[Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. / Beatmungspatienten zwischen Akutversorgung und außerstationärer Langzeitbeatmung.

BACKGROUND: The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS: In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS: In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION: Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.

[Ventilation Patients between Acute Care and Long-term Out-of-Hospital Ventilation - Routine Documentation based Analysis of the Care Situation]. / Beatmungspatienten zwischen Akutversorgung und außerstationärer Langzeitbeatmung.

BACKGROUND: The number of invasive and non-invasive long-term out-of-hospital ventilations has been increasing rapidly for years. At the same time, there is poor information on the quality of care of out-of-hospital ventilated patients. The present investigation was conducted as part of the OVER-BEAS study. The aim of this study was to describe the care situation of weaning patients from admission to discharge from the weaning center using existing routine documentation. MATERIAL AND METHODS: In our retrospective analysis, we included all patients admitted in 2018 via the weaning ward of the Thorax Center Münnerstadt. Descriptive analysis of routine data collected as part of quality management was performed. Data sources were the WeanNet database, the discharge letter of the weaning center, and the transfer report of the referring hospital. RESULTS: In the studied weaning center, 50.8 % of the patients (n = 31) could be completely weaned from the respirator and extubated or decannulated (category 3aI). If complete weaning was not successful, 75.0 % (n = 21) required the constant presence of specially trained staff or a specialist nurse in the further course. In this case, further care was mostly provided in inpatient care facilities (e. g., ventilator shared living community). CONCLUSION: Based on routine documentation, the care situation of weaning patients can be presented and compared with known data. In this way, the outcome quality of a weaning center can be made comparable.

[Patient perspective of pain assessment by nursing personnel : Qualitative cross-sectional study on use of the NRS]. / Pflegerisches Schmerzassessment aus Patientenperspektive : Qualitative Querschnittsuntersuchung zur Anwendung der NRS.

BACKGROUND: The assessment of pain as a part of adequate pain management is an integral part of the clinical routine. Much research has been carried out concerning use, relevance and validity of different assessment scales; however, patients' perspective of pain assessment has not yet been studied in Germany. The aim of the present study was to collate patients' experiences regarding pain assessment based on the numeric rating scale (NRS). MATERIALS AND METHODS: The survey was conducted as a qualitative cross-sectional study based on the grounded theory methodology by Strauss and Corbin. Interviews were carried out with 15 surgery patients. A semi-structured interview guide was used to collect data. The structured analysis was performed using MAXQDA. Data were first openly coded followed by thematic coding. Finally, the codes were compared and linked via axial coding. The data analysis was completed by object-related theory construction. RESULTS: Patients have only vague ideas about the consequences of their responses. They experience pain assessment as a nursing routine, which was perceived as being largely insignificant for therapy. On reflection patients sporadically saw the scaling as being a problem as a reference value is missing and the quality of pain as well as the procedure fail the predetermined measurement system. Metric values not only reflect the level of pain but are also intentionally used to enable targeted measures, e.g. discharge from hospital. CONCLUSION: The survey results indicate that the validity of the measurement and therefore the indicated therapy is influenced by subjective concepts. Patients themselves suggested alternatives for detecting the quality of pain. The data should be replicated in larger samples and also take possible influences on the perception of the assessment into account.

[Changes in MR images in pre-eclampsia and eclampsia]. / MR-tomografische Veränderungen bei Präeklampsie und Eklampsie.

BACKGROUND: Pre-eclampsia affects 2% of pregnancies. This multisystem disorder is a major cause of maternal, foetal and neonatal mortality and morbidity. Neurological manifestations of eclampsia are headache, nausea, vomiting, cortical blindness and recurrent seizures. OBJECTIVE: The purpose of this study was to determine whether the neurological symptoms correlate with MR imaging findings. RESULTS: In a patient with eclamptic seizure and another one with blindness due to pre-eclampsia, the white matter hyperintensities on T (2)-weighted MR and FLAIRsequence images could be demonstrated in the occipital region and in the basal ganglia. Within 3-5 days all neurological symptoms and radiological abnormalities had resolved. CONCLUSION: These cerebral lesions could be classified as posterior reversible encephalopathy syndrome (PRES) or as reversible leukoencephalopathy syndrome (PLES). Thus, MRI supports differential diagnosis regarding non pregnancy-related cerebral disease and can be helpful for therapy planning in cases of pre-eclampsia.

