Some further fragments of the chronicle of Manasses

No abstractNo abstrac

Acquiring complexity: The Portuguese of some Pirahã men

The Piraha language has been claimed to have no syntactic complexity. What happens when speakers of this language come into contact with another, more complex language? This paper reflects on the Portuguese used by a group of men of the Amazonian Piraha people. My study shows that when speaking Portuguese, most Piraha speakers employ simple syntactic constructions, characterised by juxtaposition of main clauses rather than embedding. Yet, the more proficient speakers utilize constructions that on the surface look more complex. These involve Portuguese subordinating conjunctions and complement clauses, both instances that could be analysed as complex constructions. While the subordinating conjunctions can be explained in terms of transfer and discourse marking functions, one particular speaker uses a Portuguese complement clause that could be analysed as a syntactically intermediate structure between Piraha juxtaposition and Portuguese embedding

Caloric vestibular stimulation in aphasic syndrome

Caloric vestibular stimulation (CVS) is commonly used to diagnose brainstem disorder but its therapeutic application is much less established. Based on the finding that CVS increases blood flow to brain structures associated with language and communication, we assessed whether the procedure has potential to relieve symptoms of post-stroke aphasia. Three participants, each presenting with chronic, unilateral lesions to the left hemisphere, were administered daily CVS for 4 consecutive weeks. Relative to their pre-treatment baseline scores, two of the three participants showed significant improvement on both picture and responsive naming at immediate and one-week follow-up. One of these participants also showed improved sentence repetition, and another showed improved auditory word discrimination. No adverse reactions were reported. These data provide the first, albeit tentative, evidence that CVS may relieve expressive and receptive symptoms of aphasia. A larger, sham-controlled study is now needed to further assess efficacy

Does considering key audit matters affect auditor judgment performance?

This paper investigates the potential impact of considering key audit matters (KAM) in line with the new IAASB International Standard on Auditing ISA 701 on auditor judgment performance related to goodwill impairment testing. Our study uses a 2x2 between-subjects experiment based on a goodwill impairment testing case. In this experiment with 157 auditors from two Big4 audit firms in Germany, we manipulated the two independent variables client pressure (high vs. low) and KAM consideration (present vs. absent). Client pressure was manipulated through two different components, client importance and client opposition to making audit adjustments. In the condition in which KAM consideration is present, participants were required to assess the likelihood that they will communicate matters regarding the estimation of the recoverable amount in a separate KAM section of the independent auditor’s report. We opposed this condition with a condition in which participants were only required to assess the likelihood that they will communicate matters regarding the estimation of the recoverable amount with those charged with governance (KAM consideration absent). As dependent variables, we captured skeptical judgment and action as two different facets of auditor judgment performance. Our results suggest that auditors’ reaction to our client pressure manipulation is rather weak (and in fact turns out to be insignificant). If at all, auditors seem to become slightly more skeptical in their judgments and actions when client pressure is high, which might suggest that a reasonableness constraint has been triggered. Furthermore, we find that auditors exhibit significantly less skeptical judgment (and at least possibly also action) when KAM consideration is present than when KAM consideration is absent. This finding suggests that, when considering KAM and due to moral licensing, auditors are more willing to acquiesce to their clients’ desired accounting treatments

BCI controlled robotic arm as assistance to the rehabilitation of neurologically disabled patients

