Verbal Stimulation Research Articles

Functional Syncope in Children and Adolescents: A Retrospective Cohort Study

BackgroundFunctional syncope, or psychogenic pseudosyncope, is often under-recognized. We aimed to show that functional syncope may be diagnosed in most pediatric patients by the initial neurological consultation. MethodsWe reviewed the medical records of patients who were evaluated from 2006 to 2022 in clinic for apparent transient loss of consciousness (a-TLOC) and probable functional syncope. Inclusion criteria included the following: (1) one or more episodes of a-TLOC; (2) spontaneous recovery; (3) age <19 years; (4) patients collapse or lie immobile andunresponsive to verbal stimulation; (5) normal or mildly increased heart rate and blood pressure, if assessed; (6) no other medical causes; and (7) episodes occurred during tilt, electroencephalography, or electrocardiogram or were seen by the author on a smartphone video or in clinic. Patients meeting criteria 1 to 7 were classified as “definite” functional syncope and those meeting criteria 1 to 6 as “probable” functional syncope. ResultsWe identified 31 patients with a-TLOC: 26 (23 females) had functional syncope, aged six to 17 years, whereas five were excluded (two functional seizures, one temporal lobe epilepsy, one vasovagal syncope, and one asthma). The clinical features of 13 patients in each group (definite versus probable) were not different statistically. Episodes were prolonged (1 to 270 minutes, mean 58 minutes) and frequent (daily or weekly in 65%), with eyes closed in 71% and eye flutter in 27%. After mean follow-up of 15 months in 14 patients: episodes disappeared in 29%, decreased >50% in 36%, and remained the same in 36%. ConclusionsFunctional syncope can be diagnosed at the initial neurological consultation without additional diagnostic testing in most patients.

An open pilot of GROW, a responsive parenting intervention for young children with brain injuries: preliminary efficacy

Purpose Families experience stress and burden following their child’s traumatic brain injury (TBI). Parenting styles are related to parent stress and child behavior problems and executive dysfunction. Parent-child interactions are shown to be a promising intervention target. We aimed to examine the preliminary efficacy of Gaining Real life skills Over the Web (GROW) in improving responsive parenting and reducing parent stress and depression in parents of children ages 0-4 who experienced TBI. Method Participants (n = 11) were parents of children four years old or younger, at the time of enrollment, and previously hospitalized overnight for TBI. Parent-reported measures included the Center for Epidemiologic Studies Depression Scale, Parenting Stress Inventory—Short Form, and Patient-Reported Outcomes Measurement Information System. Recordings of parent-child interactions were coded using the Play and Learning Strategies coding scheme. Study hypotheses were analyzed using independent samples t-tests, chi square analyses, and linear mixed models. Results Parental warmth (t=-3.64, p = 0.001, d=.97), responsiveness (t=-2.09, p = 0.047, d = 0.70), and verbal stimulation (t=-2.30, p = 0.029, d = 0.75) increased significantly from pretreatment to posttreatment. Improvements in parental warmth were maintained 3 months posttreatment (t=-3.15, p = 0.004, d = 1.16). There were no significant changes in depression, parental stress, or quality of life. Conclusions Results provide preliminary support for the efficacy of GROW in improving responsive parenting for children following early TBI. Future directions include tailoring GROW to better fit the needs of families and testing the utility through a randomized control trial.

Bedside ultrasound monitoring of optic nerve sheath diameter is a predictive factor for 28-day coma, delirium and death in etiologically diverse critically ill patients

