Standard Language Research Articles

Defining accurate terminology for post-injury weightbearing instructions - a multidisciplinary, nationally approved consensus policy.

Weightbearing instructions after musculoskeletal injury or orthopaedic surgery are a key aspect of the rehabilitation pathway and prescription. The terminology used to describe the weightbearing status of the patient is variable; many different terms are used, and there is recognition and evidence that the lack of standardized terminology contributes to confusion in practice. A consensus exercise was conducted involving all the major stakeholders in the patient journey for those with musculoskeletal injury. The consensus exercise primary aim was to seek agreement on a standardized set of terminology for weightbearing instructions. A pre-meeting questionnaire was conducted. The one-day consensus meeting, including patient representatives, identified three agreed terms only to be used in defining the weightbearing status of the patient: 1) non-weightbearing; 2) limited weightbearing; and 3) unrestricted weightbearing. This study represents the first and only exercise in standardizing rehabilitation terminology in orthopaedics, as agreed by all major stakeholders in the patient pathway and the patients themselves. The standardization of language allows for higher-quality and more accurate research to be conducted, and is one small part of the bigger picture in increasing the mobility of patients after orthopaedic injury or surgery.

Assessing the Language Abilities of Preterm-Born Children: An Examination of Standardized Testing and Language Sample Analysis.

To understand how best to assess the language abilities of preterm-born children, this study: (a) compared preterm- and term-born children's language skills using standardized testing and language sample analysis (LSA), (b) investigated how executive function skills and the language sampling context respectively affect standardized test and LSA scores, and (c) examined the pattern of associations between standardized test and LSA scores among preterm-/term-born groups. Twenty-five term-born and 23 preterm-born 2-year-old singletons were administered the language scales of the Bayley Scales of Infant and Toddler Development-Third Edition (receptive communication, expressive communication, language composite scores). Parent-child free-play recordings were used to quantify the (para)linguistic features of the children's speech. Executive function was measured via parent report. The preterm-born group obtained significantly lower scores than the term-born group on all Bayley language measures (though differences were not consistently observed when using cutoff scores). Few preterm-term differences in LSA measures were found. The preterm-term differences in Bayley scores were not explained by between-group differences in executive function. Some preterm-term differences in LSA scores were moderated by the language sampling context. The preterm- and term-born groups exhibited different patterns of Bayley-LSA correlations. Preterm language difficulties were more apparent on standardized test than LSA scores. Nonetheless, the Bayley-LSA correlations indicate that poor test performance (linked with preterm birth) is associated with functional communication difficulties. The discussion outlines the complementary utility of standardized tests and LSA while acknowledging the limited utility of cutoff scores and the confounding influence of the language sampling context. https://doi.org/10.23641/asha.26142661.

DEVELOPING COMMUNICATIVE COMPETENCE OF STUDENTS AT ENGLISH LESSONS

In the article the importance of developing communicative competence of students at English lessons, as one of the backgrounds for forming an individual is considered. The recent studies of solving this issue, as one of the necessary conditions in learning a foreign language, are overviewed. In the article the notion “communicative competence” and its components are determined: grammatical competence, discourse competence, that is the ability to build sentences in discourse for the purpose of forming meaningful integrity from a set of utterances, sociolinguistic competence, which lies in understanding the right usage of language standards, that depend on a particular context and strategic competence, which determines language techniques, that are used when interlocutors have a communication gap as a result of imperfect language knowledge. These techniques include: correction, paraphrase, parable, repetition and pause. The article exercises, tasks for developing communicative competence worked out by its author. Special attention is paid to the brainstorming activities, as an example, the author gives spidergram “Teacher”. The developed approach allows to monitor communicative competence development of students and to fulfil additional methodological approaches for developing creative activities of students.

Evaluation of the accuracy of conventional and digital implant impression techniques in bilateral distal extension cases: a randomized clinical trial

BackgroundThis clinical study aims to evaluate the accuracy of the conventional implant impression techniques compared to the digital impression ones in bilateral distal extension cases.MethodsA total of 32 implants were placed in eight patients missing all mandibular posterior teeth except the first premolars. Each patient received a total of four implants, with two implants placed on each side, in order to provide support for three units of screw-retained zirconia restorations. Following osteointegration, the same patient underwent two implant-level impression techniques: Conventional open-tray impressions CII (splinted pick-up) and digital implant impressions DII with TRIOS 3 Shape intraoral scanner. The accuracy of impressions was evaluated utilizing a three-dimensional superimposition analysis of standard tessellation language (STL) files. Subsequently, the scan bodies were segmented using Gom inspect software to measure three-dimensional deviations in a color-coding map. Data were statistically analyzed using the Kruskal Wallis test and then a post-hoc test to determine the significance level (P < 0.05).ResultsThe study revealed that higher angular and positional deviations were shown toward distal scan bodies compared to mesial ones for both impression techniques. However, this difference was not statistically significant (P > 0.05).ConclusionSplinted open-tray conventional impression and intraoral scanning implant impression techniques have demonstrated comparable accuracy.Trial registrationClinical Trials.gov Registration ID NCT05912725. Registered 22/06/ 2023- Retrospectively registered, https://register.clinicaltrials.gov.

Lingua francas as evidence of standard language ideology in historical perspective

Lingua francas as evidence of standard language ideology in historical perspective

A Cost-effective approach for quality control in PLA-based material extrusion 3D printing using 3D scanning

In this article, our aim is to underscore the importance of verifying that components produced through material extrusion additive manufacturing exhibit geometric and dimensional conformity with the STL (Standard Tessellation Language) model. Currently, the business world is heavily investing in additive technologies, but it is crucial to obtain feedback on the accuracy of the printed component without excessive economic expenditure. For this reason, we have opted to utilize a mid-range 3D scanner (Revopoint Mini with an accuracy of 0.02 mm) to investigate any disparities in print results using PLA material. Each model has been scanned and compared with the initial mesh to qualitatively and quantitatively assess the present errors. The analysis has revealed that the majority of features can be effectively controlled, while the remaining ones either fall within the tool's precision or necessitate a higher-quality scan. Particularly in the analysed case, flat surfaces, profiles of complex geometries, and holes have demonstrated dimensional and geometric controllability. However, details of reduced dimensions or those difficult to reach by the scanner do not allow for adequate comparison due to excessive standard deviation in the error. The analysed layer heights do not exhibit a significant impact on component accuracy.

Bilingualism and Intelligence: An Examination with a View of Peal and Lambert's Study: The Relation of Bilingualism to Intelligence

Bilingualism is based on a description of the linguistic situation in a speech community that consists of colloquial and standard language, ultimately resulting in the existence of two different languages that are used alternatively in speaking, writing, listening, and reading. The acquisition of another language will cause changes on the brain. Studies have been inquiring into the pros and cons of having two or more different languages. The study of Peal and Lambert supported significant structural changes involved in the acquisition of another language form, and that it guaranteed the enhancement of intellectual capacity, cognitive ability, and intelligence. The present study aims to shed light on the effects of bilingualism on the intellectual functioning in the brain and the life of bilingual as a whole. It adopted the descriptive method of the relation of bilingualism to intelligence. The study concluded that bilingualism could enhance life by improving cognitive abilities. It recommends conducting further studies to explore bilingualism, intelligence, and other areas, including passive vs. active, sequential vs. simultaneous, and receptive vs. productive bilingualism. Received: 3 April 2024 / Accepted: 13 June 2024 / Published: 02 July 2024

Novel digital technique for measuring the volumetric healing process of free gingival grafts surrounding dental implants

The objective of the present study was to analyze and describe a new digital technique for analyzing the volumetric healing process of free gingival grafts in both donor and recipient locations surrounding a dental implant, as well as to compare the reliability of conventional and digital techniques for measuring the width of the free gingival graft in the recipient location throughout the healing process.Materials and methodsTen patients presenting with mucositis linked to a dental implant were included. A preoperative soft tissue width &amp;lt;2 mm, with probing pocket depth &amp;lt;5 mm, edema and inflammation and bleeding on probing was determined A digital impression was taken of both donor and recipient locations using an intraoral scan, generating a Standard Tessellation Language digital file both preoperatively (STL1) and after 1 week (STL2), 1 month (STL3), 3 months (STL4), and 6 months (STL5) of follow-up. Afterwards, the digital files (STL1-STL5) were aligned using a reverse engineering morphometric software, and Student's t-test was used to analyze changes in volume at the donor and recipient locations. Additionally, widths were measured both clinically and digitally so as to compare the reliability of these measurement techniques. The repeatability and reproducibility of both these measurement techniques were also analyzed using Gage R&amp;amp;R statistical analysis.ResultsGage R&amp;amp;R found that total variability of the digital technique was 0.6% (among the measures of each operator) and 7.6% (among operators); as variability was under 10%, the results were repeatable and reproducible. In addition, there were statistically significant differences between donor and recipient locations in healing process volume (mm3) after one week (p = 0.0110), one month (p = 0.0007), three months (p &amp;lt; 0.0001) and six months (p = 0.0004) of follow-up.ConclusionThe digital measurement technique provided accurate, repeatable, and reproducible results when analyzing the volumetric and lineal measures of the healing process in both the donor and recipient locations of a free gingival graft surrounding a dental implant, with significantly higher tissue volume in the recipient location.

