Modern management of head injuries

Management of the head-injured patient is designed to prevent secondary injury and to provide the neurosurgeon with a live patient who has some hope of recovery. This review sets out the background essentials for the non-neurosurgeon dealing with the initial care of a head-injured patient.

From a ‘borderless world’ to a ‘world of borders’: ‘bringing history back in’

The first part of the paper explores some of the reasons why contemporary border studies understate the full significance of state borders and their global primacy. It is argued that this failing is rooted in a much wider lack of historical reflexivity-a reluctance to acknowledge the historical positioning (the 'where and when') of contemporary border studies themselves. This reluctance encourages a form of pseudohistory, or 'epochal thinking', which disfigures perspective on the present. Among the consequences are (a) exaggerated claims of the novelty of contemporary border change, propped up by poorly substantiated benchmarks in the past; (b) an incapacity to recognise the 'past in the present' as in the various historical deposits of state formation processes; and (c) a failure to recognise the distinctiveness of contemporary state borders and how they differ from other borders in their complexity and globality. The second part of the paper argues for a recalibration of border studies aimed at balancing their spatial emphases with a much greater, and more critical, historical sensitivity. It insists that 'boundedness', and state boundedness in particular, is a variable that must be understood historically. This is illustrated by arguing that a better analysis of contemporary border change means rethinking the crude periodisation which distinguishes the age of empire from the age of nation-states and, in turn, from some putative contemporary era 'beyond nation-states' and their borders.

Respiratory syncytial virus (RSV) vaccines - Two steps back for one leap forward

Respiratory viruses are among the most important causes of morbidity and mortality worldwide. From a vaccine viewpoint, such viruses may be divided into two principle groups-those where infection results in long-term immunity and whose continued survival requires constant mutation, and those where infection induces incomplete immunity and repeated infections are common, even with little or no mutation. Influenza virus and respiratory syncytial virus (RSV) typify the former and latter groups, respectively. Importantly, successful vaccines have been developed against influenza virus. However, this is not the case for RSV, despite many decades of research and several vaccine approaches. Similar to natural infection, the principle limitation of candidate RSV vaccines in humans is limited immunogenicity, characterised in part by short-term RSV-specific adaptive immunity. The specific reasons why natural RSV infection is insufficiently immunogenic in humans are unknown but circumvention of innate and adaptive immune responses are likely causes. Fundamental questions concerning RSV/host interactions remain to be addressed at both the innate and adaptive immune levels in humans in order to elucidate mechanisms of immune response circumvention. Taking the necessary steps back to generate such knowledge will provide the means to leap forward in our quest for a successful RSV vaccine. Recent developments relating to some of these questions are discussed. (C) 2007 Elsevier B.V. All rights reserved.