A feminist opening of resilience: Elizabeth Grosz, Liberian Peace Huts and IR critiques.

While the United Nations (UN) and other international organisations have celebrated the 20th anniversary of the Women, Peace and Security agenda, critical scholars claim that the agenda has rarely been able to foster resilience. They show how programmes have only slowly and partially achieved gender balancing and parity in war-affected countries. The limitation we identify in the debate between policy and critique is that resilience has often been reduced to an egalitarian project-where mechanical policies and schemes are deployed to ameliorate the conditions of women, enhance their participation in decision-making and pursue the equality between women and men-to advance in sustaining peace. In this article we complement the existing critiques by engaging with the feminist writings of Elizabeth Grosz, as well as with indigenous feminist practices in Liberia. We nurture a feminism that affirms the agency and inventiveness of women to begin to reimagine resilience as difference: a resilience that thrives outside governance structures and the confines of neoliberal policymaking. Supplementary Information: The online version contains supplementary material available at 10.1057/s41268-022-00264-0.

Perennial alley cropping contributes to decrease soil CO2 and N2O emissions and increase soil carbon sequestration in a Mediterranean almond orchard.

The implementation of alley cropping in orchards can be a sustainable strategy to increase farm productivity by crop diversification and contribute to climate change mitigation. In this research, we evaluated the short-term effect of alley cropping with reduced tillage on soil CO2 and N2O emissions and soil total organic carbon (TOC) in an almond orchard under Mediterranean rainfed conditions. We compared an almond monoculture with tillage in all plot surface (MC) with almond crop with reduced tillage and growth of Capparis spinosa (D1) and almond crop with reduced tillage and growth of Thymus hyemalis (D2). For two years, soil CO2 and N2O were measured, with soil sampling at the start and end of the experimental period. Results showed that CO2 emission rates followed the soil temperature pattern, while N2O emissions were not correlated with temperature nor moisture. Soil CO2 emissions were significantly higher in MC (87 mg m-2 h-1), with no significant differences between D1 and D2 (69 mg m-2 h-1). Some peaks in CO2 effluxes were observed after tillage operations during warm days. Soil N2O emission rates were not significantly different among treatments. Cumulative CO2 and CO2 equivalent (CO2e) emissions were significantly highest in MC. When CO2e emissions were expressed on a crop production basis, D2 showed the significantly lowest values (5080 g kg-1) compared to D1 (50,419 g kg-1) and MC (87,836 g kg-1), owing to the high thyme yield, additional to the almond yield. No production was obtained for C. spinosa, since at least two more years are required. TOC did not change with time in MC neither D1, but it significantly increased in D2 from 3.85 g kg-1 in 2019 to 4.62 g kg-1 in 2021. Thus, alley cropping can contribute to increase the agroecosystem productivity and reduce CO2 emissions. However, it is necessary to grow evergreen alley crops such as thyme to obtain short-term increases in soil organic matter. Thus, to estimate increases in TOC with alley cropping, the plantation density and the period required by the crop to cover most of the surface are essential factors at planning the cropping strategy.

High-Sensitivity Troponin T: A Potential Safety Predictive Biomarker for Discharge from the Emergency Department of Patients with Confirmed Influenza.

The purpose of the study was to analyze the relationship between the high-sensitivity troponin T levels in patients with confirmed influenza virus infection and its severity determined by mortality during the care process. In addition, a high-sensitivity troponin T cut-off value was sought to allow us to a safe discharge from the emergency department. An analytical retrospective observational study was designed in which high-sensitivity troponin T is determined as an exposure factor, patients are followed until the resolution of the clinical picture, and the frequency of mortality is analyzed. We included patients ≥ 16 years old with confirmed influenza virus infection and determination of high-sensitivity troponin T. One hundred twenty-eight patients were included (96.9% survivors, 3.1% deceased). Mean and median blood levels of high-sensitivity troponin T of survivors were 26.2 ± 58.3 ng/L and 14.5 ng/L (IQR 16 ng/L), respectively, and were statistically different when compared with those of the deceased patients, 120.5 ± 170.1 ng/L and 40.5 ng/L (IQR 266.5 ng/L), respectively, p = 0.012. The Youden index using mortality as the reference method was 0.76, and the cut-off value associated with this index was 24 ng/L (sensitivity 100%, specificity 76%, NPV 100%, PPV 4%) with AUC of 88,8% (95% CI: 79.8−92.2%), p < 0.001. We conclude that high-sensitivity troponin T levels in confirmed virus influenza infection are a good predictor of mortality in our population, and this predictor is useful for safely discharging patients from the emergency department.

