Encouraging communication with deaf children through visual art activities

An educational product has been developed based on a review of the literature in the field of art therapy with a focus on how art therapy may affect the communication of deaf children. A literature review has indicated that art therapy, when conducted with hearing and deaf children, has facilitated expression and communication. This has occurred through transference of feelings from the right, visualspatial and creative hemisphere of the brain to the left hemisphere, which includes conceptual and intellectual thinking as well as the \u27language function.\u27 Based on these findings, it is projected that art therapy may alleviate some of the common communication problems that exist among deaf children, especially those who have not acquired a full language. It is also projected that it may have expressive benefits when used outside of formal therapy situations such as in an art classroom. This product discusses previous case studies and the outcome of art therapy primarily with hearing children. It then suggests adaptations that may be made for using these different therapies with deaf children. It also makes recommendations on how individuals who are not art therapists may begin using art therapy exercises

An Assessment of H1N1 Influenza-Associated Acute Respiratory Distress Syndrome Severity after Adjustment for Treatment Characteristics

Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from “direct injury” within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of “rescue” therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation

Pathogenesis and clinical features of chronic pulmonary aspergillosis ? Is it possible to distinguish CNPA and CCPA clinically?

Background: The pathogenesis of chronic pulmonary aspergillosis (CPA) including chronic necrotizing pulmonary aspergillosis (CNPA), chronic cavitary pulmonary aspergillosis (CCPA), and simple aspergilloma (SA) has been poorly investigated. We examined all types of CPA cases with histopathological evidence to clarify the differences in pathogenesis and clinical features. Method: We searched for cases diagnosed as pulmonary aspergillosis by histopathological examination in Nagasaki University Hospital between 1964 and September 2010. All available clinical information including radiological findings were collected and analyzed. Result: We found 7, 5, 8, and 7 cases of proven CNPA, probable CNPA, CCPA, and SA, respectively. The radiograph of proven and probable CNPA was initially infiltrates or nodules that progress to form cavities with or without aspergilloma, whereas the radiograph of CCPA showed pre-existed cavities and pericavitary infiltrates with or without aspergilloma. The patients with proven and probable CNPA exhibited not only respiratory symptoms but also systemic symptoms and malnutrition. Aspergillus fumigatus was the most frequently isolated Aspergillus species (n = 14), however, Aspergillus niger was the predominant isolated species in proven CNPA cases (n = 4). Conclusion: Our data indicate that the cases with chronic infiltration, progressive cavitation, and subsequent aspergilloma formation should be diagnosed as CNPA, and the cases with pre-existed cavities showing peri-cavitary infiltrates with or without aspergilloma would mean CCPA. However, it may be difficult to distinguish the two subtypes if a series of adequate radiography films are not available. We propose the term "chronic progressive pulmonary aspergillosis (CPPA)" for the clinical syndrome including both CNPA and CCPA

Electroventilation

Electroventilation is a new term used to describe the production of artificial respiration by electrical stimulation of the inspiratory nerves and muscles using transthoracic electrodes. Electroventilation causes artificial respiration by negative pressure, and therefore, may not have the deleterious effects on blood pressure that occurs when using positive pressure ventilators. Experiments were performed on dogs, baboons, and man, to determine the efficacy of electroventilation. The optimal location for electrode placement was determined, and found to be similar in each of the species. Two stimulation sites were located; one in the anterior axillary region and the other just lateral to the xiphoid process. These sites remained relatively constant among animals. The relationship between stimulating current and inspired volume was also determined. In all cases, an increase in stimulating current resulted in an increased inspired volume. Passing current across the thorax raises the question of the safety of electroventilation. It is important to note that we are able to monitor blood pressure and the ECG continuously, and no cardiac arrhythmias have ever been detected during electroventilation. The safety factor (i.e., the ratio of the current required to produce an ectopic beat to the current required to produce an inspired volume of 225 ml which is approximately twice tidal volume) was determined in 12 dogs using transthoracic electrodes positioned at the optimal electroventilation site. The relationship between inspired volume and stimulus intensity was determined using a 0.8 second burst of stimuli (60/sec) with a pulse duration of 0.1 msec. Using the same electrodes, the threshold current for producing ectopic beats was determined for single pulses ranging from 0.1-10 msec duration. In all dogs, the current required to produce an ectopic beat increased greatly as the pulse duration decreased. At 0.1 msec, the safety factor for electroventilation was calculated to be 25.8. The chronaxie value, which describes the excitability characteristic of a tissue was determined for motor-nerve in the baboon and the dog, and also for ventricular myocardium in the dog. The chronaxie for motor-nerve in the dog was calculated to 0.17 msec, and 0.18 msec in the baboon. The chronaxie for myocardium was calculated to be 1.82 msec. These results indicate that to optimize stimulation of the inspiratory motor nerves, and to minimize the risk of myocardial stimulation, a very short-duration stimulating pulse should be used

Adjusted lung injury score by influenza status.

<p>Analyses adjusted for significant covariates (change of risk factor coefficient by ±15%) which included BMI, statin use and daily tidal volume used in addition to age and SOFA score.</p