[Receptive music therapy with persons suffering from a physical handicap]. / Musicothérapie réceptive en situation de handicap.

Music therapy, as a part of arts therapies, is used as a therapeutical tool for restoring, maintaining and improving the mental, physical and emotional health of human beings. The main mission of receptive music therapy is not found on the performance level, but on the level of attentive and intimate music listening that is not passive at all, contributing to musical pleasure and to wellbeing. At first we introduce the basic vocabulary used in receptive music therapy, flow experience and the main dimensions (bio-psycho-social) influenced by stimulating music listening. We also present the aims of this psycho-pedagogical project: The focus lies on determining the sensitivity of physically handicapped persons to different music stimuli (music styles). In this case, we can talk of the degree of music reception. We worked in an institution for persons suffering from a physical handicap. The applied methodology is based on the psycho-musical survey by Verdeau-Paillès (1). This psychological record consists in a basic interview and a test of music listening performances leading to the construction of a summary graph and the final receptivity psychogram. An observational frame conceived by Schiltz (2) and adapted to the actual situation offers the possibility of making exact observations as to non-verbal and verbal variables during the therapeutical sessions. Thus, we can present the results of descriptive and non-parametric statistical procedures, but also the results of case studies. The statistical tests used were Wilcoxon's sign-rank test for a pre-post comparison of variables related to non-verbal and verbal behaviour (two different sessions of music therapy with similar contents) and Spearman's Rho which permitted us to compute the correlations between non-verbal expression and verbal communication (N=14). Finally we conclude that our patients considered their musical experience as very positive. The results of the personal interview and the psycho-musical survey brought about several interesting statistical findings on how receptive music therapy physically and psychologically influenced the patients.

[Artificial blood - coming soon or never reaching clinical maturity?]. / Gibt es eine Zukunft für künstliche Blutersatzstoffe?

Formerly developed resuscitation fluids solely imitated the main function of the blood -oxygen transport. A research driven by the army requested an oxygen carrier that does not need cross typing and cooled storage. Artificial oxygen carriers (AOC) use either the molecular oxygen bondage to hemoglobin: HBOC- "hemoglobin based oxygen carriers" or the physical dissolution of oxygen in the blood plasma compartment by hyperbaric pressure in perfluorocarbon emulsions (PFC). Decades of preclinical and clinical research did pass but the results were disappointing- in Russia, a not well designed PFC is available locally and the only approved HBOC in South Africa is not being used much. Other products, just prior to filing for FDA approval, did not achieve convincing study results and research and production was stopped. Some trials have been stopped by the FDA for safety reasons, half of trials with the primary endpoint reduction of allogeneic transfusion requirement were unsuccessful or offset by an increased blood requirement later. However, some ventures currently are trying to use the knowledge gained so far and are investigating third and fourth generation products of artificial blood components. These imitate the cellular structure of red cells as micells, nanocapsules, (ABC- artificial blood cells) or gas bubbles (microbubbles), admixture of volume substitutes such as starches, gelatin or albumin or use hyperbaric oxygenation [38]. Artificial platelets are in clinical phase IIa, recombinant albumin in phase III. In this article, a short overview about the current situation on artificial blood products is given. The critical point for the break through for artificial blood products did not come yet but could be ahead-

Informática en Medicina de Urgencias y Emergencias: Gestión de la información y aplicaciones en el siglo XXI / Emergency Medicine Informatics: Information Management and Applications

La informática en Medicina de Urgencias y Emergencias (IMUE) es la recogida, gestión, procesamiento y aplicación de los datos de la atención prestada a los pacientes urgentes, así como los datos operativos. La IMUE está transformando y mejorando nuestros sistemas de atención prehospitalaria y las intervenciones de los servicios de urgencias hospitalarios(SUH). Es fundamental para la vigilancia de la salud pública, y nos permitirá ampliarla investigación clínica en las instituciones, regiones y naciones. La IMUE es una de nuestras herramientas más importantes para mejorar la atención de emergencias y repercutirá positivamente en la salud de la población. Para la atención prehospitalaria, los sistemas IMUE proporcionan información para analizar la relación coste-eficacia de las intervenciones clínicas, para organizar las operaciones del servicio médico de emergencias (SME),para coordinar la comunicación en las solicitudes de servicio, vigilar el control de calidad y las necesidades educativas, y para el seguimiento de la evolución de los pacientes. La práctica de la Medicina de Urgencias y Emergencias en el SUH requiere la captura de muchos datos y elementos temporales para que la atención del SUH sea eficiente. Los módulos IMUE apoyan el seguimiento y la precisión del triaje, el seguimiento del paciente, el control de médicos y enfermeros, la decisión clínica, el orden de entrada, las instrucciones de alta y la generación de prescripciones. Debe haber coordinación del IMUE con el hospital, laboratorio y los sistemas de información del servicio de radiología, así como con los registros sobre acceso al hospital y a las clínicas ambulatorias. La información clínica se debe agregar a una base de datos del SUH que luego se puede utilizar para (..) (AU)

