Functional outcomes after stabilization with Dynesys in patients with spinal degenerative diseases

Objective: To know the impact of the Dynesys system on the functional outcomes in patients with spinal degenerative diseases. Summary of background data: Dynesys system has been proposed as an alternative to vertebral fusion for several spinal degenerative diseases. The fact that it has been used in people with different diagnosis criteria using different tools to measure clinical outcomes makes very difficult unifying the results available nowadays. Methods: The data base of Medlars Online International Literature (MEDLINE) via PubMed©, EMBASE©, and the Cochrane Library Plus were reviewed in search of all the studies published until November 2012 in which an operation with Dynesys in patients with spinal degenerative diseases and an evaluation of the results by an analysis of functional outcomes had taken place. No limits were used to article type, date of publication or language. Results: A total of 134 articles were found, 26 of which fulfilled the inclusion criteria after being assessed by two reviewers. All of them were case series, except for a multicenter randomized clinical trial (RCT) and a prospective case-control study. The selected articles made a total of 1507 cases. The most frequent diagnosis were lumbar spinal canal stenosis (LSCS), degenerative disc disease (DDD), degenerative spondylolisthesis (DS) and lumbar degenerative scoliosis (LDS). In cases of lumbar spinal canal stenosis Dynesys was associated to surgical decompression. Several tools to measure the functional disability and general health status were found. Oswestry Disability Index (ODI), the ODI Korean version (K-Odi), Prolo, Sf-36, Sf-12, Roland-Morris disability questionnaire (RMDQ), and the pain Visual Analogue Scale (VAS) were the most used. They showed positive results in all cases series reviewed. In most studies the ODI decreased about 25% (e.g. from a score of 85% to 60%). Better results when dynamic fusion was combined with nerve root decompression were found. Functional outcomes and leg pain scores with Dynesys were statistically non-inferior to posterolateral spinal fusion using autogenous bone. When Dynesys and decompression was compared with posterior interbody lumbar fixation (PLIF) and decompression, differences in ODI and VAS were not statistically significant. Conclusions: In patients with spinal degenerative diseases due to degenerative disc disorders, spinal canal stenosis and degenerative spondylolisthesis, surgery with Dynesys and decompression improves functional outcomes, decreases disability, and reduces back and leg pain. More studies are needed to conclude that dynamic stabilization is better than posterolateral and posterior interbody lumbar fusion. Studies comparing Dynesys with decompression against decompression alone should be done in order to isolate the effect of the dynamic stabilization.

Radiomic Texture Analysis Mapping Predicts Areas of True Functional MRI Activity.

Individual analysis of functional Magnetic Resonance Imaging (fMRI) scans requires user-adjustment of the statistical threshold in order to maximize true functional activity and eliminate false positives. In this study, we propose a novel technique that uses radiomic texture analysis (TA) features associated with heterogeneity to predict areas of true functional activity. Scans of 15 right-handed healthy volunteers were analyzed using SPM8. The resulting functional maps were thresholded to optimize visualization of language areas, resulting in 116 regions of interests (ROIs). A board-certified neuroradiologist classified different ROIs into Expected (E) and Non-Expected (NE) based on their anatomical locations. TA was performed using the mean Echo-Planner Imaging (EPI) volume, and 20 rotation-invariant texture features were obtained for each ROI. Using forward stepwise logistic regression, we built a predictive model that discriminated between E and NE areas of functional activity, with a cross-validation AUC and success rate of 79.84% and 80.19% respectively (specificity/sensitivity of 78.34%/82.61%). This study found that radiomic TA of fMRI scans may allow for determination of areas of true functional activity, and thus eliminate clinician bias.

Cerebellar language and cognitive functions in childhood: A comparative review of the clinical research

Background: Recent research addressing evidence from functional neuroimaging studies, neurophysiological research, and new advances in neuropsychology together with traditional cerebellar lesion studies have recently implicated the cerebellum in adult language and cognitive functions. However, more limited information is currently available in describing the functional connectivity present in the paediatric population. Aims: It is the purpose of this paper to review recent clinical research pertaining to paediatric populations, outlining the impact of site of lesion and specific associated clinical changes in children with cerebellar disturbances. Main contribution: The specific contribution of the right cerebellar hemisphere to language function is identified to also exist in the paediatric population, highlighting the existence of functional connections between this region of the brain and left frontal cortical areas early in development. Conclusions: Implications for future research in paediatric populations are extensive, as a greater awareness and an understanding of the recently acknowledged involvement of the cerebellum in cognition and nonmotor linguistic function is anticipated to also add new dimension and direction to the analysis of childhood language outcomes associated with the cerebellum.

