Normobaric hyperoxia--induced improvement in cerebral metabolism and reduction in intracranial pressure in patients with severe head injury: a prospective historical cohort-matched study

OBJECT: The effect of normobaric hyperoxia (fraction of inspired O2 [FIO2] concentration 100%) in the treatment of patients with traumatic brain injury (TBI) remains controversial. The aim of this study was to investigate the effects of normobaric hyperoxia on five cerebral metabolic indices, which have putative prognostic significance following TBI in humans. METHODS: At two independent neurointensive care units, the authors performed a prospective study of 52 patients with severe TBI who were treated for 24 hours with 100% FIO2, starting within 6 hours of admission. Data for these patients were compared with data for a cohort of 112 patients who were treated in the past; patients in the historical control group matched the patients in our study according to their Glasgow Coma Scale scores after resuscitation and their intracranial pressure within the first 8 hours after admission. Patients were monitored with the aid of intracerebral microdialysis and tissue O2 probes. Normobaric hyperoxia treatment resulted in a significant improvement in biochemical markers in the brain compared with the baseline measures for patients treated in our study (patients acting as their own controls) and also compared with findings from the historical control group. In the dialysate the glucose levels increased (369.02 +/- 20.1 micromol/L in the control group and 466.9 +/- 20.39 micromol/L in the 100% O2 group, p = 0.001), whereas the glutamate and lactate levels significantly decreased (p < 0.005). There were also reductions in the lactate/glucose and lactate/pyruvate ratios. Intracranial pressure in the treatment group was reduced significantly both during and after hyperoxia treatment compared with the control groups (15.03 +/- 0.8 mm Hg in the control group and 12.13 +/- 0.75 mm Hg in the 100% O2 group, p < 0.005) with no changes in cerebral perfusion pressure. Outcomes of the patients in the treatment group improved. CONCLUSIONS: The results of the study support the hypothesis that normobaric hyperoxia in patients with severe TBI improves the indices of brain oxidative metabolism. Based on these data further mechanistic studies and a prospective randomized controlled trial are warranted.

Keweenaw National Historical Park: Heritage Partnerships in an Industrial Landscape

This dissertation examines the genesis and development of Keweenaw National Historical Park in Michigan's Upper Peninsula. After the decline of a once-thriving copper mining industry, local residents pursued the creation of a national park as a way to encourage economic development, revitalize their community, and preserve their historic resources. Although they were ultimately successful in creating a national park, the park that was established was not the park that they envisioned. Over the next twenty years, the National Park Service, the park's federal Advisory Commission, and the communities on the Keweenaw Peninsula struggled to align unrealistic expectations with the actual capabilities and limitations of the park. The first chapter of this dissertation includes a short history of the decline of the copper industry in and around the village of Calumet, Michigan. This chapter also includes a discussion about the techniques and challenges of preserving and interpreting industrial heritage. Chapters 2 and 3 cover the events from the initial park proposal, to the expansion of the original idea, to the establishment of the park. Chapter 4 includes an examination of the enabling legislation and a discussion about the opportunities and challenges it provided. Chapters 5 through 8 cover the tenure of each of the four NPS superintendents as they navigated the complexities presented by a park model that was part partnership park and part traditional national park. Chapter 9 includes some key lessons, an assessment of the park's success, and some considerations for the future. In particular, Chapter 9 argues for an increased focus on the partnership aspects of the park, a reduction in the perceived scope of responsibilities, and a renewed effort to rally the existing partners in pursuing additional philanthropic support for the overall park.

How scientific is the science in ethnopharmacology? Historical perspectives and epistemological problems

This commentary is based on a general concern regarding the low level of self-criticism (-evaluation) in the interpretation of molecular pharmacological data published in ethnopharmacology-related journals. Reports on potentially new lead structures or pharmacological effects of medicinal plant extracts are mushrooming. At the same time, nonsense in bioassays is an increasing phenomenon in herbal medicine research. Only because a dataset is reproducible does not imply that it is meaningful. Currently, there are thousands of claims of pharmacological effects of medicinal plants and natural products. It is argued that claims to knowledge in ethnopharmacology, as in the exact sciences, should be rationally criticized if they have empirical content as it is the case with biochemical and pharmacological analyses. Here the major problem is the misemployment of the concentration-effect paradigm and the overinterpretation of data obtained in vitro. Given the almost exponential increase of scientific papers published it may be the moment to adapt to a falsificationist methodology.