Establishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal unit. Videolaryngoscopy has the potential to facilitate successful endotracheal ...intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates.
To determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required for endotracheal intubation and increasing the success rate at first intubation in neonates.
We used the search strategy of Cochrane Neonatal. In May 2017, we searched for randomized controlled trials (RCT) evaluating videolaryngoscopy for neonatal endotracheal intubation in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, abstracts of the Pediatric Academic Societies, websites for registered trials at www.clinicaltrials.gov and www.controlled-trials.com, and reference lists of relevant studies.
RCTs or quasi-RCTs in neonates evaluating videolaryngoscopy for endotracheal intubation compared with direct laryngoscopy.
Review authors performed data collection and analysis as recommended by Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion.We used the GRADE approach to assess the quality of evidence.
The search yielded 7057 references of which we identified three RCTs for inclusion, four ongoing trials and one study awaiting classification. All three included RCTs compared videolaryngoscopy with direct laryngoscopy during intubation attempts by trainees.Time to intubation was similar between videolaryngoscopy and direct laryngoscopy (mean difference (MD) -0.62, 95% confidence interval (CI) -6.50 to 5.26; 2 studies; 311 intubations) (very low quality evidence). Videolaryngoscopy did not decrease the number of intubation attempts (MD -0.05, 95% CI -0.18 to 0.07; 2 studies; 427 intubations) (very low quality evidence). Moderate quality evidence suggested that videolaryngoscopy increased the success of intubation at first attempt (typical risk ratio (RR) 1.44, 95% CI 1.20 to 1.73; typical risk difference (RD) 0.19, 95% CI 0.10 to 0.28; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 4 to 10; 3 studies; 467 intubation attempts).Desaturation episodes during intubation attempts were similar between videolaryngoscopy and direct laryngoscopy (MD -0.76, 95% CI -5.74 to 4.23; 2 studies; 359 intubations) (low quality evidence). There was no difference in the incidence of airway trauma due to intubation attempts (RR 0.10, 95% CI 0.01 to 1.80; RD -0.04, 95% CI -0.09 to -0.00; 1 study; 213 intubations) (low quality evidence).There were no data available on other adverse effects of videolaryngoscopy.
Moderate to very low quality evidence suggests that videolaryngoscopy increases the success of intubation in the first attempt but does not decrease the time to intubation or the number of attempts for intubation. However, these studies were conducted with trainees performing the intubations and these results highlight the potential usefulness of the videolaryngoscopy as a teaching tool. Well-designed, adequately powered RCTs are necessary to confirm efficacy and address safety and cost-effectiveness of videolaryngoscopy for endotracheal intubation in neonates by trainees and those proficient in direct laryngoscopy.
Evidence shows that readers tend to follow recently-encountered patterns for interpreting ambiguous pronouns. If recent exposure includes frequent pronouns with prepositional object antecedents ...(e.g., “Matt went to the library with Ana. She took out a book”), people adapt and are more likely to assign ambiguous pronouns to prepositional antecedents than if they were exposed to pronouns with subject antecedents (Johnson & Arnold, 2022). However, it is unclear how people categorize different referential structures and how broadly they make generalizations. Johnson and Arnold (2022) found that people can learn a referential relationship specific to third-person pronouns and an antecedent's syntactic or thematic properties. The current study uses this paradigm to test how broadly people generalize categories of different types of pronouns and antecedents. Do people adapt to the behavior of categorizing “he” and “she” as individual words, or as a general class? (Experiment 1). Do people learn about likely antecedents for pronouns separately for different verb constructions (transfer vs. joint-action) and thematic roles, or broadly by grammatical function? (Experiments 2 & 3). Participants were repeatedly exposed to a referential structure of a particular type of pronouns or antecedents, and then were tested on ambiguous pronouns. All experiments showed that pronoun adaptation generalizes to new instances from the broad categorization of pronouns and antecedents.
•Provide robust evidence that referential adaptation guides pronoun comprehension.•Adaptation to he/she generalizes to each other with no advantage to comprehension of matching word.•Referential adaptation generalizes across different antecedent categories.
To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend ...treatment regimen in routine clinical practice.
Database observational study.
We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry.
A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry.
Change in visual acuity (VA) over 2 years and number of injections and visits.
Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits.
These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration.
This was a database observational study that included ...treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period.
The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters 95% confidence interval: 3.3-8.5; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%-58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 2.1 vs. 5.7 2.6; P < 0.001) and visits (8.7 1.7 vs. 6.5 2.4; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3-7.7).