Evaluation of an educational intervention (edworkcases) involving clinical cases and Nursing students: a cross-sectional observational study.

OBJECTIVE: to evaluate the impact of the (edworkcases) educational intervention on students' evaluation outcomes in their clinical practices, their attitudes towards Nursing diagnoses, and their satisfaction. METHOD: this study used a cross-sectional observational design. The participants were 69 third-year Nursing students from a public university in Madrid, Spain. The data analysed in the study were the grades obtained by students for their clinical practices, as well as pre-post intervention scores on the Positions on Nursing Diagnosis Scale and a satisfaction survey. A means comparison by participation in the project (yes/no) was carried out using Student's t-test. A means comparison by professor was conducted using Kruskal-Wallis tests. RESULTS: participation rate: 72.4%; 92% of the participants were women; median age = 21 years old. Statistically significant differences were found between participants and non-participants in terms of mean score in the Overall Evaluation and in the Case Study Evaluation, with higher scores found among the group of participants. The mean score for attitudes towards Nursing diagnoses was 99.9 (SD=2.8) before the intervention and 111.1 (SD=2.9) after the intervention [95% CI: 3.3-19.2]. CONCLUSION: the use of (edworkcases) as part of the practical training was considered satisfactory, enabling theory and practice to be combined and improving students' attitudes towards Nursing diagnoses.

Evaluation of an educational intervention (edworkcases) involving clinical cases and Nursing students: a cross-sectional observational study / Avaliação de uma intervenção educacional (edworkcases) envolvendo casos clínicos e estudantes de Enfermagem: um estudo observacional transversal / Evaluación de una intervención educativa (edworkcases) que involucra casos clínicos y estudiantes de Enfermería: estudio transversal y observacional

Abstract Objective: to evaluate the impact of the (edworkcases) educational intervention on students' evaluation outcomes in their clinical practices, their attitudes towards Nursing diagnoses, and their satisfaction. Method: this study used a cross-sectional observational design. The participants were 69 third-year Nursing students from a public university in Madrid, Spain. The data analysed in the study were the grades obtained by students for their clinical practices, as well as pre-post intervention scores on the Positions on Nursing Diagnosis Scale and a satisfaction survey. A means comparison by participation in the project (yes/no) was carried out using Student's t-test. A means comparison by professor was conducted using Kruskal-Wallis tests. Results: participation rate: 72.4%; 92% of the participants were women; median age = 21 years old. Statistically significant differences were found between participants and non-participants in terms of mean score in the Overall Evaluation and in the Case Study Evaluation, with higher scores found among the group of participants. The mean score for attitudes towards Nursing diagnoses was 99.9 (SD=2.8) before the intervention and 111.1 (SD=2.9) after the intervention [95% CI: 3.3-19.2]. Conclusion: the use of (edworkcases) as part of the practical training was considered satisfactory, enabling theory and practice to be combined and improving students' attitudes towards Nursing diagnoses.