Emergency Medicine Informatics (EMI) is the collection, management, processing, and application of emergency patient care and operational data. EMI is transforming and improving our prehospital care systems and emergency department(ED) operations, is critical for public health surveillance, and will enable us to expand clinical research in our institutions, regions, and nations. EMI is one of our most important tools for improving emergency care and positively impacting the health of the public. For prehospital care, EMI systems provide information to analyze the cost-effectiveness of clinical interventions, to organize EMS operations, to coordinate communication for service requests, to monitor quality control and educational needs, and to track patient outcomes. The practice of emergency medicine in the ED requires the capture of many data and time elements so that ED care is efficient. EMI modules support triage acuity and tracking, patient tracking, nurse and physician charting, clinical decision support, order entry, and discharge instructions and prescription generation. There must be coordination of the EMI with hospital, laboratory, and radiology reporting systems, and access to hospital and ambulatory clinic records. Clinical information should be aggregated into an ED Database which can then be used for clinical investigation. The cooperation and support of the hospital information services department, hospital administration, emergency medicine physicians, and emergency medicine researchers, is necessary so that the ED database will be well constructed, and most importantly, well used to improve patient care. Because the information from (..) (AU)

A Danish adaptation of the Pain Coping Questionnaire for children: preliminary data concerning reliability and validity.

The aim of this study was to determine the reliability and validity of a Danish translation of the Pain Coping Questionnaire (PCQ) for children in Danish children. The PCQ was translated using a translation-back-translation method. The subjects were 352 healthy children and 40 children with juvenile arthritis (JA), aged 8-17 y. Sixteen of the JA children were divided into a high-pain group (n = 7) and a low-pain group (n = 9). The results were factor analysed using principal component analysis with varimax rotation. Clinical pain intensity was measured using visual analogue scales (VAS) from the Varni/Thompson Pediatric Pain Questionnaire. Experimental pain was induced using a cold pressor pain paradigm and outcome measures were pain intensity, pain discomfort and tolerance to cold pressor pain. A seven-factor solution emerged as the most consistent factor structure. Four subscales, Seeking Social Support (SSS), Cognitive Distraction (CD), Externalizing (EXT) and Internalizing/Catastrophizing (INT), corresponded with the parallel subscales proposed by Reid et al. (Pain 1998; 76: 83-96). Two subscales, Positive Self-Statements (PSS) and Behavioral Distraction (BD), were composed of four of the five items from the previously proposed subscales. One subscale, Information Seeking/Problem Solving (IP), consisted of items from two subscales proposed by Reid et al., i.e. Information Seeking and Problem Solving. Internal consistencies of the subscales were acceptable, with reliability coefficients ranging from 0.60 (BD) to 0.83 (IP) and with test-retest reliabilities between 0.59 and 0.78. Low-pain JA patients showed significantly higher levels of BD than High-pain JA patients (p<0.05). Greater utilization of PSS and BD was associated with less patient-reported present pain and less average everyday pain (p<0.05-0.01), and greater utilization of INT was significantly associated with higher experimental pain intensity (p<0.01). These preliminary findings provide support for the reliability and validity of the Danish modification of the PCQ in a Danish population and for the hypothesis that paediatric pain-coping strategies are associated with the intensity of clinical and experimental pain.

Cold pressor pain: comparing responses of juvenile arthritis patients and their parents.

