Does Language Determine Our World’s Borders? The Deaf Beyond the Pale

Does Language Determine Our World’s Borders? The Deaf Beyond the PaleThe limits of our language are the limits of our worldLudwig Wittgenstein“If not in words, how did she organize her thoughts?,” asks contemporary American writer André Aciman thinking of his deaf mother. In other words, how did she organize her world – one could ask, since even if not consciously, it is often assumed that “the limits of our language are the limits of our world.” Taking Ludwig Wittgenstein’s well-known dictum as a starting point, I would like to present an interdisciplinary approach to the subject, set on the border of comparative literature, linguistics, and medicine. In my paper, using the works of Plato (Cratylus), Denis Diderot (Paradox of Acting), Étienne Bonnot de Condillac (Philosophical Writings of Etienne Bonnot Abbé de Condillac), Oliver Sacks (Seeing Voices: A Journey into the World of the Deaf), and others, I focus on how people perceive the borders (limits) of our world through the prism of language. Is language just a prosthesis, a grafted limb one can live without? Do hands speak more intimately than words? Or maybe deafness is more of a disability than blindness? Is hearing essential for creating memory, allowing comparison, judgment and association of ideas? From a medical point of view, it is impossible to develop speech without hearing. So how does not hearing and therefore not speaking limit our world? Does it at all? Czy język określa granice naszego świata? Głusi poza nawiasemGranice naszego języka są granicami naszego świata.(Ludwig Wittgenstein)Jeśli nie w słowach, jak organizowała swoje myśli? – pyta współczesny amerykański pisarz André Acimana w eseju o swoje głuchej matce. Innymi słowy, można zapytać - jak organizowała swój świat - bo nawet nieświadomie wierzymy, że: granice naszego języka są granicami naszego świata. Biorąc za punkt wyjścia słynne powiedzenie Ludwiga Wittgensteina oraz wykorzystując dzieła Platona (Kratylos), Denisa Diderota (Paradoks o aktorze), Étienne’a Bonnota de Condillaca (Traktat o wrażeniach zmysłowych), Olivera Sacksa (Zobaczyć głos) i innych, analizuję postrzeganie granic świata przez pryzmat języka, w ujęciu interdyscyplinarnym, z pogranicza literatury porównawczej, językoznawstwa i medycyny. Czy język to tylko proteza, bez której można żyć? Czy ręce mówią dokładniej niż słowa? A może bycie głuchym to niepełnosprawność znacznie bardziej ograniczająca niż bycie niewidomym? Czy słyszenie jest naprawdę ważne, ponieważ odgrywa kluczową rolę w tworzeniu pamięci, umożliwiając porównywanie, ocenianie i tworzenie skojarzeń? Słyszenie, z medycznego punktu widzenia, jest niezbędne do wykształcenia mowy. Jak zatem niesłyszenie, a zatem niemówienie ogranicza nasz świat? Czy ogranicza

ANÁLISE das Relações Serviço, Ensino e Comunidade na Formação Médica

A presente tese enfoca a formação médica indicando a urgência de mudanças para se constituir uma política de formação em que o espaço público seja privilegiado, afirmado e potencializado no exercício desse ofício. Espaço público entendido como o espaço que se constitui com a inclusão de usuários, trabalhadores e gestores do sistema de saúde público brasileiro, o SUS, de tal maneira a perseguir um processo de formação pautado no trabalho coletivo, integrando ensino, serviço e comunidade. Objetiva-se analisar se a inclusão dos alunos de graduação do curso de Medicina da Universidade Vila Velha (UVV) no Programa de Interação Serviço, Ensino e Comunidade (PISEC), que tem afirmado práticas que enfatizam o espaço público, não reduzidas ao aspecto biomédico, práticas com capacidade de realizar trabalho compartilhado em cogestão com usuários, trabalhadores e gerentes. Para tanto, foram apresentados documentos oficiais sobre a formação médica, relacionados à UVV, ao curso de Medicina e à PMVV, entre outros. Incluímos, também, relatos sobre as vivências nos locais de trabalho em saúde do município e a própria experiência da autora como preceptora e atual coordenadora do PISEC da UVV. Realizamos entrevistas com os vários atores do processo: alunos, preceptores, profissionais e usuários, além de entrevista com o coordenador do PISEC de 2007 a 2013. Utilizamos questões disparadoras para nortear os momentos das entrevistas, as quais foram transcritas integralmente para as análises. A pesquisa foi submetida e aprovada pelo Comitê de Ética em Pesquisa da UFES, após ter sido autorizada pela Secretaria de Saúde de Vila Velha e pela Universidade Vila Velha, e todos os sujeitos participantes assinaram um Termo de Consentimento Livre e Esclarecido. Nas análises dos vários discursos demonstrou-se que o PISEC se apresenta como uma possível estratégia de formação em saúde pública, caso consiga se afirmar como uma política de formação do profissional médico e não se constitua como programas de formação desarticulados. Uma formação que se efetive de forma transversal e o médico atue como profissional de saúde que compõe uma equipe, que não tenha apenas uma prática assistencialista, mas também efetive práticas de coordenação dos processos de trabalho, numa diretriz que afirma a indissociabilidade entre clínica e política. Apostamos em uma política de formação que amplia e afirma uma prática assistencial em saúde que seja democrática, participativa, lateralizada