A comprehensive picture of using standardized nursing languages in long-term care systems: An integrative review.

This integrative review was conducted to provide a comprehensive picture of the use of standardized nursing languages (SNLs) in long-term care (LTC) systems. A comprehensive search was performed with terminological variants of "standardized terminology" and "long-term care" in eight electronic databases up to December 2021. Eligible studies were further identified by screening the reference lists of publications that met the inclusion criteria. The quality of the included studies was appraised using the Joanna Briggs Institute checklists. The study findings were organized into themes, which represent the focus of the study. Eighty-one publications that studied 12 SNLs in 17 countries are presented in this review. The Omaha System, NANDA-I, NIC, and NOC were the most common SNLs. Study foci were classified into five themes: evaluating the applicability of 10 SNLs (n=22), characterizing nursing care using six SNLs (n=16), developing core sets and tools based on seven SNLs (n=15), documenting nursing care by using four SNLs (n=14), and implementing intervention programs based on six SNLs (n=14). SNLs can be used for various purposes, and the available evidence supports the expansion of their utilization. Further studies should continue to identify gaps in the existing versions of SNLs to reflect the LTC nursing process in multiple societies. Additionally, the successful use of SNLs requires background knowledge of nursing informatics; therefore, preparation should be started in the nursing curriculum and continued in healthcare facilities, including LTC settings. These research findings will assist healthcare managers, researchers, and policymakers in the LTC field in effectively utilizing SNLs.

Systems Architecture Meta‐Model for the MagicGrid Framework

AbstractAlthough Model‐Based Systems Engineering (MBSE) might be understood and applied across diverse communities and industries differently, its fundamental principles and practices described in INCOSE Systems Engineering Handbook, are common. It is known that successful application of MBSE is impossible without a tool, language, and method as well as harmony among these three. The de‐facto standard modeling language for MBSE is Systems Modeling Language (SysML). However, SysML is only a language, and it is not aligned with terminology systems engineers use daily in their work. This paper studies SysML as the standard language to model systems, and MagicGrid as the framework to bridge the gap between Systems Engineering (SE) terminology described in the INCOSE Systems Engineering Handbook and SysML specification. It proposes a new systems engineering meta‐model to describe a common SE terminology and bind it to the SysML concepts.

Evaluation of Surface Roughness of Acrylic Denture Bases Polished Using Algishine, a Novel Polishing Material: An In Vitro Study.

Introduction Surface roughness (Ra) significantly impacts the aesthetic and functional qualities of dental prosthetics. Traditional polishing involves pumice, a material routinely used in dental practice. This study introduces Algishine as a potential cost-effective eco-friendly alternative. Materials and methods A 3D design software (Geomagic) created a Standard Tesselation Language (STL) file of 10 mm x 10 mm x 2 mm. 30 STL file outputs were generated. The output was milled in wax. This was then flasked and processed. 30 acrylic resin specimens were fabricated and divided into two groups. Group A was polished using traditional pumice, and Group B was polished using Algishine. The Ra of each sample was measured using surface profilometry, with three readings per sample averaged for each group. Results Kruskal-Wallis test was performed to compare the two groups with the pre-testing samples, which showed p<0.05; indicating that there was a significant difference between the two groups. The average Ra value for unpolished acrylic was 7.105, while the specimens polished with pumice showed an Ra value of 2.218; specimens polished with novel materialAlgishine showed an Ra value of 1.743. This illustrates that Algishine achieves surface smoothness significantly superior to commonly used polishing agent andpumice. Discussion The results of our study demonstrate that Algishine, a novel polishing material derived from recycled alginate, effectively reduces the Ra of acrylic resin. This finding has significant implications, both clinically and environmentally. The primary clinical benefit of a smoother acrylic resin surface is the enhanced aesthetic appearance and increased patient comfort. A polished surface reduces plaque accumulation, thereby decreasing the risk of oral infections and improving the longevity of the dental prosthesis. The results show that Algishine achieves surface smoothness comparable to or better than pumice indicating that it can maintain, if not enhance, these clinical outcomes. Dental professionals can confidently use Algishine, knowing it meets the high standards required for patient care. Conclusion Algishine effectively reduces the Ra of acrylic resin, suggesting it is a viable, eco-friendly alternative to traditional pumice for dental polishing procedures. This indicates potential benefits in maintaining clinical outcomes while promoting environmental sustainability.

