons aux transferts et interférences, donc l’influence qu’une langue puisse avoir sur une autre langue. Certaines caractéristiques peuvent également apparaitre sans qu’ils soient dus à l’influence inter-langagière, nous nous pencherons donc aux types d’erreurs, notamment les erreurs de développement qui sont des erreurs qui font partie de la compétence transitionnelle d’apprenant de langue, mais ne proviennent pas de sa première langue. Nous aborderons la notion d’interlangue, ce qui est la langue entre deux langues, contenant des transferts et des interférences fossilisés. Le dernier aspect auquel nous nous intéressons dans l’étude présente est l’alternance codique, donc utilisation d’une langue lors d’autre. Pour étudier ces aspects, nous avons enregistré des productions de sept enfants de 7-9 ans, bilingues en français et finnois. Ces enfants sont des élèves de l’école finlandaise de Paris (Pariisin Suomi-koulu). Nous avons créé une situation d’interaction qui vise à obtenir des productions obtenant des différentes utilisations de la langue finnoise. Pour ce faire, trois images différentes ont été montrées aux enfants. Les enfants en ont parlé et nous avons enregistré et transcrit ces productions. Nous avons utilisé une grille pour classer, quel type d’éléments sont présentes dans la parole des enfants. Les résultats de l’étude montrent que la plupart des caractéristiques « pas natives » sont des erreurs de développement, notamment dans les cas grammaticaux du finnois. Nous avons également pu révéler que les enfants ont essayé d’appliquer l’article de la même manière qu’en français. L’interlangue de ces enfants constituait de ce fait d’ajouter des pronoms pas nécessaires dans la langue finnoise. Dernièrement, l’étude met en évidence que les enfants n’utilisent quasiment pas d’alternance codique dans ce type de situation de communication