The Bowel CLEANsing National Initiative: High-Volume Split-Dose Vs Low-Volume Split-Dose Polyethylene Glycol Preparations: A Randomized Controlled Trial.

BACKGROUND & AIMS: The aim of this study was to compare high-volume polyethylene glycol (PEG) with low-volume PEG with bisacodyl split-dosing regimens. METHODS: Adult outpatients in 10 Canadian tertiary hospitals were randomized, stratified by morning or afternoon colonoscopy, to high-volume split-dose PEG (2 L + 2 L) (High-SD) or low volume (1 L + 1 L) + bisacodyl (15 mg) PEG (Low-SD), with a second randomization to liquid or low-residue diets. The primary end point, using noninferiority hypothesis testing, was adequate bowel cleansing (Boston Bowel Preparation Scale total score of ≥6, with each of 3 colonic segments subscores ≥2). Secondary objectives were willingness to repeat the preparation, withdrawal time, cecal intubation, and polyp detection rates. RESULTS: Over 29 months, 2314 subjects were randomized to High-SD (N = 1157) or Low-SD (N = 1157) (mean age, 56.2 ± 13.4 y; 52.1% women). Colonoscopy indications were 38.2% diagnostic, 36.8% screening, and 25.0% surveillance, with no between-group imbalances in patient characteristics. Low-SD satisfied noninferiority criteria vs High-SD for adequate bowel cleanliness with only marginally inferior results (90.1% vs 88.1%; P = .02; difference, 2.0%; 95% CI [0.0%; 4.5%]). High-SD was associated with lower willingness to repeat (66.9% vs 91.9%; P < .01), was less well tolerated (7.3 ± 2.3 vs 8.1 ± 1.9; P < .01), causing more symptoms. No differences in procedural outcomes were noted except for more frequent cecal intubation rates after High-SD (97.4% vs 95.6%; P = .02). Among the High-SD group, adequate bowel preparation was greater after a clear liquid diet (93.6% vs 87.9%; P < .01), a finding not seen in the Low-SD group. CONCLUSIONS: Low-SD is noninferior to High-SD in providing adequate bowel preparation. Low-SD results in fewer symptoms, with greater willingness to repeat and tolerability. The overall impact of diet was modest.The study was approved by the research ethic boards from all sites and was registered at ClinicalTrials.gov (NCT02547571).

The Bowel CLEANsing National Initiative: A Low-Volume Same-Day Polyethylene Glycol (PEG) Preparation vs Low-Volume Split-Dose PEG With Bisacodyl or High-Volume Split-Dose PEG Preparations-A Randomized Controlled Trial.

INTRODUCTION: Bowel cleanliness has been shown to be superior with split-dose vs nonsplit preparations; we aimed to directly assess the poorly characterized comparative efficacies of split-dose vs same-day polyethylene glycol (PEG) regimens. METHODS: In this study, one of a series of randomized trials performed across 10 Canadian endoscopy units, patients undergoing colonoscopies between 10:30 and 16:30 were allocated to PEG low-volume same-day (15 mg bisacodyl the day before, 2 L the morning of the procedure), low-volume split-dose (15 mg bisacodyl the day before, 1 L + 1 L), or high-volume split-dose (2 L + 2 L). Coprimary endpoints were adequate bowel cleansing based on the Boston Bowel Preparation Scale using in turn different threshold cutoffs. RESULTS: Overall, 1,750 subjects were randomized equally across the 3 groups, with no differences in adequate bowel cleanliness rates (low-volume same-day, 90.5%; high-volume split-dose, 92.2%; P = 0.34; and low-volume split-dose, 87.9%; P = 0.17) for the Boston Bowel Preparation Scale ≥6 and 2 for each segment. Willingness to repeat the preparation was not significantly different between low-volume same-day (91.0%) and low-volume split-dose (92.5%; P = 0.40) but was greater than the high-volume split-dose (68.9%; P < 0.01). No significant differences were noted for withdrawal time, cecal intubation, or polyp detection rates. DISCUSSION: In this large randomized trial of PEG regimens, low-volume same-day resulted in similar bowel cleanliness compared with high-volume or low-volume split-dosing. Willingness to repeat and tolerability were superior with low-volume same-day compared with high-volume split-dose and similar to low-volume split-dose.

Breathy voice and low-register: A case of trading relation in Shanghai Chinese tone perception?