Resumo Objetivo: avaliar o impacto da intervenção educacional (edworkcases) nos resultados da avaliação dos alunos em suas práticas clínicas, suas atitudes em relação aos diagnósticos de Enfermagem e sua satisfação. Método: estudo observacional transversal, realizado com 69 estudantes do terceiro ano de Enfermagem de uma universidade pública de Madri, Espanha. Os dados analisados foram obtidos das notas dos alunos em suas práticas clínicas, bem como, os escores pré- e pós-intervenção na Escala de Posições frente ao Diagnóstico de Enfermagem e uma pesquisa de satisfação. A comparação de médias por participação no projeto (sim/não) foi realizada por meio do teste t de Student. A comparação de médias por professor foi realizada por meio de testes de Kruskal-Wallis. Resultados: taxa de participação: 72,4%; 92% dos participantes eram mulheres; mediana de idade de 21 anos. Foram encontradas diferenças estatisticamente significativas entre participantes e não participantes em termos de pontuação média na Avaliação Geral e na Avaliação do Estudo de Caso, com maiores pontuações encontradas entre o grupo de participantes. A pontuação média das atitudes em relação aos diagnósticos de Enfermagem foi de 99,9 (DP=2,8) antes da intervenção e 111,1 (DP=2,9) após a intervenção [IC 95%: 3,3-19,2]. Conclusão: a utilização de edworkcases como parte do treinamento prático foi considerada satisfatória, permitindo a articulação teoria e prática e melhorando as atitudes dos alunos em relação aos diagnósticos de Enfermagem.

Resumen Objetivo: evaluar el efecto de la intervención educativa (edworkcases) sobre los resultados de la evaluación de los estudiantes en sus prácticas clínicas, sus actitudes hacia los diagnósticos de Enfermería y su nivel de satisfacción. Método: en este estudio se empleó un diseño transversal y observacional. Los participantes fueron 68 estudiantes de tercer año de la carrera de Enfermería de una universidad pública de Madrid, España. Los datos que se analizaron en el estudio fueron las calificaciones obtenidas por los estudiantes en sus prácticas clínicas, al igual que las puntuaciones antes y después de la intervención en la Escala de Posicionamiento ante el Diagnóstico de Enfermería y en una encuesta de satisfacción. Se utilizó la prueba t de Student para realizar una comparación de valores medios por participación en el proyecto (sí/no). La comparación de valores medios por profesor se llevó a cabo por medio de pruebas Kruskal-Wallis. Resultados: índice de participación: 72,4%; el 92% de los participantes eran mujeres, con una mediana de edad de 21 años. Se encontraron diferencias estadísticamente significativas entre participantes y no participantes en cuanto a la puntuación media en la Evaluación General y en la Evaluación de Estudios de Caso, con puntuaciones más elevadas en el grupo de participantes. Las puntuaciones medias correspondientes a las actitudes con respecto a los diagnósticos de Enfermería fueron 99,9 (SD=2,8) y 111.1 (SD=2.9) antes y después de la intervención, respectivamente [IC 95%: 3,3-19,2]. Conclusión: se consideró satisfactorio utilizar edworkcases como parte te la capacitación práctica, lo que permitió combinar teoría y práctica y mejorar las actitudes de los estudiantes con respecto a los diagnósticos de Enfermería.

Evaluation of Self-Concept in the Project for People with Intellectual Disabilities: "We Are All Campus".

The inclusion of people with disabilities, intellectual in the case that concerns this research, has been one of the main concerns of society in recent years. The University of Murcia has launched the "We are all Campus" program in order to facilitate the inclusion of this group from a training perspective. Being aware of the influence of self-concept in such inclusion, this research aims to analyze the influence of the self-concept of people with intellectual disabilities in their expectations of inclusion. For this purpose, 18 subjects were asked to carry out a SWOT analysis, assessing the situation in which they find themselves through a qualitative perspective and a phenomenological design. The research reveals, among other conclusions, how important personal development is to them, especially by generating autonomy in their daily routines, and also the relevance of their relationships to feel socially included.

Estimating soil organic carbon changes in managed temperate moist grasslands with RothC.

