The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease

<p>Abstract</p> <p>Background</p> <p>Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD) even with pharmacological treatment (levodopa). A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN). Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography.</p> <p>Methods</p> <p>Ten patients (median age 66, range 59–69 years) with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start randomized). In both test conditions, the following were assessed: motor symptoms (descriptive purposes), clinical performance tests, fear of falling ratings, and posturography with and without vibratory proprioceptive disturbance.</p> <p>Results</p> <p>STN stimulation alone significantly (p = 0.002) increased the scores of the Berg balance scale, and the median increase was 6 points. The results of all timed performance tests, except for sharpened Romberg, were significantly (p ≤ 0.016) improved. The patients rated their fear of falling as less severe, and the total score of the Falls-Efficacy Scale(S) increased (p = 0.002) in median with 54 points. All patients completed posturography when the STN stimulation was turned ON, but three patients were unable to do so when it was turned OFF. The seven patients with complete data showed no statistical significant difference (p values ≥ 0.109) in torque variance values when comparing the two test situations. This applied both during quiet stance and during the periods with vibratory stimulation, and it was irrespective of visual input and sway direction.</p> <p>Conclusion</p> <p>In this sample, STN stimulation alone significantly improved the results of the clinical performance tests that mimic activities in daily living. This improvement was further supported by the patients' ratings of fear of falling, which were less severe with the STN stimulation turned ON. Posturography could not be performed by three out of the ten patients when the stimulation was turned OFF. The posturography results of the seven patients with complete data showed no significant differences due to STN stimulation.</p

Contribución de los procesos verbales al discurso narrativo en español Contribuição dos processos verbais para o discurso narrativo em Espanhol The contribution of verbal processes to narrative discourse in Spanish

En este artículo exploramos, desde una perspectiva sistémico-funcional, el papel que desempeñan dos subgrupos de procesos verbales, los "procesos de decir + cualidad" y los "proceso de juicio", en la codificación de significados centrales a la creación de diferentes elementos en textos narrativos, más específicamente su contribución a la construcción de los personajes y el tenor entre ellos, al desarrollo de la acción y a la articulación de los temas de la narración. Nuestras observaciones se basan en una muestra de textos narrativos de dos autores latino-americanos, Julio Cortázar y Eduardo Galeano, y procuramos apoyar estas observaciones por referencia a las propiedades semánticas y léxico-gramaticales de los procesos bajo estudio y los patrones que estos establecen en el texto. Nos apoyamos en descripciones de transitividad desarrolladas en el marco de la Gramática Sistémico-Funcional y en trabajos de Halliday (1971, 2002) y Hassan (1985, 1996) que proponen principios para una Estilística de base Lingüística.Neste artigo exploramos, de uma perspectiva sistêmica-funcional, o papel desempenhado pelos dois subgrupos de processos verbais, "processos de dizer + qualidade" e "processos de julgamento", ao codificar significados centrais para a criação de elementos diferentes em narrativas, mais especificamente sua contribuição para o retrato de caracteres e o teor entre eles, para o avanço da ação e para a articulação dos temas mais profundos nas narrativas. Baseamos nossas observações em uma amostra de textos narrativos de dois autores hispano-americanos, Julio Cortázar e Eduardo Galeano,.e, para fornecermos evidência lingüística para a nossa análise pretendemos apoio nas propriedades lexico gramaticais e semânticas dos processos sob estudo e nos padrões que formam no texto,. Bseamo-nos em descrições de transitividade na lingüística funcional sistêmica e no trabalho de Halliday e de Hassan estabelecendo princípios para uma estilística linguística.In this article we explore, from a systemic-functional perspective, the role played by two subgroups of verbal processes, "processes of saying + quality" and "processes of judgment", in encoding meanings central to the creation of different elements in narratives, more specifically their contribution to the portrayal of characters and the tenor between them, to the advancement of action and to the articulation of the more profound themes in the narratives. We base our observations on a sample of narrative texts by two hispano-american authors, Julio Cortázar and Eduardo Galeano, and we seek to support them by reference to the semantic and lexico-grammatical properties of the processes under study and to patterns they form in the text. We draw upon transitivity descriptions within Systemic Functional Linguistics and on work by Halliday (1971, 2002) and by Hassan (1985, 1996) setting forth principles for a Linguistic Stylistics

The applicability of Porter’s generic strategies in pure online firms: a case study approach

The aim of this paper is to investigate the usability and applicability of Porter's generic strategies in the current e-business environment. In this paper, a review of Porter's generic strategies was conducted to recognise the limitations and weaknesses of the model, which prevent its effective application in the e-business environment. To do so, a case study approach on three pure online firms, e.g., Amazon, e-bay and Google was employed. The findings acknowledged the application of Porter's generic strategies to pure online firms in order to achieve competitive advantage and proved the positive impact of generic strategies on firms' performance. The paper suggests that although cost leadership strategy is able to generate greater performance, pursuing a differentiation strategy can be more worthwhile and sustainable for pure online firms compared to cost leadership strategy. This research contributes to existing research by suggesting Porter's generic strategies as a valid and viable model for pure online firms which operate in the current e-business environment