Towards UAF Implementation in SysML V2

AbstractThe ongoing transformation in the industry from a document‐based systems engineering to a model‐based systems engineering approach reveals gaps in existing modeling standards. Evolution of standards is inevitable. A de facto standard modeling language, SysML (Systems Modeling Language), is undergoing a major transformation in its evolution, with the introduction of SysML version 2, which is a complete redesign of the language architecture. With the major update of SysML, all related standards need to be redesigned. The Unified Architecture Framework (UAF) is not an exception. UAF version 2 is a future version of the standard to be based on SysML V2. Currently, the development of UAF based on SysML V2 is in the very early stages, and various organizations involved in its development are independently researching the way forward. This paper describes one of the research projects to test the feasibility of SysML V2 to address UAF community needs.

Ethnic Integration and Evolution of the Phonological Features of Northern Standard Chinese Language

Ethnic Integration and Evolution of the Phonological Features of Northern Standard Chinese Language

Empowering Model‐Based Systems Engineering Through Metamodeling

AbstractA critical enabler for Model‐Based Systems Engineering (MBSE) and Digital Engineering (DE) is the generation of coherent and consistent views of a system‐of‐interest based on information within a system model. In practice, system model development is facilitated through domain‐specific profiles, style guides, reference models, and low‐fidelity meta‐models to create coherent and consistent system information. Each of these approaches are useful but are insufficient for robust and automated verification of system models to an ideal. Furthermore, the expression of domain‐specific concepts and semantics relies on the proliferation of non‐standard, domain‐specific profiles as standard system modeling languages like the Systems Modeling Language (SysML) are general purpose. This paper proposes a novel approach to creating precise, machine‐interpretable metamodels implemented as a lightweight Unified Modeling Language (UML) profile. The profile includes numerous features that allow model architects to quickly specify context and domain‐specific modeling constructs without creating non‐standard stereotypes to apply domain‐specific meaning and usage rules. Three kinds of constraints can be inferred based on the relationships between meta‐model elements: type, multiplicity, and default value. Applications of well‐formed metamodels include a shared understanding of the intended model format and structure, as well as the one‐time programmatic generation of an encompassing suite of validation rules to evaluate a system model against the inferred constraints, thus ensuring consistency. Additional applications include programmatic generation of model analysis metrics, system models from metamodels, metamodels from reference models and element finding queries, and the ability to update a system model based upon the updated metamodel automatically. Use of the approach results in reduced time in system model development and analysis and ensures coherency and consistency of information thus increasing stakeholder use and confidence in the system model.