To explore whether the optic nerve sheath diameter (ONSD) within 24 hours of intensive care unit (ICU) admission is the predictor of 28-day delirium or coma and death in etiologically diverse critically ill patients. A prospective, observational study was conducted. The critically ill patients admitted to the emergency ICU of Cangzhou Central Hospital from January 2021 to October 2022 were enrolled. Bedside ultrasound monitoring ONSD was performed within 24 hours of ICU admission. The consciousness status was assessed daily during ICU hospitalization. Coma was defined as Glasgow coma scale (GCS) score < 8 or Richmond agitation-sedation scale (RASS) score -4 or -5. Delirium was defined as responsiveness to verbal stimulation and with a positive confusion assessment method-intensive care unit (CAM-ICU). A positive result of CAM-ICU was defined as acute change or fluctuating course of mental status+inattention+altered level of consciousness or disorganized thinking. X-tile software analysis was used to visualize the best cut-off value for creating divisions in predicting 28-day coma or delirium and death, and then Kaplan-Meier curves were plotted. ONSD≥the optimal cut-off value from X-tile analysis was defined as ONSD broadening. ONSD broadening and related indicators were enrolled, and multivariate Cox regression analysis was used to analyze the risk factors of 28-day coma or delirium and 28-day death in etiologically diverse critically ill patients. A total of 321 critically ill patients were enrolled. Of them, 49 had primary brain injury, 54 had hypoxic ischemic brain injury (HIBI) after cardiac arrest, 70 had acute heart failure, 73 had sepsis, and 75 had other causes. Coma affected 184 patients (57.3%), and delirium affected 173 patients (53.9%). At 28 days of follow-up, 100 patients died, 16 patients remained comatose and 20 patients remained delirious. In all patients, as the GCS score decreased upon admission to the ICU, there was a gradually increasing trend in ONSD [GCS score 15 group: 5.20 (4.93, 5.43) mm, GCS score 10-14 group: 5.30 (4.90, 5.65) mm, GCS score 6-9 group: 5.40 (5.10, 5.80) mm, GCS score < 6 group: 5.70 (5.20, 5.96) mm, P < 0.05]. X-tile software analysis showed that in all patients and five etiological subgroups, ONSD broadening was a predictor for 28-day coma or delirium, and the optimal cut-off value was obtained (5.60 mm for all patients, 4.90 mm for primary brain injury, 5.75 mm for HIBI after cardiac arrest, 5.40 mm for acute heart failure, 5.90 mm for sepsis, and 5.75 mm for other causes). The Kaplan-Meier curves were plotted according to the optimal cut-off values, and the results showed that the higher the ONSD, the higher the incidence and duration of coma or delirium within 28 days in above patient population. X-tile software analysis showed that in all patients, and HIBI after cardiac arrest, sepsis and other causes patients, ONSD was a predictor for 28-day death, and the optimal cut-off value was obtained (6.20 mm for all patients, 5.85 mm for HIBI after cardiac arrest, 5.35 mm for sepsis, and 6.10 mm for other causes). The Kaplan-Meier curves were plotted according to the optimal cut-off values, and the results showed that the higher the ONSD, the higher the 28-day survival rate and the shorter survival duration in above patient population. Multivariate Cox regression analysis showed that ONSD broadening was an independent risk factor for 28-day coma or delirium in all patients [hazard ratio (HR) = 1.513, 95% confidence interval (95%CI) was 1.093-2.095, P = 0.013] and patients with primary brain injury (HR = 5.739, 95%CI was 2.112-15.590, P = 0.001). However, ONSD broadening was not independently associated with 28-day death in all patients or in the five etiological subgroups. ONSD within 24 hours of ICU admission is an independent risk factor for 28-day coma or delirium in etiologically diverse critically ill patients. It serves as a predictor for 28-day coma or delirium in 5 subgroups of etiology including primary brain injury, HIBI after cardiac arrest, acute heart failure, sepsis, and other causes, but not for 28-day death.

Evaluating the Quality of Systematic Reviews on Pediatric Sedation in Dentistry: An Umbrella Review.

