Perspective and practice patterns of mediastinal staging among thoracic surgeons.

Background: Accurate mediastinal staging of lung cancer patients is critical for determining appropriate treatment. Mediastinoscopy and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration are the most commonly utilized techniques. Limited data exist on training and practice trends among thoracic surgeons. We aimed to determine training and practice patterns and find whether there is a paradigm shift in mediastinal staging after the introduction of EBUS into practice among thoracic surgeons in the United States. Methods: 28-question survey was constructed querying demographic, training, and practice patterns with mediastinoscopy and EBUS and was sent to practicing thoracic surgeons in the United States. Descriptive statistics were used to summarize quantitative data. Results: Ninety-eight responded with a 93% completion rate. Eighty-seven percent of respondents received training in EBUS and 70% perform EBUS routinely. All respondents believe EBUS should be incorporated into thoracic surgery training curriculums. Majority of those who prefer EBUS feel EBUS is safer than mediastinoscopy, allows access to lymph nodes stations or lesions inaccessible by mediastinoscopy and prefer EBUS to avoid re-do mediastinoscopy and in irradiated mediastinum. Majority of those who prefer mediastinoscopy reported they perform more accurate staging compared to EBUS, that mediastinoscopy is more accurate in diagnosing lymphoma or sarcoidosis and that frozen section can be done at the same interval as resection. Among surgeons who prefer EBUS, 94% biopsy 3 or more lymph node stations, 86% routinely biopsy hilar (N1) nodes while 8% never biopsy N1 nodes. Of surgeons who prefer mediastinoscopy. Ninety-seven percent biopsy 3 or more lymph node stations, only 27% routinely biopsy N1 nodes and 70% never biopsy N1 nodes. Conclusions: EBUS is used frequently by thoracic surgeons in their practice for mediastinal staging. Methods of obtaining proficiency in EBUS widely varied among surgeons. In addition to mediastinoscopy, dedicated EBUS training should be incorporated into thoracic surgery training curriculums.

Data on acoustic phonetic properties of non-coronal fricatives in monosyllabic words of Zhongjiang Chinese.

The data reported in this article are non-coronal fricative measurements from 10 (5 male; 5 female) native speakers of Zhongjiang Chinese. Each speaker produced 10 repetitions of 90 monosyllabic words beginning with either a velar fricative, /x/, or a labial-dental fricative, /f/. The measurements reported include spectral properties often used to characterize fricative variation, including: spectrum center of gravity (CoG), spectrum standard deviation (SD), spectrum skew, spectrum kurtosis, maximum amplitude frequency, and maximum amplitude. These measurements are compared across two data filtering conditions: a high pass filter condition, in which a 300Hz high pass filter was applied to the data before spectral measurements were calculated, and a no filter condition. The 90 monosyllabic words include the target fricatives in different phonetic environments. Target words include some that historically derive from different fricatives and show variation across regional varieties of Mandarin Chinese. Subsets of the target materials enable several closely matched comparisons of items. We describe measurements across the whole dataset, comparing as well the effect that filtering has on the measurements. The data also include a CSV file with measurements of each token, which enables comparison of phonetic contexts, lexical effects and individual differences in fricative variation beyond those described here. For further discussion of the data, please refer to the full length article entitled "The role of gestural timing in non-coronal fricative mergers in Southwestern Mandarin: acoustic evidence from a dialect island. Journal of Phonetics" [6].

More on the articulation of devoiced [u] in Tokyo Japanese: effects of surrounding consonants.

Past work investigating the lingual articulation of devoiced vowels in Tokyo Japanese has revealed optional but categorical deletion. Some devoiced vowels retained a full lingual target, just like their voiced counterparts, whereas others showed trajectories that are best modelled as targetless, i.e., linear interpolation between the surrounding vowels. The current study explored the hypothesis that this probabilistic deletion is modulated by the identity of the surrounding consonants. A new EMA experiment with an extended stimulus set replicates the core finding of Shaw, Jason & Shigeto Kawahara. 2018b. The lingual gesture of devoiced [u] in Japanese. Journal of Phonetics 66. 100-119. DOI:https://doi.org/10.1016/j.wocn.2017.09.007 that Japanese devoiced [u] sometimes lacks a tongue body raising gesture. The current results moreover show that surrounding consonants do indeed affect the probability of tongue dorsum targetlessness. We found that deletion of devoiced vowels is affected by the place of articulation of the preceding consonant; deletion is more likely following a coronal fricative than a labial fricative. Additionally, we found that the manner combination of the flanking consonants, fricative-fricative versus fricative-stop, also has an effect, at least for some speakers; however, unlike the effect of C1 place, the direction of the manner combination effect varies across speakers with some deleting more often in fricative-stop environments and others more often in fricative-fricative environments.