Reappraising contemporary theories of subcortical participation in language: Proposing an interhemispheric regulatory function for the subthalamic nucleus (STN) in the mediation of high-level linguistic processes

Apropos the basal ganglia, the dominant striatum and globus pallidus internus (GPi) have been hypothesised to represent integral components of subcortical language circuitry. Working subcortical language theories, however, have failed thus far to consider a role for the STN in the mediation of linguistic processes, a structure recently defined as the driving force of basal ganglia output. The aim of this research was to investigate the impact of surgically induced functional inhibition of the STN upon linguistic abilities, within the context of established models of basal ganglia participation in language. Two males with surgically induced 'lesions' of the dominant and non-dominant dorsolateral STN, aimed at relieving Parkinsonian motor symptoms, served as experimental subjects. General and high-level language profiles were compiled for each subject up to 1 month prior to and 3 months following neurosurgery, within the drug-on state (i.e., when optimally medicated). Comparable post-operative alterations in linguistic performance were observed subsequent to surgically induced functional inhibition of the left and right STN. More specifically, higher proportions of reliable decline as opposed to improvement in post-operative performance were demonstrated by both subjects on complex language tasks, hypothesised to entail the interplay of cognitive-linguistic processes. The outcomes of the current research challenge unilateralised models of functional basal ganglia organisation with the proposal of a potential interhemispheric regulatory function for the STN in the mediation of high-level linguistic processes.

Professionalism and functional outcomes

A foundation principle of professionalism is listening carefully to clients' needs. This paper reviews current studies that have sought to listen to the needs of people with aphasia and their families. The preliminary evidence to date suggests that people with aphasia have goals that cover the bio-psycho-social spectrum but place a lot of importance on functional outcomes such as participation in life's activities, relationships, and personal self-esteem. In contrast, descriptions of current aphasia management practices reflect a predominantly medical model approach that emphasizes impairment-level goals. This paper suggests that a proportion of speech-language pathologists are not truly listening and responding to their clients' needs. This leads to a mismatch between the therapists' and clients' goals in therapy. The concept of person-centred goal-setting is described. This may contribute to greater alignments of goals and better outcomes of rehabilitation. Learning outcomes: As a result of reading this work, the participant will be able to: (a) have knowledge of criticisms of aphasia therapy by people with aphasia; (b) understand the concept of person-centred goal-setting; (c) understand the complexity of mismatched goals between therapist and client. (c) 2006 Elsevier Inc. All rights reserved.

Obstacles to a totally functional programming style

"Totally functional programming" (TFP) advocates the complete replacement of symbolic representations for data by functions. TFP is motivated by observations from practice in language extensibility and functional programming. Its technical essence extends the role of "fold" functions in structuring functional programs to include methods that make comparisons on elements of data structures. The obstacles that currently prevent the immediate uptake of TFP as a style within functional programming equally indicate future research directions in the areas of theoretical foundations, supporting technical infrastructure, demonstrated practical applicability, and relationship to OOP.

Interhemispheric differences of spectral power in expressive language:a MEG study with clinical applications

In the last decade we have seen an exponential growth of functional imaging studies investigating multiple aspects of language processing. These studies have sparked an interest in applying some of the paradigms to various clinically relevant questions, such as the identification of the cortical regions mediating language function in surgical candidates for refractory epilepsy. Here we present data from a group of adult control participants in order to investigate the potential of using frequency specific spectral power changes in MEG activation patterns to establish lateralisation of language function using expressive language tasks. In addition, we report on a paediatric patient whose language function was assessed before and after a left hemisphere amygdalo-hippocampectomy. Our verb generation task produced left hemisphere decreases in beta-band power accompanied by right hemisphere increases in low beta-band power in the majority of the control group, a previously unreported phenomenon. This pattern of spectral power was also found in the patient's post-surgery data, though not her pre-surgery data. Comparison of pre and post-operative results also provided some evidence of reorganisation in language related cortex both inter- and intra-hemispherically following surgery. The differences were not limited to changes in localisation of language specific cortex but also changes in the spectral and temporal profile of frontal brain regions during verb generation. While further investigation is required to establish concordance with invasive measures, our data suggest that the methods described may serve as a reliable lateralisation marker for clinical assessment. Furthermore, our findings highlight the potential utility of MEG for the investigation of cortical language functioning in both healthy development and pathology.