Sedation is a depression of a patient's state of consciousness, induced by medications, that can reach different levels of intensity during a medical procedure. Conscious sedation produces a minimally depressed level of consciousness without impairment of the ability to maintain an open airway, of protective reflexes or of responses to verbal and physical stimulation. This umbrella review is aimed at critically assessing the available systematic reviews (SRs) and meta-analyses (MA) on sedation in children/adolescents. An electronic database search was conducted that included Pubmed-Medline, Web of Science, Cochrane, Scopus, Scielo, Embase, LILACS and TRIP and the scope of which extended until January 2023. The risk of bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). Of 998 entries, 37 SRs were included. In terms of methodological quality, eight studies were assessed as having critically low quality, four studies had low quality, nine studies had moderate quality, and sixteen were considered to be of high quality. Based on the current guidelines, the most employed drugs in pediatric dentistry for sedation are nitrous oxide and midazolam; however, the available evidence supporting their use is insufficient and of low/critically low quality. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). The optimal dose of oral midazolam is 0.75 mg/kg. The level of methodological quality of SRs is expected to increase according to the results and future directions of this umbrella review.

Digital Echoes of Discrimination: Investigating the Reception of Hate Speech Against Korean Chinese in Online Communities

abstract: This study aims to investigate the circulation, consumption, and learning of anonymous users’ hatred in online communities, focusing on the reception process of hate speech targeting Korean Chinese people, a group long discriminated against by native Koreans and the media. It identifies critical factors shaping attitudes toward Korean Chinese (i.e., Chaoxianzu), defining hate as long-term sentiments resulting from repeated immediate emotions triggered by specific incidents and social identities. This study adopts a grounded theory approach, employing interviews to construct a paradigm model that captures the authentic perspectives of online community users. Following the coding process, 17 categories and 38 subcategories emerged. Online audiences consolidate or maintain their attitudes through admission, resistance, exploration, and reproduction after exposure to hate expressions toward Korean Chinese. Self-intervention, personal experience, quality of verbal stimulation, and patriotism function as interventional conditions or environmental contexts throughout this process.

Evaluation of Patients Complaining of Staring Spells: Single Center Experience

Objective: This study aimed to analyze the demographic characteristics, spell semiology, and electroencephalographic characteristics of children with a complaint of staring spells and determine the factors that differentiate epileptic and non-epileptic etiology. Material and Methods: Fifty-six patients were included retrospectively between October 1, 2022, and December 1, 2023. The patients’ age, gender, co-morbidities, and other characteristics of the staring spells (duration, frequency, automatism, and presence of post-attack symptoms), access time to the pediatric neurologist, referring unit and access time to the final diagnosis were also recorded. Electroencephalography (EEG) was performed on all patients. Results: Fifty-six patients were divided into two according to epileptic and non-epileptic etiology. Thirty-three patients (59%) were diagnosed with non-epileptic staring spells, 15 (26.7%) were diagnosed with generalized epilepsy, and 8 (14.3%) were diagnosed with focal epilepsy. The non-epileptic group had a longer spell time and spell frequency, the presence of verbal stimulation response, and no post-attack symptoms (p&amp;lt;0.001). The access time to the pediatric neurologist was detected as 5.5 days, and the access time to the final diagnosis was 6.6 days. EEG was diagnostic in 100% of the epileptic group. Most of the patients were referred by pediatricians and family physicians (p&amp;lt;0.001). Conclusion: Identifying the cause of staring spells is crucial for further follow-up. In this study, we emphasized that history and routine EEG are important to determine the etiology. It has been observed that access time to pediatric neurologists and final diagnosis are shorter in our country compared to the literature. It can be concluded that pediatricians and family physicians have a high awareness of staring spells.

Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation.

