Cortical language localization in left, dominant hemisphere

1989 ◽  
Vol 71 (3) ◽  
pp. 316-326 ◽  
Author(s):  
George Ojemann ◽  
Jeff Ojemann ◽  
E. Lettich ◽  
M. Berger
Keyword(s):  
Early Life ◽  
Classical Model ◽  
Individual Variability ◽  
Clinical Implications ◽  
Minimal Risk ◽  
Language Function ◽  
Verbal Intelligence ◽  
Dominant Hemisphere ◽  
Content Type ◽  
A Current

✓ The localization of cortical sites essential for language was assessed by stimulation mapping in the left, dominant hemispheres of 117 patients. Sites were related to language when stimulation at a current below the threshold for afterdischarge evoked repeated statistically significant errors in object naming. The language center was highly localized in many patients to form several mosaics of 1 to 2 sq cm, usually one in the frontal and one or more in the temporoparietal lobe. The area of individual mosaics, and the total area related to language was usually much smaller than the traditional Broca-Wernicke areas. There was substantial individual variability in the exact location of language function, some of which correlated with the patient's sex and verbal intelligence. These features were present for patients as young as 4 years and as old as 80 years, and for those with lesions acquired in early life or adulthood. These findings indicate a need for revision of the classical model of language localization. The combination of discrete localization in individual patients but substantial individual variability between patients also has major clinical implications for cortical resections of the dominant hemisphere, for it means that language cannot be reliably localized on anatomic criteria alone. A maximal resection with minimal risk of postoperative aphasia requires individual localization of language with a technique like stimulation mapping.

Cortical language localization in left, dominant hemisphere

2008 ◽  
Vol 108 (2) ◽  
pp. 411-421 ◽  
Author(s):  
George Ojemann ◽  
Jeff Ojemann ◽  
E. Lettich ◽  
M. Berger
Keyword(s):  
Early Life ◽  
Classical Model ◽  
Individual Variability ◽  
Clinical Implications ◽  
Object Naming ◽  
Minimal Risk ◽  
Language Function ◽  
Verbal Intelligence ◽  
Dominant Hemisphere ◽  
A Current

✓ The localization of cortical sites essential for language was assessed by stimulation mapping in the left, dominant hemispheres of 117 patients. Sites were related to language when stimulation at a current below the threshold for afterdischarge evoked repeated statistically significant errors in object naming. The language center was highly localized in many patients to form several mosaics of 1 to 2 sq cm, usually one in the frontal and one or more in the temporoparietal lobe. The area of individual mosaics, and the total area related to language was usually much smaller than the traditional Broca-Wernicke areas. There was substantial individual variability in the exact location of language function, some of which correlated with the patient's sex and verbal intelligence. These features were present for patients as young as 4 years and as old as 80 years, and for those with lesions acquired in early life or adulthood. These findings indicate a need for revision of the classical model of language localization. The combination of discrete localization in individual patients but substantial individual variability between patients also has major clinical implications for cortical resections of the dominant hemisphere, for it means that language cannot be reliably localized on anatomic criteria alone. A maximal resection with minimal risk of postoperative aphasia requires individual localization of language with a technique like stimulation mapping.

Stereotactic biopsy of nonpolar tumors in the dominant hemisphere: a prospective study of effects on language functions

1997 ◽  
Vol 86 (6) ◽  
pp. 923-926 ◽  
Author(s):  
Ann-Marie Thomson ◽  
Robert Taylor ◽  
Diane Fraser ◽  
Ian R. Whittle
Keyword(s):  
Stereotactic Biopsy ◽  
Language Function ◽  
Dominant Hemisphere ◽  
Ct Guided ◽  
Content Type ◽  
Language Functions ◽  
Before And After ◽  
Normal Language ◽  
A Prospective Study ◽  
Fine Print

✓ A prospective study of patients undergoing computerized tomography (CT)—guided stereotactic biopsy of nonpolar tumors in the dominant hemisphere was undertaken to determine if stereotactic biopsy caused a deterioration of language functions. Language was assessed using the Western Aphasia Battery (WAB) and the Boston Naming Test (BNT) before and after a biopsy sample was obtained. Of 16 patients studied, five (31%) were dysphasic preoperatively. After the biopsy the Aphasia Quotient (AQ), derived from the WAB, had significantly deteriorated in four (80%) of these patients, whereas in the fifth it remained relatively unchanged. One of these patients with an extensive infiltrating hemispheric oligoastrocytoma subsequently recovered normal language function after radiotherapy. In 10 of the 11 patients who had normal language function preoperatively there were no deleterious changes after biopsy in either the WAB subtest or BNT scores. In the other patient whose WAB score was normal preoperatively, there was a significant deterioration in postoperative AQ. This patient, who declined steroid therapy before and after biopsy, had a glioblastoma multiforme in Wernicke's area. A postoperative CT scan revealed no changes from what was shown on preoperative scan. This clinical study shows that CT-guided stereotactic biopsy of nonpolar tumors in the dominant hemisphere using the Brown-Roberts-Wells system and the Sedan—Nashold biopsy cannula carries a 9% risk (95% confidence intervals 0–26%) of impairing language functions if the patient is not dysphasic preoperatively. If the patient is dysphasic preoperatively, there is a very high risk of aggravating the dysphasia with stereotactic biopsy.