A Narrative Review of update in per oral endoscopic myotomy (POEM) and endoscopic esophageal surgery.

The field of endoscopic esophageal surgery is based on the concept of natural orifice transluminal endoscopic surgery (NOTES). Submucosal space surgery or third space surgery with the use of flexible endoscopy allows for decreased morbidity and hospital length of stay with equivalent outcomes for patients. In the case of achalasia, per oral endoscopic myotomy (POEM) allows for management of refractory cases in setting of previous Heller Myotomy or in patients whom laparoscopic or thoracoscopic surgery is contraindicated. Lastly, POEM more directly divides circular muscular layer of esophagus without destroying surrounding structures that exist to prevent reflux. The innovations in endoscopic surgery began in the animal lab with experiments in the porcine model to develop a way to access the peritoneal cavity through an entry point in the gastric mucosa. Over the last 10 years, the biggest treatment innovations in endoscopy have focused on management of achalasia with the use of POEM. POEM became possible as technology was developed that revolutionized the use of flexible technology and the methods of mucosal closure. In addition to benign esophageal disease, endoscopic methods improved in management of esophageal malignancy with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The innovations of endoscopic surgery have been developed through the utilization of the submucosal space as a method to ensure adequate closure of the mucosal entry point into the peritoneal cavity. The goal of this review paper is to explore POEM and other techniques in endoscopic esophageal surgery for the management of esophageal diverticulum, submucosal tumors, gastroparesis, and gastrointestinal esophageal reflux disease.

Can a Portable Balance System Predict Fall Risk in Community-Dwelling Older Women?

PURPOSE: Increased fall risk has been linked to age, being female, and age-related changes in the postural control system. The purpose of this study was to determine if a portable balance system could predict fall risk by determining the relationship among the modified Clinical Test for Sensory Interaction on Balance (mCTSIB) scores, age, the Activities-specific Balance Confidence Scale (ABC) score, and the Berg Balance Scale (BBS) score in community-dwelling older women. Insight into these relationships may facilitate early intervention and decrease fall risk in older women. METHODS: This study was a non-experimental, prospective, cross-sectional, exploratory analysis to determine the relationship among the mCTSIB, age, ABC, and BBS. Women aged 65 years and over were selected from two independent living facilities using a sample of convenience (n=42). RESULTS: The mCTSIB firm surface, eyes open and the ABC predicted fall risk (BBS) scores, F(2, 36)=35.72, p<0.001, R2=0.67, but adding age did not significantly improve the model, b= -0.17, t(36)= -1.71, p=0.10. CONCLUSION: A portable balance system may be an effective screening tool to predict fall risk in community-dwelling older women and may be used by a variety of allied health professionals. Postural sway, and perceived balance, predicted fall risk scores (BBS). More specifically, data obtained from the mCTSIB firm surface, eyes open test condition when combined with ABC scores could lead to identification of increased fall risk, allowing clinicians to recommend early treatment intervention to prevent future falls.

Prosody leaks into the memories of words.

The average predictability (aka informativity) of a word in context has been shown to condition word duration (Seyfarth, 2014). All else being equal, words that tend to occur in more predictable environments are shorter than words that tend to occur in less predictable environments. One account of the informativity effect on duration is that the acoustic details of probabilistic reduction are stored as part of a word's mental representation. Other research has argued that predictability effects are tied to prosodic structure in integral ways. With the aim of assessing a potential prosodic basis for informativity effects in speech production, this study extends past work in two directions; it investigated informativity effects in another large language, Mandarin Chinese, and broadened the study beyond word duration to additional acoustic dimensions, pitch and intensity, known to index prosodic prominence. The acoustic information of content words was extracted from a large telephone conversation speech corpus with over 400,000 tokens and 6000 word types spoken by 1655 individuals and analyzed for the effect of informativity using frequency statistics estimated from a 431 million word subtitle corpus. Results indicated that words with low informativity have shorter durations, replicating the effect found in English. In addition, informativity had significant effects on maximum pitch and intensity, two phonetic dimensions related to prosodic prominence. Extending this interpretation, these results suggest that predictability is closely linked to prosodic prominence, and that the lexical representation of a word includes phonetic details associated with its average prosodic prominence in discourse. In other words, the lexicon absorbs prosodic influences on speech production.

Clinical Characteristics and Outcome of Pneumomediastinum in Patients with COVID-19 Pneumonia.