Family caregivers (FC) contribute to reducing the misdiagnosis rate in patients with disorders of consciousness (DOC). Unfortunately, the recent pandemic of COVID-19 imposed drastic restrictions that limited the access of FC to the sensory/cognitive stimulation protocols. Telemedicine approaches have been implemented to avoid discontinuity in care pathways and to ensure caregivers involvement in rehabilitation programs. The aim was to investigate whether the presence of FC remotely connected might help clinicians in eliciting higher cortically mediated behavioral responses in patients with DOC. Cross-sectional study. Post-acute Unit of Neurorehabilitation. DOC due to severe brain injury. Consecutive patients with DOC were assessed by means of the Coma Recovery Scale-Revised (CRS-R) by two expert examiners. Each patient underwent to five assessments in two weeks in three different conditions: 1) by the examiner only (standard); 2) with the verbal stimulation given by the FC remotely connected by PC tablet (caregiver in remote); and 3) with the verbal stimulation given by the FC physically present (caregiver in presence). Thirty patients with DOC (VS/UWS=10; MCS=20; mean age: 51, range: 21-79; vascular: 16; anoxic: 6; TBI=8) and their FC were enrolled. Higher total scores of CRS-R were recorded both in "caregiver in remote" and in "caregiver in presence" than in standard condition (standard vs. remote, Z=2.942, P=0.003; standard vs. presence, Z=3.736, P<0.001). Furthermore, the administration of the CRS-R with a FC, elicited higher levels of behavioral responses in MCS patients, than CRS-R performed in standard condition. In particular, 2 patients out of 30 (6.66%) showed higher scores and better diagnosis when the CRS-R was administered with FC in remote. Similarly, 5 out of 30 patients (16.66%) showed better diagnoses when the CRS-R was administered with FC in presence. Five patients changed diagnosis between standard and presence conditions (3 MCS- were diagnosed as MCS+; 2 MCS+ were diagnosed as conscious). Our findings add new evidence regarding the beneficial role of family members in the diagnosis of DOC, even mediated by telemedicine approach. In future guidelines, FC should have an active and supporting role in the diagnostic and rehabilitative process of DOC.

Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery: a randomised controlled trial

BackgroundAn orientation strategy providing repeated verbal reminders of time, place, and person has been widely used for the non-pharmacological management of delirium. We hypothesised that using this strategy could reduce emergence agitation and improve recovery profiles. MethodsThis prospective observer-blinded RCT included male and female patients aged 18–70 yr undergoing minimally invasive abdominal surgery. During emergence from general anaesthesia, subjects in the orientation group (n=57) were provided a repeated reminder, including orientation: ‘(Patient's name), you are now recovering from general anaesthesia after surgery at Seoul National University Hospital, open your eyes!’ via noise-cancelling headphones, whereas those in the control group (n=57) only heard their name: ‘(Patient's name), open your eyes!‘. The primary outcome was the incidence of emergence agitation (Riker sedation agitation scale [SAS] ≥5). The incidence of dangerous agitation (SAS=7), maximal SAS score in the operating room, and recovery profile until 24 h postoperatively were evaluated as secondary outcomes. ResultsThe incidence of emergence agitation in the operating room was significantly lower in the orientation group than in the control group (16/57 [28.1%] vs 38/57 [66.7%]; relative risk [95% confidence interval], 0.5 [0.3–0.7]; P<0.001). The incidence of dangerous agitation (0 [0.0%] vs 10 [17.5%], P=0.001) and the median maximal SAS score (4 [4–5] vs 5 [4–6], P<0.001) were also lower in the orientation group. Secondary outcomes, other than agitation-related variables, were comparable between the two groups. ConclusionsRepeated verbal stimulation of orientation may serve as a simple and easily applicable strategy to reduce emergence agitation after general anaesthesia. Clinical trial registrationNCT05105178.

CHANGE OF LANGUAGE DEVELOPMENT WITH FINGER PUPPETS STIMULATION IN CHILDREN'S PRESCHOOL

Introduction: The study is based on a lack of children's language skills to repeat the contents of the previous story—evidence of the speaking ability of most children not being good enough. An easy-to-use verbal skill stimulation tool is the finger puppet. Stimulation finger puppet effective with storytelling method. This study aims to analyze the effectiveness of finger puppet stimulation on the language development of preschool children. Methods: This study used to pretest and posttest control group design. The sampling technique was simple random sampling, with a sample of 66 respondents (33 intervention, 33 control). The research instrument by observation used a checklist. The bivariate analysis uses the Wilcoxon and Mann-Whitney tests with a significance level α&lt;0,05. Results: The Wilcoxon test showed finger puppet stimulation effectively improved children's language development in the intervention group (p=0,000). The Mann-Whitney test shows a difference between children's language development in the intervention group and the control group (p=0,000). Conclusions: The development of children's language will be better stimulation often because, with simulation, children will record the language known and practice when communicating with other people.