Purpose: Brain–computer interface (BCI)-controlled assistive robotic systems have been developed with increasing success with the aim to rehabilitation of patients after brain injury to increase independence and quality of life. While such systems may use surgically implanted invasive sensors, non-invasive alternatives can be better suited due to the ease of use, reduced cost, improvements in accuracy and reliability with the advancement of the technology and practicality of use. The consumer-grade BCI devices are often capable of integrating multiple types of signals, including Electroencephalogram (EEG) and Electromyogram (EMG) signals. Materials and Methods: This paper summarizes the development of a portable and cost-efficient BCI-controlled assistive technology using a non-invasive BCI headset “OpenBCI” and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm. To avoid risks of injury while the device is being used in clinical settings, appropriate measures were incorporated into the software control of the arm. A short survey was used following the system usability scale (SUS), to measure the usability of the technology to be trialed in clinical settings. Results: From the experimental results, it was found that EMG is a very reliable method for assistive technology control, provided that the user specific EMG calibration is done. With the EEG, even though the results were promising, due to insufficient detection of the signal, the controller was not adequate to be used within a neurorehabilitation environment. The survey indicated that the usability of the system is not a barrier for moving the system into clinical trials. Implication on rehabilitation For the rehabilitation of patients suffering from neurological disabilities (particularly those suffering from varying degrees of paralysis), it is necessary to develop technology that bypasses the limitations of their condition. For example, if a patient is unable to walk due to the unresponsiveness in their motor neurons, technology can be developed that used an alternate input to move an exoskeleton, which enables the patient to walk again with the assistance of the exoskeleton. This research focuses on neuro-rehabilitation within the framework of the NHS at the Kent and Canterbury Hospital in UK. The hospital currently does not have any system in place for self-driven rehabilitation and instead relies on traditional rehabilitation methods through assistance from physicians and exercise regimens to maintain muscle movement. This paper summarises the development of a portable and cost-efficient BCI controlled assistive technology using a non-invasive BCI headset “OpenBCI” and an open source robotic arm, U-Arm, to accomplish tasks related to rehabilitation, such as access to resources, adaptability or home use. The resulting system used a combination of EEG and EMG sensor readings to control the arm, which could perform a number of different tasks such as picking/placing objects or assist users in eating

Co‐creating system‐wide improvement for people with traumatic brain injury across one integrated care system in the United Kingdom to initiate a transformation journey through co‐production

Background and Objective There is a need for better integration of services across communities and sectors for people living with traumatic brain injury (TBI) to meet their complex needs. Building on insights gained from earlier pilot work, here we report the outcomes of a participatory workshop that sought to better understand the challenges, barriers and opportunities that currently exist within the care pathway for survivors of TBI. Methods A diverse range of stakeholders from the acute and rehabilitation care pathway and the health and social care system were invited to participate in a 3-h workshop. The participants worked in four mixed subgroups using practice development methodology, which promotes person-centred, inclusive and participatory action. Results Thematic analysis identified shared purposes and values that were used to produce a detailed implementation and impact framework for application at both the level of the care interface and the overarching integrated care system. A variety of enablers were identified that related to collective values and behaviours, case management, team leadership and integrated team working, workforce capability, evidence-based practice and resourcing. The clinical, economic, cultural and social outcomes associated with these enablers were also identified, and included patient safety, independence and well-being, reduced waiting times, re-admission rates, staff retention and professional development. Conclusion The co-produced recommendations made within the implementation and impact framework described here provide a means by which the culture and delivery of health and social care services can be better tailored to meet the needs of people living with TBI. We believe that the recommendations will help shape the formation of new services as well as the development of existing ones. Patient or Public Contribution Patient and public involvement have been established over a 10-year history of relationship building through a joint forum and events involving three charities representing people with TBI, carers, family members, clinicians, service users, researchers and commissioners, culminating in a politically supported event that identified concerns about the needs of people following TBI. These relationships formed the foundation for the interactive workshop, the focus of this publication

A durable gain in motor and non-motor symptoms of Parkinson’s Disease following repeated caloric vestibular stimulation: A single-case study

Objective: To gain ‘first-in-man’ evidence that repeated caloric vestibular stimulation (CVS), a non-invasive form of neuro-modulation, can induce a lasting and clinically-relevant reduction in Parkinson’s Disease (PD) symptoms. Methods: A 70yr old male, diagnosed with PD 7 years prior to study enrolment, self-administered CVS at home 2x20 minutes per day for three months using a solid-state portable device. Standardised neuropsychological assessments of motor, cognitive, affective and independent function were carried out prior to stimulation, at the start and end of the sham (month 1) and active (months 2-3) phases, and 5 months post-stimulation. Results: Relative to the pre-stimulation baseline, behavioural improvements that exceeded the minimal detectable change were observed on the EQ5D, Unified Parkinson’s Disease Rating Scale, Schwab and England scale, 2 minute walk, Timed up and go, Non-motor symptom assessment scale for PD, Montreal cognitive assessment, Hospital depression scale and Epworth sleepiness scale. The level of change exceeded the threshold for a minimal clinically important difference on all scales for which a threshold has been published. By contrast, little improvement was seen during the sham (i.e. placebo) phase. Conclusion: Caloric vestibular stimulation may offer a novel, home-based method of relieving everyday symptoms of PD, and merits further evaluative study

Obstructive Sleep Apnea Syndrome Is Less Frequent in Patients With Well-Controlled Acromegaly Treated With Somatostatin Analogues, Pegvisomant or in Combination

Background: Obstructive sleep apnea (OSA) often occurs in patients with active acromegaly and improves after treatment. Less is known about the development of OSA in patients after a longer period of control treated with somatostatin analogues (SSA) and pegvisomant. Methods: Seventy-nine patients (12 females, 17 males; age 49 +/- 14 years; body mass index 29.9 +/- 5.4 kg/m(2); IGF-1 184 +/- 73 mu g/L; disease duration 13 +/- 8 years (mean +/- standard deviation)) with wellcontrolled acromegaly treated with SSA (38%), pegvisomant (38%) or in combination (24%) who underwent ambulatory polygraphy were included in a prospective multicenter cross-sectional study. Results: Fourteen percent had OSA (range of apnea-hypopnea index (AHI) 5 -15). Patients with OSA (AHI >= 5 vs. < 5) had a longer disease duration (16 +/- 1 vs. 12 +/- 8 years; P = 0.01) and were older (61 +/- 9 vs. 47 +/- 13 years; P = 0.037). The AHI of all patients correlated with age (P = 0.01; r = 0.44). No differences were seen in terms of BMI and Epworth sleepiness scale score. Previous transsphenoidal surgery and radiation had no impact of the detection of OSA. The duration of well-controlled acromegaly was 7 +/- 3 years. Conclusion: OSA in patients with well-controlled acromegaly treated with SSA, pegvisomant or in combination is less frequent (14%) than previously described. Early treatment to reduce the active disease period should be aimed to prevent OSA

Low Cost Inertial Sensors for the Motion Track-ing and Orientation Estimation of Human Upper Limbs in Neurological Rehabilitation

This paper presents the feasibility of utilizing low cost inertial sensors such as those found in Sony Move, Nintendo Wii (Wii Remote with Wii MotionPlus) and smartphones for upper limb motion mon-itoring in neurorehabilitation. Kalman and complementary filters based on data fusion are used to estimate sensor 3D orientation. Furthermore, a two-segment kinematic model was developed to estimate limb segment position tracking. Performance has been compared with a high-accuracy measurement system using the Xsens MTx. The experimental results show that Sony Move, Wii and smartphones can be used for measuring upper limb orientation, while Sony Move and smartphones can also be used for specific applications of upper limb segment joint orientation and position tracking during neurorehabilitation. Sony Move’s accuracy is within 1.5° for Roll and Pitch and 2.5° for Yaw and position tracking to within 0.5 cm over a 10 cm movement. This accuracy in measurement is thought to be adequate for upper limb orientation and position tracking. Low cost inertial sensors can be used for the accurate assessment/measurement of upper limb movement of patients with neurological disorders and also makes it a low cost replacement for upper limb motion measurements. The low cost inertial sensing systems were shown to be able to accurately measure upper limb joint orienta-tion and position during neurorehabilitation