An investigation into formal and functional characteristics of qualifications in legislative writing and its application to English for academic legal purposes.

The present investigation is based on a linguistic analysis of the 'Housing Act 1980' and attempts to examine the role of qualifications in the structuring of the legislative statement. The introductory chapter isolates legislative writing as a "sub-variety “of legal language and provides an overview of the controversies surrounding the way it is written and the problems it poses to its readers. Chapter two emphasizes the limitations of the available work on the description of language-varieties for the analysis of legislative writing and outlines the approach adopted for the present analysis. This chapter also gives some idea of the information-structuring of legislative provisions and establishes qualification as a key element in their textualisation. The next three chapters offer a detailed account of the ten major qualification-types identified in the corpus, concentrating on the surface form they take, the features of legislative statements they textualize and the syntactic positions to which they are generally assigned in the statement of legislative provisions. The emerging hypotheses in these chapters have often been verified through a specialist reaction from a Parliamentary Counsel, largely responsible for the writing of the ‘Housing Act 1980’• The findings suggest useful correlations between a number of qualificational initiators and the various aspects of the legislative statement. They also reveal that many of these qualifications typically occur in those clause-medial syntactic positions which are sparingly used in other specialist discourse, thus creating syntactic discontinuity in the legislative sentence. Such syntactic discontinuities, on the evidence from psycholinguistic experiments reported in chapter six, create special problems in the processing and comprehension of legislative statements. The final chapter converts the main linguistic findings into a series of pedagogical generalizations, offers indications of how this may be applied in EALP situations and concludes with other considerations of possible applications.

A unification-based natural language interface to a database.

An implementation of a Lexical Functional Grammar (LFG) natural language front-end to a database is presented, and its capabilities demonstrated by reference to a set of queries used in the Chat-80 system. The potential of LFG for such applications is explored. Other grammars previously used for this purpose are briefly reviewed and contrasted with LFG. The basic LFG formalism is fully described, both as to its syntax and semantics, and the deficiencies of the latter for database access application shown. Other current LFG implementations are reviewed and contrasted with the LFG implementation developed here specifically for database access. The implementation described here allows a natural language interface to a specific Prolog database to be produced from a set of grammar rule and lexical specifications in an LFG-like notation. In addition to this the interface system uses a simple database description to compile metadata about the database for later use in planning the execution of queries. Extensions to LFG's semantic component are shown to be necessary to produce a satisfactory functional analysis and semantic output for querying a database. A diverse set of natural language constructs are analysed using LFG and the derivation of Prolog queries from the F-structure output of LFG is illustrated. The functional description produced from LFG is proposed as sufficient for resolving many problems of quantification and attachment.

A new role for Low German? Language insertion as bilingual practice in the process of language shift

This article analyses language insertion as a bilingual communicative practice, applying a functional, speaker-focused approach to the study of sociolinguistics and language contact. The article is based on a study of contact phenomena in a formerly diglossic region in Northern Germany, where the previously spoken language – Low German – is in the process of being replaced by the dominant standard variety, German. It examines regional publications in order to establish the linguistic techniques by which Low German elements are incorporated into the Standard German texts and the communicative purposes that they serve. The paper concludes that in the process of language shift an emblematic repertoire from Low German is created which can be applied into the dominant contact language, German, for specific communicative purposes.

Disciplinary talk:a systemic functional exploration of university seminar discussions

Despite the growth of spoken academic corpora in recent years, relatively little is known about the language of seminar discussions in higher education. This thesis compares seminar discussions across three disciplinary areas. The aim of this thesis is to uncover the functions and patterns of talk used in different disciplinary discussions and to highlight language on a macro and micro level that would be useful for materials design and teaching purposes. A framework for identifying and analysing genres in spoken language based on Hallidayan Systemic Functional Linguistics (SFL) is used. Stretches of talk sharing a similar purpose and predictable functional staging, termed Discussion Macro Genres (DMGs) are identified. Language is compared across DMGs and across disciplines through use of corpus techniques in conjunction with SFL genre theory. Data for the study comprises just over 180,000 tokens and is drawn from the British Academic Spoken English corpus (BASE), recorded at two universities in the UK. The discipline areas investigated are Arts and Humanities, Social Sciences and Physical Sciences. Findings from this study make theoretical, empirical and methodological contributions to the field of spoken EAP. The empirical findings are firstly, that the majority of the seminar discussion can be assigned to one of the three main DMG in the corpus: Responding, Debating and Problem Solving. Secondly, it characterises each discipline area according to two DMGs. Thirdly, the majority of the discussion is non-oppositional in nature, suggesting that ‘debate’ is not the only form of discussion that students need to be prepared for. Finally, while some characteristics of the discussion are tied to the DMG and common across disciplines, others are discipline specific. On a theoretical level, this study shows that an SFL genre model for investigating spoken discourse can be successfully extended to investigate longer stretches of discourse than have previously been identified. The methodological contribution is to demonstrate how corpus techniques can be combined with SFL genre theory to investigate extended stretches of spoken discussion. The thesis will be of value to those working in the field of teaching spoken EAP/ ESAP as well as to materials developers.

