Search

Transplant recipients who are seronegative for Toxoplasma and receive an organ from a seropositive donor are at high risk for donor‐derived toxoplasmosis in the absence of prophylaxis. While the risk in cardiac transplant recipients is well known, this infection is often underrecognized in noncardiac transplant recipients. Toxoplasmosis in transplant patients is associated with high mortality, and diagnosis is challenging as the presentation is nonspecific. Recommendations for prophylaxis in cardiac transplant recipients are well‐defined, but the optimal prophylactic strategy in noncardiac transplant recipients, especially those with sulfa allergies, is unknown. We report a case of donor‐derived disseminated toxoplasmosis in a liver transplant recipient who did not receive prophylaxis due to documented sulfa allergy. The patient subsequently underwent a challenge with trimethoprim/sulfamethoxazole and was successfully treated with this therapy. This case underscores the variable clinical presentation of donor‐derived toxoplasmosis as well as the critical importance of accurate allergy evaluation pretransplant. [ABSTRACT FROM AUTHOR]

BackgroundInfluenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection.ObjectivesTo describe the spectrum and clinical impact of co-infections.Study designRetrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis.ResultsOf 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p=0.003), leukocytosis (>11K/μl, OR 3.7 [2.2-6.2], p

BackgroundInfluenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013-2014 influenza season. Little is known about the epidemiology of severe influenza during this season.MethodsA retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.ResultsA total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4-6.9], P=.006 and 50-64 years, 2.5 [1.3-4.9], P=.007; reference age 18-49 years), male sex (1.9 [1.1-3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9-37.0], P

Background Recurrent Clostridioides difficile infection (rCDI) occurs frequently, and concomitant antibiotic (CA) during the initial episode for treatment of non-CDI is a major risk factor. We sought to address the comparative efficacy of fidaxomicin versus vancomycin in the setting of CA during the initial CDI episode. Methods We conducted a randomized, controlled, open-label trial at 2 hospitals in Ann Arbor, Michigan. We consecutively consented and enrolled hospitalized patients ≥18 years old with diarrhea, a positive test for C. difficile , and ≥1 qualifying CA. Complicated CDI, CDI treatment for >24 hours prior to enrollment, and planned long-term (>12 weeks) CA use were notable exclusions. Clinical cure was defined as resolution of diarrhea for 2 consecutive days maintained until 2 days after therapy, and rCDI as recurrent diarrhea with positive testing ≤30 days after initial treatment. Patients were randomized to fidaxomicin or vancomycin. Results Baseline characteristics were similar in the 2 groups of 144 patients. Rates of clinical cure (73% vs 62.9%, P =.195) and rCDI (3.3% vs 4.0%; P >.99) were similar for fidaxomicin and vancomycin in the intention-to-treat and per-protocol cohorts, respectively. Only 4 patients developed rCDI. Conclusions In this study of patients with CDI receiving CA, a numerically higher proportion were cured with fidaxomicin versus vancomycin, but this result did not reach statistical significance. Overall recurrence was lower than anticipated in both arms compared with previous studies that did not extend duration of CDI treatment during CA. Clinical Trials Registration www.clinicaltrials.gov (NCT02692651). [ABSTRACT FROM AUTHOR]

Complexity theory is a field of physics that studies the nature and behavior of complex systems, systems whose elements interact in complex and unpredictable ways. Recent years have seen a number of attempts to extend its scope to the biological and social sciences, and now Larsen-Freeman and Cameron offer a view of applied linguistics from a complexity perspective, claiming to show the relevance of the theory to various aspects of the language sciences. In this review of their book I look at their claims, and point out some of the reasons why these claims do not hold. (Contains 5 notes.)

In recent years, a number of researchers in the field of second language acquisition have voiced discontent regarding the tendency of second language acquisition (SLA) research to be conducted within a framework of cognitive science (Firth and Wagner, 1997; Atkinson, 2002; Johnson, 2004). Watson-Gegeo (2004) expresses this same discontent, and goes beyond it to call for a new SLA paradigm, the "language socialization paradigm". In this article, I point out the various ways in which Watson-Gegeo has misunderstood the nature of cognitive science research in general, and SLA research in particular, and show why her call should go unheeded.

