Search

In Shona (Bantu, Zimbabwe), bare plurals and bare singulars seem to have different scope possibilities with respect to a class of modifiers which I term “scopeless quantity words” (including numerals, shoma ‘(a) few’, and ose ‘all’). I argue that this is due to two factors. First, the scopeless quantity words are intersective modifiers rather than quantifying determiners, so that DPs containing them denote entities rather than generalised quantifiers. Second, transitive sentences involving plural arguments are usually interpreted using the **-operator, which gives a cumulative reading; the apparent wide and narrow scope readings of bare plurals are both subcases of this reading, but a narrow scope reading for bare singulars cannot be subsumed by the cumulative reading. I also discuss the scope behaviour of a quantifying determiner, oga-oga ‘every’, which shows a subject/object asymmetry: in subject position, it appears to show the expected scopal ambiguity, but in object position, it appears to have the same readings as a scopeless quantity word; I argue that this is because of the location of existential closure. This adds to the evidence suggesting that many words giving quantity are intersective modifiers rather than quantifying determiners or adverbial quantifiers.

Background Although posterior lumbar interbody fusion (PLIF) is regarded as an effective treatment for spondylolisthesis, few studies have reported comprehensive, long-term outcome data, and none has investigated the incidence of deterioration of outcomes. Objective To determine and compare the success rates and long-term stability of outcomes of open PLIF and minimal-access PLIF in the treatment of radicular pain and back pain in patients with spondylolisthesis. Methods Forty-three patients were followed for a minimum of 3 years. They completed a Short-Form Health Survey and visual analog scores for back pain and leg pain and underwent lumbar spine radiography. Outcomes were compared with baseline data and 12-month data. Results Surgery succeeded in reducing listhesis and increasing disc height, but had little effect on lumbar lordosis or the angulation of the segment treated. At 12 months after surgery, listhesis was reduced, disc height was increased, leg pain was reduced or eliminated, and physical functioning restored. Back pain was less often relieved. These outcomes were largely maintained over the ensuing 2 years. Only 5% to 10% of patients reported deterioration in their relief of pain. Depending on the definition adopted for success, the long-term success rate of PLIF may be as high as 70%. Conclusion For the relief of leg pain, the success rates of open PLIF (70%) and minimal-access PLIF (67%) for spondylolisthesis are high and durable in the long-term. PLIF is less often successful in relieving back pain, but the outcomes are maintained. The outcomes of open PLIF and minimal-access PLIF were statistically indistinguishable. Abbreviations MCIC, minimally clinically important changeMPLIF, minimal-access posterior lumbar interbody fusionOPLIF, open-access posterior lumbar interbody fusionPLIF, posterior lumbar interbody fusionSF-36, Short-Form Health Survey.

We present a patient with spontaneous intracranial hypotension due to a calcified thoracic disc prolapse. Although most cases of spontaneous intracranial hypotension resolve with conservative measures, a few reported patients require surgical intervention. We discuss an uncommon presentation of spontaneous intracranial hypotension, requiring surgical repair of a thoracic dural defect to achieve symptom resolution.

This retrospective study evaluated the recovery of ankle dorsiflexion (ADF) weakness following decompressive surgery in order to identify factors indicative of a better outcome. Fifty-six consecutive patients with ADF weakness secondary to nerve root compression underwent lumbar decompressive surgery. The demographic features, duration and severity of preoperative ADF weakness, associated radicular pain, as well as the radiological and intraoperative findings were recorded. ADF weakness at the time of initial follow-up at 6 weeks following surgery, and the latest follow-up at a median of 24 months was recorded. The patients had a mean age of 50.5 years with equal numbers of men and women. Acute disc prolapse was the compressive pathology in 88%. Clinical foot drop, defined as an ADF power of

