19 research outputs found
The Debate on Maturational Constraints in Bilingual Development: A Perspective from First-Language Attrition
A controversial topic in research on second-language acquisition is whether residual variability and optionality in high-proficiency late second-language (L2) learners is merely the outcome of cross-linguistic transfer, competition, and processing limitations, or whether late learners have an underlying representational deficit due to maturational constraints on ultimate attainment in L2. This study argues that insights into this question can be gained by comparing advanced late L2 learners with late bilinguals who grew up with the language under investigation as their first language (L1), prior to emigrating to another country. The latter group, who use the language of the host country predominantly in their daily lives, typically exhibit increased optionality in their native language as a result of cross-linguistic transfer and L1 attrition. They do not, however, have a representational deficit in their L1, having acquired it monolingually during childhood. Such a comparison has the potential to distinguish grammatical features that are prone to bilingualism effects from those that natives can maintain but with which L2ers struggle persistently, possibly due to maturational limitations. This study compares 20 long-term attriters (English L2) with 20 highly advanced immersed learners of German (English L1) and 20 predominantly monolingual controls. The bilingual populations are matched for proficiency and for their use of German in daily life. The analysis comprises a group comparison and an investigation of individual performance, to assess whether there are L2 speakers who perform within the accuracy ranges of a larger population of attriters (n = 53) on all features, and similarly, whether any of the attriters perform within the accuracy range of a population of native controls (n = 53). The findings indicate that there are some areas of grammar (e.g., obligatory word order) where the L2 speakers are similar to the L1 attriters, and others (in particular noun phrase morphology) where attriters and monolinguals behave differently from the L2ers. This finding is interpreted as being consistent with an account that assumes some form of maturational constraint on language learning
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Exploratory study of sleeping patterns in children admitted to hospital
AimsSleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses
A review of technology and policy deep decarbonization pathway options for making energy-intensive industry production consistent with the Paris Agreement
The production of commodities by energy-intensive industry is responsible for 1/3 of annual global greenhouse gas (GHG) emissions. The climate goal of the Paris Agreement, to hold the increase in the global average temperature to well below 2 °C above pre-industrial levels while pursuing efforts to limit the temperature increase to 1.5 °C, requires global GHG emissions reach net-zero and probably negative by 2055–2080. Given the average economic lifetime of industrial facilities is 20 years or more, this indicates all new investment must be net-zero emitting by 2035–2060 or be compensated by negative emissions to guarantee GHG-neutrality. We argue, based on a sample portfolio of emerging and near-commercial technologies for each sector (largely based on zero carbon electricity & heat sources, biomass and carbon capture, and catalogued in an accompanying database), that reducing energy-intensive industrial GHG emissions to Paris Agreement compatible levels may not only be technically possible, but can be achieved with sufficient prioritization and policy effort. We then review policy options to drive innovation and investment in these technologies. From this we synthesize a preliminary integrated strategy for a managed transition with minimum stranded assets, unemployment, and social trauma that recognizes the competitive and globally traded nature of commodity production. The strategy includes: an initial policy commitment followed by a national and sectoral stakeholder driven pathway process to build commitment and identify opportunities based on local zero carbon resources; penetration of near-commercial technologies through increasing valuation of GHG material intensity through GHG pricing or tradable performance based regulations with protection for competitiveness and against carbon leakage; research and demand support for the output of pilot plants, including some combination of guaranteed above-market prices that decline with output and an increasing requirement for low carbon inputs in government procurement; and finally, key supporting institutions
Zealandia: Earth’s Hidden Continent
A 4.9 Mkm2 region of the southwest Pacific Ocean is made up of continental crust. The region has elevated bathymetry relative to surrounding oceanic crust, diverse and silica-rich rocks, and relatively thick and low-velocity crustal structure. Its isolation from Australia and large area support its definition as a continent— Zealandia. Zealandia was formerly part of Gondwana. Today it is 94% submerged, mainly as a result of widespread Late Cretaceous crustal thinning preceding supercontinent breakup and consequent isostatic balance. The identification of Zealandia as a geological continent, rather than a collection of continental islands, fragments, and slices, more correctly represents the geology of this part of Earth. Zealandia provides a fresh context in which to investigate processes of continental rifting, thinning, and breakup
Associations Between Hyperphagia, Symptoms of Sleep Breathing Disorder, Behaviour Difficulties and Caregiver Well-Being in Prader-Willi Syndrome: A Preliminary Study
Prader-Willi syndrome (PWS) is a rare genetic disorder characterised by neurodevelopmental delays, hyperphagia, difficulties with social communication and challenging behaviours. Individuals require intensive supervision from caregivers which may negatively affect caregiver quality of life. This study used data collected in the Australasian PWS Registry (n = 50, mean age 11.2 years) to evaluate associations between child behaviours and caregiver mental well-being. Symptoms of sleep-related breathing disorder, child depression and social difficulties were associated with poorer caregiver mental and physical well-being. Growth hormone therapy use was associated with better caregiver mental and physical well-being. Optimising management of problematic behaviours and sleep disturbances have the potential to support caregivers who are the most vital network of support for individuals affected by PWS
Sleep-disordered breathing in Australian children with Prader-Willi syndrome following initiation of growth hormone therapy
Aim: In children with Prader-Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep-disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow-up with polysomnography is still advised in most clinical guidelines. Methods: This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed-rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. Results: We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1–13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0–32.9); 35% had an obstructive AHI above 1.0/h. Follow-up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7–21%) developed moderate/severe OSA, with clinical management implications. Conclusions: Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children