Temperate grassland soils store significant amounts of carbon (C). Estimating how much livestock grazing and manuring can influence grassland soil organic carbon (SOC) is key to improve greenhouse gas grassland budgets. The Rothamsted Carbon (RothC) model, although originally developed and parameterized to model the turnover of organic C in arable topsoil, has been widely used, with varied success, to estimate SOC changes in grassland under different climates, soils, and management conditions. In this paper, we hypothesise that RothC-based SOC predictions in managed grasslands under temperate moist climatic conditions can be improved by incorporating small modifications to the model based on existing field data from diverse experimental locations in Europe. For this, we described and evaluated changes at the level of: (1) the soil water function of RothC, (2) entry pools accounting for the degradability of the exogenous organic matter (EOM) applied (e.g., ruminant excreta), (3) the month-on-month change in the quality of C inputs coming from plant residues (i.e above-, below-ground plant residue and rhizodeposits), and (4) the livestock trampling effect (i.e., poaching damage) as a common problem in areas with higher annual precipitation. In order to evaluate the potential utility of these changes, we performed a simple sensitivity analysis and tested the model predictions against averaged data from four grassland experiments in Europe. Our evaluation showed that the default model's performance was 78% and whereas some of the modifications seemed to improve RothC SOC predictions (model performance of 95% and 86% for soil water function and plant residues, respectively), others did not lead to any/or almost any improvement (model performance of 80 and 46% for the change in the C input quality and livestock trampling, respectively). We concluded that, whereas adding more complexity to the RothC model by adding the livestock trampling would actually not improve the model, adding the modified soil water function and plant residue components, and at a lesser extent residues quality, could improve predictability of the RothC in managed grasslands under temperate moist climatic conditions.

La Voz del Silencio: Evaluación Cualitativa de Prácticas de Bullying en Personas con Discapacidad Intelectual / The Voice of Silence: Qualitative Evaluation of Bullying Practices in People with Intellectual Disability

RESUMEN: En los múltiples movimientos académicos acaecidos en pos de la inclusión del alumnado, las instituciones universitarias están abriendo sus títulos a colectivos tradicionalmente olvidados en el ámbito de la educación superior, como las personas con discapacidad intelectual. El acoso escolar es una realidad que puede afectar a todo el alumnado, siendo más complejo conforme avanza la edad de los estudiantes. El objetivo de este trabajo radica en recabar información acerca de la percepción de las personas con discapacidad intelectual sobre el bullying y reconocer las diferentes manifestaciones de acoso a personas con discapacidad intelectual. A través de una investigación biográfico-narrativa y bajo un diseño evaluativo de carácter mixto, se ha contado con la participación de 17 estudiantes que cursan el Título Universitario de Estudios Propios Todos Somos Campus para fomentar la inserción socio-laboral del colectivo de jóvenes con discapacidad intelectual. A través de un análisis cualitativo de los datos, los resultados muestran que existe una situación de acoso, tanto físico como psicológico, basada en críticas y percepciones negativas acerca de la discapacidad, lo cual les hace más sensibles a la condición de diferentes. Igualmente, se refuerza la imagen de autoridad como eje de las acciones contra el bullying, destacando el papel de la mediación en la exposición de soluciones. Se concluye que las relaciones establecidas entre las manifestaciones del acoso en el ámbito académico y sus posibles soluciones no se presentan de forma aislada, sino que se muestran como una red que facilita respuesta a dicha problemática.

ABSTRACT: In the multiple academic movements for the inclusion of students, university institutions are opening their undergraduate degrees to groups traditionally forgotten in the field of Higher Education, such as people with intellectual disabilities. Bullying is a reality that can affect all students, being more complex as the age of the students advances. The objective of this work is to gather information about the perception of people with intellectual disabilities about bullying and, thus, recognize the different manifestations of harassment to people with intellectual disabilities. Through a biographical-narrative research and a mixed evaluative design, we counted on the participation of 17 students who are attending the Título Universitario de Estudios Propios Todos Somos Campus - University Degree of Own Studies We are all Campus - to promote the social and labor insertion of the collective of young people with intellectual disabilities. Through a qualitative data analysis, the results showed that there is a situation of harassment, both physical and psychological, based on criticism and negative perceptions about the disability, which make it more sensitive to the status of different. In the same way, it reinforces the image of authority as an anti-bullying action, highlighting the role of mediation in the exposition of solutions. It is concluded that the relations established between the manifestations of bullying in the academic sphere and their possible solutions are not presented in isolation, but they are shown as a network that facilitates the answer to this problem.

Assessment of sustainable land management practices in Mediterranean rural regions.

Sustainable land management practices can be suitable vehicles to simultaneously address the causes and consequences of land degradation, desertification, and climate change in land managed systems. Here, we assess the potential of a variety of sustainable land management practices that, beyond addressing specific and local issues, assist in tackling Mediterranean Basin-wide land-use challenges. With this work, we aim to highlight those options that simultaneously promote local and regional Basin-wide adaptation. To do that, we developed a novel multi-objective assessment that evaluates the effectiveness of 104 practices adopted within the Mediterranean Basin and documented in the World Overview of Conservation Approaches and Technologies global database. Results indicate that agroforestry and green covers in perennial woody crops can promote multiple ecosystem services while addressing climate change adaptation. We further argue that these two practices together with reforestation, assist in regulating the hydrological cycle of the Basin and in maintaining its multifunctional landscape. Lastly, we reflect on potential biophysical and socio-economic barriers and opportunities associated with the implementation of the three practices. Our approach provides a Basin-wide integrated view that facilitates the coordination of sustainable management strategies across the Mediterranean region.

Prácticas educativas en salud: eje fundamental en el desarrollo de la primera infancia en centros de desarrollo integral / Educational practices in health: fundamental axis in the development of early childhood in integral development centers

RESUMEN La primera infancia es considerada un periodo importante del ciclo vital humano, debido a que durante esta etapa se establecen las bases para el adecuado desarrollo integral del individuo, permitiéndole en la edad adulta avances significativos en sus capacidades educativas, emocionales y sociales para su desenvolvimiento en los diferentes escenarios. Las prácticas educativas en salud llevadas a cabo en los Centros de Desarrollo Integral se constituyen en eje fundamental para el desarrollo de la primera infancia, puesto que forman parte de la cotidianidad del cuidado que se brinda en dichos centros durante esta primera etapa de vida. Teniendo en cuenta lo anterior, las personas que tienen a su cargo el cuidado de niños y niñas menores de cinco años en los Centros de Desarrollo Integral deben poseer formación amplia y pertinente sobre temas relacionados con la nutrición y alimentación, higiene personal, crecimiento y desarrollo del infante, estilos de vida saludables y el buen trato; de manera que les permita fomentar ambientes propicios de aprendizaje y, por consiguiente, contribuir al fortalecimiento del crecimiento y desarrollo integral de los niños y niñas.

ABSTRACT Early childhood is considered an important period of the human life cycle, because during this stage the foundations are established for the adequate integral development of the individual, allowing him, in adulthood, significant advances in his educational, emotional and social capacities for his development in different scenarios. Health education practices carried out in Integral Development Centers (CDI) are a fundamental axis for the development of early childhood, since they are part of the daily care provided in these centers during this first stage of life. Taking into account the above, the people who are responsible for the care of children under five years of age in the Integral Development Centers (CDI), must have extensive and relevant training on topics related to nutrition and food, personal hygiene, growth and development of the infant, healthy lifestyles and good treatment; in a way that allows them to foster favorable learning environments and, therefore, contribute to strengthening the growth and integral development of children.

Participatory coastal management through elicitation of ecosystem service preferences and modelling driven by "coastal squeeze".

The Baixo Vouga Lagunar (BVL) is part of Ria de Aveiro coastal lagoon in Portugal, which is classified as a Special Protection Area under the European Habitats and Birds Directives. This part of the system, corresponding to the confluence of the Vouga River with the lagoon, is very important culturally and socioeconomically for the local communities, taking place several human activities, especially agriculture. To prevent salt water intrusion from the Ria de Aveiro into agriculture fields, a floodbank was initiated in the 90's. In frame of ongoing changes in Ria de Aveiro hydrodynamics, the existing floodbank will be now extended, introducing further changes in the ecological dynamics of the BVL and its adjacent area. As a consequence, the water level in the floodbank downstream side is expected to rise, increasing the submersion period in tidal wetlands, and leading to coastal squeeze. The aim of this study is to apply an ecosystem based-management approach to mitigate the impacts on biodiversity resulting from the management plan. To do so, we have modelled the implications of the changes in several hydrological and environmental variables on four saltmarsh species and habitats distribution, as well as on their associated ecosystem services, both upstream and downstream of the floodbank. The ecosystem services of interest were prioritized by stakeholders' elicitation, which were then used as an input to a spatial multi-criteria analysis aimed to find the best management actions to compensate for the unintended loss of biodiversity and ecosystem services in the BVL. According to our results, the main areas to be preserved in the BVL were the traditional agricultural mosaic fields; the freshwater courses and the subtidal estuarine channels. By combining ecology with the analysis of social preferences, this study shows how co-developed solutions can support adaptive management and the conservation of coastal ecosystems.

Intracranial hemorrhage following surgery for occult spinal dysraphism: a case-based update.

BACKGROUND: Intracranial cerebrospinal fluid (CSF) volume depletion causes diverse clinical syndromes most of them constituting the manifestations of decreased intracranial pressure. Subdural collections or chronic subdural hematomas are the best-known consequences of persistent CSF leaks, especially in overshunted hydrocephalus. Continuous CSF escape also occurs after lumbar puncture, spinal anesthesia, and diverse spinal surgeries. CASE DESCRIPTION: A 6-year-old boy submitted to reoperation of spinal cord compression due to partial sacral agenesis complained of postoperative orthostatic headaches and vomiting initially attributed to CSF hypotension. There were neither subcutaneous fluid accumulations nor CSF leakage from the wound. The child was treated with strict bed rest and intravenous hydration for 5 days. On reassuming orthostatism, the patient had syncope but did not hit his head. A cranial computerized tomography scan showed an acute subdural hematoma that was managed conservatively with total recovery. DISCUSSION AND CONCLUSION: A review of current literature showed scanty reports of acute intracranial bleeding occurring after CSF depletion following spinal surgical procedures. To our knowledge, our reported patient represents the second case of this occurrence following surgery for closed spinal dysraphism in a child. The authors briefly review documented instances of acute subdural hematoma following spinal procedures, advise about its diagnosis, and suggest preventive measures.

Coenzyme Q10 protects human endothelial cells from ß-amyloid uptake and oxidative stress-induced injury.

Neuropathological symptoms of Alzheimer's disease appear in advances stages, once neuronal damage arises. Nevertheless, recent studies demonstrate that in early asymptomatic stages, ß-amyloid peptide damages the cerebral microvasculature through mechanisms that involve an increase in reactive oxygen species and calcium, which induces necrosis and apoptosis of endothelial cells, leading to cerebrovascular dysfunction. The goal of our work is to study the potential preventive effect of the lipophilic antioxidant coenzyme Q (CoQ) against ß-amyloid-induced damage on human endothelial cells. We analyzed the protective effect of CoQ against Aß-induced injury in human umbilical vein endothelial cells (HUVECs) using fluorescence and confocal microscopy, biochemical techniques and RMN-based metabolomics. Our results show that CoQ pretreatment of HUVECs delayed Aß incorporation into the plasma membrane and mitochondria. Moreover, CoQ reduced the influx of extracellular Ca(2+), and Ca(2+) release from mitochondria due to opening the mitochondrial transition pore after ß-amyloid administration, in addition to decreasing O2(.-) and H2O2 levels. Pretreatment with CoQ also prevented ß-amyloid-induced HUVECs necrosis and apoptosis, restored their ability to proliferate, migrate and form tube-like structures in vitro, which is mirrored by a restoration of the cell metabolic profile to control levels. CoQ protected endothelial cells from Aß-induced injury at physiological concentrations in human plasma after oral CoQ supplementation and thus could be a promising molecule to protect endothelial cells against amyloid angiopathy.