STUDY DESIGN Retrospective cohort. OBJECTIVE To evaluate the effect of graft subsidence associated with the use of dynamic cervical plates on cervical alignment and clinical outcome of patients undergoing anterior cervical decompression and fusion. SUMMARY AND BACKGROUND DATA Dynamic cervical plates allow graft loading which may enhance fusion. However, subsidence of the bone graft may result in changes in cervical alignment. The extent of settling of the graft and its impact on cervical alignment has not been determined. Also whether such change in alignment has an impact on clinical outcome is not known. METHODS Fifty-five patients with spondylitic myelopathy or radiculopathy underwent anterior cervical decompression and fusion using a dynamic plate for stabilization (ABC, Braun/Aesculap). The surgical indications included myelopathy (n = 21), radiculopathy (n = 30), or myeloradiculopathy (n = 4). Regional and local cervical angles, graft subsidence, and fusion rates were assessed before surgery, immediately after surgery and at 6 months after surgery. Visual analogue scores for neck and radicular pain, Neck Disability Indexes, and Nurick grades for myelopathy were recorded. Patients were observed up for at least 6 months with a median of 14 months (range: 6-48 months). RESULTS Radicular pain improved by a median of 5 points (P < 0.0001), whereas Neck pain improved by a median score of 3 (P < 0.0001). A median improvement in Neck Disability Index score of 18 (P < 0.0001) was observed. Nurick grades improved in 68% of patients with myelopathy. Fusion was achieved in 96% of cases. The mean graft subsidence at 6 months was 1.7 mm (range: 0-6 mm). A change of local cervical angle toward lordosis of 5.8 degrees (P < 0.0001) was obtained as a result of surgery. However, there was a loss of 2.7 degrees of lordosis in the first 6 months following surgery (P = 0.001). The extent of subsidence correlated with the local loss of lordosis (P = 0.0003). There was no change in the regional cervical angle in the 6 months following surgery. There was no significant association between clinical outcome and changes in cervical angles. CONCLUSION Dynamic anterior cervical plating after anterior decompression and grafting provides comparable fusion rates to that reported following the use of rigid cervical plating. Immediate changes in cervical alignment towards lordosis are partially lost on follow-up. The loss of lordosis is related to the amount of graft settling.

NF-kappaB (Rel) transcription factors control physiological and pathological immune cell function. The scaffold proteins Bcl-10 and MALT1 couple antigen-receptor signals to the canonical NF-kappaB pathway and are pivotal in lymphomagenesis. Here we found that Bcl-10 and MALT1 differentially regulated B cell receptor-induced activation of RelA and c-Rel. Bcl-10 was essential for recruitment of the kinase IKK into lipid rafts for the activation of RelA and c-Rel, for blocking apoptosis and for inducing division after B cell receptor ligation. In contrast, MALT1 participated in survival signaling but was not involved in IKK recruitment or activation and was dispensable for RelA induction and proliferation. MALT1 selectively activated c-Rel to control a distinct subprogram. Our results provide mechanistic insights into B cell receptor-induced survival and proliferation signals and demonstrate the selective control of c-Rel in the canonical NF-kappaB pathway.

Powders of small particle size and low bulk density find widespread use. Methods of handling must minimise their release into the atmosphere so as to reduce environmental and health implications. These methods are considered in detail here.

To assess patient recall of intraoperative pain, anxiety, fear, and sensory (visual and auditory) perceptions during second eye clear corneal cataract surgery using assisted topical anaesthesia (ATA), in comparison with first eye cataract surgery using the same technique.This prospective, consecutive, observational study was conducted in a free-standing dedicated ophthalmic day surgery centre. A voluntary questionnaire was distributed to 129 consecutive patients who underwent clear corneal cataract surgery using ATA. Two patients had to be converted to block anaesthesia, and were excluded. Patients were asked to rate intraoperative pain, anxiety, and fear using a visual analogue scale (VAS), and recollection of intraoperative visual and auditory perceptions. Results were analysed using the Mann-Whitney U and Spearman correlation tests.There were 70/127 (55%) patients undergoing first eye cataract surgery and 57/127 (45%) undergoing second eye surgery. There was no significant difference in mean pain, anxiety, and fear scores between those undergoing the second eye operation compared with those undergoing their first eye operation. Similarly, there was no significant difference in sensory perceptions between the two cohorts. Overall, there was a small but significant positive correlation between recall of visual and auditory perceptions and combined pain, fear, and anxiety scores (r=0.33, P=0.0002).There was no significant difference in levels of intraoperative pain, anxiety, fear, and sensory perceptions experienced by patients between the first eye and second eye surgeries. We recommend that preoperative counselling for a patient's second eye be as comprehensive as for the first eye surgery.

During T cell development in the thymus, high-affinity/avidity TCR engagement induces negative selection by apoptosis, while lower affinity/avidity TCR interactions lead to positive selection and survival of thymocytes. Yet, the mechanisms that discriminate between positive and negative selection are not fully understood. One major regulator of survival and apoptosis in lymphoid cells is the transcription factor NF-κB. Several reports have indicated key roles for NF-κB in positive and negative selection. In peripheral T cells, TCR ligation activates NF-κB through a selective pathway that involves protein kinase Cθ, Bcl10, and Malt1. While protein kinase Cθ is dispensable for thymic TCR signaling, the molecular roles of Bcl10 and Malt1 in thymocytes have not been investigated. In the present study, we show that both Bcl10 and Malt1 are essential for TCR signaling in thymocytes as a genetic disruption of either molecule blocks TCR-induced NF-κB activation in these cells. To investigate the function of this pathway in thymic selection, we introduced the Bcl10 or Malt1 mutations into three well-established TCR transgenic mouse models. Surprisingly, using several in vivo or in vitro assays, we were unable to demonstrate a role for TCR-induced NF-κB activation in either positive or negative selection. Thus, while TCR signaling to NF-κB controls the activation of mature T cells, we suggest that this pathway is not involved in the positive or negative selection of thymocytes.

Management of the cervical spine following blunt trauma is commonplace. In 2013, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) published practice guidelines drawn from evidence dating to 2011. Since then, further publications have emerged that are reviewed, and a simple management algorithm produced to assist practitioners in Australian trauma centres. These publications attempt to shed light on two controversial scenarios, those being the management of symptomatic patients with negative computed tomography (CT) and management of the obtunded patient.The search strategy mirrored that of the AANS/CNS guidelines. A search of the National Library of Medicine (PubMed) database for manuscripts published between January 2011 and October 2014 was conducted. One reviewer extracted data from studies assessing the performance of various imaging modalities in identifying traumatic cervical spine injuries. In clinical scenarios where little evidence has emerged since the AANS/CNS guidelines, key manuscripts published prior to 2011 were identified from bibliographies.Awake, asymptomatic patients may be 'cleared' without further imaging. Awake, symptomatic patients without pathology on CT and without neurological deficit can safely be 'cleared' without magnetic resonance imaging. There is no longer a role for flexion-extension films. In the obtunded patient, findings remain conflicting.Several of these findings represent a departure from previous practices, including clearance of patients with non-neurological symptoms on the basis of CT and the exclusion of flexion-extension film in detecting injury. Management of the obtunded patient remains controversial.

¶Background. The surgical management of elderly patients with aneurysmal subarachnoid haemorrhage (SAH) is controversial. The present study was performed to more clearly define issues facing elderly SAH patients undergoing surgical repair of their aneurysms. Method. Between 1990 and 2000, 100 patients, aged 70 years or older, were managed consecutively with aneurysmal surgical repair at Verona City Hospital. Ninety-seven of these were analysed with regard to age, clinical grade on admission, radiological features, and specific management components (3 patients were excluded from further analysis because of inadequate follow up data). Surviving patients were followed up for a minimum of 6 months and clinical outcome was assessed. Findings. Hydrocephalus requiring permanent CSF diversion occurred in 44% of cases surviving beyond 10 days from their SAH. The development of hydrocephalus requiring shunting was delayed more than 6 weeks in 7% of these cases. Medical complications occurred in 22% of cases. Clinical grade of haemorrhage (p

Human beings can easily describe their control behaviours with IF-THEN rules, which can be transferred to similar tasks with only slight local changes. However, standard techniques for function approximation like neural networks or associative memories are unable to work with rules. We introduce a method for extracting and importing rules from and to a B-spline fuzzy controller. Rule importation is used to initialise a B-spline fuzzy controller with a priori knowledge to reduce the learning time and to improve the poor generalisation capability. Through "learning-by-doing" and "learning-from-others", set of rules for a two-arm cooperation task can be generated and further transferred to a robot screwing operation and a three-arm cooperation. The successful experiments show how rule-based knowledge can be used for skill transfer in analogue tasks to help significantly accelerating a learning process.

Intra-abdominal vascular injury due to blunt trauma is unusual in children. Due to its rarity, detailed reports dealing with its management are scarce in paediatric literature. Diagnosis of these injuries is challenging, and a high degree of awareness is necessary for rapid identification and treatment of these injuries. We report the case of a child with seatbelt sign and mesenteric vein injury due to blunt trauma to the abdomen during a motor vehicle accident where the seatbelt was incorrectly placed. She also sustained cervical vertebral injury. The pattern of injuries in children in these situations may differ from that found in adults. While seatbelts have undoubtedly saved many lives, awareness about correct placement of these restraints is extremely necessary.