Challenges and Feasibility of Applying Reasoning and Decision Making for a Lifeguard Undertaking a Rescue

ABSTRACT: In areas where lifeguard services operate, less than 6% of all rescued persons need medical attention and require CPR. In contrast, among areas where no lifeguard services are provided almost 30% require CPR. This difference indicates in importance of the lifeguard. Lifeguard work requires effective problem identification, diagnostic strategies and management decisions to be made in high-risk environments, where time is of the essence. The purpose of this investigation was to assess all variables involved in lifeguard work related to a water rescue, and how the information obtained could inform lifeguard training and therefore performance. Methods: By using the drowning timeline, the authors explored all variables involved in a single rescue event by inviting 12 lifeguards to complete a survey of their professional role using a three-round Delphi survey technique. The total potential number of decisions for each phase and sub-phases, the number of variables, the probability of a single event repeating, the duration of each sub-phase and amount of variables demanded per minute were measured. Each sub-phase was presented as predominantly rational (if less than 1 variable per/min) or intuitive (if more than 1/min). Results: The variables identified in sub-phases were: “preparation to work” (8 variables and 0.0001 variables/min) and “prevent” (22 variables; 0.03 variables/min); these sub-phases were predominately considered to lead to rational decisions. The variables identified during “rescue” (27 variables and 2.7 variables/min) and “first-aid” (7 variables and 1.7 variables) were predominantly considered intuitive processes. Conclusion: This study demonstrates the complexity of a decision-making process during the quick, physically and mentally stressful moments of rescuing someone. The authors propose better decision-making processes can be achieved by reducing the time interval between identification of a problem and making a decision. Understanding this complex mechanism may allow more efficient training resulting, in faster and more reliable decision-makers, with the overall benefit of more lives save

"Atenção Integral à Saúde Bucal na Estratégia Saúde da Familia"

O desafio do SUS é atender às necessidades dos usuários, sendo que a escuta da opinião de quem recebe a assistência é um elemento importante na avaliação dos serviços de saúde. Com isto, objetivou-se desvelar a percepção dos usuários acerca do acolhimento e demais dispositivos que orientam a atenção integral à saúde bucal nas US de Araçás e Ibes - Vila Velha, ES. Através de entrevistas semiestruturadas e análise de conteúdo, evidenciou-se o prolongado tempo de espera por uma consulta, a dificuldade de horário para quem trabalha, dificuldade para quem necessita de visita domiciliar, além das dificuldades de acesso às consultas especializadas. Conclui-se que, apesar de os usuários estarem satisfeitos no geral com o atendimento, há um desconhecimento dos seus direitos, não há entendimento do que seja um acolhimento, e o serviço é ainda confundido com filantropia

Association of Drowning Mortality with Preventive Interventions: A Quarter of a Million Deaths Evaluation in Brazil

In 2015, drowning in Brazil was responsible for 6,043 deaths and was the second leading cause of death in children. Although several prevention strategies have been promoted to reduce drowning, most are still based on low levels of evidence. This study evaluated the effectiveness of prevention and water safety interventions in reducing drowning mortality. Data obtained from the National Mortality System for 36 years were split in two time periods to allow the comparison of drowning mortality numbers before and after implementation of SOBRASA’s drowning prevention and water safety programs and to check for any positive effects attributable to such programs. To assess differences between the two periods, a “drowning water safety score” (DSS) was estimated and compared to mortality/100,000 of population. There were 258,834 drowning deaths over 36 years. A significant decrease of 27% in drowning rates (5.2 to 3.8/100,000;

A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions

Aim: To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. Methods: We recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases. Results: We recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions). Conclusion: Within these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices. © 2023 The Author(s)Dr. Amy Peden is funded by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship (Grant ID: APP2009306) which supported open access publication. No funding was obtained for the conduct of the study

A systematic review on the effectiveness of anti-choking suction devices and identification of research gaps

Aim: Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions. Methods: Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices’ dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE. Results: Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen's Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low. Conclusions: There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations