Squier W.,West Wing
Acta Neuropathologica | Year: 2011
The "Shaken Baby" syndrome (SBS) is the subject of intense controversy; the diagnosis has in the past depended on the triad of subdural haemorrhage (SDH), retinal haemorrhage and encephalopathy. While there is no doubt that infants do suffer abusive injury at the hands of their carers and that impact can cause catastrophic intracranial damage, research has repeatedly undermined the hypothesis that shaking per se can cause this triad. The term non-accidental head injury has therefore been widely adopted. This review will focus on the pathology and mechanisms of the three physiologically associated findings which constitute the "triad" and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions. "Sub" dural bleeding in fact originates within the deep layers of the dura. The potential sources of SDH include: the bridging veins, small vessels within the dura itself, a granulating haemorrhagic membrane and ruptured intracranial aneurysm. Most neuropathologists do not routinely examine eyes, but the significance of this second arm of the triad in the diagnosis of Shaken Baby syndrome is such that it merits consideration in the context of this review. While retinal haemorrhage can be seen clinically, dural and subarachnoid optic nerve sheath haemorrhage is usually seen exclusively by the pathologist and only rarely described by the neuroradiologist. The term encephalopathy is used loosely in the context of SBS. It may encompass anything from vomiting, irritability, feeding difficulties or floppiness to seizures, apnoea and fulminant brain swelling. The spectrum of brain pathology associated with retinal and subdural bleeding from a variety of causes is described. The most important cerebral pathology is swelling and hypoxic-ischaemic injury. Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. Clefts and haemorrhages in the immediate subcortical white matter have been assumed to be due to trauma but factors specific to this age group offer other explanations. Finally, examples of the most common causes of the triad encountered in clinical diagnostic and forensic practice are briefly annotated. © 2011 Springer-Verlag.
Yusuf I.H.,West Wing
Journal of Glaucoma | Year: 2016
INTRODUCTION:: The evidence for low cerebrospinal fluid pressure (CSFP) as a key parameter in the pathogenesis of glaucoma is increasing. Primate models have demonstrated the onset normal tension glaucoma (NTG) from experimentally induced chronic intrathecal hypotension; an approach not possible in human subjects. CASE PRESENTATION:: A 27-year-old man presented with a central scotoma in his left eye. He had undergone 8 CSF shunt revision procedures over a 25-year period secondary to recurrent low CSFP following surgical excision of a pinealoblastoma, aged 2. A focal nerve fiber layer defect was detected in the left eye associated with reduced retinal sensitivity on microperimetry. Three adjacent optic disc hemorrhages had been documented in the same position over an 18-month period. A diagnosis of left-sided NTG was made; the patient was started on Latanoprost 0.005%. A new generation CSF shunting device (ProGAV)—which neutralizes CSFP fluctuations analogously to trabeculectomy surgery for intraocular pressure—was considered necessary in this patient to alleviate persistent headaches and reduce the risk of progressive glaucomatous visual loss. CONCLUSIONS:: This exceptional case illustrates how premature onset NTG may occur as a result of chronic, recurrent intrathecal hypotension—a “pure” human model. We describe an original management approach of implanting an adjustable, programmable CSF shunt valve (ProGAV) to reduce fluctuations in the translaminar cribrosa pressure difference, and reduce the risk of glaucomatous visual loss. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Goutos I.,West Wing
Journal of Burn Care and Research | Year: 2014
Obesity is an emerging healthcare problem and affects an increasing number of burn patients worldwide. An email survey questionnaire was constructed and distributed among the 16 U.K. burn services providing adult inpatient facilities to investigate nutritional practices in obese thermally injured patients. Responses received from all dieticians invited to participate in the study were analyzed, and a relevant literature review of key aspects of nutritional care is presented. The majority of services believe that obese patients warrant a different nutritional approach with specific emphasis to avoid overfeeding. The most common algebraic formulae used to calculate calorific requirements include the Schofield, Henry, and modified Penn State equations. Indirect calorimetry despite being considered the "criterion standard" tool to calculate energy requirements is not currently used by any of the U.K. burn services. Gastric/enteral nutrition is initiated within 24 hours of admission in the services surveyed, and a variety of different practices were noted in terms of fasting protocols before procedures requiring general anesthesia/sedation. Hypocaloric regimens for obese patients are not supported by the majority of U.K. facilities, given the limited evidence base supporting their use. The results of this survey outline the wide diversity of dietetic practices adopted in the care of obese burn patients and reveal the need for further study to determine optimal nutritional strategies. Copyright © 2014 by the American Burn Association.