Object. This study was performed to further elucidate technical and patient-specific risk factors for perioperative stroke in patients undergoing temporary arterial occlusion during the surgical repair of their aneurysms. Methods. One hundred twelve consecutive patients in whom temporary arterial occlusion was performed during surgical repair of an aneurysm were retrospectively analyzed. Confounding factors (inadvertent permanent vessel occlusion and retraction injury) were identified in six cases (5%) and these were excluded from further analysis. The demographics for the remaining 106 patients were analyzed with respect to age, neurological status, aneurysm characteristics, intraoperative rupture, duration of temporary occlusion, and number of occlusive episodes; end points considered were outcome at 3-month follow up and symptomatic and radiological stroke. Conclusions. Overall 17% of patients experienced symptomatic stroke and 26% had radiological evidence of stroke attributable to temporary arterial occlusion. A longer duration of clip placement, older patient age, a poor clinical grade (Hunt and Hess Grades IV–V), early surgery, and the use of single prolonged clip placement rather than repeated shorter episodes were associated with a higher risk of stroke based on univariate analysis. Intraoperative aneurysm rupture did not affect stroke risk. On multivariate analysis, only poorer clinical grade (p = 0.001) and increasing age (p = 0.04) were significantly associated with symptomatic stroke risk.

OBJECTIVE Whereas cardiac hormones increase after subarachnoid haemorrhage (SAH), and may contribute to sodium wastage and hyponatraemia, there is controversy concerning the relative roles of atrial natriuretic peptide (ANP) vs. brain natriuretic peptide (BNP) and the factors initiating their secretion. Noting previous work linking stress hormone responses with cardiac injury after SAH, we have studied responses in stress hormones, markers of cardiac injury and the temporal changes in ANP and BNP and related them to changes in sodium status post ictus and during recovery from acute SAH. DESIGN, PATIENTS, MEASUREMENTS Eighteen patients with verified SAH of variable severity were studied in a single unit for a 14-day period post ictus under controlled conditions of sodium and fluid intake. All received a standardized protocol of daily dexamethasone and nimodipine throughout the study. Severity was graded using criteria of Hess and Hunt at admission. Stress hormones (AVP, catecholamines and admission plasma cortisol), markers of cardiac injury (ECG and daily plasma troponin T) and cardiac hormones (ANP and BNP) were measured daily and related to severity, plasma sodium and renin-aldosterone activity. Hormone levels (ANP, BNP and endothelin) in cerebrospinal fluid (CSF) were also measured in nine patients. RESULTS Intense neurohormonal activation (AVP, cortisol and catecholamines) at admission was associated with increased levels of both plasma ANP and BNP whereas levels in CSF were unaffected. In individual patients plasma levels of ANP and BNP were strongly correlated (P < 0.001). Cardiac events (abnormal ECG and/or elevated troponin) occurred in six of seven patients graded severe but neither stress hormones nor cardiac peptides differed significantly in patients with mild (n = 11) vs. severe (n = 7) SAH. During the course of a progressive fall in plasma sodium concentration (P = 0.001), there was a delayed activation of renin-aldosterone which was inversely correlated with declining levels of plasma ANP/BNP (P < 0.002). CONCLUSIONS Excessive secretion of both ANP and BNP occurs in all patients after acute subarachnoid haemorrhage and is unrelated to severity, stress hormone activation or markers of cardiac injury. Inhibition of renin-aldosterone by cardiac hormones may impair renal sodium conservation and contribute to developing hyponatraemia. In the absence of evidence for activation of natriuretic peptides within the brain, the prompt and consistent increase in both ANP and BNP strongly supports the view that the heart is the source of increased natriuretic peptide secretion after acute subarachnoid haemorrhage.

In this paper we present a method for two robot manipulators to learn cooperative tasks. If a single robot is unable to grasp an object in a certain orientation, it can only continue with the help of other robots. The grasping can be realized by a sequence of cooperative operations that re-orient the object. Several sequences are needed to handle the different situations in which an object is not graspable for the robot. It is shown that a distributed learning method based on a Markov decision process is able to learn the sequences for the involved robots, a master robot that needs to grasp and a helping robot that supports him with the re-orientation. A novel state-action graph is used to store the reinforcement values of the learning process. Further an example of aggregate assembly shows the generality of this approach.

The author makes a distinction between communication that deepens a relationship and communication that resolves conflict. An approach to therapy, relational conversation, is presented in which meaningful conversation is designed to increase relational fortitude and promote a consistent level of intentional and loving connection. The approach is based on the body of literature that supports the theory that good communication is important to good relating.