In Shanghai Chinese as well as many other Wu dialects, breathy voice is a well-documented accompaniment of the low-register tone syllables with obstruent as well as sonorant onsets. But Shanghai Chinese is rapidly changing and the breathy voice associated with low-register tones tends to disappear in young speakers' productions. In this study, we asked whether breathy voice is nevertheless still perceived and whether it pushes tone identification toward low-register tones. We conducted forced-choice tone identification tests on young native listeners of Shanghai Chinese, using low-high register tone continua-from tone T3 (23) to tone T2 (34)-imposed on base syllables with either modal or breathy voice quality, and beginning with various onset consonants. We used continua constructed from either naturally produced or synthesized syllables. Our results show that breathy voice does bias tone identification responses toward the low-register tone T3. This result held for both synthesized and natural stimuli, except for the /m/-onset stimuli derived from naturally produced syllables. We propose that the phonetic change at issue-loss of breathiness in production-is not due to misperception but reflects the ever-stronger influence of Standard Mandarin Chinese. In other words, this particular case of sound change seems to be led by production rather than perception. It remains an open question whether this kind of sound change is only determined by sociolinguistic factors (here, the dominance of Mandarin Chinese) or is independently motivated by phonetic and/or phonological factors.

Corrigendum: Differential Difficulties in Perception of Tashlhiyt Berber Consonant Quantity Contrasts by Native Tashlhiyt Listeners vs. Berber-Naïve French Listeners.

[This corrects the article on p. 209 in vol. 7, PMID: 26973551.].

Differential Difficulties in Perception of Tashlhiyt Berber Consonant Quantity Contrasts by Native Tashlhiyt Listeners vs. Berber-Naïve French Listeners.

In a discrimination experiment on several Tashlhiyt Berber singleton-geminate contrasts, we find that French listeners encounter substantial difficulty compared to native speakers. Native listeners of Tashlhiyt perform near ceiling level on all contrasts. French listeners perform better on final contrasts such as fit-fitt than initial contrasts such as bi-bbi or sir-ssir. That is, French listeners are more sensitive to silent closure duration in word-final voiceless stops than to either voiced murmur or frication duration of fully voiced stops or voiceless fricatives in word-initial position. We propose, tentatively, that native speakers of French, a language in which gemination is usually not considered to be phonemic, have not acquired quantity contrasts but yet exhibit a presumably universal sensitivity to rhythm, whereby listeners are able to perceive and compare the relative temporal distance between beats given by successive salient phonetic events such as a sequence of vowel nuclei.

Subliminal repetition primes help detection of phonemes in a picture: Evidence for a phonological level of the priming effects.

In this research, we combine a cross-form word-picture visual masked priming procedure with an internal phoneme monitoring task to examine repetition priming effects. In this paradigm, participants have to respond to pictures whose names begin with a prespecified target phoneme. This task unambiguously requires retrieving the word-form of the target picture's name and implicitly orients participants' attention towards a phonological level of representation. The experiments were conducted within Spanish, whose highly transparent orthography presumably promotes fast and automatic phonological recoding of subliminal, masked visual word primes. Experiments 1 and 2 show that repetition primes speed up internal phoneme monitoring in the target, compared to primes beginning with a different phoneme from the target, or sharing only their first phoneme with the target. This suggests that repetition primes preactivate the phonological code of the entire target picture's name, hereby speeding up internal monitoring, which is necessarily based on such a code. To further qualify the nature of the phonological code underlying internal phoneme monitoring, a concurrent articulation task was used in Experiment 3. This task did not affect the repetition priming effect. We propose that internal phoneme monitoring is based on an abstract phonological code, prior to its translation into articulation.

Endoscopy reporting standards.

OBJECTIVES: The Canadian Association of Gastroenterology (CAG) recently published consensus recommendations for safety and quality indicators in digestive endoscopy. The present article focuses specifically on the identification of key elements that should be found in all electronic endoscopy reports detailing recommendations adopted by the CAG consensus group. METHODS: A committee of nine individuals steered the CAG Safety and Quality Indicators in Endoscopy Consensus Group, which had a total membership of 35 voting individuals with knowledge on the subject relating to endoscopic services. A comprehensive literature search was performed with regard to the key elements that should be found in an electronic endoscopy report. A task force reviewed all published, full-text, adult and human studies in French or English. RESULTS: Components to be entered into the standardized report include identification of procedure, timing, procedural personnel, patient demographics and history, indication(s) for procedure, comorbidities, type of bowel preparation, consent for the procedure, pre-endoscopic administration of medications, type and dose of sedation used, extent and completeness of examination, quality of bowel preparation, relevant findings and pertinent negatives, adverse events and resulting interventions, patient comfort, diagnoses, endoscopic interventions performed, details of pathology specimens, details of follow-up arrangements, appended pathology report(s) and, when available, management recommendations. Summary information should be provided to the patient or family. CONCLUSION: Continuous quality improvement should be the responsibility of every endoscopist and endoscopy facility to ensure improved patient care. Appropriate documentation of endoscopic procedures is a critical component of such activities.

