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This article investigates the effect of age of first exposure and the quantity and quality of input to which non-native acquirers (L2ers) are exposed in their acquisition of grammatical gender in Dutch. Data from 103 English-speaking children, preteens and adults were analysed for gender agreement on definite determiners. It was observed that although most learners regularly overgeneralized the common gender definite determiner de to neuter nouns, there also existed child and adult L2ers who consistently produced the target neuter determiner het with these nouns (contra Carroll, 1989

How to quantify bilingual experience? Findings from a Delphi consensus survey

While most investigations of bilingualism document participants’ language background, there is an absence of consensus on how to quantify bilingualism. The high number of different language background questionnaires used by researchers and practitioners jeopardises data comparability and cross-pollination between research and practice. Using the Delphi consensus survey method, we asked 132 panellists (researchers, speech and language therapists, teachers) from 29 countries to rate 124 statements on a 5-point agreement scale. Consensus was pre-defined as 75% agreement threshold. After two survey rounds, 79% of statements reached consensus. The need for common measures to quantify bilingualism was acknowledged by 96% of respondents. Agreement was reached to document: language exposure and use, language difficulties, proficiency (when it cannot be assessed directly), education and literacy, input quality, language mixing practices, and attitudes (towards languages and language mixing). We discuss the implications of these findings for the creation of a new tool to quantify bilingual experience

A review of questionnaires quantifying bilingual experience in children: do they document the same constructs?

Questionnaires documenting children’s bilingual experience have been used frequently in research on language and cognitive development. However, there has been little investigation of the comparability between these tools. In this review, we (i) provide a list of available questionnaires used to quantify bilingual experience in children; (ii) identify the components of bilingual experience documented across questionnaires; and (iii) discuss the comparability of the measures used to operationalise these components. In doing so, we review 48 questionnaires and identify 32 overarching constructs, manifested as 194 components, and we calculate the frequency with which they are documented. Finally, by focusing on a subset of overarching constructs (language exposure and use, activities, and current language skills), we observe high variability in how they are operationalised across tools. These findings highlight the need for greater transparency in how we document bilingualism and for more comparable measures

Mechanisms of Psychological Distress following War in the Former Yugoslavia: The Role of Interpersonal Sensitivity

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.This study was funded by a grant from the European Commission, contract number INCO-CT-2004-509176. AN was supported by a Clinical Early Career Research Fellowship (113295) and a Project Grant (104288

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Background Phenytoin is the recommended second-line intravenous anticonvulsant for treatment of paediatric convulsive status epilepticus in the UK; however, some evidence suggests that levetiracetam could be an effective and safer alternative. This trial compared the efficacy and safety of phenytoin and levetiracetam for second-line management of paediatric convulsive status epilepticus.Methods This open-label, randomised clinical trial was undertaken at 30 UK emergency departments at secondary and tertiary care centres. Participants aged 6 months to under 18 years, with convulsive status epilepticus requiring second-line treatment, were randomly assigned (1:1) using a computer-generated randomisation schedule to receive levetiracetam (40 mg/kg over 5 min) or phenytoin (20 mg/kg over at least 20 min), stratified by centre. The primary outcome was time from randomisation to cessation of convulsive status epilepticus, analysed in the modified intention-to-treat population (excluding those who did not require second-line treatment after randomisation and those who did not provide consent). This trial is registered with ISRCTN, number ISRCTN22567894.Findings Between July 17, 2015, and April 7, 2018, 1432 patients were assessed for eligibility. After exclusion of ineligible patients, 404 patients were randomly assigned. After exclusion of those who did not require second-line treatment and those who did not consent, 286 randomised participants were treated and had available data: 152 allocated to levetiracetam, and 134 to phenytoin. Convulsive status epilepticus was terminated in 106 (70%) children in the levetiracetam group and in 86 (64%) in the phenytoin group. Median time from randomisation to cessation of convulsive status epilepticus was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (24 to not assessable) in the phenytoin group (hazard ratio 1·20, 95% CI 0·91–1·60; p=0·20). One participant who received levetiracetam followed by phenytoin died as a result of catastrophic cerebral oedema unrelated to either treatment. One participant who received phenytoin had serious adverse reactions related to study treatment (hypotension considered to be immediately life-threatening [a serious adverse reaction] and increased focal seizures and decreased consciousness considered to be medically significant [a suspected unexpected serious adverse reaction]). Interpretation Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus

Light Stress Responses by the Eelgrass, Zostera marina (L)

Zostera marina is the dominant seagrass species in the Northern Hemisphere where it grows in sheltered bays and estuaries. As a consequence of its distribution its conservation is commonly threatened by poor coastal water quality. The high minimum light requirements of seagrasses results in water quality degradation (high turbidity and eutrophication) being a significant risk. Bioindicators of light stress can be used to interpret seagrass responses to light limitation and therefore act as sentinels for conservation management. However, there exists limited experimental inter-comparison of the effectiveness of multiple individual bioindicator responses. Meta-analysis suggests that rhizome sugars, shoot C:N, shoot growth, and number of leaves per shoot provide the most consistent response variables to increasing light limitation in seagrass, but this premise remains largely untested at the plant level as a direct comparison of multiple bioindicators. The present study aimed to test the morphological, physiological, and photo-physiological bioindicator responses of Z. marina to light stress applied within controlled laboratory conditions. These bioindicators were used to assign minimum light thresholds. Growth rate and photophysiological parameters (alpha, Ek, and ETRmax) were rapidly (1st week) and drastically affected by low light shade treatments (20.12 μmol photons m−2s−1 and lower). After 3 weeks at low light, significant reductions in maximum leaf length and leaf width were observed. Principal Component Analysis identified leaf length, shoot growth, shoot surface area, ETRmax, Ek, and alpha as having the strongest responses to reduced light. Shoot growth, ETRmax, Ek, and alpha were found to provide the best early warning of light limitation after 5–8 days. These results provide evidence for bioindicators of light stress in Z. marina and highlights the importance of understanding these responses for the successful management and conservation of this species

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

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