Blind Spots: Domestic Entrepreneurship and Private-sector Development in South-Sudan

Policy discourse on private sector development in fragile states has started attributing great importance to domestic entrepreneurship. This chapter follows Dutch initiatives to support entrepreneurs in South Sudan between 2009 and 2015. Despite the rhetoric, support for entrepreneurs did not materialise. Donor representatives refer to a lack of small and medium-sized enterprises and entrepreneurial skills as prime reasons. Our research reveals that in practice, the apolitical interventionist rationale characterising donor support in South Sudan conflicts with the politicised nature of the private sector. In fact, interventions side-line domestic entrepreneurship, reinforcing an image of a ‘missing middle’ and diverting attention to international firms as ‘capacity builders’

Persistence of postconcussional symptoms in uncomplicated mildly head-injured patients: a prospective cohort study

We report the follow-up of 41 nonhospitalized subjects with uncomplicated mild head injury (MHI) and no premorbid compromising condition. At 3 months after the trauma 22 patients still complained of at least 1 postconcussional symptom (PCS) and 10 patients had 3 or more PCS. At 6 months 12 patients complained of at least 1 PCS, whereas 9 patients still had 3 symptoms or more. Patients with persistent PCS complained more of emotional symptoms. Results obtained with objective tests indicated that this group was characterized by a decreased performance on the Stroop Color Word Interference Test and a reduced tolerance to light and sound stimuli in comparison with patients with only few or no PCS. Persistent neurobehavioral deficits were correlated with scores on a postconcussive/cognitive rating scale, but not with scores on an emotional/vegetative scale. Although most patients may substantially recover after MHI, about 1 in 4 patients may persist with a residue of neurobehavioral deficits. Patients with persistent PCS should be evaluated in a multidiagnostic and objective way in order to gain a better understanding of the nature and origin of the subjective symptoms

Water metabolism and postconcussional symptoms 5 weeks after mild head injury

Posttraumatic diabetes insipidus has been reported as a sequela to head injury. It is unknown whether subclinical types of diabetes insipidus, or other types of water metabolism disorders, occur after mild head injury (MHI) and, if so, whether they are related to the persistence of postconcussional symptoms. MHI patients (n = 38) were screened for disturbances of water metabolism by comparing plasma and urine osmolalities at about 5 weeks after the trauma. Eight patients had evidence of an increased plasma osmolality together with a relatively decreased urine osmolality after an overnight fast. The presence of this disturbance was significantly related to the persistence of postconcussional symptoms. The results suggest that subclinical disturbances of water metabolism may, among other factors, be related to the persistence of symptoms after MHI