Biomechanically preferred consonant-vowel combinations fail to appear in adult spoken corpora.

Certain consonant/vowel (CV) combinations are more frequent than would be expected from the individual C and V frequencies alone, both in babbling and, to a lesser extent, in adult language, based on dictionary counts: Labial consonants co-occur with central vowels more often than chance would dictate; coronals co-occur with front vowels, and velars with back vowels (Davis & MacNeilage, 1994). Plausible biomechanical explanations have been proposed, but it is also possible that infants are mirroring the frequency of the CVs that they hear. As noted, previous assessments of adult language were based on dictionaries; these "type" counts are incommensurate with the babbling measures, which are necessarily "token" counts. We analyzed the tokens in two spoken corpora for English, two for French and one for Mandarin. We found that the adult spoken CV preferences correlated with the type counts for Mandarin and French, not for English. Correlations between the adult spoken corpora and the babbling results had all three possible outcomes: significantly positive (French), uncorrelated (Mandarin), and significantly negative (English). There were no correlations of the dictionary data with the babbling results when we consider all nine combinations of consonants and vowels. The results indicate that spoken frequencies of CV combinations can differ from dictionary (type) counts and that the CV preferences apparent in babbling are biomechanically driven and can ignore the frequencies of CVs in the ambient spoken language.

Perception of initial obstruent voicing is influenced by gestural organization.

Cross-language differences in phonetic settings for phonological contrasts of stop voicing have posed a challenge for attempts to relate specific phonological features to specific phonetic details. We probe the phonetic-phonological relationship for voicing contrasts more broadly, analyzing in particular their relevance to nonnative speech perception, from two theoretical perspectives: feature geometry and articulatory phonology. Because these perspectives differ in assumptions about temporal/phasing relationships among features/gestures within syllable onsets, we undertook a cross-language investigation on perception of obstruent (stop, fricative) voicing contrasts in three nonnative onsets that use a common set of features/gestures but with differing time-coupling. Listeners of English and French, which differ in their phonetic settings for word-initial stop voicing distinctions, were tested on perception of three onset types, all nonnative to both English and French, that differ in how initial obstruent voicing is coordinated with a lateral feature/gesture and additional obstruent features/gestures. The targets, listed from least complex to most complex onsets, were: a lateral fricative voicing distinction (Zulu /ɬ/-ɮ/), a laterally-released affricate voicing distinction (Tlingit /tɬ/-/dɮ/), and a coronal stop voicing distinction in stop+/l/ clusters (Hebrew /tl/-/dl/). English and French listeners' performance reflected the differences in their native languages' stop voicing distinctions, compatible with prior perceptual studies on singleton consonant onsets. However, both groups' abilities to perceive voicing as a separable parameter also varied systematically with the structure of the target onsets, supporting the notion that the gestural organization of syllable onsets systematically affects perception of initial voicing distinctions.

Do 11-month-old French infants process articles?

The first part of this study examined (Parisian) French-learning 11-month-old infants' recognition of the six definite and indefinite French articles: le, la, les, un, une, and des. The six articles were compared with pseudoarticles in the context of disyllabic or monosyllabic nouns, using the Head-turn Preference Procedure. The pseudo articles were similar to real articles in terms of phonetic composition and phonotactic probability, and real and pseudo noun phrases were alike in terms of overall prosodic contour. In three experiments, 11-month-old infants showed preference for real over pseudo articles, suggesting they have the articles' word-forms stored in long-term memory. The second part of the study evaluates several hypotheses about the role of articles in 11-month-olds infants' word recognition. Evidence from three experiments supports the view that articles help infants to recognize the following words. We propose that 11-month-olds have the capacity to parse noun phrases into their constituents, which is consistent with the more general view that function words define a syntactic skeleton that serves as a basis for parsing spoken utterances. This proposition is compared to a competing account, which argues that 11-month-olds recognize noun-phrases as whole-words.

On the role of regular phonological variation in lexical access: evidence from voice assimilation in French.

The present study investigated whether lexical access is affected by a regular phonological variation in connected speech: voice assimilation in French. Two associative priming experiments were conducted to determine whether strongly assimilated, potentially ambiguous word forms activate the conceptual representation of the underlying word. Would the ambiguous word form [sud] (either assimilated soute 'hold' or soude 'soda') facilitate "bagage" 'luggage', which is semantically related to soute but not to soude? In Experiment 1, words in either canonical or strongly assimilated form were presented as primes. Both forms primed their related target to the same extent. Potential lexical ambiguity did not modulate priming effects. In Experiment 2, the primes such as assimilated soute pronounced [sud] used in Experiment 1 were replaced with primes such as soude canonically pronounced [sud]. No semantic priming effect was obtained with these primes. Therefore, the effect observed for assimilated forms in Experiment 1 cannot be due to overall phonological proximity between canonical and assimilated forms. We propose that listeners must recover the intended words behind the assimilated forms through the exploitation of the remaining traces of the underlying form, however subtle these traces may be.

