Measurements of adequacy of anesthesia and level of consciousness during surgery and intensive care

The adequacy of anesthesia has been studied since the introduction of balanced general anesthesia. Commercial monitors based on electroencephalographic (EEG) signal analysis have been available for monitoring the hypnotic component of anesthesia from the beginning of the 1990s. Monitors measuring the depth of anesthesia assess the cortical function of the brain, and have gained acceptance during surgical anesthesia with most of the anesthetic agents used. However, due to frequent artifacts, they are considered unsuitable for monitoring consciousness in intensive care patients. The assessment of analgesia is one of the cornerstones of general anesthesia. Prolonged surgical stress may lead to increased morbidity and delayed postoperative recovery. However, no validated monitoring method is currently available for evaluating analgesia during general anesthesia. Awareness during anesthesia is caused by an inadequate level of hypnosis. This rare but severe complication of general anesthesia may lead to marked emotional stress and possibly posttraumatic stress disorder. In the present series of studies, the incidence of awareness and recall during outpatient anesthesia was evaluated and compared with that of in inpatient anesthesia. A total of 1500 outpatients and 2343 inpatients underwent a structured interview. Clear intraoperative recollections were rare the incidence being 0.07% in outpatients and 0.13% in inpatients. No significant differences emerged between outpatients and inpatients. However, significantly smaller doses of sevoflurane were administered to outpatients with awareness than those without recollections (p<0.05). EEG artifacts in 16 brain-dead organ donors were evaluated during organ harvest surgery in a prospective, open, nonselective study. The source of the frontotemporal biosignals in brain-dead subjects was studied, and the resistance of bispectral index (BIS) and Entropy to the signal artifacts was compared. The hypothesis was that in brain-dead subjects, most of the biosignals recorded from the forehead would consist of artifacts. The original EEG was recorded and State Entropy (SE), Response Entropy (RE), and BIS were calculated and monitored during solid organ harvest. SE differed from zero (inactive EEG) in 28%, RE in 29%, and BIS in 68% of the total recording time (p<0.0001 for all). The median values during the operation were SE 0.0, RE 0.0, and BIS 3.0. In four of the 16 organ donors, EEG was not inactive, and unphysiologically distributed, nonreactive rhythmic theta activity was present in the original EEG signal. After the results from subjects with persistent residual EEG activity were excluded, SE, RE, and BIS differed from zero in 17%, 18%, and 62% of the recorded time, respectively (p<0.0001 for all). Due to various artifacts, the highest readings in all indices were recorded without neuromuscular blockade. The main sources of artifacts were electrocauterization, electromyography (EMG), 50-Hz artifact, handling of the donor, ballistocardiography, and electrocardiography. In a prospective, randomized study of 26 patients, the ability of Surgical Stress Index (SSI) to differentiate patients with two clinically different analgesic levels during shoulder surgery was evaluated. SSI values were lower in patients with an interscalene brachial plexus block than in patients without an additional plexus block. In all patients, anesthesia was maintained with desflurane, the concentration of which was targeted to maintain SE at 50. Increased blood pressure or heart rate (HR), movement, and coughing were considered signs of intraoperative nociception and treated with alfentanil. Photoplethysmographic waveforms were collected from the contralateral arm to the operated side, and SSI was calculated offline. Two minutes after skin incision, SSI was not increased in the brachial plexus block group and was lower (38 ± 13) than in the control group (58 ± 13, p<0.005). Among the controls, one minute prior to alfentanil administration, SSI value was higher than during periods of adequate antinociception, 59 ± 11 vs. 39 ± 12 (p<0.01). The total cumulative need for alfentanil was higher in controls (2.7 ± 1.2 mg) than in the brachial plexus block group (1.6 ± 0.5 mg, p=0.008). Tetanic stimulation to the ulnar region of the hand increased SSI significantly only among patients with a brachial plexus block not covering the site of stimulation. Prognostic value of EEG-derived indices was evaluated and compared with Transcranial Doppler Ultrasonography (TCD), serum neuron-specific enolase (NSE) and S-100B after cardiac arrest. Thirty patients resuscitated from out-of-hospital arrest and treated with induced mild hypothermia for 24 h were included. Original EEG signal was recorded, and burst suppression ratio (BSR), RE, SE, and wavelet subband entropy (WSE) were calculated. Neurological outcome during the six-month period after arrest was assessed with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Twenty patients had a CPC of 1-2, one patient had a CPC of 3, and nine patients died (CPC 5). BSR, RE, and SE differed between good (CPC 1-2) and poor (CPC 3-5) outcome groups (p=0.011, p=0.011, p=0.008, respectively) during the first 24 h after arrest. WSE was borderline higher in the good outcome group between 24 and 48 h after arrest (p=0.050). All patients with status epilepticus died, and their WSE values were lower (p=0.022). S-100B was lower in the good outcome group upon arrival at the intensive care unit (p=0.010). After hypothermia treatment, NSE and S-100B values were lower (p=0.002 for both) in the good outcome group. The pulsatile index was also lower in the good outcome group (p=0.004). In conclusion, the incidence of awareness in outpatient anesthesia did not differ from that in inpatient anesthesia. Outpatients are not at increased risk for intraoperative awareness relative to inpatients undergoing general anesthesia. SE, RE, and BIS showed non-zero values that normally indicate cortical neuronal function, but were in these subjects mostly due to artifacts after clinical brain death diagnosis. Entropy was more resistant to artifacts than BIS. During general anesthesia and surgery, SSI values were lower in patients with interscalene brachial plexus block covering the sites of nociceptive stimuli. In detecting nociceptive stimuli, SSI performed better than HR, blood pressure, or RE. BSR, RE, and SE differed between the good and poor neurological outcome groups during the first 24 h after cardiac arrest, and they may be an aid in differentiating patients with good neurological outcomes from those with poor outcomes after out-of-hospital cardiac arrest.