Concealed accessory pathway with long conduction times and incremental properties: a case report.

Concealed AP with Slow and Incremental Conduction. We report a peculiar form of permanent junctional reciprocating tachycardia that occurs only during daytime and physical activity. ECG obtained during tachycardia showed an unusual progressive shortening of the ventriculoatrial (VA) interval that was maximal at the first complex and shortest at the last one before block occurred, always at the accessory pathway level. This phenomenon has not been previously described and appears to be a reverse type of Wenckebach block. It was observed during salvos of spontaneous tachycardia and could be reproduced by right ventricular pacing. The accessory pathway was ablated successfully at the right posteroseptal region, close to the coronary sinus ostium. After ablation, there was no VA conduction, and tachycardia did not recur during a 9-month follow-up period.

The basis of transfer in artificial grammar learning.

In two experiments, we examined the extent to which knowledge of sequential dependencies and/or patterns of repeating elements is used during transfer in artificial grammar learning. According to one view of transfer, learners abstract the grammar's sequential dependencies and then learn a mapping to new vocabulary at test (Dienes, Altmann, & Gao, 1999). Elements that are repeated have no special status on this view, and so a logical prediction is that learners should transfer as well after exposure to a grammar without repetitions as after exposure to a grammar with them. On another view, repetition structure is the very basis of transfer (Brooks & Vokey, 1991; Mathews & Roussel, 1997). Learners were trained on grammars with or without repeating elements to test these competing views. Learners demonstrated considerable knowledge of sequential dependencies in their training vocabulary but did not use such knowledge to transfer to a new vocabulary. Transfer only occurred in the presence of repetition structure, demonstrating this to be the basis of transfer.

Infant artificial language learning and language acquisition.

The rapidity with which children acquire language is one of the mysteries of human cognition. A view held widely for the past 30 years is that children master language by means of a language-specific learning device. An earlier proposal, which has generated renewed interest, is that children make use of domain-general, associative learning mechanisms. However, our current lack of knowledge of the actual learning mechanisms involved during infancy makes it difficult to determine the relative contributions of innate and acquired knowledge. A recent approach to studying this problem exposes infants to artificial languages and assesses the resulting learning. In this article, we review studies using this paradigm that have led to a number of exciting discoveries regarding the learning mechanisms available during infancy. These studies raise important issues with respect to whether such mechanisms are general or specific to language, the extent to which they reflect statistical learning versus symbol manipulation, and the extent to which such mechanisms change with development. The fine-grained characterizations of infant learning mechanisms that this approach permits should result in a better understanding of the relative contributions of, and the dynamic between, innate and learned factors in language acquisition.

Artificial grammar learning by 1-year-olds leads to specific and abstract knowledge.

Four experiments used the head-turn preference procedure to assess whether infants could extract and remember information from auditory strings produced by a miniature artificial grammar. In all four experiments, infants generalized to new structure by discriminating new grammatical strings from ungrammatical ones after less than 2 min exposure to the grammar. Infants acquired specific information about the grammar as demonstrated by the ability to discriminate new grammatical strings from those with illegal endpoints (Experiment 1). Infants also discriminated new grammatical strings from those with string-internal pairwise violations (Experiments 2 and 3). Infants in Experiment 4 abstracted beyond specific word order as demonstrated by the ability to discriminate new strings produced by their training grammar from strings produced by another grammar despite a change in vocabulary between training and test. We discuss the implications of these findings for the study of language acquisition.

Grammatical and caregiver cues in early sentence comprehension.

In order to begin to learn a language, young children must be able to locate and distinguish linguistic units in the speech they hear. A number of cues in the speech stream may aid them in this task. Some cues, such as frequently occurring grammatical morphemes and prosodic changes at linguistic boundaries are inherent in the language. Other cues, such as short utterance length and placement of key words in utterance-final position, are not integral to the grammar of the language but are characteristically provided by caregivers. Although previous studies suggest that even infants are sensitive to many of these cues, it is not clear that young listeners actually use them in assigning structure to sentences. The experiments reported here asked whether 60 children aged 2;0 to 2;2 used grammatical and caregiver cues in sentence comprehension and how different types of cues interacted. Two findings are of note: children used all of the cues tested, and the presence of one type of cue did not diminish use of another.