대조언어학적 관점을 통한 베트남어권 한국어 학습자를 위한 비음화 오류양상 고찰과 시사점

Objectives The purpose of this study is to obtain educational implications by examining the patterns of nasalization errors (correct and incorrect answers) that appear in each environment among Vietnamese Korean language learners. Methods In order to proceed with this discussion, we first reviewed previous research and theoretical background, and then established standards to analyze the nasalization error rate by environment. After that, from January 30, 2023 to January 30, 2024, in Korea, 19 to 30-year-olds After a basic survey, 15 Vietnamese Korean language learners (5 men and 10 women each) met 1:1 via Zoom and were asked to utter pre-prepared words related to nasal pronunciation. Then, by determining whether the answer was incorrect or correct, more detailed error types and their characteristics according to the overall results and characteristics of each environment were extracted. Results As a result of the analysis, through a review of previous research related to contrastive linguistics, it was possible to understand the fundamental cause of nasalization through differences in syllable structure between the two languages, and through a basic survey, despite the high demand for nasalization education, there was no awareness due to lack of educational experience. I could see that it was lacking. In addition, the results of error patterns by environment showed that the highest rate was in the case of ‘nasalization after adding ‘ㄴ’ or ‘nasalization after consonant group simplification.’ It was found that this was caused by a lack of awareness of nasalization by environment among the nasalization rules of Korean, the standard language. In addition, the higher error rate at ‘word boundaries’ rather than ‘word interior’ showed that nasalization education should be done ‘by phrase’. Lastly, as a result of examining error patterns by region, grade, and gender in an environment that previously showed a high error rate, all grades showed similar difficulties in pronunciation of bar consonants, but by region, it was more common in the south than in the north and central regions, and by gender, more than in women. A high error rate was observed in men. Conclusions In this way, this study identified the actual status of nasalization errors (total error rate by environment and error rate by word interior/boundary) of Vietnamese learners in more diverse environments and, unlike existing previous studies, provided basic data and implications for preparing educational measures. It was a meaningful study in that it was able to obtain results.

Indonesian Slang Word Formation Processes in TikTok

Language changes over time due to social and cultural factors. These changes are evident through language varieties such as standard and non-standard languages, dialects, accents, and registers. This research focuses on one type of language variation, namely slang. Slang words show that language is constantly changing. For example, there are many new slang words that emerge and old ones that are no longer used or replaced. Slang also reflects people’s creativity because through slang we can see how someone can be very creative in making new words or modifying existing words. This research aims to identify the slang words that appear in the comments section of the TikTok during June to December 2022 and analyze the word formation process of each slang found. The authors used the qualitative descriptive method in order to present the data thoroughly. This study found that there were 39 slang words that appeared repeatedly and there were six most common word formation processes found in TikTok comments, namely blending, clipping, borrowing, acronym, affixation, and multiple processes. The most frequent processes are blending and clipping. The least frequent word formation processes are affixation and borrowing.

Effect of preparation design and scan pattern on the accuracy of intraoral scans for complete arch laminate veneers under simulated intraoral variables.

The purpose of the study was to investigate the influence of different preparation designs and scan patterns on the accuracy of intraoral scans for complete-arch maxillary laminate veneers. Three maxillary typodonts were used to obtain reference models with three different laminate veneer preparation designs: windows (W), beveled (B), and incisal overlap (IO). Reference scans were obtained with a desktop scanner. A total of 90 complete arch intraoral scans were made with an intraoral scanner (Medit i700) following three different scan patterns: straight motion (SM), zigzag motion (ZM), and combined motion (CM). Ten scans were made in each subgroup and exported as standard tessellation language (STL) files. Assessment of accuracy was conducted with a 3D software analysis program (Geomagic Control X). Each STL file was individually aligned with the reference scan using the best fit algorithm tool, and 3D differences were calculated using the root mean square (RMS) value. Two-way analysis of variance (ANOVA) followed by post hoc comparison tests were applied to analyze precision and trueness data (α = 0.05). Two-way ANOVA and post hoc comparison tests revealed significant differences among different preparation designs and scan patterns (p < 0.05). Regarding trueness, the IO when scanned with SM presented higher mean RMS than the other preparation designs (W and B) scanned with the same scanning pattern (p < 0.05). Regarding precision, the groups of W and IO presented significantly higher mean RMS than the group of B when scanned with ZM (p < 0.05). Accuracy of intraoral scans for complete-arch laminate veneers was affected by different laminate veneer preparation designs and scan patterns. Modifying scan pattern according to preparation design helps to improve scan accuracy for complete-arch laminate veneers.

Anachronism or Cultural Transfer? Latin Journals in the Public Sphere of the Hungarian Kingdom in the Eighteenth and Nineteenth Centuries

Latin journalism in Europe flourished between 1600 and 1750. However, in the peripheral regions east of the German-speaking lands, including Hungary, periodicals began to appear in greater numbers only from the early eighteenth century. By that time, Latin journalism was losing its popularity in the central regions of Europe due to the widespread establishment of the vernacular press and the standardization of native languages. Yet, the editors of the newly established periodicals in Hungary could not follow this pattern due to several reasons. One solution to their problems was to develop the Latin-language press. This paper attempts to reconceptualize the role of late Latin journalism from the perspective of specific peripheral cultural circumstances, with a special focus on the periodical genre of &amp;lsquo;ephemerides&amp;rsquo;. The focus of the analysis is on Ephemerides Statistico-Politicae / Posonienses (1804&amp;ndash;38), a popular and significant nineteenth-century Latin journal, and its supplementary annexes.