Bridging the gap between stylistic and cognitive approaches to authorship analysis using systemic functional linguistics and multidimensional analysis

In the present state of the art of authorship attribution there seems to be an opposition between two approaches: cognitive and stylistic methodologies. It is proposed in this article that these two approaches are complementary and that the apparent gap between them can be bridged using Systemic Functional Linguistics (SFL) and in particular some of its theoretical constructions, such as codal variation. This article deals with the theoretical explanation of why such a theory would solve the debate between the two approaches and shows how these two views of authorship attribution are indeed complementary. Although the article is fundamentally theoretical, two example experimental trials are reported to show how this theory can be developed into a workable methodology of doing authorship attribution. In Trial 1, a SFL analysis was carried out on a small dataset consisting of three 300-word texts collected from three different authors whose socio-demographic background matched across a number of parameters. This trial led to some conclusions about developing a methodology based on SFL and suggested the development of another trial, which might hint at a more accurate and useful methodology. In Trial 2, Biber's (1988) multidimensional framework is employed, and a final methodology of authorship analysis based on this kind of analysis is proposed for future research. © 2013, EQUINOX PUBLISHING.

A Language for Compositional Programming: A Rationale and Design

Бойко Бл. Банчев - Представена е обосновка и описание на език за програмиране в композиционен стил за опитни и учебни цели. Под “композиционен” имаме предвид функционален стил на програмиране, при който пресмятането е йерархия от композиции и прилагания на функции. Един от данновите типове на езика е този на геометричните фигури, които могат да бъдат получавани чрез прости правила за съотнасяне и така също образуват йерархични композиции. Езикът е силно повлиян от GeomLab, но по редица свойства се различава от него значително. Статията разглежда основните черти на езика; подробното му описание и фигурноконструктивните му възможности ще бъдат представени в съпътстваща публикация.

Principal component analysis and assessment of language network activation patterns in pediatric epilepsy

This dissertation establishes a novel data-driven method to identify language network activation patterns in pediatric epilepsy through the use of the Principal Component Analysis (PCA) on functional magnetic resonance imaging (fMRI). A total of 122 subjects’ data sets from five different hospitals were included in the study through a web-based repository site designed here at FIU. Research was conducted to evaluate different classification and clustering techniques in identifying hidden activation patterns and their associations with meaningful clinical variables. The results were assessed through agreement analysis with the conventional methods of lateralization index (LI) and visual rating. What is unique in this approach is the new mechanism designed for projecting language network patterns in the PCA-based decisional space. Synthetic activation maps were randomly generated from real data sets to uniquely establish nonlinear decision functions (NDF) which are then used to classify any new fMRI activation map into typical or atypical. The best nonlinear classifier was obtained on a 4D space with a complexity (nonlinearity) degree of 7. Based on the significant association of language dominance and intensities with the top eigenvectors of the PCA decisional space, a new algorithm was deployed to delineate primary cluster members without intensity normalization. In this case, three distinct activations patterns (groups) were identified (averaged kappa with rating 0.65, with LI 0.76) and were characterized by the regions of: (1) the left inferior frontal Gyrus (IFG) and left superior temporal gyrus (STG), considered typical for the language task; (2) the IFG, left mesial frontal lobe, right cerebellum regions, representing a variant left dominant pattern by higher activation; and (3) the right homologues of the first pattern in Broca's and Wernicke's language areas. Interestingly, group 2 was found to reflect a different language compensation mechanism than reorganization. Its high intensity activation suggests a possible remote effect on the right hemisphere focus on traditionally left-lateralized functions. In retrospect, this data-driven method provides new insights into mechanisms for brain compensation/reorganization and neural plasticity in pediatric epilepsy.