Sensitivity to grammatical morphemes in children with specific language impairment.

Grammatical morphemes, such as articles and auxiliary verbs, provide potentially useful information to language learners. However, children with specific language impairment (SLI) frequently fail to produce grammatical morphemes, raising questions about their sensitivity to them. To address this issue, two experiments were conducted in which 3- to 5-year-old children with SLI and with normally developing language (NL) heard sentences asking them to identify a picture corresponding to a named target word. The target occurred in either a grammatical sentence or one with an incorrectly used grammatical morpheme. In Experiment 1, the picture representing the target occurred with three unrelated distractor pictures. In Experiment 2, distractor sets included pictures that were semantically related to the target. In both studies, the SLI group chose fewer correct pictures when the target followed an incorrectly used morpheme. In Experiment 2, the SLI group chose more semantically related than unrelated distractors. These results suggest that children with SLI are sensitive to grammatical morphemes and that their incorrect picture choices may reflect a failure to maintain the target in memory.

An electrophysiological study of infants' sensitivity to the sound patterns of English speech.

The study explores 10- to 11-month-old infants' sensitivity to the phonological characteristics of their native language. Event-related potentials (ERPs) were obtained for tones that were superimposed on two versions of a story: an Unmodified version containing normal English function morphemes, and a Modified version in which the prosodic and segmental properties of a subset of function morphemes were changed to make them atypical. The 11-month-olds exhibited significantly lower amplitude ERPs to the tones during the Modified story than to the Unmodified story, whereas the 10-month-olds showed no differences. These results suggest that the 11-month-olds discriminated the two versions of the story based on their representations of the phonological properties of English. Further, the tone-probe ERP method can successfully be used to study the development of speech perception in the pre-linguistic infant.

Prosody's role in language acquisition and adult parsing.

There has been recent interest in the role of prosody in language acquisition as well as in adult sentence processing. Although the specific questions about prosody asked in these two domains may appear to differ, there are at least three basic issues that they have in common. These include the role of prosody in segmentation (i.e., deciding whether two adjacent sections of speech belong to the same or to different linguistic units), structural bracketing (i.e., discerning structural relations among linguistic units), and the reliability of prosodic cues. Data from both language acquisition and adult parsing research suggest that, although prosody almost certainly plays a role in segmentation, it probably does not aid in bracketing. Research on the reliability of prosodic cues suggest that these are probably more reliable and robust in child-directed than in adult-directed speech registers, raising questions about how child and adult listeners interpret the presence vs. absence of prosodic cues.

[Ventricular fibrillation in a patient with the permanent form of junctional reciprocating tachycardia]. / Fibrilação ventricular em paciente com forma permanente da taquicardia juncional reciprocante.

A case of a 20 year old young man having the permanent form of junctional reciprocating tachycardia complicated by ventricular fibrillation (VF) is reported. A number of antiarrhythmic drugs either as single or combined therapy fail to control tachycardia. Paroxisms of a faster palpitation which never lasted longer than a few minutes were felt over the last six months before the occurrence of VF. At admission, a narrow QRS tachycardia 250 beats/min was recorded and soon degenerated into VF. After electrical shock with 350J permanent form of junctional tachycardia resumed. Electrophysiologic evaluation identified an accessory pathway with long conducting times in postero-septal location, enhanced atrioventricular node conduction and inducible atrial flutter. The patient underwent successful radiofrequency ablation and is doing well after 18 months of follow-up, being off antiarrhythmic drug and tachycardia free.

Fibrilação; ventricular em pacientes com forma permanente da taquicardia juncional reciprocante / Ventricular fibrillation in a patient with the permanent form of junctional reciprocating tachycardia

Homem de 20 anos, portador de taquicardia de apresentaçäo incessante há longos anos, sem resposta a medicaçöes antiarrítmicas. Seis meses antecedendo a admissäo referia paroxismos de taquicardia mais rápida, de duraçäo curta, autolimitada. Na admissäo apresentava flutter atrial com conduçäo 1:1 (250 bpm) que degenerou em fibrilaçäo ventricular, revertida com 350J. O estudo eletrofisiológico identificou taquicardia atrioventricular, utilizando conexäo anômala "oculta" de localizaçäo póstero-septal deita com conduçäo lenta e propriedade decremental, conduçäo atrioventricular acelerada, observando-se precipitaçäo de fibrilaçäo atrial com resposta rápida pós-atropinizaçäo. Foi submetido a ablaçäo por cateter pro radiofrequência com sucesso. Esta assintomático, 18 meses após o procedimento.

