The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy

An interdisciplinary European group of clinical experts in the field of movement disorders and experienced Botulinum toxin users has updated the consensus for the use of Botulinum toxin in the treatment of children with cerebral palsy (CP). A problem-orientated approach was used focussing on both published and practice-based evidence. In part I of the consensus the authors have tabulated the supporting evidence to produce a concise but comprehensive information base, pooling data and experience from 36 institutions in 9 European countries which involves more than 10,000 patients and over 45,000 treatment sessions during a period of more than 280 treatment years. In part II of the consensus the Gross Motor Function Measure (GMFM) and Gross Motor Function Classification System (GMFCS) based Motor Development Curves have been expanded to provide a graphical framework on how to treat the motor disorders in children with CP. This graph is named "CP(Graph) Treatment Modalities - Gross Motor Function" and is intended to facilitate communication between parents, therapists and medical doctors concerning (1) achievable motor function, (2) realistic goal-setting and (3) treatment perspectives for children with CP. The updated European consensus 2009 summarises the current understanding regarding an integrated, multidisciplinary treatment approach using Botulinum toxin for the treatment of children with CP.

Temporary zinc oxide-eugenol cement: eugenol quantity in dentin and bond strength of resin composite

Uptake of eugenol from eugenol-containing temporary materials may reduce the adhesion of subsequent resin-based restorations. This study investigated the effect of duration of exposure to zinc oxide–eugenol (ZOE) cement on the quantity of eugenol retained in dentin and on the microtensile bond strength (μTBS) of the resin composite. The ZOE cement (IRM Caps) was applied onto the dentin of human molars (21 per group) for 1, 7, or 28 d. One half of each molar was used to determine the quantity of eugenol (by spectrofluorimetry) and the other half was used for μTBS testing. The ZOE-exposed dentin was treated with either OptiBond FL using phosphoric acid (H3PO4) or with Gluma Classic using ethylenediaminetetraacetic acid (EDTA) conditioning. One group without conditioning (for eugenol quantity) and two groups not exposed to ZOE (for eugenol quantity and μTBS testing) served as controls. The quantity of eugenol ranged between 0.33 and 2.9 nmol mg−1 of dentin (median values). No effect of the duration of exposure to ZOE was found. Conditioning with H3PO4 or EDTA significantly reduced the quantity of eugenol in dentin. Nevertheless, for OptiBond FL, exposure to ZOE significantly decreased the μTBS, regardless of the duration of exposure. For Gluma Classic, the μTBS decreased after exposure to ZOE for 7 and 28 d. OptiBond FL yielded a significantly higher μTBS than did Gluma Classic. Thus, ZOE should be avoided in cavities later to be restored with resin-based materials.

Combining charcoal sediment and molecular markers to infer a Holocene fire history in the Maya Lowlands of Petén, Guatemala

Vegetation changes in the Maya Lowlands during the Holocene are a result of changing climate conditions, solely anthropogenic activities, or interactions of both factors. As a consequence, it is difficult to assess how tropical ecosystems will cope with projected changes in precipitation and land-use intensification over the next decades. We investigated the role offire during the Holocene by combining macroscopic charcoal and the molecular fire proxies levoglucosan, mannosan and galactosan. Combining these two different fire proxies allows a more robust understanding of the complex history of fire re- gimes at different spatial scales during the Holocene. In order to infer changes in past biomass burning, we analysed a lake sediment core from Lake Peten Itza, Guatemala, and compared our results with millennial-scale vegetation and climate change available in the area. We detected three periods of high fire activity during the Holocene: 9500 e 6000 cal yr BP, 3700 cal yr BP and 2700 cal yr BP. We attribute the first maximum mostly to climate conditions and the last maximum to human activities. The rapid change between burned vegetation types at the 3700 cal yr BP fire maximum may result from human activity.