Electroencephalogram Pattern under Exposure of Audio Stimulation and Verbal Memory Assessment

Discovering brain activities during mental and cognitive assessments is interesting research work. It aids people in understanding how the information is stimulated and processed in the brain. This recent work aims to investigate brain activities using electroencephalography (EEG) under audio and verbal memory assessment stimulation. Besides, the effect of audio on verbal memory performance was investigated based on behavioral data and its association with EEG patterns. The subject was required to memorize a list of words at three difficulties level under control conditions, listening to their favorite song, and exposure to ambient noise. The brain signal was acquired during the memorizing period using an EEG machine based 10-20 electrode placement system. The raw EEG signal was filtered using a Butterworth bandpass filter at 4 to 40 Hz. After that, the brain rhythms of alpha, beta, gamma, and theta were extracted from the EEG signal. The mean voltage and relative rhythm power were obtained to determine their pattern under provided stimulation. The findings indicated that the mean EEG voltage and relative rhythms power were the highest and the most influenced under audio stimulation for all assessment phases compared to the control condition. The relative rhythm power showed the increment and decrement trend relative to the control condition. Theta rhythms exhibit the highest relative power with the maximum value found in ambient noise stimulation. The behavioral data revealed that the subject memorized better the word lists in ambient noise conditions.

Changes in cortical auditory evoked potentials in response to auditory training in elderly hearing aid users: A pilot study.

To compare the cortical auditory evoked potential responses pre-and post-Auditory Musical Training associated with hearing aid adaptation in elderly people with presbycusis. This is a pilot, prospective, randomized, single-blind study. Eight presbiacusis elderly people between 65 and 80 years, new hearing aid users, divided into two groups participated in the study: Hearing Aid Group: use of hearing aid; and Auditory Training Group: use of hearing aid in addition to musical auditory training for 16 sessions. All participants were submitted to cortical auditory evoked potential tests with verbal stimulation in two different moments: Initial assessment, carried out before hearing aid adaptation and auditory training, and after three months, final assessment at the end of the auditory training sessions. All participants were adapted bilaterally with digital mini hearing aids. There was a decrease in the P3a latency component for the Auditory Training Group when initial and final assessment were compared. There was a change in the cortical auditory evoked potential in elderly people with presbycusis in response to the Musical Auditory Training associated with the use of hearing aids in elderly people with presbycusis.

Socioeconomic status and caregiving sensitivity among Chinese childcare centre teachers: adaptive caregiving belief as a mediator and childcare centre type as a moderator

ABSTRACT The critical developmental implications of childcare centre teachers’ caregiving sensitivity have been extensively documented. More efforts are pressing to identify antecedents of such sensitivity and elucidate implicated mechanisms. This study examined the association between socioeconomic status and caregiving sensitivity among Chinese childcare centre teachers, with adaptive caregiving belief as a mediator and childcare centre type as a moderator. Survey data for 1,316 Chinese teachers were used. The results indicated that teachers’ monthly income was positively associated with their caregiving sensitivity via positive associations with their verbal stimulation beliefs. This effect did not vary by childcare centre type. Our findings highlight possible avenues for interventions aimed at promoting caregiving quality in childcare centre setting, such as improving teachers’ adaptive caregiving belief.

Effect of sustained high buprenorphine plasma concentrations on fentanyl-induced respiratory depression: A placebo-controlled crossover study in healthy volunteers and opioid-tolerant patients.

