From holism to compositionality: memes and the evolution of segmentation, syntax, and signification in music and language

Steven Mithen argues that language evolved from an antecedent he terms “Hmmmmm, [meaning it was] Holistic, manipulative, multi-modal, musical and mimetic”. Owing to certain innate and learned factors, a capacity for segmentation and cross-stream mapping in early Homo sapiens broke the continuous line of Hmmmmm, creating discrete replicated units which, with the initial support of Hmmmmm, eventually became the semantically freighted words of modern language. That which remained after what was a bifurcation of Hmmmmm arguably survived as music, existing as a sound stream segmented into discrete units, although one without the explicit and relatively fixed semantic content of language. All three types of utterance – the parent Hmmmmm, language, and music – are amenable to a memetic interpretation which applies Universal Darwinism to what are understood as language and musical memes. On the basis of Peter Carruthers’ distinction between ‘cognitivism’ and ‘communicativism’ in language, and William Calvin’s theories of cortical information encoding, a framework is hypothesized for the semantic and syntactic associations between, on the one hand, the sonic patterns of language memes (‘lexemes’) and of musical memes (‘musemes’) and, on the other hand, ‘mentalese’ conceptual structures, in Chomsky’s ‘Logical Form’ (LF)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A reproducibility study of corpus cavernosum electromyography in young healthy volunteers under controlled conditions.

Item does not contain fulltextINTRODUCTION: Although the corpus cavernosum electromyography (CC-EMG) has been studied already for 16 years, doubts regarding its reproducibility have remained. AIM: To assess the reproducibility of CC-EMG under controlled conditions and the influence of confounding factors. METHODS: Three CC-EMG recording sessions were performed in 13 healthy young men under the same conditions. Furthermore, the effects of potentially confounding factors, such as intake of caffeine, alcohol and smoking, and sexual activity, were investigated in the same population. Using auto- and cross-correlation techniques, CC-potentials were characterized with parameters amplitude (A), duration (D), dominant frequency (DF), maximum cross-correlation coefficient of longitudinal and bilateral CC-potential pairs (Rmax-lon. and Rmax-bi.), and propagation velocity (PV ). MAIN OUTCOME MEASURES: Comparison of CC-EMG parameters A, D, DF, Rmax-lon., and Rmax-bi. between three recording sessions and assessment of the impact of confounding factors on these parameters. RESULTS: DF, D, A, and Rmax-lon. showed significant correlations among three sessions; PV showed significant correlations between two sessions performed within the same day but not between those performed on different days; Rmax-bi. did not show significant correlations between any two sessions. Intake of caffeine, alcohol, and smoking did not affect CC-potentials, while the recordings shortly after ejaculation showed more irregular oscillations and less CC-potentials with smaller A. CONCLUSIONS: CC-potential parameters DF, D, A, and Rmax-lon. have been demonstrated to be reproducible. The results provide a basis for the clinical and scientific application of CC-EMG. CC-potentials are not sensitive to confounding factors such as intake of caffeine, alcohol, and smoking, while measurements shortly after ejaculation should be avoided

Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial

Background: The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome. Objective: To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS). Design, setting, and participants: Prospective, multicenter, phase-III trial patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0). Intervention: Randomization to limited (obturator, and internal and external iliac nodes) versus extended LND (in addition, deep obturator, common iliac, presacral, paracaval, interaortocaval, and para-aortal nodes up to the inferior mesenteric artery). Outcome measurements and statistical analysis: The primary endpoint was RFS. Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), and complications. The trial was designed to show 15% advantage of 5-yr RFS by extended LND. Results and limitations: In total, 401 patients were randomized from February 2006 to August 2010 (203 limited, 198 extended). The median number of dissected nodes was 19 in the limited and 31 in the extended arm. Extended LND failed to show superiority over limited LND with regard to RFS (5-yr RFS 65% vs 59%; hazard ratio [HR] = 0.84 [95% confidence interval 0.58-1.22]; p = 0.36), CSS (5-yr CSS 76% vs 65%; HR= 0.70; p = 0.10), and OS (5-yr OS 59% vs 50%; HR= 0.78; p = 0.12). Clavien grade >= 3 lymphoceles were more frequently reported in the extended LND group within 90 d after surgery. Inclusion of T1G3 tumors may have contributed to the negative study result. Conclusions: Extended LND failed to show a significant advantage over limited LND in RFS, CSS, and OS. A larger trial is required to determine whether extended compared with limited LND leads to a small, but clinically relevant, survival difference (ClinicalTrials.gov NCT01215071). Patient summary: In this study, we investigated the outcome in bladder cancer patients undergoing cystectomy based on the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce the rate of tumor recurrence in the expected range. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved