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Background As the population ages, increasing numbers of older adults are undergoing surgery. Frailty is prevalent in older adults and may be a better predictor of post-operative morbidity and mortality than chronological age. The aim of this review was to examine the impact of frailty on adverse outcomes in the ‘older old’ and ‘oldest old’ surgical patients. Methods A systematic review was undertaken. Electronic databases from 2010 to 2015 were searched to identify articles which evaluated the relationship between frailty and post-operative outcomes in surgical populations with a mean age of 75 and older. Articles were excluded if they were in non-English languages or if frailty was measured using a single marker only. Demographic data, type of surgery performed, frailty measure and impact of frailty on adverse outcomes were extracted from the selected studies. Quality of the studies and risk of bias was assessed by the Epidemiological Appraisal Instrument. Results Twenty-three studies were selected for the review and they were assessed as medium to high quality. The mean age ranged from 75 to 87 years, and included patients undergoing cardiac, oncological, general, vascular and hip fracture surgeries. There were 21 different instruments used to measure frailty. Regardless of how frailty was measured, the strongest evidence in terms of numbers of studies, consistency of results and study quality was for associations between frailty and increased mortality at 30 days, 90 days and one year follow-up, post-operative complications and length of stay. A small number of studies reported on discharge to institutional care, functional decline and lower quality of life after surgery, and also found a significant association with frailty. Conclusion There was strong evidence that frailty in older-old and oldest-old surgical patients predicts post-operative mortality, complications, and prolonged length of stay. Frailty assessment may be a valuable tool in peri-operative assessment. It is possible that different frailty tools are best suited for different acuity and type of surgical patients. The association between frailty and return to pre-morbid function, discharge destination, and quality of life after surgery warrants further research.

This article provides the first formal account of empirical generalizations concerning the adaptation of Japanese vowels in Truku, an Austronesian language spoken in Taiwan. It is shown that while most Truku native markedness constraints are respected in loanword adaptation, two of the language's markedness constraints are sacrificed to satisfy loanword-sensitive faithfulness constraints and one is blocked only in unaffixed loanwords, exhibiting a derived environment effect. Other than native phonology, perceptual saliency is also shown to play a role in loanword adaptation, as evidenced by the different adaptation behaviors between voiced and voiceless vowels and between peripheral and mid vowels. The fact that both perception and native phonology play roles in vowel adaptation in Truku loanwords thus supports the Perception-Phonology Approach of loanword adaptation, a perception-oriented theory that involves the native phonology.

Frailty is a state of decreased physiologic reserve and resistance to stressors. Its prevalence increases with age and is estimated to be 26% in those aged above 85 years. As the population ages, frailty will be increasingly seen in surgical patients receiving anesthesia. Here, we evaluate the instruments which have been developed and validated for measuring frailty in surgical patients and summarize frailty tools used in 110 studies linking frailty status with adverse outcomes post-surgery. Frail older people are vulnerable to geriatric syndromes, and complications such as postoperative cognitive dysfunction and delirium are explored. This review also considers how frailty, with its decline of organ function, affects the metabolism of anesthetic agents and may influence the choice of anesthetic technique in an older person. Optimal perioperative care includes the identification of frailty, a multisystem and multidisciplinary evaluation preoperatively, and discussion of treatment goals and expectations. We conclude with an overview of the emerging evidence that Comprehensive Geriatric Assessment can improve postoperative outcomes and a discussion of the models of care that have been developed to improve preoperative assessment and enhance the postoperative recovery of older surgical patients.

