肺保护策略机械通气的再评价

通常认为急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应用肺保护策略机械通气可降低病死率,主要由于潮气量的降低。对已发表的随机对照研究再次分析,发现平台压与患者病死率明显相关。平台压低于30cmH2O时,潮气量可以在一定范围内增加,不影响患者预后。但选择小潮气量可能对病人有害。随机对照研究在试验设计、统计学分析、病人同质性等方面依然存在很多问题。从现有资料看,潮气量和平台压都很重要。     

恶性肿瘤皮肤表现

恶性肿瘤皮肤表现可分为肿瘤直接效应与间接效应。直接效应是指恶性肿瘤或其转移灶生长影响周围器官或组织正常功能;间接效应是指恶性肿瘤或其转移灶经复杂生物学效应影响远处器官或组织正常功能,也称为副肿瘤性皮肤病。恶性肿瘤皮肤表现发病率根据原发肿瘤而束同,可能是患者潜在肿瘤首发临床表现,并且与肿瘤复发转移相关。     

Intonation and Emotion in Autistic Spectrum Disorders

The classic picture of an autistic individual includes an impoverished ability to interpret or express emotion. The prosody of spoken language in autistic children is thought to lack emotional content. In this study, the verbal intonation of children with autism was examined and compared to that of children with Asperger Syndrome (AS) and normal controls (ctrl). Utterances elicited by repetition and by spontaneous story completion were analyzed by quantifying phonetic features (pitch, amplitude, and length) and comparing them to subjective ratings of produced emotion (happy, sad or angry). Since the most consistent phonetic correlate of these emotional targets has been demonstrated to be pitch range, speakers with autistic spectrum disorders were expected to have decreased pitch range; however in the repetition task, autistic subjects actually had a larger pitch range than the other groups. Other measures of intonation including amplitude, duration, and location of pitch peak revealed defects that are more complex than predicted. In spontaneous speech, autistic subjects performed more poorly on both phonetic targets and subjective ratings than ctrls, and AS subjects fell between autistics and normals.     

An experimental approach to detecting dementia in Down syndrome: a paradigm for Alzheimer's disease

Measures developed from animal models of aging may detect dementia of the Alzheimer's type in a population at-risk for Alzheimer's disease (AD). Although, by middle age, individuals with Down syndrome (DS) show an extraordinarily high prevalence of AD-type pathology, their severe idiopathic cognitive deficits tend to confound the clinical diagnosis of AD. The current study was designed to improve detection of AD in DS by using measures of learning and memory derived from animal models of aging. Adults with DS (N=34) were assessed and reassessed (n=19) approximately one year later using stimulus-response (S-R) test methods derived from experimental literature, as well as standardized informant-based tests. Results demonstrated high validity and reliability of select tests. The implication of early symptom detection in a population at-risk for AD-type dementia was discussed in terms of potential brain regions of interest.     

An evaluation of the effectiveness of exposure and response prevention on repetitive behaviors associated with Tourette's syndrome

Exposure and response prevention (ERP) was evaluated as treatment for three repetitive behaviors in an 11-year-old boy using a multiple baseline across behaviors design. The repetitive behaviors and associated self-reported distress were eliminated. At 3-month follow-up, the frequency for two of the three behaviors returned to baseline levels. This study demonstrates that ERP may be a useful treatment for repetitive behaviors, although booster sessions may be needed to maintain the treatment effects.     

The Cultural Education of Academic Evaluators: Lessons from a University-Hmong Community Partnership

This article explores some of the lessons a university-based evaluation team learned while attempting to hire, retain, and work with staff members from a local Hmong community. These staff members were hired to assist a federally-funded community collaborative with implementing and evaluating a family strengthening program for Hmong families with adolescents. Over the course of two years, a succession of individuals were hired and resigned from a key staff position. These resignations occurred at critical points in the project, undermining a critical component of the program's evaluation. Through interviews, observations, self-reflection, and feedback from colleagues and reviewers, a better understanding of the reasons for these difficulties began to emerge. The challenges examined in this article help to illustrate some of the complexities faced by academics when conducting a community-based project with an underserved racial ethnic population. The article concludes by discussing some of the lessons learned and what they might suggest for others doing similar types of work.     

The analytic nursery: Ferenczi's 'wise baby' meets Jung's 'divine child'

In 1923, Sandor Ferenczi wrote a paper entitled 'The dream of the clever baby', in which he identified a phenomenon he discovered through his clinical work: the notion that young children who had been traumatized often had accelerated developmental characteristics that led them to acquire highly acute sensitivities and intuitions--in short, wisdom beyond their years. He characterized them as 'wise' babies. Similarly, C. G. Jung, with Karl Kerenyi, (1949) elaborated a myth known as the 'divine child'--identifying an archetype which activates healing and intuitive understanding in children and adults. In their work, Jung (and Kerenyi) explored the 'divine child' archetype from a mythological and a psychological perspective. The following paper elaborates aspects of Ferenczi's 'wise child' and Jung's 'divine child', comparing and contrasting them, and suggesting new perspectives on the connections between Ferenczi's and Jung's theoretical and clinical perspectives, and the two men themselves. As well, and specifically, the paper explores a comparative understanding of the development of two different modalities of early psychodynamic concepts with regard to children and their response to trauma, aspects that continue through theoretical and clinical practice today.     

What makes counting count? Verbal and visuo-spatial contributions to typical and atypical number development

Williams Syndrome (WS) is marked by a relative strength in verbal cognition coupled with a serious impairment in non-verbal cognition. A strong deficit in numerical cognition has been anecdotally reported in this disorder; however, its nature has not been systematically investigated. Here, we tested 14 children with WS (mean age=7 years 2 months), 14 typically developing controls individually matched on visuo-spatial ability (mean age=3 years 5 months) as well as a larger group of typically developing controls (mean age=3 years 4 months) on two tasks to assess their understanding that counting determines the exact quantity of sets (cardinality principle). The understanding of the cardinality principle in children with WS is extremely delayed and only at the level predicted by their visuo-spatial MA. In this clinical group, only language accounted for a significant amount of the variance in cardinality understanding, whereas in the normal comparison group only visuo-spatial competence predicted the variance. The present findings suggest that visuo-spatial ability plays a greater role than language ability in the actual development of cardinality understanding in typically developing children, whereas the opposite obtains for the clinical group.     

Treatment of vocal tics in children with Tourette syndrome: investigating the efficacy of habit reversal

Habit reversal was used to treat vocal tics in 5 children with Tourette syndrome. Vocal tics were reduced in 4 of the 5 children, the untreated motor tics did not increase, and treatment was acceptable to the children's parents.