Introduction: Pneumomediastinum (PM) is characterized by the presence of air within the mediastinum. The association between PM and coronavirus 2019 (COVID-19) has not been well established in the current literature. We sought to summarize the limited body of literature regarding PM in patients with COVID-19 and characterize the presentation and clinical outcomes of PM in patients with severe acute respiratory syndrome (SARS)-COV-2 pneumonia at our institution to better define the incidence, prognosis, and available treatment for this condition. Materials and Methods: All patients with a proven diagnosis of COVID-19 and PM between March 18, 2020 and May 5, 2020 were identified through hospital records. Retrospective analysis of radiology records and chart review were conducted. Clinical characteristics and outcomes were collected and descriptive statistics was analyzed. Results: Thirty-six patients met inclusion criteria. Out of the 346 intubated COVID-19 patients, 34 (10%) had PM. The incidence of PM increased for the first 4 weeks of the pandemic, and then began to decrease by week 5. At the endpoint of the study, 12 (33.33%) patients were alive and 24 patients (66.67%) had died. Conclusion: PM, although a rare phenomenon, was more prevalent in COVID-19 patients compared with historical patients with adult respiratory distress syndrome. The etiology of this condition may be attributed to higher susceptibility of patients infected with SARS-CoV-2 to a combination of barotrauma and airway injury.

Gender and social network brokerage: A meta-analysis and field investigation.

In this article, we aim to address 2 important questions: (a) Are women less likely than men to occupy network brokerage positions? And if so, (b) what mechanisms may explain their fewer brokerage roles? Study 1, a meta-analysis examining gender differences in network brokerage, analyzed a cumulative sample of 15,743 individuals (69 independent samples) to show that women were less likely to be brokers in both instrumental and expressive networks, which partly explained their lower career success. Study 2, a follow-up study with 2 independent samples of new employees (n = 150 and 245, respectively), examined both structural opportunity (job-based opportunity and workplace discrimination) and individual agency (proactive networking) as potential mechanisms underlying the relationship between gender and network brokerage. Results of these 2 samples consistently show that proactive networking mediated gender's effect on network brokerage that was measured 6 months after the new employees entered their organizations. The predictions regarding the mediation effects of job-based opportunity and workplace discrimination were not supported. Our findings offer valuable insights into the relative positions of women and men in informal structures of organizational networks, advance our understanding of gender inequality in career outcomes, and shed new light on the relative importance of individual agency and structural opportunity in explaining individuals' occupancy of advantageous network positions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 and the workplace: Implications, issues, and insights for future research and action.

The impacts of COVID-19 on workers and workplaces across the globe have been dramatic. This broad review of prior research rooted in work and organizational psychology, and related fields, is intended to make sense of the implications for employees, teams, and work organizations. This review and preview of relevant literatures focuses on (a) emergent changes in work practices (e.g., working from home, virtual teamwork) and (b) emergent changes for workers (e.g., social distancing, stress, and unemployment). In addition, potential moderating factors (demographic characteristics, individual differences, and organizational norms) are examined given the likelihood that COVID-19 will generate disparate effects. This broad-scope overview provides an integrative approach for considering the implications of COVID-19 for work, workers, and organizations while also identifying issues for future research and insights to inform solutions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Localized Bathless Metal-Composite Plating via Electrostamping.

Composite plating with particles embedded into the metal matrix can enhance the properties of the metal coating to make it more or less conductive, hard, durable, lubricated or fluorescent. However, it can be more challenging than metal plating, because the composite particles are either 1) not charged so they do not have a strong electrostatic attraction to the cathode, 2) are hygroscopic and are blocked by a hydration shell, or 3) too large to remain stagnate at the cathode while stirring. Here, we describe the details of a bathless plating method that involves anode and cathode nickel plates sandwiching an aqueous concentrated electrolyte paste containing large hygroscopic phosphorescent particles and a hydrophilic membrane. After applying a potential, the nickel metal is deposited around the stagnant phosphor particles, trapping them in the film. The composite coatings are characterized by optical microscopy for film roughness, thickness and composite surface loading. In addition, fluorescence spectroscopy can be used to quantify the illumination brightness of these films to assess the effects of various current densities, coating duration and phosphor loading.

Effects of vowel coproduction on the timecourse of tone recognition.