Linguistic grammars with very low complexity

We have presented an overview of the FSIG approach and related FSIG gram- mars to issues of very low complexity and parsing strategy. We ended up with serious optimism according to which most FSIG grammars could be decom- posed in a reasonable way and then processed efficiently.

Taking the linguistic turn seriously: Strategy as a multifaceted interdiscursive phenomenon

Although we have seen a proliferation of studies examining the discursive aspects of strategy, the full potential of the linguistic turn has not yet been realized. This paper argues for a multifaceted interdiscursive approach that can help to go beyond simplistic views on strategy as unified discourse and pave the way for the new research efforts. At the meta-level, it is important to focus attention on struggles over competing conceptions of strategy in this body of knowledge. At the meso-level it is interesting to examine alternative strategy narratives to better understand the polyphony and dialogicality in organizational strategizing. At the micro-level, it is useful to reflect on the rhetorical tactics and skills that are used in strategy conversations to promote or resist specific views. This paper calls for new focused analyses at these different levels of analysis, but also for studies of the processes linking these levels.

Reasonability and the Linguistic - Division of Labor in Institutional Work

We examine institutional work from a discursive perspective and argue that reasonability, the existence of acceptable justifying reasons for beliefs and practices, is a key part of legitimation. Drawing on philosophy of language, we maintain that institutional work takes place in the context of ‘space of reasons’ determined by widely held assumptions about what is reasonable and what is not. We argue that reasonability provides the main contextual constraint of institutional work, its major outcome, and a key trigger for actors to engage in it. We draw on Hilary Putnam’s concept ‘division of linguistic labor’ to highlight the specialized distribution of knowledge and authority in defining valid ways of reasoning. In this view, individuals use institutionalized vocabularies to reason about their choices and understand their context with limited understanding of how and why these structures have become what they are. We highlight the need to understand how professions and other actors establish and maintain the criteria of reasoning in various areas of expertise through discursive institutional work.

Language universals and linguistic complexity : Three case studies in core argument marking

In this dissertation I study language complexity from a typological perspective. Since the structuralist era, it has been assumed that local complexity differences in languages are balanced out in cross-linguistic comparisons and that complexity is not affected by the geopolitical or sociocultural aspects of the speech community. However, these assumptions have seldom been studied systematically from a typological point of view. My objective is to define complexity so that it is possible to compare it across languages and to approach its variation with the methods of quantitative typology. My main empirical research questions are: i) does language complexity vary in any systematic way in local domains, and ii) can language complexity be affected by the geographical or social environment? These questions are studied in three articles, whose findings are summarized in the introduction to the dissertation. In order to enable cross-language comparison, I measure complexity as the description length of the regularities in an entity; I separate it from difficulty, focus on local instead of global complexity, and break it up into different types. This approach helps avoid the problems that plagued earlier metrics of language complexity. My approach to grammar is functional-typological in nature, and the theoretical framework is basic linguistic theory. I delimit the empirical research functionally to the marking of core arguments (the basic participants in the sentence). I assess the distributions of complexity in this domain with multifactorial statistical methods and use different sampling strategies, implementing, for instance, the Greenbergian view of universals as diachronic laws of type preference. My data come from large and balanced samples (up to approximately 850 languages), drawn mainly from reference grammars. The results suggest that various significant trends occur in the marking of core arguments in regard to complexity and that complexity in this domain correlates with population size. These results provide evidence that linguistic patterns interact among themselves in terms of complexity, that language structure adapts to the social environment, and that there may be cognitive mechanisms that limit complexity locally. My approach to complexity and language universals can therefore be successfully applied to empirical data and may serve as a model for further research in these areas.