Individual variability in cortical localization of language

1979 ◽  
Vol 50 (2) ◽  
pp. 164-169 ◽  
Author(s):  
George A. Ojemann
Keyword(s):  
Classical Model ◽  
Intractable Epilepsy ◽  
Individual Variability ◽  
Constant Current ◽  
Brain Dominance ◽  
Content Type ◽  
Left Brain ◽  
Sample Technique ◽  
The Individual ◽  
High Degree

✓ Individual variability in the localization of language, as measured by object-naming, was assessed for left lateral peri-Sylvian cortex with a multi-sample technique of stimulation mapping at a constant current. This study was performed during craniotomy under local anesthesia in 10 patients with medically intractable epilepsy and the usual pattern of left brain dominance for language. A high degree of variability in the exact location of naming was present. Only one area, a small portion of the third frontal convolution immediately in front of the motor strip, showed naming changes in all patients in whom it was sampled. This area is considerably smaller than the classical Broca's area. Elsewhere in language cortex, including all parts of the posterior language area, there was considerable individual variability. Because of this, the classical model of language localization is an inaccurate basis for establishing the risk of aphasia in surgical therapy of dominant hemisphere peri-Sylvian lesions in this and related patient populations. Rather, that risk should be assessed from the individual localization of language, established by the multisample technique of stimulation mapping.

Critical success factors of Lean Six Sigma deployment: a current review

2015 ◽  
Vol 6 (4) ◽  
pp. 339-348 ◽  
Author(s):  
Fairul Anwar Abu Bakar ◽  
Khairanum Subari ◽  
Mohd Amran Mohd Daril
Keyword(s):  
Six Sigma ◽  
Critical Success Factors ◽  
Success Factors ◽  
Lean Six Sigma ◽  
Success Story ◽  
Content Type ◽  
Critical Success ◽  
Improvement Methodologies ◽  
Practical Implications ◽  
A Current

Purpose – The purpose of this paper is to review and gather the latest critical success factors (CSF) of Lean Six Sigma (LSS) deployment and implementation into a comprehensive list of factors. Design/methodology/approach – The approach taken by authors in this study was to analyze the latest literature review starting 2010 onwards and focus on CSFs of LSS (not dedicated as Lean or Six Sigma) by excluding other improvement methodologies or initiatives, e.g. Lean, Six Sigma, TQM, TRIZ etc. Findings – Five significant CSFs were identified (initially 97 CSFs listed from 13 papers) out of nine groups/headers listed in clustering analysis using Affinity Diagram tool and new headers mapping. Practical implications – Most of the organisations were aware of the success story on LSS, but did not scrutinize or consider its CSFs. By knowing the outcome of this paper, it can help open eyes regarding readiness before implementing LSS. Originality/value – At the end of this paper, the authors tried to cluster the CSFs similarities that could intentionally provide the guidelines and references to industries/companies for successful deployment and implementation of LSS in future endeavours.

Surgical management of giant sacral schwannomas

1986 ◽  
Vol 65 (3) ◽  
pp. 286-295 ◽  
Author(s):  
Chad D. Abernathey ◽  
Burton M. Onofrio ◽  
Bernd Scheithauer ◽  
Peter C. Pairolero ◽  
Thomas C. Shives
Keyword(s):  
Preoperative Assessment ◽  
Daily Activities ◽  
Joint Involvement ◽  
Complete Relief ◽  
Minimal Risk ◽  
Low Back ◽  
Content Type ◽  
Benign Schwannoma ◽  
Anterior Aspect

✓ Thirteen cases of giant sacral schwannomas with erosion of the anterior aspect of the sacrum and associated intrapelvic extension are reviewed. These tumors showed no sex predilection; the patients' mean age was 38.6 years at the time of diagnosis, and their symptoms predated the diagnosis by an average of 5.2 years. The most common symptoms were low-back pain and lower-extremity dysesthesiae. Plain roentgenograms, myelography, and computerized tomography constituted essential and complementary studies in the preoperative assessment. Choice of surgical approach (anterior transabdominal vs. posterior transsacral) was dependent upon the amount of sacral destruction, intrapelvic extension, and sacroiliac joint involvement. Microscopic examination revealed classic features of benign schwannoma in all but three cases, which were classified as cellular schwannomas. Patients who presented with pain and dysesthesiae reported immediate and complete relief of symptoms following surgery. In addition, all 13 patients were ambulatory and able to resume their routine daily activities postoperatively. At the last reported follow-up examination, which ranged from 5 months to 33 years and 3 months (mean 9 years) after surgery, two patients had died of unrelated causes, two reported return of preoperative symptoms, and the remainder were asymptomatic. This experience suggests that these histologically benign but neurologically devastating tumors should be aggressively resected with the intent of complete extirpation, and that this goal may be accomplished with minimal risk and an excellent prognosis.