Vowel contrasts tend to be perceived independently of pitch modulation, but it is not known whether pitch can be perceived independently of vowel quality. This issue was investigated in the context of a lexical tone language, Mandarin Chinese, using a printed word version of the visual world paradigm. Eye movements to four printed words were tracked while listeners heard target words that differed from competitors only in tone (test condition) or also in onset consonant and vowel (control condition). Results showed that the timecourse of tone recognition is influenced by vowel quality for high, low, and rising tones. For these tones, the time for the eyes to converge on the target word in the test condition (relative to control) depended on the vowel with which the tone was coarticulated with /a/ and /i/ supporting faster recognition of high, low, and rising tones than /u/. These patterns are consistent with the hypothesis that tone-conditioned variation in the articulation of /a/ and /i/ facilitates rapid recognition of tones. The one exception to this general pattern-no effect of vowel quality on falling tone perception-may be due to fortuitous amplification of the harmonics relevant for pitch perception in this context.

Does Hands-on Guarding Influence Performance on the Functional Gait Assessment?

BACKGROUND AND PURPOSE: An accurate fall risk assessment is an important component of fall prevention, though a fall could occur during testing. To minimize this risk, different guarding methods are used, though there is disagreement regarding the optimal method. The purpose of this study was to compare the effect of 2 guarding methods, contact guarding (CG) and standby guarding (SG), on performance during the Functional Gait Assessment (FGA). We hypothesized that (1) there would not be a significant difference in FGA scores when comparing CG with SG, and (2) participants would not perceive a difference between the 2 guarding methods. METHODS: Twenty-three community-dwelling older adults, mean age 73.6 (SD = 6.2) years, participated in this study. Each participant completed 2 trials of the FGA, one with CG and another with SG. Guarding for all trials was provided by the same experienced physical therapist (PT) for this within-subjects design. All trials were video recorded for review by 2 PT raters who were blinded to the purpose of the study. RESULTS AND DISCUSSION: Functional Gait Assessment scores for the 2 PT raters indicated high internal agreement for both CG and SG conditions (CG: intraclass correlation coefficient [ICC] = 0.949; SG: ICC = 0.935), and CG FGA scores did not significantly differ from SG FGA scores (t22 = 0.15, P = .882). Furthermore, none of the participants perceived a difference in guarding methods. CONCLUSIONS: The results of this study indicate that hands-on guarding does not significantly influence performance on the FGA when the guarding is provided by an experienced PT and the participant is a community-dwelling older adult.

The Use of Fluorescence Imaging in Colon Interposition for Esophageal Replacement: A Technical Note.

Every field of surgery has seen an explosion of new technologies aimed at improving surgical technique and reducing complications. The use of near-infrared (NIR) fluorescence to assess perfusion has been described in several surgical disciplines. NIR provides the surgeon with real-time perfusion assessment of a target organ or anastomosis and can be invaluable in aiding decision-making during the index operation. In the following article we discuss the use of fluorescence-guided perfusion assessment during colonic interposition for esophageal replacement. To our knowledge this is the first description of the use of fluorescence-guided perfusion assessment during colonic interposition.

Spatially Conditioned Speech Timing: Evidence and Implications.

Patterns of relative timing between consonants and vowels appear to be conditioned in part by phonological structure, such as syllables, a finding captured naturally by the two-level feedforward model of Articulatory Phonology (AP). In AP, phonological form - gestures and the coordination relations between them - receive an invariant description at the inter-gestural level. The inter-articulator level actuates gestures, receiving activation from the inter-gestural level and resolving competing demands on articulators. Within this architecture, the inter-gestural level is blind to the location of articulators in space. A key prediction is that intergestural timing is stable across variation in the spatial position of articulators. We tested this prediction by conducting an Electromagnetic Articulography (EMA) study of Mandarin speakers producing CV monosyllables, consisting of labial consonants and back vowels in isolation. Across observed variation in the spatial position of the tongue body before each syllable, we investigated whether inter-gestural timing between the lips, for the consonant, and the tongue body, for the vowel, remained stable, as is predicted by feedforward control, or whether timing varied with the spatial position of the tongue at the onset of movement. Results indicated a correlation between the initial position of the tongue gesture for the vowel and C-V timing, indicating that inter-gestural timing is sensitive to the position of the articulators, possibly relying on somatosensory feedback. Implications of these results and possible accounts within the Articulatory Phonology framework are discussed.

Effects of Surprisal and Entropy on Vowel Duration in Japanese.