Three- and four-year-olds' perceptual confusions for spoken words.

Although infants have the ability to discriminate a variety of speech contrasts, young children cannot always use this ability in the service of spoken-word recognition. The research reported here asked whether the reason young children sometimes fail to discriminate minimal word pairs is that they are less efficient at word recognition than adults, or whether it is that they employ different lexical representations. In particular, the research evaluated the proposal that young children's lexical representations are more "holistic" than those of adults, and are based on overall acoustic-phonetic properties, as opposed to phonetic segments. Three- and four-year-olds were exposed initially to an invariant target word and were subsequently asked to determine whether a series of auditory stimuli matched or did not match the target. The critical test stimuli were nonwords that varied in their degree of phonetic featural overlap with the target, as well as in terms of the position(s) within the stimuli at which they differed from the target, and whether they differed from the target on one or two segments. Data from four experiments demonstrated that the frequency with which children mistook a nonword stimulus for the target was influenced by extent of featural overlap, but not by word position. The data also showed that, contrary to the predictions of the holistic hypothesis, stimuli differing from the target by two features on a single segment were confused with the target more often than were stimuli differing by a single feature on each of two segments. This finding suggests that children use both phonetic features and segments in accessing their mental lexicons, and that they are therefore much more similar to adults than is suggested by the holistic hypothesis.

Do English-learning infants use syllable weight to determine stress?

A linguistic factor governing the assignment of English lexical stress is syllable weight. Heavy syllables which have either a long (tense) vowel or are closed with a consonant are heavy and automatically bear stress. Are infants sensitive to this aspect of the English stress system? Previous research by Jusczyk, Cutler, and Redanz (1993) showed that nine-month-olds listened longer to words exhibiting Strong-Weak than Weak-Strong stress pattern. However, they did not investigate the role of syllable weight in this preference. A series of three experiments explored infants' preference for Strong-Weak versus Weak-Strong lists, but systematically manipulated the syllable weight of Strong syllables. The results suggest that syllable weight is not a necessary component of the Strong-Weak preference observed in previous studies. Rather it appears that infants prefer both words that begin with a Strong syllable and Strong syllables that are heavy. Thus, the results suggest that sensitivity to surface linguistic patterns and the principles that underlie them may be independent in early language acquisition.

A metrical template account of children's weak syllable omissions from multisyllabic words.

Young children learning English as well as many other languages frequently omit weakly stressed syllables from multisyllabic words. In particular, they are more likely to omit weak syllables from word-initial positions than from word-internal or -final positions. For example, the weak syllable of a weak-strong (WS) word like giraffe is much more likely to be omitted than the weak syllable of a SW word like tiger. Three hypotheses for this omission pattern have been offered. In two, children's weak syllable omissions reflect innate perceptual biases either to ignore initial weak syllables or to encode word-final syllables. In contrast, the SW Production Template Hypothesis states that children have a template for producing a strong syllable followed by an optional weak syllable. When they apply a series of SW templates to their intended utterances, weak syllables that do not fit the templates are more likely to be omitted than those that do. To compare the three hypotheses, young two-year-olds were asked to say four-syllable SWWS and WSWS nonsense words. Children's pattern of weak syllable preservations was highly consistent with the SW production template hypothesis, but not with the perception-based hypotheses. Implications of this research for children's function morpheme omissions and for the relation of metrical and segmental production templates are discussed.

When prosody fails to cue syntactic structure: 9-month-olds' sensitivity to phonological versus syntactic phrases.

