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

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

Spontaneous Coronary Artery Dissection in the Third Trimester -- implications for investigation and delivery.

Spontaneous coronary artery dissection (SCAD) is a rare condition which occurs predominantly in the postpartum period in young women. A SCAD whilst pregnant is very rare and poses significant risk to the mother and unborn child, and with minimal data on SCAD antenatally, this case highlights antepartum clinical considerations.</jats:p

Spontaneous coronary artery dissection in the third trimester-Implications for investigation and delivery

This case of spontaneous coronary artery dissection in pregnancy highlights the diagnostic, treatment and delivery dilemmas in the antepartum period. This is a rare condition that usually manifests in the postpartum period. This case provides multidisciplinary considerations that were encountered for optimal maternal and fetal outcome.Full Tex

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