Research on English and other languages has shown that syllables and words that contain more information tend to be produced with longer duration. This research is evolving into a general thesis that speakers articulate linguistic units with more information more robustly. While this hypothesis seems plausible from the perspective of communicative efficiency, previous support for it has come mainly from English and some other Indo-European languages. Moreover, most previous studies focus on global effects, such as the interaction of word duration and sentential/semantic predictability. The current study is focused at the level of phonotactics, exploring the effects of local predictability on vowel duration in Japanese, using the Corpus of Spontaneous Japanese. To examine gradient consonant-vowel phonotactics within a consonant-vowel-mora, consonant-conditioned Surprisal and Shannon Entropy were calculated, and their effects on vowel duration were examined, together with other linguistic factors that are known from previous research to affect vowel duration. Results show significant effects of both Surprisal and Entropy, as well as notable interactions with vowel length and vowel quality. The effect of Entropy is stronger on peripheral vowels than on central vowels. Surprisal has a stronger positive effect on short vowels than on long vowels. We interpret the main patterns and the interactions by conceptualizing Surprisal as an index of motor fluency and Entropy as an index of competition in vowel selection.

Person-based differences in pay reactions: A compensation-activation theory and integrative conceptual review.

Compensation research has focused traditionally on how pay design characteristics (e.g., pay level, individual or group incentives) relate to average employee outcomes and, in toto, on how these outcomes affect organizational performance. Recently, scholars have begun to pay more attention to how individuals vary in the strength of their reactions to pay. Empirical research in several disciplines examines how the interplay of pay systems and person-based characteristics (psychological individual differences, demographics, and relative performance or position in a group) relate to important work-related outcomes. We develop a compensation-activation theory that frames compensation design characteristics as workplace "situations" providing cues that activate individuals' corresponding fundamental social motives made salient due to chronic or transient person-based characteristics. Where activation occurs, stronger-than-average responses to the compensation "situation" are expected. Using the theory as a lens, we synthesize and reinterpret existing research on person-based reactions to pay characteristics, including sorting, incentive/motivational effects, and effects on collective pay system reactions and unit/organizational outcomes. We conclude with a research agenda aimed at refining compensation-activation theory and advancing the study of compensation as it affects individual and organizational outcomes. (PsycINFO Database Record

Synchronous Hodgkin's lymphoma and seminoma: a rare coexistence and an important lesson.

Synchronous presentation of seminoma and lymphoma is rare but has important ramifications for the treatment of both malignancies. Without clinical vigilance, this situation may be easily missed, leading to inappropriate management. We describe a patient with synchronous seminoma and Hodgkin's lymphoma and discuss the implication on his treatment.

Simultaneous unilateral anterior thoracoscopy with transcervical thyroidectomy for the resection of large mediastinal thyroid goiter.

BACKGROUND: Almost 25% of thyroid goiters have an intrathoracic component. Although the majority of mediastinal goiters may be approached through a cervical approach, up to a third of substernal goiters require a sternotomy or thoracotomy for resection. As an alternative to conventional sternotomy, we herein describe a combined anterior thoracoscopic and transcervical approach to large mediastinal thyroid goiters. METHODS: Between 2012 and 2015, seven patients with symptomatic thyroid goiters with significant intrathoracic extension were approached via simultaneous cervical exploration and anterior thoracoscopy. Thoracoscopy was performed on the side of maximal goiter extension. RESULTS: Simultaneous thoracoscopy and transcervical thyroidectomy was technically successful in all patients. No patients required conversion to open approach and one patient required reoperation for hemorrhage. CONCLUSIONS: Simultaneous anterior thoracoscopy and cervical exploration is a safe and effective approach to large mediastinal thyroid goiter. Patients with significant intrathoracic goiter extension may benefit from preoperative thoracic surgical evaluation and planned thoracoscopy at the time of thyroidectomy.

A comparison of acoustic and articulatory methods for analyzing vowel differences across dialects: Data from American and Australian English.

In studies of dialect variation, the articulatory nature of vowels is sometimes inferred from formant values using the following heuristic: F1 is inversely correlated with tongue height and F2 is inversely correlated with tongue backness. This study compared vowel formants and corresponding lingual articulation in two dialects of English, standard North American English, and Australian English. Five speakers of North American English and four speakers of Australian English were recorded producing multiple repetitions of ten monophthongs embedded in the /sVd/ context. Simultaneous articulatory data were collected using electromagnetic articulography. Results show that there are significant correlations between tongue position and formants in the direction predicted by the heuristic but also that the relations implied by the heuristic break down under specific conditions. Articulatory vowel spaces, based on tongue dorsum position, and acoustic vowel spaces, based on formants, show systematic misalignment due in part to the influence of other articulatory factors, including lip rounding and tongue curvature on formant values. Incorporating these dimensions into dialect comparison yields a richer description and a more robust understanding of how vowel formant patterns are reproduced within and across dialects.