These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
Establishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal intensive care unit. Videolaryngoscopy has the potential to facilitate successful ...endotracheal intubation, and decrease adverse consequences of a delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates. This is an update of a review first published in 2015, and updated in 2018.
To determine the effectiveness and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required for endotracheal intubation and increasing the success rate on first intubation attempt in neonates (0 to 28 days of age).
In November 2022, we updated the search for trials evaluating videolaryngoscopy for neonatal endotracheal intubation in CENTRAL, MEDLINE, Embase, CINAHL, and BIOSIS. We also searched abstracts of the Pediatric Academic Societies, clinical trials registries (www.
gov; www.controlled-trials.com), and reference lists of relevant studies.
Randomized controlled trials (RCTs), quasi-RCTs, cluster-RCTs, or cross-over trials, in neonates (0 to 28 days of age), evaluating videolaryngoscopy with any device used for endotracheal intubation compared with direct laryngoscopy.
Three review authors performed data collection and analysis, as recommended by Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion. We used the GRADE approach to assess the certainty of the evidence.
The updated search yielded 7786 references, from which we identified five additional RCTs for inclusion, seven ongoing trials, and five studies awaiting classification. Three studies were included in the previous version of the review. For this update, we included eight studies, which provided data on 759 intubation attempts in neonates. We included neonates of either sex, who were undergoing endotracheal intubation in international hospitals. Different videolaryngoscopy devices (including C-MAC, Airtraq, and Glidescope) were used in the studies. For the primary outcomes; videolaryngoscopy may not reduce the time required for successful intubation when compared with direct laryngoscopy (mean difference MD 0.74, 95% confidence interval CI -0.19 to 1.67; 5 studies; 505 intubations; low-certainty evidence). Videolaryngoscopy may result in fewer intubation attempts (MD -0.08, 95% CI -0.15 to 0.00; 6 studies; 659 intubations; low-certainty evidence). Videolaryngoscopy may increase the success of intubation at the first attempt (risk ratio RR 1.24, 95% CI 1.13 to 1.37; risk difference RD 0.14, 95% CI 0.08 to 0.20; number needed to treat for an additional beneficial outcome NNTB 7, 95% CI 5 to 13; 8 studies; 759 intubation attempts; low-certainty evidence). For the secondary outcomes; the evidence is very uncertain about the effect of videolaryngoscopy on desaturation or bradycardia episodes, or both, during intubation (RR 0.94, 95% CI 0.38 to 2.30; 3 studies; 343 intubations; very-low certainty evidence). Videolaryngoscopy may result in little to no difference in the lowest oxygen saturations during intubation compared with direct laryngoscopy (MD -0.76, 95% CI -5.74 to 4.23; 2 studies; 359 intubations; low-certainty evidence). Videolaryngoscopy likely results in a slight reduction in the incidence of airway trauma during intubation attempts compared with direct laryngoscopy (RR 0.21, 95% CI 0.05 to 0.79; RD -0.04, 95% CI -0.07 to -0.01; NNTB 25, 95% CI 14 to 100; 5 studies; 467 intubations; moderate-certainty evidence). There were no data available on other adverse effects of videolaryngoscopy. We found a high risk of bias in areas of allocation concealment and performance bias in the included studies.
Videolaryngoscopy may increase the success of intubation on the first attempt and may result in fewer intubation attempts, but may not reduce the time required for successful intubation (low-certainty evidence). Videolaryngoscopy likely results in a reduced incidence of airway-related adverse effects (moderate-certainty evidence). These results suggest that videolaryngoscopy may be more effective and potentially reduce harm when compared to direct laryngoscopy for endotracheal intubation in neonates. Well-designed, adequately powered RCTS are necessary to confirm the efficacy and safety of videolaryngoscopy in neonatal intubation.
In three experiments, we measured individual patterns of pronoun comprehension (Experiments 1 and 2) and referential prediction (Experiment 3) in implicit causality (IC) contexts and compared these ...with a measure of participants’ print exposure (Author Recognition Task; ART). Across all three experiments, we found that ART interacted with verb bias, such that participants with higher scores demonstrated a stronger semantic bias, i.e., they tended to select the pronoun or predict the re-mention of the character that was congruent with an implicit cause interpretation. This suggests that print exposure changes the way language is processed at the discourse level, and in particular, that it is related to implicit cause sensitivity.
