INTRODUCTION:
The role of defecation dysfunction (DD) and rectal sensitivity in opioid related chronic constipation (CC) is unknown. The purpose of this study is to evaluate the relationship between ...opioid use and rectal sensation, defecatory function, and balloon expulsion on physiology testing.
METHODS:
This was a retrospective cohort study of consecutive adult patients who underwent high-resolution anorectal manometry (HRAM) at a tertiary care center for CC. Baseline patient clinical characteristics and HRAM findings were reviewed. Rectal hyposensitivity was defined by increased rectal sensation volume for first sensation, urge, and maximal tolerance. DD was defined by impaired anal sphincter relaxation (<20% decrease from resting pressure) during strain maneuver with or without weak push, defined as inadequate rectal contraction pressure (<40 mmHg increase from baseline). Successful balloon expulsion was defined by evacuation of 50 mL balloon within 2 minutes. Statistical analyses were performed using Fisher exact or student t-test for univariate analyses and logistical or general linear regression for multivariate analyses.
RESULTS:
317 patients (mean age 50.3 years; 86.8% female) were included. Patients with recent opioid use (<3 months of HRAM) had significantly increased volume for first rectal sensation (70.4 mL vs 61.5,
P
= 0.043), urge sensation (120.4 vs 104.5,
P
= 0.04), and maximal tolerance (170.2 mL vs 149.6,
P
= 0.0083) when compared to those without recent opioid use. No significant difference in rectal sensation was found in patients with a distant history of opioid use (>3 months) (Figure 1). Patients with recent opioid use also had increased risk of DD (63.4% vs 44.9%,
P
= 0.029), but no difference in failed balloon expulsion (75.9% vs 74.8%,
P
= 0.90). On multivariate analyses after controlling for potential confounders including history of irritable bowel syndrome (IBS), age, sex and history of abdominal or pelvic surgeries, recent opioid use (<3 months), but not distant use (>3 months), remained independently associated with increased volume for urge sensation (β-coefficient 14.3,
P
= 0.03) and maximal tolerance (β-coefficient 22.8,
P
= 0.006), and higher risk for DD (OR 1.67,
P
= 0.04) (Table 1).
CONCLUSION:
Recent opioid use was an independent risk factor for rectal hyposensitivity and DD on HRAM in patients with CC, but that effect may decrease with discontinuation of use. Anorectal physiology testing may be considered in patients on opioids with CC.
Some concepts are more essential for human communication than others. In this paper, we investigate whether the concept of agent-backgrounding is sufficiently important for communication that ...linguistic structures for encoding this concept are present in young sign languages. Agent-backgrounding constructions serve to reduce the prominence of the agent – the English passive sentence a book was knocked over is an example. Although these constructions are widely attested cross-linguistically, there is little prior research on the emergence of such devices in new languages. Here we studied how agent-backgrounding constructions emerge in Nicaraguan Sign Language (NSL) and adult homesign systems. We found that NSL signers have innovated both lexical and morphological devices for expressing agent-backgrounding, indicating that conveying a flexible perspective on events has deep communicative value. At the same time, agent-backgrounding devices did not emerge at the same time as agentive devices. This result suggests that agent-backgrounding does not have the same core cognitive status as agency. The emergence of agent-backgrounding morphology appears to depend on receiving a linguistic system as input in which linguistic devices for expressing agency are already well-established.
Two differences between signed and spoken languages that have been widely discussed in the literature are: the degree to which morphology is expressed simultaneously (rather than sequentially), and ...the degree to which iconicity is used, particularly in predicates of motion and location, often referred to as classifier predicates. In this paper we analyze a set of properties marking agency and number in four sign languages for their crosslinguistic similarities and differences regarding simultaneity and iconicity. Data from American Sign Language (ASL), Italian Sign Language (LIS), British Sign Language (BSL), and Hong Kong Sign Language (HKSL) are analyzed. We find that iconic, cognitive, phonological, and morphological factors contribute to the distribution of these properties. We conduct two analyses—one of verbs and one of verb phrases. The analysis of classifier
shows that, as expected, all four languages exhibit many common formal and iconic properties in the expression of agency and number. The analysis of classifier
(VPs)—particularly, multiple-verb predicates—reveals (a) that it is grammatical in all four languages to express agency and number within a single verb, but also (b) that there is crosslinguistic variation in expressing agency and number across the four languages. We argue that this variation is motivated by how each language prioritizes, or ranks, several constraints. The rankings can be captured in Optimality Theory. Some constraints in this account, such as a constraint to be redundant, are found in all information systems and might be considered non-linguistic; however, the variation in constraint ranking in verb phrases reveals the grammatical and arbitrary nature of linguistic systems.
Introduction: Diverticulosis is a common and usually asymptomatic condition, but with potentially significant complications. Colonic dysmotility and constipation, including dyssynergic defection, ...have been implicated to increase the risk for diverticulosis. Pregnancy and vaginal delivery may be risk factors for defecatory dysfunction, but an association between obstetric history and risk of diverticulosis has not been previously investigated. We aimed to determine the association between the obstetric history and prevalence of diverticulosis on colonoscopy. Methods: This was a retrospective cohort study of consecutive adult female patients who presented for colonoscopy and high-resolution anorectal manometry (HRAM) between 2013-2017. Patient demographics, comorbidities, clinical symptoms, obstetric history, and findings on colonoscopy and HRAM were recorded. Fisher exact test, student t-test and logistic regression were used to assess for differences. Results: 256 subjects (mean age 57.7± 15.1 years) met inclusion criteria. Patients with diverticulosis (67±11 vs 55±15, p<0.001) and those with a history of vaginal delivery were older (59±14 vs 43±16, p<0.001). A history of vaginal delivery was associated with an increased prevalence of diverticula found on colonoscopy (31.6% vs 13.3%, p=0.01), as well as lower resting anal sphincter tone (40.5±28.6 mmHg vs 56.8±42.7 mmHg, p=0.009), maximal squeeze pressure (96.2±54.1 mmHg vs 129±66.4 mmHg, p=0.0006), and rectal contraction pressure (9.35±26.0 mmHg vs 21.4±27.2 mmHg, p=0.005) on HRAM. Diverticulosis was significantly more severe among those with prior vaginal delivery than those without (Graph 1), but there was no difference in the regional distribution of diverticula between cohorts. On multivariate analysis controlling for potential confounders including constipation, dyssynergia, and narcotic use, a history of vaginal delivery (OR 2.73, p=0.04) and older age (OR 14.0, p=0.01) remained independently associated with diverticulosis. Conclusion: A history of vaginal delivery and older age were independent predictors for diverticular disease among women presenting for colonoscopy and HRAM for bowel and anorectal symptoms. Disruption of pelvic floor and anorectal musculature by vaginal delivery, and the potential resultant alteration in defecation mechanics may predispose to the development of diverticula disease.
Homesign: Contested Issues Goico, Sara A; Horton, Laura
Annual review of linguistics,
01/2023, Letnik:
9, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The term homesign has been used to describe the signing of deaf individuals who have not had sustained access to the linguistic resources of a named language. Early studies of child homesigners ...focused on documenting their manual communication systems through the lens of developmental psycholinguistics and generative linguistics, but a recent wave of linguistic ethnographic investigations is challenging many of the established theoretical presuppositions that underlie the foundational homesign research. Sparked by a larger critical movement within Deaf Studies led by deaf scholars, this new generation of scholarship interrogates how researchers portray deaf individuals and their communication practices and questions the conceptualization of language in the foundational body of homesign research. In this review, we discuss these contested issues and the current moment of transition within research on homesign.
Background
Defecation dysfunction may contribute to chronic constipation (CC), but the impact of obesity on anorectal physiology in CC remains unclear. We aimed to evaluate the relationship between ...obesity and anorectal function on physiologic testing in patients presenting with CC.
Methods
This was a retrospective cohort study of consecutive adults who underwent high resolution anorectal manometry (HRAM) at a tertiary center for CC. Patient demographics, clinical history, surgical/obstetric history, medications, and HRAM results were reviewed. Patients were classified into obese (BMI > 30 kg/m
2
) vs non-obese (BMI < 30 kg/m
2
) groups at the time of HRAM. Fisher-exact/student
t
-test for univariate analyses and general linear regression for multivariable analysis were performed.
Results
383 adults (mean 50.3 years; 85.8% female) with CC were included. On HRAM, patients with obesity had lower anal sphincter resting tone (37.3 vs 48.5 mmHg,
p
= 0.005) and maximum squeeze pressure (104.8 mmHg vs 120.0 mmHg,
p
= 0.043). No significant differences in dyssynergia (61% vs 53%,
p
= 0.294) and failed balloon expulsion (18% vs 25%,
p
= 0.381) were found between obese and non-obese groups. On balloon distention testing, the maximum tolerated (163.5 vs 147.6 mL,
p
= 0.042) and urge sensation (113.9 vs 103.7 mL,
p
= 0.048) volumes were significantly increased among patients with obesity. After adjusting for potential confounders, obesity remained independently associated with increased maximum tolerated volume (
β
-coefficient 13.7,
p
= 0.049).
Conclusion
Obesity was independently associated with altered rectal sensitivity among patients with CC. Altered rectal sensation may play an important role in CC among patients with obesity. Anorectal physiology testing should be considered to understand the pathophysiology and guide management.
This article provides a cross-cultural study of language socialization through sign language in three indigenous Mesoamerican communities. We explore whether child signers are socialized to use ...visual communicative practices as participants or observers. We present four conversations that illustrate how child signers are socialized into these practices. Child signers in our study acquire appropriate visual practices, even when they are primarily observers. But sign language socialization practices may be distinct from broader patterns of spoken language socialization in terms of participant frameworks. We find that recognition of child signers as full participants in sign conversation is shaped by a constellation of local child-rearing beliefs and language ecology dynamics.
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