BackgroundOpioid-induced respiratory depression driven by ligand binding to mu-opioid receptors is a leading cause of opioid-related fatalities. Buprenorphine, a partial agonist, binds with high affinity to mu-opioid receptors but displays partial respiratory depression effects. The authors examined whether sustained buprenorphine plasma concentrations similar to those achieved with some extended-release injections used to treat opioid use disorder could reduce the frequency and magnitude of fentanyl-induced respiratory depression.MethodsIn this two-period crossover, single-centre study, 14 healthy volunteers (single-blind, randomized) and eight opioid-tolerant patients taking daily opioid doses ≥90 mg oral morphine equivalents (open-label) received continuous intravenous buprenorphine or placebo for 360 minutes, targeting buprenorphine plasma concentrations of 0.2 or 0.5 ng/mL in healthy volunteers and 1.0, 2.0 or 5.0 ng/mL in opioid-tolerant patients. Upon reaching target concentrations, participants received up to four escalating intravenous doses of fentanyl. The primary endpoint was change in isohypercapnic minute ventilation (VE). Additionally, occurrence of apnea was recorded.ResultsFentanyl-induced changes in VE were smaller at higher buprenorphine plasma concentrations. In healthy volunteers, at target buprenorphine concentration of 0.5 ng/mL, the first and second fentanyl boluses reduced VE by [LSmean (95% CI)] 26% (13–40%) and 47% (37–59%) compared to 51% (38–64%) and 79% (69–89%) during placebo infusion (p = 0.001 and < .001, respectively). Discontinuations for apnea limited treatment comparisons beyond the second fentanyl injection. In opioid-tolerant patients, fentanyl reduced VE up to 49% (21–76%) during buprenorphine infusion (all concentration groups combined) versus up to 100% (68–132%) during placebo infusion (p = 0.006). In opioid-tolerant patients, the risk of experiencing apnea requiring verbal stimulation following fentanyl boluses was lower with buprenorphine than with placebo (odds ratio: 0.07; 95% CI: 0.0 to 0.3; p = 0.001).InterpretationResults from this proof-of-principle study provide the first clinical evidence that high sustained plasma concentrations of buprenorphine may protect against respiratory depression induced by potent opioids like fentanyl.

Feasibility of Chest Wall and Diaphragm Proprioceptive Neuromuscular Facilitation (PNF) Techniques in Mechanically Ventilated Patients.

Physical therapy is part of the treatment for patients admitted to ICU. Proprioceptive neuromuscular facilitation (PNF) is one of the physiotherapy concepts including manual techniques and verbal stimulation. The purpose of this paper is to examine the feasibility of PNF techniques in mechanically ventilated (MV) ICU patients. Another aim is to verify whether the technique using resistance during the patient’s inhalation will have a different effect than the technique used to teaching the correct breathing patterns. Methods: Patients admitted to tertiary ICU were enrolled in this study, randomly divided into two groups, and received four 90-second manual breathing stimulations each. The following vital signs were assessed: HR, SBP, DBP, and SpO2. Results: 61 MV ICU adult patients (mean age 67.8; 25 female and 36 male) were enrolled in this study. No significant differences in HR, SBP, and DBP were observed both for two techniques measured separately and between them. Statistically significant differences were noticed analysing SpO2 in the rhythmic initiation technique (RIT) group (p-value = 0.013). Conclusions: Short-term PNF interventions did not influence clinically relevant vital parameters among MV patients and seem to be feasible in this group of ICU patients.

Porous Polydimethylsiloxane Elastomer Hybrid with Zinc Oxide Nanowire for Wearable, Wide-Range, and Low Detection Limit Capacitive Pressure Sensor.

We propose a flexible capacitive pressure sensor that utilizes porous polydimethylsiloxane elastomer with zinc oxide nanowire as nanocomposite dielectric layer via a simple porogen-assisted process. With the incorporation of nanowires into the porous elastomer, our capacitive pressure sensor is not only highly responsive to subtle stimuli but vigorously so to gentle touch and verbal stimulation from 0 to 50 kPa. The fabricated zinc oxide nanowire–porous polydimethylsiloxane sensor exhibits superior sensitivity of 0.717 kPa−1, 0.360 kPa−1, and 0.200 kPa−1 at the pressure regimes of 0–50 Pa, 50–1000 Pa, and 1000–3000 Pa, respectively, presenting an approximate enhancement by 21−100 times when compared to that of a flat polydimethylsiloxane device. The nanocomposite dielectric layer also reveals an ultralow detection limit of 1.0 Pa, good stability, and durability after 4000 loading–unloading cycles, making it capable of perception of various human motions, such as finger bending, calligraphy writing, throat vibration, and airflow blowing. A proof-of-concept trial in hydrostatic water pressure sensing has been demonstrated with the proposed sensors, which can detect tiny changes in water pressure and may be helpful for underwater sensing research. This work brings out the efficacy of constructing wearable capacitive pressure sensors based on a porous dielectric hybrid with stress-sensitive nanostructures, providing wide prospective applications in wearable electronics, health monitoring, and smart artificial robotics/prosthetics.