There is extensive evidence that people are sensitive to the statistical patterns of linguistic elements at the phonological, lexical, and syntactic levels. However, much less is known about how ...people classify referential events and whether they adapt to the most frequent types of references. Reference is particularly complex because referential tokens can be multiply categorized, raising questions about what can be learned through referential exposure. We test the role of linguistic exposure to referential patterns in five experiments on pronoun comprehension, examining linguistic contexts like "X is doing something with Y" (Experiments 1a, b, and c) and transfer events like "X gave something to Y" (Experiments 2a and b). We ask whether the interpretation of ambiguous he or she pronouns is influenced by recent exposure and find that indeed it is, supporting the hypothesis that adaptation affects discourse processing. In Experiment 1, we further ask whether adaptation persists across three types of referring expressions (he or she pronouns, I/you pronouns, and names) and find that it is limited to he or she pronouns. In Experiment 2, we test whether people can learn both syntactically conditioned and semantically conditioned frequency patterns with transfer verbs. Results showed that they learned both patterns. These results provide critical new evidence that discourse processing biases are informed by exposure to referential patterns.
Models of language comprehension show that predictable elements are easier to understand. Does predictability also guide production? While many models suggest it does (e.g., Arnold, 1998; Aylett & ...Turk, 2004; Levy & Jaeger, 2007; Jurafsky, Bell, Gregory, & Raymond, 2001; Mahowald, Fedorenko, Piantadosi, & Gibson; Orita, Vornov, Feldman & Daumé, 2015; Tily & Piantadosi, 2009), several models suggest that it does not make speakers more likely to select pronouns (Fukumura & van Gompel, 2010; Kehler et al., 2008; Kehler & Rohde, 2013; Kehler & Rohde, 2019; Stevenson et al., 1994). Claims that predictability does not affect pronoun production are based on evidence that certain semantic roles are more likely to be re-mentioned in discourse, but speakers do not prefer pronouns for those event roles, especially when predictability stems from implicit causality estimates. These findings contrast with studies of transfer verbs, where goals are more predictable than sources, and speakers do use pronouns more for goals versus sources (Arnold, 2001; Rosa & Arnold, 2017). Our study takes a closer look at the predictability of implicit causes, using a novel experimental paradigm that is more contextualized than the methods used in previous studies. In two experiments, we find that implicit causality does affect pronominalization. This suggests that predictability may play a broad role in both reference production and language production more generally.
One of the core components of language is referring, which requires the speaker to choose between expressions that are highly explicit (e.g., the UNC professor, or Peter), and reduced lexical forms ...(e.g., he). This paper reviews claims that this process is largely driven by the accessibility or salience of the referent, and the psychological processes that underlie these effects. Two classes of constraint are examined: (1) Discourse status, which has traditionally been identified as the determinant of referential choices and (2) Non-linguistic processing constraints that increase the use of explicit forms. These effects together support a modified version of the traditional claim that speakers choose referential explicitness so that the listener can identify the referent, and underscore the need for accessibility to be mediated by a non-linguistic representation. Adapted from the source document
Dietary specialization, exploiting a small fraction of available food resources, is commonly reported for gulls and skuas. Predation of birds by these species is usually considered a specialist ...strategy employed by the minority of the population but non-specialists also predate birds and may actually have a greater impact on the prey species. To date, most studies have focused on predatory bird-specialists, down-playing the possible importance of opportunistic predation by non-specialists. We addressed this by studying diet (regurgitated pellets and prey remains) and behavior of breeding Herring Gulls (Larus argentatus) over three summers at Gull Island, a mixed-species breeding colony in Lake Ontario. One-third of all pellets analyzed contained bird remains, primarily the most numerous breeding bird: Ring-billed Gull (L. delawarensis) chicks (51%) and adults (36%). Although all but one pair of Herring Gulls ate birds, all pairs maintained broad and mostly similar diets, with birds accounting for at most one-third of prey. Behavior also indicated that Herring Gulls at Gull Island were not predatory bird-specialists because predation was too infrequent to meet energetic requirements, was largely unsuccessful and was only ever observed when Ring-billed Gulls strayed into Herring Gull breeding territories. Instead, bird predation appeared mainly opportunistic, increasing with seasonal availability, access to shoreline, proximity to nesting Ring-billed Gulls and breeding territory size. Compared with predatory specialist Herring Gulls in the same region, individuals that predated birds at Gull Island did not display specialist behaviors and killed six times fewer birds (0.1-0.4 per day, on average) but were over 20 times more numerous (98% of the population versus 4%). Thus, our results indicate that opportunistic predation by non-specialists may have important consequences for prey species. Since opportunistic predation cannot be effectively managed using techniques widely advocated for specialist predators, it is essential to investigate cause of predation by large gulls prior to lethal management.
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