The Almost Person: Myth, Narrative and The Doctor

Paul Ricœur describes selfhood as the product of a communal narrative. Communal narratives structured as symbolic myths provide a narrative identity and an ethic of selfhood. The psychologist Jerome Bruner, for instance, places the source of such a narrative identity in the family, where ‘canonical stories’ are formed. ‘Home’ becomes a mode of discourse, a way of recognizing ourselves in the narratives given to us by others. This paper will draw on these concepts of narrative identity in order to investigate the problems to selfhood which face the character of The Doctor in the BBC series Doctor Who. I will identify The Doctor as a character who acts within a self-constructed narrative vacuum, reading the character by contrasting two types of personal myth-making, one ‘real’, as in a lived narrative, and one ‘counterfeit’; a conjured myth to replace and obscure the lived self. The paper will pay particular attention to the twenty-first century reincarnations of Doctor Who. I will argue that the writing of Russell T. Davis and later Steven Moffat in particular directly address this tension of myth and selfhood, as The Doctor struggles between his self-imposed role as a modern Prometheus and the insistent haunting and return of his own story. In these incarnations, his companions become mirrors to The Doctor, bringing with them their own narrative and ethical identities. In turn, it is through his companions that The Doctor is able to build his own lived narrative of sorts, which challenges his self-created ‘mythology’. In contrast to the weeping angels, whose horrific agency manifests only when not apprehended, the Doctor’s story continues to become more real the more he is ‘perceived’, both by the human race and by the viewer.

Prometheus on Mars: Nineteenth-Century Science Fiction and the Language of Romanticism

The development of astrophysics in the nineteenth century drew mankind closer to the planets. For the first time, it was possible to give serious scientific consideration to the possibilities for life on other planets. The greatest leap, however, was in recognizing what was not known, and acknowledging the limits of human intuition. ‘Ideas,’ wrote Agnes M. Clerke, ‘have all at once become plastic’. As the scientific community tested the limits of scientific understanding, it became the role of science-fiction writers to imagine the universe beyond these limits. This paper will examine the ways in which nineteenth-century science fiction used the inheritance of the poetic language of Romanticism to reinstate the centrality of human being in the universe. I will explore the ways in which writers such as Edward Bulwer-Lytton (The Coming Race, 1871) and W. S. Lach-Szyrma (Aleriel, 1883) extended the Byronic hero to envisage extra-terrestrial utopias. The Hegelian systematic mythology described by Byron and Shelley had reimagined paradise and redemption on earth. Through science fiction, this mythology extended out towards the stars. A discourse on the possibilities of extra-terrestrial life became a Romantic discourse on the possibilities of being. The Byronic hero could now find a home not by escaping the shackles of religion, but as an angelic citizen of Venus or Mars. In this way, the paper will explore how science-fiction writers appropriated the language of Romantic poetry to build a bridge between the framework of scientific knowledge and the extent of human imagination.

Vegetation and fire history of coastal north-eastern Sardinia (Italy) under changing Holocene climates and land use

Little is known about the vegetation and fire history of Sardinia, and especially the long-term history of the thermo-Mediterranean belt that encompasses its entire coastal lowlands. A new sedimentary record from a coastal lake based on pollen, spores, macrofossils and microscopic charcoal analysis is used to reconstruct the vegetation and fire history in north-eastern Sardinia. During the mid-Holocene (c. 8,100–5,300 cal bp), the vegetation around Stagno di Sa Curcurica was characterised by dense Erica scoparia and E. arborea stands, which were favoured by high fire activity. Fire incidence declined and evergreen broadleaved forests of Quercus ilex expanded at the beginning of the late Holocene. We relate the observed vegetation and fire dynamics to climatic change, specifically moister and cooler summers and drier and milder winters after 5,300 cal bp. Agricultural activities occurred since the Neolithic and intensified after c. 7,000 cal bp. Around 2,750 cal bp, a further decline of fire incidence and Erica communities occurred, while Quercus ilex expanded and open-land communities became more abundant. This vegetation shift coincided with the historically documented beginning of Phoenician period, which was followed by Punic and Roman civilizations in Sardinia. The vegetational change at around 2,750 cal bp was possibly advantaged by a further shift to moister and cooler summers and drier and milder winters. Triggers for climate changes at 5,300 and 2,750 cal bp may have been gradual, orbitally-induced changes in summer and winter insolation, as well as centennial-scale atmospheric reorganizations. Open evergreen broadleaved forests persisted until the twentieth century, when they were partly substituted by widespread artificial pine plantations. Our results imply that highly flammable Erica vegetation, as reconstructed for the mid-Holocene, could re-emerge as a dominant vegetation type due to increasing drought and fire, as anticipated under global change conditions.