Social Networking Sites and Grammar Learning: The Views of Learners and Practitioners

This study examines the impact of online English Teachers' Stroking Behaviors on L2 grammar learning through online learning of L2 grammar for EFL learners. Sixty intermediate EFL learners were chosen for this reason and split randomly into three telegram groups. A researcher-made grammar test was administered as a pre-test prior to beginning the online course. For all three groups during one month, the determined grammar points were instructed in the same manner by one teacher. The instructor also used some pre-planned terms and phrases in the first category that suggested a positive conditional stimulation in her input during the teaching process. The researcher often used some per-planned terms and phrases with negative conditional stimulation for the next group, and the instructor provided the students with the input for the last group as the control group, suggesting no emotional themes. Another researcher-made grammar test was given as the post test for three groups at the final session. The findings showed that the positive verbal conditional stimulation of the teacher was substantially more efficient than the negative conditional stimulations; however, the negative ones were more efficient than no stimulation. Interview results revealed that, compared to receiving no stimulations, the participants prefer to receive stimulations from the instructor, including harmful ones.

Anesthesia Depth Measurement with Bispectral Index Monitoring during Minor Surgery among Children With and Without Cerebral Palsy

Introduction: Unfortunately, few studies have been performed on the pharmacodynamic effects of anesthesia in children suffering cerebral palsy(CP).Patients were candidates for surgeryfor various reasons. Due to the lower need for anesthesiain these children, side effects of various anesthetic agents, adverse drug reactions, delayed awareness and higher costs can be prevented in these children. The present study aims to evaluate and compare the depth of anesthesia in minor surgeries using Bispectral Index (BSI) in children sufferingCP. Materials and Methods: This cohort study was performed on 64 children aged two to ten years in two groups with and without cerebral palsy inMofid Hospital, Tehran, Iran in 2020. BIS index, mean arterial blood pressure and heart rate were measured before and after anesthesia induction, every ten minutes during operation, after extubation and when being able to respond to verbal stimulation. Results: This studyexamined 64 patients equally divided into two study groups “with and without cerebral palsy”. The mean BIS level in children suffering CP was lower than children without cerebral palsy. The dosage of isoflurane gas used for anesthesia in CPpatientswas meaningfully lower than itsdosage in children without cerebral palsy. Conclusion: Monitoring of anesthesia in this study, showed that use of BIS could reduce the use of anesthetic agents and related side effects to provide the appropriate depth of anesthesia.

Child Development Knowledge and Father Engagement: The Mediating Role of Parenting Self-efficacy

Early father engagement is associated with numerous positive child outcomes including cognitive development, emotional regulation, and fewer problem behaviors. Various fathering programs attempt to encourage father engagement through teaching fathers about young children’s development and needs. This study examined 181 low-income fathers’ child development knowledge (self-perceived and objective) as predictors of father engagement (verbal stimulation, caregiving, and physical play) with infants. Additionally, parenting self-efficacy (PSE) was examined as a mediator. Results revealed that fathers’ self-perceived child development knowledge positively predicted engagement with infants (verbal stimulation and caregiving), but objective knowledge did not. PSE did not mediate the relationship between self-perceived knowledge and father engagement. These findings yield important implications for fathering research and interventions, suggesting that it may be particularly beneficial to increase fathers’ confidence in their ability to understand and meet their child’s needs rather than exclusively focusing on improving fathers’ knowledge of child development.