Linguistic and perceptual processing of communicative cues in Asperger Syndrome

Asperger Syndrome (AS) belongs to autism spectrum disorders where both verbal and non-verbal communication difficulties are at the core of the impairment. Social communication requires a complex use of affective, linguistic-cognitive and perceptual processes. In the four studies included in the current thesis, some of the linguistic and perceptual factors that are important for face-to-face communication were studied using behavioural methods. In all four studies the results obtained from individuals with AS were compared with typically developed age, gender and IQ matched controls. First, the language skills of school-aged children were characterized in detail with standardized tests that measured different aspects of receptive and expressive language (Study I). The children with AS were found to be worse than the controls in following complex verbal instructions. Next, the visual perception of facial expressions of emotion with varying degrees of visual detail was examined (Study II). Adults with AS were found to have impaired recognition of facial expressions on the basis of very low spatial frequencies which are important for processing global information. Following that, multisensory perception was investigated by looking at audiovisual speech perception (Studies III and IV). Adults with AS were found to perceive audiovisual speech qualitatively differently from typically developed adults, although both groups were equally accurate in recognizing auditory and visual speech presented alone. Finally, the effect of attention on audiovisual speech perception was studied by registering eye gaze behaviour (Study III) and by studying the voluntary control of visual attention (Study IV). The groups did not differ in eye gaze behaviour or in the voluntary control of visual attention. The results of the study series demonstrate that many factors underpinning face-to-face social communication are atypical in AS. In contrast with previous assumptions about intact language abilities, the current results show that children with AS have difficulties in understanding complex verbal instructions. Furthermore, the study makes clear that deviations in the perception of global features in faces expressing emotions as well as in the multisensory perception of speech are likely to harm face-to-face social communication.

Strength Symmetry Index: A measure of seizure adequacy in ECT

Seizure electroencephalography (EEG) was recorded from two channels-right (Rt) and left (Lt)-during bilateral electroconvulsive therapy (ECT) (n = 12) and unilateral ECT (n = 12). The EEG was also acquired into a microcomputer and was analyzed without knowledge of the clinical details. EEG recordings of both ECT procedures yielded seizures of comparable duration. The Strength Symmetry Index (SSI) was computed from the early- and midseizure phases using the fractal dimension of the EEG. The seizures of unilateral ECT were characterized by significantly smaller SSI in both phases. More unilateral than bilateral ECT seizures had a smaller than median SSI in both phases. The seizures also differed on other measures as reported in the literature. The findings indicate that SSI may be a potential measure of seizure adequacy that remains to be validated in future research.

Linguistic Polarization and Conflict in the Basque Country

This paper investigates the relationship between linguistic polarization and conflict in the Basque Country. During the 40 years of Franco’s dictatorship the use of the Basque language was banned. Therefore, there may be some linguistic roots underlying the conflict in the Basque Country. We show that at the municipality level, linguistic polarization reduces the level of conflict. This finding is robust to various ways of measuring linguistic and ideological polarization and the inclusion of other covariates. In addition, we find that a high level of the stock of human capital is beneficial for reducing conflict intensity.

EUSMT: incorporating linguistic information to SMT for a morphologically rich language. Its use in SMT-RBMT-EBMT hybridation

148 p.: graf.

Digging into signs: Developing standard annotation practices for cross-linguistic, quantitative analysis of sign language data. Final Report.

For sign languages used by deaf communities, linguistic corpora have until recently been unavailable, due to the lack of a writing system and a written culture in these communities, and the very recent advent of digital video. Recent improvements in video and computer technology have now made larger sign language datasets possible; however, large sign language datasets that are fully machine-readable are still elusive. This is due to two challenges. 1. Inconsistencies that arise when signs are annotated by means of spoken/written language. 2. The fact that many parts of signed interaction are not necessarily fully composed of lexical signs (equivalent of words), instead consisting of constructions that are less conventionalised. As sign language corpus building progresses, the potential for some standards in annotation is beginning to emerge. But before this project, there were no attempts to standardise these practices across corpora, which is required to be able to compare data crosslinguistically. This project thus had the following aims: 1. To develop annotation standards for glosses (lexical/word level) 2. To test their reliability and validity 3. To improve current software tools that facilitate a reliable workflow Overall the project aimed not only to set a standard for the whole field of sign language studies throughout the world but also to make significant advances toward two of the world’s largest machine-readable datasets for sign languages – specifically the BSL Corpus (British Sign Language, http://bslcorpusproject.org) and the Corpus NGT (Sign Language of the Netherlands, http://www.ru.nl/corpusngt).

Word frequency cues word order in adults: cross-linguistic evidence

[EN] One universal feature of human languages is the division between grammatical functors and content words. From a learnability point of view, functors might provide entry points or anchors into the syntactic structure of utterances due to their high frequency. Despite its potentially universal scope, this hypothesis has not yet been tested on typologically different languages and on populations of different ages. Here we report a corpus study and an artificial grammar learning experiment testing the anchoring hypothesis in Basque, Japanese, French, and Italian adults. We show that adults are sensitive to the distribution of functors in their native language and use them when learning new linguistic material. However, compared to infants’ performance on a similar task, adults exhibit a slightly different behavior, matching the frequency distributions of their native language more closely than infants do. This finding bears on the issue of the continuity of language learning mechanism.