Archival Big Data and the Spanish Flu in Copenhagen

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kim Abildgren
Keyword(s):  
Big Data ◽  
Birth Cohort ◽  
Mortality Risk ◽  
Early Life ◽  
Birth Cohorts ◽  
Content Type ◽  
Individual Level ◽  
Early Life Exposure ◽  
Spanish Flu ◽  
One Year

Purpose The Spanish Flu 1918–1920 saw a high degree of excess mortality among young and healthy adults. The purpose of this paper is a further exploration of the hypothesis that high mortality risk during The Spanish Flu in Copenhagen was associated with early life exposure to The Russian Flu 1889–1892. Design/methodology/approach Based on 37,000 individual-level death records in a new unique database from The Copenhagen City Archives combined with approximate cohort-specific population totals interpolated from official censuses of population, the author compiles monthly time series on all-cause mortality rates 1916–1922 in Copenhagen by gender and one-year birth cohorts. The author then analyses birth cohort effects on mortality risk during The Spanish Flu using regression analysis. Findings The author finds support for hypotheses relating early life exposure to The Russian Flu to mortality risk during The Spanish Flu. Some indications of possible gender heterogeneity during the first wave of The Spanish Flu – not found in previous studies – should be a topic for future research based on data from other countries. Originality/value Due to lack of individual-level death records with exact dates of birth and death, previous studies on The Spanish Flu in Denmark and many other countries have relied on data with lower birth cohort resolutions than the one-year birth cohorts used in this study. The analysis in this paper illustrates how archival Big Data can be used to gain new insights in studies on historical pandemics.

Is bribing a good strategy? Imbalanced interdependence and hazard of opportunism in bribery

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ho Wook Shin ◽  
Jinsil Kim ◽  
Seung-hyun Lee
Keyword(s):  
Instrumental Variable ◽  
Design Methodology ◽  
Resource Dependence ◽  
Business Environment ◽  
Government Officials ◽  
Content Type ◽  
Relational Contract ◽  
Current Resource ◽  
The Government ◽  
A Current

PurposeIn fragile institutional environments, firms often have no choice but bribery as the means to access the services monopolized by the government. Corrupt government officials whose resources are valuable to many different firms can easily find other firms willing to offer bribes. The purpose of this paper is to examine whether and how this imbalanced interdependence exposes the bribing firm to the hazard of opportunism from the bribed officials.Design/methodology/approachThis study draws on World Business Environment Survey (WBES) data and the instrumental variable (IV) Probit estimator with Heckman correction for the potential selection bias.FindingsThe authors find that the more firms depend on bribery to acquire governmental resources, the severer the level of opportunism they encounter from the government officials. In addition, the authors find that although the presence of a legal alternative to bribery reduces the level of a corrupt government official's opportunism that a bribing firm experiences, the more firms depend on bribery despite the presence of a legal alternative, the higher the level of the corrupt official's opportunism that the firm will experience. Finally, the authors find that establishing a relational contract with government officials reduces the hazard of opportunism.Originality/valueThe study contributes to the resource dependence literature by finding that a greater imbalance in the interdependence between two parties in bribery exposes the more dependent party to a larger hazard of opportunism. The finding that an ineffective alternative to a current resource provider would not strengthen but weaken a resource seeker's bargaining power expands the literature. The authors also contribute to the corruption research by showing the significant strategic, not legal, risk to bribing firms of engaging in bribery, which to date has not been sufficiently discussed.

