Atypical tibial fracture in a 63-Year-old woman with intermittent use of bisphosphonate unmasking hypophosphatasia

We report an unusual case of atypical proximal tibial stress fracture (APTF) associated with intermittent use of bisphosphonates (BPs) and persistently low serum alkaline phosphatase (ALP) levels. We describe the case of a 63-year-old white woman who had experienced an APTF after 4 years of intermittent exposure to alendronate given for recurrent metatarsal stress fractures. BP administration was stopped after the diagnosis of the APTF. A review of her previous serum ALP levels revealed they had been consistently low. Adult hypophosphatasia (HPP) was diagnosed by the low serum ALP activity and elevated urine phosphoethanolamine levels. She was treated conservatively with analgesics. Adult HPP is an underrecognized condition associated with atypical insufficiency fractures, and BP use compounds this risk. To the best of our knowledge, we report the first case of intermittent BP exposure preceding an APTF in an adult patient with HPP, highlighting the uncommon site of the proximal tibia for BP-associated atypical insufficiency fractures, the need to screen for HPP in those with persistently low ALP levels before they begin BP therapy, and the importance of avoiding BP use in those with HPP

Reproductive effects of occupational DDT exposure among male malaria control workers.

To assess potential effects of human DDT [1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane] exposure, we evaluated the reproductive history of 2,033 workers in the antimalaria campaign of Mexico. Data on occupational exposure to DDT and reproductive outcomes were gathered through a questionnaire, and workers provided information about 9,187 pregnancies. We estimated paternal exposure to DDT before each pregnancy using three approaches: a) a dichotomous indicator for pregnancies before and after exposure began, b) a qualitative index of four exposure categories, and c) an estimation of the DDT metabolite DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene] accumulated in fat. To assess associations, we used logistic regression models that accounted for correlated observations and adjusted for parents' age at each child's birth, exposure to other pesticides, exposure to chemical substances in other employment, smoking, and alcohol consumption. The odds ratio for birth defects comparing pregnancies after and before the first exposure was 3.77 [95% confidence interval (95% CI), 1.19-9.52]. Compared with the lowest quartile of estimated DDE in fat, the ORs were 2.48 (95% CI, 0.75-8.11), 4.15 (95% CI, 1.38-12.46), and 3.76 (95% CI, 1.23-11.44) for quartiles 2, 3, and 4, equivalent to p,p -DDE in fat of 50, 82, and 298 microg/g fat, respectively. No significant association was found for spontaneous abortion or sex ratio. We found an increased risk of birth defects associated with high occupational exposure to DDT in this group of workers. The significance of this association at lower exposure levels found in the general population remains uncertain

The interplay between learner beliefs and foreign language anxiety: insights from the Turkish EFL context

Foreign language learning in classroom settings has long been found to be associated with anxiety (Horwitz, 1986). Though it is known that sources of foreign language anxiety are varied (Young, 1991), whether anxiety is related to learners’ inherent beliefs about language learning is understudied. To this end, the present study examines the possible relationship between learner beliefs and language anxiety in the under-researched Turkish EFL context. A population of university-level Turkish EFL learners (n=153) completed the Beliefs about Language Learning Inventory (BALLI) and the Foreign Language Classroom Anxiety scale (FLCAS). The underlying constructs in both instruments were explored using an Exploratory Factor Analysis (EFA). A series of Pearson Product-Moment Correlation Coefficient (PPMCC) tests were performed on the factor scores from both instruments. The findings revealed that fear of ambiguity was positively linked to classroom performance anxiety and negative feelings towards English. In addition, the more confident learners feel themselves using English, the more desire they seem to have to interact with native speakers. Overall, positive beliefs about language learning may be helpful in reducing anxiety and boosting confidence in language learning. These findings not only enhance our understanding of the complex psychology of language learning but also have important implications for instructed EFL/ESL settings

Learners’ use of communication strategies in text-based and video-based synchronous computer-mediated communication environments: opportunities for language learning

This study investigates the different learning opportunities enabled by text-based and video-based synchronous computer-mediated communication (SCMC) from an interactionist perspective. Six Chinese-speaking learners of English and six English-speaking learners of Chinese were paired up as tandem (reciprocal) learning dyads. Each dyad participated in four kinds of interactions, namely, English text-based SCMC, Chinese text-based SCMC, English video-based SCMC and Chinese video-based SCMC. Their use of communication strategies (CSs) were analyzed along with an after-task questionnaire and with stimulated reflection to explore systematically and comprehensively the differences between text-based and video-based SCMC. In addition to the main role of qualitative analysis, the quantitative analysis was undertaken to provide an overview of the relative frequencies of the occurrence of the different strategies and to understand their distribution in the different conditions. A MANOVA was applied to understand to what extent the differences are likely to have occurred by chance. The results showed that learners used CSs differently in text-based and video-based SCMC and indicated different learning opportunities provided by these two modes of SCMC. While text-based SCMC appears to have greater potential for learning target-like language forms, video-based SCMC seems particularly effective for fluency development as well as pronunciation improvement

Climate change litigation: a review of research on courts and litigants in climate government

Studies of climate change litigation have proliferated over the past two decades, as lawsuits across the world increasingly bring policy debates about climate change mitigation and adaptation, as well as climate change‐related loss and damage to the attention of courts. We systematically identify 130 articles on climate change litigation published in English in the law and social sciences between 2000 and 2018 to identify research trajectories. In addition to a budding interdisciplinarity in scholarly interest in climate change litigation we also document a growing understanding of the full spectrum of actors involved and implicated in climate lawsuits and the range of motivations and/or strategic imperatives underpinning their engagement with the law. Situating this within the broader academic literature on the topic we then highlight a number of cutting edge trends and opportunities for future research. Four emerging themes are explored in detail: the relationship between litigation and governance; how time and scale feature in climate litigation; the role of science; and what has been coined the “human rights turn” in climate change litigation. We highlight the limits of existing work and the need for future research—not limited to legal scholarship—to evaluate the impact of both regulatory and anti‐regulatory climate‐related lawsuits, and to explore a wider set of jurisdictions, actors and themes. Addressing these issues and questions will help to develop a deeper understanding of the conditions under which litigation will strengthen or undermine climate governance. This article is categorized under: Policy and Governance > Multilevel and Transnational Climate Change Governanc

Differences in Brain Function and Changes with Intervention in Children with Poor Spelling and Reading Abilities

Previous fMRI studies in English-speaking samples suggested that specific interventions may alter brain function in language-relevant networks in children with reading and spelling difficulties, but this research strongly focused on reading impaired individuals. Only few studies so far investigated characteristics of brain activation associated with poor spelling ability and whether a specific spelling intervention may also be associated with distinct changes in brain activity patterns. We here investigated such effects of a morpheme-based spelling intervention on brain function in 20 children with comparatively poor spelling and reading abilities using repeated fMRI. Relative to 10 matched controls, children with comparatively poor spelling and reading abilities showed increased activation in frontal medial and right hemispheric regions and decreased activation in left occipito-temporal regions prior to the intervention, during processing of a lexical decision task. After five weeks of intervention, spelling and reading comprehension significantly improved in the training group, along with increased activation in the left temporal, parahippocampal and hippocampal regions. Conversely, the waiting group showed increases in right posterior regions. Our findings could indicate an increased left temporal activation associated with the recollection of the new learnt morpheme-based strategy related to successful training