In a recent paper (Jordan, Geoff Jordan takes issue with some of my claims about second language acquisition (SLA) theory. Specifically, he queries the necessity of a property theory, and he finds my discussion of explanation unsatisfactory. In this brief reply, I try to answer his criticisms. In a brief but interesting paper, Geoff Jordan (2004: 539) raises the issue of explanation in SLA theory. Jordan lists the following "key questions" in discussing theories of SLA: (i) What is the domain of a theory of SLA? (ii) What counts as a good explanation of the phenomena in that domain? (iii) What criteria should be used to evaluate competing theories in the same domain? (iv) Is there any need to keep to a minimum the number of rival theories in a domain? He finds my answers "not entirely satisfactory." I'm happy to agree with him. Still, I'm afraid I find his specific criticisms misplaced, and in what follows I'll try to briefly show why.

Discusses "emergenitism," a view of cognition stressing interaction between organism and environment and denying existence of predetermined, domain-specific faculties or capacities. It is an alternative to special nativist theories of the mind, such as theories of universal grammar. rejects arguments raised against "special nativism" and looks at arguments for an emergentist account of second language acquisition. (VWL)

In response to Ellis (2002), which resurrects the notion that language acquisition consists of frequency-based abstraction of regularities from input, this article suggests Ellis ignores fundamental and well-known problems, including the poverty of the stimulus, cases of instantaneous acquisition, and evidence for innate knowledge. (Author/VWL)

Includes a response to an article written previously on what a postmodernist perspective might do for second language acquisition research and a comment by the author of the original article reacting to the response. (Author/VWL)

In 1993, "Applied Linguistics" published an issue on theory construction in second-language acquisition, including papers by Beretta and Crookes, Gregg, and Long. The article argues that these papers and the rationalist understanding of scientific research exemplified in them, have become the object of misguided critiques, including Block (1996). The article replies to these criticisms. (41 references) (Author/CK)

Examines the work of two scholars who have made the greatest contributions to the variabilist perspective on second-language acquisition, and discusses the acquisition models that each of these scholars has proposed. (50 references) (Author/VWL)

Focuses on Eckman's (1996) discussion of the nativism controversy. This article supplements Eckman's discussion and argues in favor of a generative approach to second language acquisition theory, specifically for an autonomous and modular grammatical theory. (five references) (CK)

Background Severe coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment. Methods We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections. Outcomes in patients who received tocilizumab compared with tocilizumab-untreated controls were evaluated using multivariable Cox regression with propensity score inverse probability of treatment weighting (IPTW). Results 154 patients were included, of whom 78 received tocilizumab and 76 did not. Median follow-up was 47 days (range, 28–67). Baseline characteristics were similar between groups, although tocilizumab-treated patients were younger (mean: 55 vs 60 years), less likely to have chronic pulmonary disease (10% vs 28%), and had lower D-dimer values at time of intubation (median: 2.4 vs 6.5 mg/dL). In IPTW-adjusted models, tocilizumab was associated with a 45% reduction in hazard of death (HR,.55; 95% CI,.33–.90) and improved status on the ordinal outcome scale [OR per 1-level increase,.58;.36–.94). Although tocilizumab was associated with an increased proportion of patients with superinfections (54% vs 26%; P  < .001), there was no difference in 28-day case fatality rate among tocilizumab-treated patients with versus without superinfection (22% vs 15%; P  = .42). Staphylococcus aureus accounted for ~50% of bacterial pneumonia. Conclusions In this cohort of mechanically ventilated COVID-19 patients, tocilizumab was associated with lower mortality despite higher superinfection occurrence. [ABSTRACT FROM AUTHOR]

Critically reviews Bonnie Schwartz' 1986 article "The Epistemological Status of Second Language Acquisition," and focuses on the applicability of the modularity thesis of Chomsky and Fodor to second language learning (L2A); and on the relationship of such a theory to Krashen's model of L2A. (LMO)