Alan Alda is asking scientists to explain the science of sound to 11-year-olds. More Scientists, it's time to lend your ears (and your knowledge) to this year's big science competition: Explaining the science of sound to 11-year-olds. The winning answer will help not only children across the world understand sound, but also the contest's founder, actor Alan Alda. Alda is known for his work on the TV series "M*A*S*H" and "The West Wing," and now heads the Alan Alda Center for Communicating Science at Stony Brook University in New York. Since 2012, the center has organized an annual competition, asking scientists — be they graduate students, professors or retired — to explain complicated concepts in an engaging and easy-to-understand way. Hundreds of researchers have stepped forward, answering questions about color, sleep, time and flame. [Easy Answers to the Top 5 Science Questions Kids Ask] In fact, Alda started the competition based on an experience he had at age 11. He remembers asking his teacher to explain flame, and she responded with one word: oxidation. "I never got a good explanation," Alda told Live Science last year. "I didn't know what oxidation was. Oxidation was just another word for me." Years later, he started the contest as a way to engage 11-year-olds in science, and to connect scientists with the next generation. Each year, children submit questions they want answered. Alda presents the winning question to scientists, and asks that they submit a 300-word explanation, a graphic response or a 5-minute video explaining the concept. "There are so many ways in which sounds affect us, so many ways that different animals use sound, and so many kinds of sound," Alda said in a statement. "I can't wait to see how creatively scientists will explain exactly what sound is. The kids and I are all ears." Entries will be judged by 11-year-olds around the world. Two winning scientists — one with a written entry and one with a video or graphic entry — will receive a $1,000 cash prize and a free trip to New York City, where they will meet Alda at the 2016 World Science Festival. More than one child asked, "what is sound," and all of them are looking forward to an answer, including Aidan Green, a fifth-grader from Maungatapu Primary School in Tauranga, New Zealand. "I like to listen to the sounds around me and wonder how they all sound different" Aidan said in a statement. "What makes them do that?" He added that "we have a student who is currently having double cochlear implants and we have been told that he will hear things differently now, than when he just had hearing aides. How does that work?" The contest deadline is 11:59 p.m. EST on Jan. 19, 2016. Learn more about the rules at the center's website. Copyright 2015 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
The closest I came to meeting Steve Jobs was in the late 2000s, shortly after the birth of the iPhone. I was attending Foo Camp, a California mustering of digital demigods. Jeff Bezos of Amazon was a regular; the year before, Google co-founder Larry Page had turned up in his helicopter. Everyone but me took such things in their stride. That year, however, there was something different in the air: a rumour had spread that Steve Jobs himself might join us. He never showed up, but such was his unique status that even his absence generated more excitement than the presence of other tech giants. Blessed as he was with formidable taste and rock-star showmanship, Jobs was always going to stand out from the crowd of awkward nerds (like me) who populate much of the technology landscape. Add to this his death at the height of his powers, and we have all the ingredients of a legend. This is not undeserved. Many technologists talk of changing the world; Jobs actually did so. More than anyone else, he broke down the barriers between technology and humanity, helping to turn computers into consumer products. Then, with the iPhone, he pulled off the reverse, turning an established consumer product into a computer. How best to understand such a life? Jobs's answer was to invite high-flying writer and former media executive Walter Isaacson to pen his biography — a superb account published within days of Jobs's death. Steve Jobs (Simon and Schuster, 2011) is likely to remain the closest we will ever get to a definitive account. The film version of Isaacson's blockbuster is a highly competent creation — as you would expect from writer Aaron Sorkin (The Social Network, The West Wing) and director Danny Boyle (Slumdog Millionaire, Trainspotting). The dialogue zips along at 100 beats per minute; the acting (especially by Michael Fassbender in the title role) is at times outstanding; and the direction is as slick as that of any other Hollywood offering. Yet many people will watch this film to better understand its subject — and by that measure, it falls short. The plot hinges on Jobs's relationship with his daughter, Lisa Brennan-Jobs, and plays on the contrast between his lavishing of obsessive attention on his latest electronic brainchild and his ignoring, or disowning, of his flesh and blood. It does this by going backstage at three seminal product launches: those of the Macintosh in 1984, the NeXT Computer in 1988 and the iMac in 1998. This convenient three-act structure, which catches Jobs at three key moments in his life, also serves as a metaphor for the contrast between his suave public persona and his chaotic life. This leaves a lot out. And therein lies the main weakness of this film: there are umpteen other contradictions to explore in Jobs. He was simultaneously a hippy and a control freak. He was an ascetic drawn to mysticism who built the world's preeminent consumer-products company. He was egocentric and impossible, inspiring both incredible feats of engineering (starting with the design of the Apple II by co-founder Steve Wozniak) and deep affection (despite frequently taking credit for the work of Wozniak and others). Of course, covering all this ground in a two-hour film would be difficult. But the setting means that Jobs's close colleagues, relatives and key antagonists must all be at the launches with him, wanting to discuss their gripes in the same few minutes before he is due to step on stage. (In one amusing 'meta' moment, Fassbender actually notes precisely this.) This frequently stretches credibility too far. The first two-thirds of the film thus struggle to engage — and will probably confuse people unfamiliar with the story and the cast of characters. It includes plenty of wonderfully quotable lines and aphorisms from the book, such as Jobs's burning desire to “put a dent in the universe”. But the rat-a-tat-tat form feels more like a collage than a coherent narrative. In short, it could have done with a dose of Jobsian minimalism. That said, the film redeems itself in the third act — rather like Jobs's career. If you want an impressionistic, almost dreamlike montage of key moments in Jobs's life, see Steve Jobs. If you want to understand Jobs the man, you will be disappointed. But see the film anyway: it makes a great trailer for the book.