The effect on the performance of a dynamic navigation system of superimposing a standard tessellation language (STL) file obtained with an intraoral scan on a cone beam computer tomograph (CBCT). An experimental in vitro study

ObjectivesTo compare the accuracy and operative time of implant placement using a dynamic computer assisted implant surgery (dCAIS) system based on a cone beam computer tomography (CBCT) image, with and without superimposing a standard tessellation language (STL) file of an intraoral scan of the patient. MethodsTen identical resin models simulating an upper maxilla with posterior edentulism were assigned to two groups. In the CBCT+STL group, a CBCT file and an intraoral STL file were superimposed and used for registration; in the CBCT group, registration was performed using CBCT images. Six implants were placed in each model using the Navident® dynamic navigation system. Anatomy registration was performed by tracing fiducial points on the CBCT or STL image, depending on the group. Preoperative and postoperative CBCT images were overlaid to assess implant placement accuracy. ResultsSixty implants were analyzed (30 implants in each group). 3D platform deviation was significantly lower (mean difference (MD): 0.17 mm; 95 % confidence interval (CI): 0.01 to 0.23; P = 0.039) in the CBCT+STL group (mean: 0.71 mm; standard deviation (SD): 0.29) than in the CBCT group (mean: 0.88 mm; SD: 0.39). The remaining accuracy outcome variables (angular deviation MD: -0.01; platform lateral deviation MD: 0.08 mm; apex global MD: 0.01 mm; apex depth MD: 0.33 mm) and surgery time (MD: 3.383 min.) were similar in both groups (p > 0.05). ConclusionsThe introduction of an intraoral scan (STL) seems to reduce deviations slightly in dental implant placement with dCAIS systems. However, the clinical repercussion of this improvement is questionable. Clinical significanceSuperimposing an intraoral scan on the CBCT image does not seem to increase the accuracy of dCAIS systems but can be useful when radiographic artifacts are present.

Vocabulary and expressive morpho-syntax in individuals with Down syndrome: Links to narration

BackgroundNarrative ability is crucial for social participation in everyday and school life but involves different language abilities such as vocabulary and morpho-syntax. This is particularly difficult for individuals who display both language and cognitive impairments. Previous research has identified productive vocabulary as a possible key factor for narrative performance in individuals with Down syndrome. Considering a close connection between lexical and morpho-syntactic performance within language acquisition and the distinct impairments that individuals with Down syndrome display concerning their morpho-syntactic skills, the nature of a relation between vocabulary and narrative skills under the influence of grammatical deficits requires further investigation. MethodsNarrations were obtained from 28 children and adolescents with Down syndrome (aged 10;0–20;1) using a non-verbal picture book. Narrative abilities were rated using the Narrative Scoring Scheme across seven narrative aspects (including macro- and microstructure). Vocabulary analyses and morpho-lexical context analyses including verb and conjunction enumerations, evaluation of verb position and MLU were conducted. Findings from the transcript analysis have been supplemented with data from standardized language measures evaluating expressive lexical and morpho-syntactic development. A multiple regression analysis was conducted to identify significant predictors for narrative outcome in the participants with Down syndrome. ResultsLexical analyses revealed a high heterogeneity in production of subordinating conjunctions as a link between lexical and morpho-syntactic abilities. Comparisons of standardized and narrative data demonstrated differences in subordinate clause production depending on the elicitation setting. A multiple regression analysis identified the number of different verbs in the narrative task as the most significant predictor for narrative performance in individuals with Down syndrome. Discussion and implicationsThe findings of this study contribute to the knowledge regarding factors that influence narrative performance in individuals with language impairment. A differentiated verb lexicon can be identified as the key ability for reaching advanced narrative skills in participants with Down syndrome. These findings are of clinical relevance for therapeutic and educational support and contribute to an understanding of the relation between strengths in vocabulary and morpho-syntactic weaknesses in individuals with Down syndrome within communicative participation.