The life cycle of a feature: modelling the transitions between feature states

2017 ◽  
Vol 34 (8) ◽  
pp. 1229-1251 ◽  
Author(s):  
Raaid Batarfi ◽  
Aziz Guergachi ◽  
M.I.M. Wahab
Keyword(s):  
Life Cycle ◽  
Design Methodology ◽  
Quality Attributes ◽  
The State ◽  
Detailed Model ◽  
Content Type ◽  
Dead State ◽  
Feature Modelling ◽  
Major Factors ◽  
A Current

Purpose Studies have suggested that attributes are dynamic and a life cycle of product and service attributes exists. When an innovative feature is introduced, the feature might attract and delight customers. However, with the passage of time the state of the attractiveness of this feature may change, for better or for worse. The purpose of this paper is to provide a detailed model that shows the factors and related sub-factors that affect the life cycle of a feature and thereby explain the changes that may happen to a feature over time. Design/methodology/approach This model provide detailed explanations of the direct and indirect factors that affect the states of a feature, the ones that affect the rate of adoption, and the ones that trigger the changes between states. The model uses a current-market product’s feature to discuss the effects of these factors on the life cycle of this feature in detail. Findings This paper extends the theory of attractive quality attributes by identified seven states of the feature in its life cycle. These states are as follows: unknown/unimportant state, honey pot state, racing state, required state, standard state, core state, and dead state. This paper also identified eight major factors that affect the transition of the feature from one state to another. These factors include demographic, socioeconomic, behavioural, psychological, geographical, environmental, organisational, and technological factors. Originality/value The findings of this paper provide additional evidence that product and service attributes are dynamic. This paper also increases the validity of the attractive quality attributes theory and the factors that affect the state of the feature in its life cycle. The understanding of the state of the feature in its life cycle, and the factors that influence this change, helps not only in the introduction of completely new features but also in knowing when to remove obsolescent ones.

Inhibition of Manual Movements at Speech Arrest Sites in the Posterior Inferior Frontal Lobe

Neurosurgery ◽  
2018 ◽  
Vol 85 (3) ◽  
pp. E496-E501 ◽  
Author(s):  
Jonathan D Breshears ◽  
Derek G Southwell ◽  
Edward F Chang
Keyword(s):  
Frontal Lobe ◽  
Functional Relationship ◽  
Inferior Frontal Gyrus ◽  
Hand Movement ◽  
Language Function ◽  
Motor Inhibition ◽  
Dominant Hemisphere ◽  
Intraoperative Localization ◽  
Stimulation Of ◽  
Motor Areas

Abstract BACKGROUND Intraoperative stimulation of the posterior inferior frontal lobe (IFL) induces speech arrest, which is often interpreted as demonstration of essential language function. However, prior reports have described “negative motor areas” in the IFL, sites where stimulation halts ongoing limb motor activity. OBJECTIVE To investigate the spatial and functional relationship between IFL speech arrest areas and negative motor areas (NMAs). METHODS In this retrospective cohort study, intraoperative stimulation mapping was performed to localize speech and motor function, as well as arrest of hand movement, hand posture, and guitar playing in a set of patients undergoing awake craniotomy for dominant hemisphere pathologies. The incidence and localization of speech arrest and motor inhibition was analyzed. RESULTS Eleven patients underwent intraoperative localization of speech arrest sites and inhibitory motor areas. A total of 17 speech arrest sites were identified in the dominant frontal lobe, and, of these, 5 sites (29.4%) were also identified as NMAs. Speech arrest and arrest of guitar playing was also evoked by a single IFL site in 1 subject. CONCLUSION Inferior frontal gyrus speech arrest sites do not function solely in speech production. These findings provide further evidence for the complexity of language organization, and suggest the need for refined mapping strategies that discern between language-specific sites and inhibitory motor areas.

Do we need medical leadership or medical engagement?

2015 ◽  
Vol 28 (3) ◽  
pp. 173-184 ◽  
Author(s):  
Peter Spurgeon ◽  
Paul Long ◽  
John Clark ◽  
Frank Daly
Keyword(s):  
Care Quality ◽  
Current Evidence ◽  
Organisational Performance ◽  
Content Type ◽  
Care Quality Commission ◽  
The Uk ◽  
Medical Leadership ◽  
First Time ◽  
Practical Implications ◽  
A Current

Purpose – The purpose of this paper is to address issues of medical leadership within health systems and to clarify the associated conceptual issues, for example, leadership versus management and medical versus clinical leadership. However, its principle contribution is to raise the issue of the purpose or outcome of medical leadership, and, in this respect, it argues that it is to promote medical engagement. Design/methodology/approach – The approach is to provide evidence, both from the literature and empirically, to suggest that enhanced medical engagement leads to improved organisational performance and, in doing so, to review the associated concepts. Findings – Building on current evidence from the UK and Australia, the authors strengthen previous findings that effective medical leadership underpins the effective organisational performance. Research limitations/implications – There is a current imbalance between the size of the databases on medical engagement between the UK (very large) and Australia (small but developing). Practical implications – The authors aim to equip medical leaders with the appropriate skill set to promote and enhance greater medical engagement. The focus of leaders in organisations should be in creating a culture that fosters and supports medical engagement. Social implications – This paper provides empowerment of medical professionals to have greater influence in the running of the organisation in which they deliver care. Originality/value – The paper contains, for the first time, linked performance data from the Care Quality Commission in the UK and from Australia with the new set of medical engagement findings.

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