Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry.

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤ 2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.

Systematic analysis of esophageal pressure topography in high-resolution manometry of 68 normal volunteers.

The introduction of high-resolution manometry (HRM) has been a significant advance in esophageal diagnostics. Normative values however are currently based upon a single set of published reference values, and multiple new metrics have been added over the past several years. Our goal was to provide a second set of 'normal-values' and to include all current metrics suggested by the 2012 Chicago classification. Sixty-eight subjects without foregut symptoms or previous surgery (median age 25.5 years, ranging from 20-58 years, 53% female) underwent esophageal motility assessment via an established standardized protocol. Normative thresholds were calculated for esophago-gastric junction (EGJ) characteristics (resting, relaxation, intrabolus pressure, and lengths) as well as for esophageal body strength (contraction amplitudes at multiple levels, distal contractile integral, integrity of peristalsis) and wave propagation (contractile front velocity, distal latency). Overall, our findings where strikingly similar to the previously described metrics derived from 75 control subjects of the Northwestern group. This suggests a high degree of reproducibility of HRM.

The influence of phonological context on the sound errors of a speaker with Wernicke's aphasia.

A corpus of phonological errors produced in narrative speech by a Wernicke's aphasic speaker (R.W.B.) was tested for context effects using two new methods for establishing chance baselines. A reliable anticipatory effect was found using the second method, which estimated chance from the distance between phoneme repeats in the speech sample containing the errors. Relative to this baseline, error-source distances were shorter than expected for anticipations, but not perseverations. R.W.B.'s anticipation/perseveration ratio measured intermediate between a nonaphasic error corpus and that of a more severe aphasic speaker (both reported in Schwartz et al., 1994), supporting the view that the anticipatory bias correlates to severity. Finally, R.W.B's anticipations favored word-initial segments, although errors and sources did not consistently share word or syllable position.

Serial order in phonological encoding: an exploration of the 'word onset effect' using laboratory-induced errors.

One controversial phenomenon concerning slips of the tongue is the tendency for the onsets of words to slip more frequently than segments at other word positions. Some researchers attribute this effect to the phonological properties of word onsets, while others suggest it reflects something specific about the role played by the word onset during phonological recovery and/or sequencing. The study reported here examined these two possibilities using a tongue-twister paradigm in which subjects were asked to repeatedly recite a visually-presented word quadruple. The lexical status of the words in target sequences was manipulated independently of their broader phonological characteristics (overall sonority profile and consonant composition) by simply altering their constituent vowels (e.g. case port bed moon vs. koss pait bod marn). Errors elicited on real word targets were found to exhibit a strong word onset effect; this effect was entirely confined to between-word contextual errors. However, nonword targets generated no word onset effect, either overall or on between-word errors considered alone. These findings suggest that the word onset effect cannot be entirely attributed to phonological factors, but instead reflects something about the larger role word onsets play in (real word) speech planning. A new account is offered, which attributes the word onset effect to order-based competition between items at the lexical level.

Cyhalothrin--a novel acaricidal and insecticidal synthetic pyrethroid for the control of the cattle tick (Boophilus microplus) and the buffalo fly (Haematobia irritans exigua).

Cyhalothrin, a novel synthetic pyrethroid, was evaluated for control of the major resistant strains of the cattle tick (Boophilus microplus) and for control of the buffalo fly (Haematobia irritans exigua) on cattle. In regulated treatment trials with 0.007% cyhalothrin, greater than 99% control of the Biarra, Mackay, Mt Alford, DDT resistant and Ulam cattle tick strains was obtained. Protective-period trials were conducted in which animals which had been sprayed with 0.007% cyhalothrin then received a continuing heavy challenge of the organophosphate-resistant Biarra tick strain. The first semi-engorged adult ticks appeared no earlier than 27 days after treatment, which corresponds to a minimum protective period against reinfestation of 7 days. Protective-periods ranging from 7 to 15 days were obtained in trials that were conducted. Field trials on cattle confirmed that dipping in 0.007% cyhalothrin provided a high level of tick control and a minimum of 7 days protective period against reinfestation. Thus a 28 day treatment interval was employed. It was possible to further extend dipping intervals to as long as 7 weeks once tick populations were reduced on the pasture. Furthermore at least 28 days protection from reinfestation with buffalo fly was also provided. In backspraying trials on cattle, 200 mg cyhalothrin applied to each animal as an 0.2% aqueous emulsion gave greater than 28 days protection against reinfestation with buffalo fly.