UNLABELLED: The objective of this study was to compare the reactions to experimental cold pressor pain of Juvenile Arthritis (JA) patients, healthy children, and their parents. METHODS: We compared pain threshold, discomfort, intensity, and tolerance to experimental cold pressor pain in 15 JA patients (age 9-15) and one of their parents and a control group of 25 healthy children (age 9-12) and one of their parents. RESULTS: JA-patients exhibited significantly lower mean pain tolerance than healthy children. Pain tolerance correlated significantly with disease duration. Parents of JA-patients showed significantly greater mean pain intensity than parents of healthy children, and had higher estimates of their child's ability to endure pain than parents of healthy children. Correlations were found between pain scores of children and their parents for both pain intensity and tolerance. The pain coping category of Catastrophizing was associated with several of the experimental pain response measures. CONCLUSION: The results suggest that JA patients may differ from healthy children with regard to their responses to experimental pain, and that pain responses of both JA patients and healthy children could be related to the pain response of their parents.

Heme oxygenase substrates acutely lower blood pressure in hypertensive rats.

Heme oxygenase catalyzes the metabolism of heme to biliverdine, free iron, and carbon monoxide. The current study was designed to determine if treatment with the heme oxygenase substrates heme-L-arginate or heme-L-lysinate, to stimulate formation of heme oxygenase products, can lower blood pressure in the rat. Heme-L-arginate (45 mumol/kg ip) and heme-L-lysinate (45 mumol/kg ip) acutely lowered blood pressure in awake spontaneously hypertensive rats (SHR) by approximately 35 mmHg. For both heme oxygenase substrates, this effect was blunted by pretreatment with an inhibitor of heme oxygenase, zinc deuteroporphyrin 2,4-bis glycol. Heme-L-lysinate also lowered arterial pressure in deoxycorticosterone acetate-salt hypertensive rats and in rats with phenylephrine-induced hypertension, indicating that the vasodepressive actions of heme may be extended to other hypertensive models. However, neither heme-L-arginate nor heme-L-lysinate decreased blood pressure in normotensive controls. The heme oxygenase product biliverdine did not lower blood pressure in SHR, and the vasodepressive actions of heme-L-lysinate were unaffected by pretreatment with deferoxamine to chelate free iron. Carbon monoxide (12 ml/kg ip) lowered blood pressure in SHR and in rats made hypertensive by phenylephrine infusion, had no effect on blood pressure in Wistar-Kyoto rats, and elicited only a modest vasodepressive response in normotensive Sprague-Dawley rats. We conclude that heme-bearing preparations can lower blood pressure in hypertensive rats, presumably via heme oxygenase-mediated formation of carbon monoxide.

The heliosphere as an astrophysical laboratory for particle acceleration.

Particle acceleration is one of the most important topics in plasma astrophysics as well as in cosmic-ray astrophysics. The heliosphere is an ideal astrophysical laboratory, wherein one can observe in situ the elementary mechanisms involved in the particle acceleration processes. Two phenomena of special interest are stochastic acceleration in the magnetohydrodynamic turbulence around comets and stochastic shock acceleration at interplanetary shock waves.

Comet giacobini-zinner: in situ observations of energetic heavy ions.

Conclusive evidence is presented for the existence of energetic ( approximately 535,0000 to 150,000 electron volts), heavy (>-12 atomic mass units), singly charged cometary ions within approximately 1.5 x 10(6) kilometers of comet Giacobini-Zinner. The observations were made with the University of Maryland/Max-Planck-Institut ultralow-energy charge analyzer on, the International Cometary Explorer spacecraft. The most direct evidence for establishing the mass of these ions was obtained from an analysis of the energy signals in one of the solid-state detectors; it is significant at the three-sigma level. Maximum fluxes were recorded approximately 1 hour before and approximately 1 hour after closest approach to the cometary nucleus. Transformation of the particle angular distributions observed at approximately 50,000 kilometers radial distance from the comet during the inbound pass into a rest frame in which the distributions are nearly isotropic requires a transformation velocity that is consistent with the local solar wind velocity if one assumes that these particles are primarily singly ionized with a mass of 18 +/- 6 atomic mass units. The existence of a frame of reference in which these water-group ions were isotropic implies that they underwent strong pitch angle scattering after their ionization. Particle energies in the rest frame extend to substantially higher values than would be expected if these ions were locally ionized and then picked up by the solar wind, implying that the ions were accelerated or heated. The derived ion density, approximately 0.1 per cubic centimeter, is consistent with a crude model for the production and transport of pickup ions.