OTUB1 modulates c-IAP1 stability to regulate signalling pathways.

The cellular inhibitor of apoptosis (c-IAP) proteins are E3 ubiquitin ligases that are critical regulators of tumour necrosis factor (TNF) receptor (TNFR)-mediated signalling. Through their E3 ligase activity c-IAP proteins promote ubiquitination of receptor-interaction protein 1 (RIP1), NF-κB-inducing kinase (NIK) and themselves, and regulate the assembly of TNFR signalling complexes. Consequently, in the absence of c-IAP proteins, TNFR-mediated activation of NF-κB and MAPK pathways and the induction of gene expression are severely reduced. Here, we describe the identification of OTUB1 as a c-IAP-associated deubiquitinating enzyme that regulates c-IAP1 stability. OTUB1 disassembles K48-linked polyubiquitin chains from c-IAP1 in vitro and in vivo within the TWEAK receptor-signalling complex. Downregulation of OTUB1 promotes TWEAK- and IAP antagonist-stimulated caspase activation and cell death, and enhances c-IAP1 degradation. Furthermore, knockdown of OTUB1 reduces TWEAK-induced activation of canonical NF-κB and MAPK signalling pathways and modulates TWEAK-induced gene expression. Finally, suppression of OTUB1 expression in zebrafish destabilizes c-IAP (Birc2) protein levels and disrupts fish vasculature. These results suggest that OTUB1 regulates NF-κB and MAPK signalling pathways and TNF-dependent cell death by modulating c-IAP1 stability.

Severe spinal cord injury in craniocervical dislocation. Case-based update.

BACKGROUND: Craniocervical distraction injuries, including atlanto-axial dislocation (AAD) and atlanto-ocipital dislocation (AOD), are often associated with severe spinal cord involvement with high morbidity and mortality rates. Many patients with these injuries die at the accident scene, but advances in emergency resuscitation and transport permit that many patients arrive alive to hospitals. DISCUSSION: Children with craniocervical distraction injuries usually present with a severe cranioencephalic traumatism that is the most relevant lesion at admission. After resuscitation and hemodynamic stabilization, the spinal cord damage appears as the main lesion. Apnea and quadriparesis, or quadriplegia, are usually present at the onset. Early diagnosis and management perhaps decrease life-threatening manifestations of the spinal lesion. But even so, the primary spinal cord insult is often irreversible and precludes obtaining a satisfactory functional outcome. PATIENTS AND METHODS: We report the findings of four children with craniocervical distraction injuries (AOD and AAD) who presented with severe spinal cord damage. All patients were admitted with respiratory distress or apnea together with significant brain injuries. The medical records pertaining to these patients are summarized in regard to clinical features, management, and outcome. CONCLUSIONS: In spite of timely and aggressive management, craniocervical injuries with spinal cord involvement continue to have a dismal prognosis. Outcome is closely related to the severity of the initial brain and spinal cord damage and is nearly always fatal in cases of complete spinal cord transection. Priority should be given to life-threatening complications. Ethic issues on indications for surgery deserve a detailed discussion with the children's parents.

Pediatric head injuries from earthquakes.

By means of some illustrations, the authors briefly report the effects of some accidental head injuries caused by diverse mechanisms occurring in children. Many of these accidents seem to be preventable, but others are completely unavoidable and escape prevention as the one that is depicted in the cover of this issue.

Pediatric crushing head injury: biomechanics and clinical features of an uncommon type of craniocerebral trauma.