According to prosodic bootstrapping accounts of syntax acquisition, language learners use the correlation between syntactic boundaries and prosodic changes (e.g., pausing, vowel lengthening, large increases or decreases in fundamental frequency) to cue the presence and arrangement of syntactic constituents. However, recent linguistic accounts suggest that prosody does not directly reflect syntactic structure but rather is governed by independent prosodic units such as phonological phrases. To examine the implications of this view for the prosodic bootstrapping hypothesis, infants in Experiment 1 were presented with sentences in which pauses were inserted either between the subject noun phrase (NP) and verb or after the verb. Half of the infants heard sentences with lexical NP subjects, in which prosodic structure is consistent with syntactic structure. The other half heard sentences with pronoun subjects, in which prosodic structure does not mirror syntactic structure. In a preferential listening paradigm, infants in the lexical NP condition listened longer to materials containing pauses between the subject and verb, the main syntactic constituents. However, in the pronoun NP condition, infants showed no difference in listening times for the two pause locations. To determine if other sentence types containing pronoun subjects potentially provide information about the syntactic constituency of these elements, infants in Experiment 2 heard yes-no questions with pronoun subjects, in which the prosodic structure reflects the constituency of the subject. Infants listened longer when pauses were inserted between the subject and verb than after the verb. Taken together, our results suggest that the prosodic information in an individual sentence is not always sufficient to assign a syntactic structure. Rather, learners must engage in active inferential processes, using cross-sentence comparisons and other types of information to arrive at the correct syntactic representation.

Patterns of growth deficiency in rats exposed in utero to undernutrition, ethanol, or the neuroteratogen methylazoxymethanol (MAM).

Children and experimental animals exposed to ethanol (EtOH) in utero commonly have low birthweights, and many remain small at maturity. Low body weight or small stature in adulthood may reflect an inability to recover from in utero growth retardation, or it may reflect a separate, postnatal growth deficiency. In this study, daily body weights (postnatal days 1 to 60) were compared among the offspring of the following groups of Long Evans rats: dams fed liquid diet containing 35% EtOH-derived calories; their pair-fed and chow-fed controls; and dams exposed to methylazoxymethanol (MAM) in two previous studies, in which offspring exhibited reduced numbers of growth hormone releasing factor (GRF) neurons. All treatments produced a number of offspring with weight deficits beginning after birth and persisting into maturity. Three distinct patterns of growth deficiency were observed: (1) weight loss relative to controls in the first weeks of life, seen in offspring exposed to EtOH, pair feeding, or MAM on gestation day 13 (G13); (2) a delay in the onset of the prepubertal growth spurt, seen in all EtOH-exposed offspring and in G13 MAM-exposed dwarfs; and (3) failure to sustain the prepubertal growth spurt, seen only after exposure to MAM on G14. The results of this study support the view that prenatal EtOH exposure is capable of affecting postnatal growth specifically; moreover, the pattern of growth deficiency seen in EtOH-exposed offspring was distinct from that of the undernourished offspring of pair-fed dams.

Purified Pasteurella multocida protein toxin reduces acid phosphatase-positive osteoclasts in the ventral nasal concha of gnotobiotic pigs.

To study the in vivo response of conchal (turbinate) osteoclasts to Pasteurella multocida toxin, four gnotobiotic pigs (7 days of age) were inoculated subcutaneously with 0.2 microgram/kg of purified toxin. One toxin-treated pig along with one control pig were necropsied at 2, 5, 9, and 14 days postinoculation. The entire length of nasal concha from the nasal planum toi ethmoid region was removed, blocked by transverse cuts into five areas, decalcified, sectioned, and then stained with tartrate-resistant acid phosphatase (TRAP) to identify osteoclasts. In each section, total area of concha, total osteoclast cytoplasmic area, and number of osteoclasts were determined using an image analysis morphometric unit. Also collected from pigs were blood and serum for complete blood counts, electrolyte levels, liver enzymes, and TRAP levels. Conchal atrophy increased in severity with time after 2 days postinoculation. In general, the ventral conchae from toxin-treated pigs at 9 and 14 days postinoculation had decreased surface area, osteoclast cytoplasmic area, and numbers of osteoclasts. Serum levels of TRAP were mildly elevated when compared with age-matched controls. No other significant alterations in blood cells or chemistries occurred and no lesions were present histologically in tissues (liver, kidney, lung, heart, and spleen) other than concha. This study shows that the P. multocida toxin induces rapid bone resorption and increases serum levels of acid phosphatase but leads to diminished acid phosphatase expression and presumably, numbers of osteoclasts.