Формирование компенсаторной и прагматической компетенций студентов языковых направлений подготовки с помощью когнитивно-вербальной деятельности

The research objective includes identifying the role of verbal cognitive activity when forming linguistic students’ compensatory and pragmatic competences. The article analyses correlation of linguistic competences and speech activity (language usage) from the viewpoint of foreign language teaching. Specificity of the competences manifestation depending on a type of thinking is revealed. Scientific originality of the research involves justifying the thesis that students’ verbal cognitive activity stimulation allows simultaneous development of their pragmatic and compensatory competences taking into account similarity of intellectual models. The authors introduce a definition of verbal cognitive activity and reveal the educational potential of the case-study method. The research findings are as follows: the authors identify the stages of verbal cognitive activity development with a focus on forming students’ compensatory and pragmatic competences on the basis of the case-study technology.

Analgesia in the intensive care unit

Background. Sedation is a technique of using drugs to put a patient in a condition in which he can tolerate unpleasant procedures, while maintaining cardiorespiratory function. The main problems associated with analgesia and sedation (AS) are associated with the development of hypoxia, vomiting and aspiration, hypotension and hemodynamic instability, apnea.&#x0D; Objective. To describe the features of the modern AS.&#x0D; Materials and methods. Analysis of literature data on this issue.&#x0D; Results and discussion. AS can be performed with the help of different drugs. Benzodiazepines (preferably midazolam) and/or propofol in combination with low doses of opioids should be used in patients with concomitant cardiac abnormalities. The use of propofol in this category of patients is carried out by fractional administration (on average, 50 mg) with an interval of 30-40 seconds until an adequate sedative effect is achieved. Dexmedetomidine has been suggested as an adjuvant. It should be kept in mind that benzodiazepines are not suitable for creating a long-lasting sedative effect, and can cause paradoxical agitation in the elderly. Features of sedation in patients at risk of obstructive sleep apnea syndrome are represented with the use of a minimum dose of hypnotics without the use of opioids. Dexmedetomidine is considered as an alternative. It is advisable to use continuous positive airways pressure by inhalation of oxygen through the nasal cannula. Patients with morbid obesity should avoid lying on their back. For the effective control of airway patency, it is advisable to use endotracheal intubation. It is recommended to avoid long-acting drugs and drugs that cause respiratory depression. The use of propofol in this group is often associated with respiratory complications, so the use of remifentanil and dexmedetomidine is recommended as an alternative. For patients with chronic renal failure, midazolam and/or fentanyl should be preferred, however, the cardiovascular and pulmonary side effects of any of these drugs are exacerbated when they are used concomitantly. In patients with hepatic dysfunction, midazolam may exacerbate symptoms, so propofol should be preferred. If the latter is used, the doctor should be near the patient throughout the procedure and monitor him exclusively. As for dexmedetomidine, this drug selectively binds and activates presynaptic α2-adrenoreceptors, inhibiting the release of norepinephrine. As a result, postsynaptic activation of adrenoceptors is inhibited, sympathetic activity is suppressed, leading to analgesia, sedation and decrease of anxiety. Under conditions of mild or moderate sedation caused by dexmedetomidine, patients respond to verbal stimulation and are able to communicate and cooperate with medical staff, and after awakening show high results in tests of central nervous system activity. Dexmedetomidine is less likely to cause postoperative delirium than midazolam (54 % vs. 76.6 %) and does not adversely affect sleep quality, unlike propofol. Dexmedetomidine can be used together with paracetamol. Intravenous paracetamol significantly reduces postoperative pain and the need for opioids.&#x0D; Conclusions. 1. AS can be performed with the use of benzodiazepines, propofol, dexmedetomidine. 2. Benzodiazepines are not suitable for creating a long-lasting sedative effect, and can cause paradoxical agitation in the elderly. 3. Patients with different comorbid conditions are characterized by different features of required AS. 4. Dexmedetomidine gives the patient the opportunity to communicate and cooperate with medical staff, rarely causes postoperative delirium and does not adversely affect the sleep quality. 5. Intravenous paracetamol significantly reduces postoperative pain and the need for opioids.