Perceptual processing of partially and fully assimilated words in French.

Models of speech perception attribute a different role to contextual information in the processing of assimilated speech. This study concerned perceptual processing of regressive voice assimilation in French. This phonological variation is asymmetric in that assimilation is partial for voiced stops and nearly complete for voiceless stops. Two auditory-visual cross-modal form priming experiments were used to examine perceptual compensation for assimilation in French words with voiceless versus voiced stop offsets. The results show that, for the former segments, assimilating context enhances underlying form recovery, whereas it does not for the latter. These results suggest that two sources of information -- contextual information and bottom-up information from the assimilated forms themselves -- are complementary and both come into play during the processing of fully or partially assimilated word forms.

Phonological mediation in visual masked priming: evidence from phonotactic repair.

In a series of 4 experiments, the authors show that phonological repair mechanisms, known to operate in the auditory modality, are directly translated in the visual modality. This holds with the provision that printed stimuli are presented for a very brief duration and that the effect of phonological repair is tested after a delay of some 100 ms has elapsed after that presentation. The case of phonological repair chosen to exemplify the parallelism between print and speech is the prosthesis of /e/ in utterances beginning with /s/ followed by a consonant in Spanish. Native speakers of Spanish hear a prothetic /e/ in auditorily presented pseudowords such as special (/speojal/, derived from "especial") as well as stuto (/stuto/, derived from "astuto"). It is shown here that they also hear that same vowel /e/ when presented with the printed pseudowords "special" and "stuto." This finding of a phonological repair effect in print has implications for the issue of phonological activation from print, as well as for the prelexical locus and mandatory nature of phonological repair mechanisms in general.

Cross language phonetic influences on the speech of French-English bilinguals.

We examined the voice onset times (VOTs) of monolingual and bilingual speakers of English and French to address the question whether cross language phonetic influences occur particularly in simultaneous bilinguals (that is, speakers who learned both languages from birth). Speakers produced sentences in which there were target words with initial /p/, /t/ or /k/. In French, natively bilingual speakers produced VOTs that were significantly longer than those of monolingual French speakers. French VOTs were even longer in bilingual speakers who learned English before learning French. The outcome was analogous in English speech. Natively bilingual speakers produced shorter English VOTs than monolingual speakers. English VOTs were even shorter in the speech of bilinguals who learned French before English. Bilingual speakers had significantly longer VOTs in their English speech than in their French. Accordingly, the cross language effects do not occur because natively bilingual speakers adopt voiceless stop categories intermediate between those of native English and French speakers that serve both languages. Monolingual speakers of French or English in Montreal had VOTs nearly identical respectively to those of monolingual Parisian French speakers and those of monolingual Connecticut English speakers. These results suggest that mere exposure to a second language does not underlie the cross language phonetic effect; however, these findings must be resolved with others that appear to show an effect of overhearing.

Dental-to-velar perceptual assimilation: a cross-linguistic study of the perception of dental stop+/l/ clusters.

French listeners perceive illegal /tl/ and /dl/ clusters as legal /kl/ and /gl/, suggesting that /dl, tl/ undergo "phonotactic perceptual assimilation" to the phonetically most similar permissible clusters [Hallé et al., J. Exp. Psychol. Hum. Percept. Perform. (1998)]. However, without a comparison to native speakers of a language allowing initial /tl, dl/, other explanations remain open (e.g., universal phonetic biases). Experiment 1 compared native French and Hebrew listeners on perception of Hebrew /tl/-/kl/ and /dl/-/gl/. On a language-specific phonotactics account, these contrasts should be difficult for listeners whose language disallows initial /tl, dl/ while allowing /kl, gl/ (French), but not for listeners whose language permits all four clusters (Hebrew). Indeed, French but not Hebrew listeners showed difficulty discriminating /tl/-/kl/, and tended to categorize the initial consonant of /tl/ as /k/; analogous effects for /dl/-/gl/ were weaker. Experiment 2 tested speakers of American English, which also disallows initial /tl, dl/ but realizes stop-voicing differently than French or Hebrew, to examine possible contributions of language-specific phonetic settings. Their performance was similar to that of French listeners, though they had significantly greater difficulty with /dl-/gl/. The results support the proposal of language-specific phonotactic perceptual assimilation, with modest contributions from language-specific phonetic settings.