BACKGROUND: Head injuries constitute one of the leading causes of pediatric morbidity and mortality. Most injuries result from accidents involving an acceleration/deceleration mechanism. However, a special type of head injury occurs when the children sustain a traumatism whose main component is a static load in relation to a crushing mechanism with the head relatively immobile. PATIENTS AND METHODS: We report a series of children who sustained a craniocerebral injury of variable severity produced by head crushing. We also analyze epidemiological and clinical data, and biomechanics in these injuries. RESULTS: Mean age of the group (13 boys/6 girls) was 4.1 years. All patients showed external lesions (scalp wounds or hemorrhage from the nose, ears, or throat). Eleven children were initially unconscious. Six children presented cranial nerve deficits in addition to impaired hearing. Skull base fractures were seen in most cases with extension to the vault in 11 instances. Fourteen patients had an associated intracranial lesion, including two with diffuse axonal injury. Surgery was performed in three instances. Only seven patients were left with sequelae. DISCUSSION AND CONCLUSIONS: The observed skull, brain, and cranial nerve lesions corresponded to a mechanism of bilateral compression of the children's heads mainly occasioned by a static load, although an associated component of dynamic forces was also involved. The skull and its covering and the cranial nerves were the most severely affected structures while the brain seemed to be relatively well preserved. Most crush injuries appear to be preventable by the appropriate supervision of the children.

Chiari type 1 anomaly in pseudohypoparathyroidism type Ia: pathogenetic hypothesis.

AIM: This study aims to report a patient with Chiari type 1 malformation (CM1) occurring in the context of pseudohypoparathyroidism type 1a (PHP-Ia) that we believe represents the first instance of this association in the current literature. CASE REPORT: The authors describe the case of a 6-year-old girl diagnosed with PHP-Ia who presented an associated tonsillar descent. During the follow-up, the skull vault and the occipital squama became extremely thickened at the same time as the tonsillar herniation showed a marked regression. DISCUSSION: Chronic tonsillar descent has been reported in diverse genetic and metabolic diseases of bone. A constant finding in PH-Ia consists of changes that mainly involve the bones of the patients' hands and feet. Cerebral anomalies have also been documented in PHP-Ia, especially cerebral calcifications, but in contrast involvement of the skull bones has seldom been described in this condition. The authors briefly discuss the probable role played by the observed skull changes in the origin and subsequent regression of the tonsillar descent in this child. CONCLUSIONS: We suggest that CM1 may develop in patients with PHP-Ia and that it should be actively sought, especially in individuals diagnosed with PHP-Ia presenting with neurological manifestations. Probably, the seeming rarity of chronic tonsillar descent in PHP-Ia is due to the fact that many patients with this condition are rarely investigated with magnetic resonance.

Hydrocephalus and arachnoid cysts.

AIM: The management of arachnoid cysts (AC) remains controversial. An additional problem derives from the management of hydrocephalus associated with an AC. In this work, we discuss existing procedures proposed in the current literature for their treatment. METHODS: We reviewed selected reports on intracranial ACs placing special interest in those about the association of hydrocephalus and ACs. We also briefly surveyed data of our patients with this association. RESULTS AND DISCUSSION: Hydrocephalus is often found in midline and posterior fossa ACs. Interhemispheric lesions may also evolve with ventriculomegaly, while middle fossa lesions rarely produce hydrocephalus. Patients' age, cyst location and size, and macrocephaly have all been related to the development of hydrocephalus. Some authors remark on the role played by hydrocephalus and hypothesize that some ACs would result from disturbed cerebrospinal fluid (CSF) dynamics. They also propose that ACs might represent a localized form of hydrocephalus. We also comment on hydrocephalus in relation to the diverse locations of ACs. Neuroendoscopic techniques have transformed previous ways of management as cystoperitoneal shunting and open fenestration. CONCLUSIONS: ACs may be pathogenetically related with hydrocephalus, and conversely, ACs may cause hydrocephalus. In some patients, aberrant CSF dynamics seems to play a major role in the development of both cyst and hydrocephalus. Hydrocephalus and ACs may be treated exclusively with neuroendoscopic procedures, although some patients will still require CSF shunting. The ideal option seems to consist of choosing the method that offers the highest success with a single procedure for treating the hydrocephalus and the AC simultaneously.