In this paper, I discuss tonal reduplication in Kunming, which has received little attention in the formal linguistics literature. Based on first hand data, I show that tonal reduplication in Kunming is interesting in two respects. First, a Base tone is not always transferred to the RED (reduplicant); while a Hr (high register) Base tone (i.e., yinping 44, shangsheng 53) is transferred to the RED, the RED corresponding to a Lr (low register) Base tone (i.e., yangping 31, qusheng 11) surfaces with a non-correspondent high tone. I propose that the non-corresponding high tone comes from a floating tone that accompanies reduplication and is only realized on the RED corresponding to Lr Base tones, but not to Hr Base tones, because Hr Base tones are prominent and more easily preserved on the RED. Second, as far as yinping tone sandhi is concerned, though it applies normally on the Base and outside the BR complex, on the RED it unexpectedly underapplies when the RED carries a yinping tone copied from the Base. I propose that tone sandhi underapplies only on a copied yinping tone, and not elsewhere, because only underapplication of yinping tone sandhi in this case can help improve BR Identity.

Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

This paper presents a novel generalization of the reduplicant (henceforth red ) placement in CV reduplication in Isbukun Bunun. It is shown that the variable red placements cannot be explained in terms of the presence of a PF marker or merely by the syllable number of the root, as assumed in previous studies. Rather, the variable red placements are argued to be simultaneously governed by the size and the syllable well-formedness of the root. The red is normally prefixed to the root; however, if onsetless red is generated under normal copying, the placement of the red shifts one syllable rightward, except for shorter (bimoraic) roots. Thus, the variable placements of the red are driven by a universal tendency for the red to be unmarked and the need for the P-Root to sustain a minimal size.

This paper examines the true nature of the reduplicant vowels in the two major types of reduplication in Truku, Ce- reduplication and CeCe- reduplication, which have been previously assumed to involve monosyllabic and disyllabic copying, respectively. The reduplicants of the two patterns (i.e., Ce-and CeCe-) contain schwas that are always considered as reduced vowels derived from the pretonic vowel reduction rule. Drawing evidence from three types of reduplication forms that have not been previously noticed/documented, that is, reduplication forms showing CeC- ~CeCe- variation, as well as reduplication taking place on monosyllabic words and on CV.?- initial words, this paper argues that the schwas in the reduplicants of the two reduplication patterns do not always come from vowel reduction. Although the first schwa in the CeCe-reduplicant does come from vowel reduction, the final schwas in the CeCe-andCe- reduplicant are actually inserted vowels that function to break up CC clusters. The findings also show that Ce- reduplication only copies consonants from the Base. Therefore, Truku, just as Squliq Atayal, also involves bare consonant copying.

This paper investigates tone sandhi phenomena in the Chinese dialect of Tianjin, which are noteworthy for the rule application directionalities observed in tri-tonal strings. The rule application directionalities appear to be ungoverned, as none of the principles proposed to date that may contribute to determining directionalities can account for them. Based on the constraint-based theory of OT, this paper shows that the rule operation directionalities in Tianjin are by no means ungoverned.Normally tone sandhi applies from left to right for identity reasons. This is captured by the OO-faithfulness constraint IDENT-BOT, which requires identity between prosodically related outputs. The left-to-right directionality is sacrificed only when it would result in output forms that involve marked sequences or toneme deletion at the prominent edge of a tone, which are forbidden by the markedness constraint OCP-T and the positional IO-faithfulness constraint MAX-IO-t-R, respectively. Thus the rule application directionalities in Tianjin are naturally predicted by the interaction of IDENT-BOT, OCP-T, and MAX-IO-t-R, where IDENT-BOT must be dominated by the latter two constraints.

本論文以優選理論研究噶瑪蘭語重疊詞結構。噶瑪蘭語重疊詞綴有相當多樣的結構。前人研究噶瑪蘭語重疊詞時指出，該語言重疊詞綴的結構深受詞基首音節結構之影響。本文提出不同的看法。本文指出，噶瑪蘭語重疊詞受制於兩股衝突的力量；重疊詞一方面希望完整複製詞基首音節，另一方面又希望達到雙音拍 (bimoraic) 大小；兩股力量作用之下，使得有些詞基有一種以上的重疊結構。當詞基首音節為雙音拍時，重疊詞綴直接複製詞基首音節而無變異；而當詞基首音節小於雙音拍時，除了複製詞基首音節外，重疊詞綴也會複製詞基首音節以外的成分以達成雙音拍大小；此時，重疊詞綴便有一種以上的重疊結構