The complexity of narrative interferes in the use of conjunctions in children with specific language impairment

PURPOSE: To verify the use of conjunctions in narratives, and to investigate the influence of stimuli's complexity over the type of conjunctions used by children with specific language impairment (SLI) and children with typical language development. METHODS: Participants were 40 children (20 with typical language development and 20 with SLI) with ages between 7 and 10 years, paired by age range. Fifteen stories with increasing of complexity were used to obtain the narratives; stories were classified into mechanical, behavioral and intentional, and each of them was represented by four scenes. Narratives were analyzed according to occurrence and classification of conjunctions. RESULTS: Both groups used more coordinative than subordinate conjunctions, with significant decrease in the use of conjunctions in the discourse of SLI children. The use of conjunctions varied according to the type of narrative: for coordinative conjunctions, both groups differed only between intentional and behavioral narratives, with higher occurrence in behavioral ones; for subordinate conjunctions, typically developing children's performance did not show differences between narratives, while SLI children presented fewer occurrences in intentional narratives, which was different from other narratives. CONCLUSION: Both groups used more coordinative than subordinate conjunctions; however, typically developing children presented more conjunctions than SLI children. The production of children with SLI was influenced by stimulus, since more complex narratives has less use of subordinate conjunctions.

Content and English Language Integrated Learning: The use of Moodle in Aircraft Maintenance Training Programs

The aim of this work is to develop a prototype of an e-learning environment that can foster Content and Language Integrated Learning (CLIL) for students enrolled in an aircraft maintenance training program, which allows them to obtain a license valid in all EU member states. Background research is conducted to retrace the evolution of the field of educational technology, analyzing different learning theories – behaviorism, cognitivism, and (socio-)constructivism – and reflecting on how technology and its use in educational contexts has changed over time. Particular attention is given to technologies that have been used and proved effective in Computer Assisted Language Learning (CALL). Based on the background research and on students’ learning objectives, i.e. learning highly specialized contents and aeronautical technical English, a bilingual approach is chosen, three main tools are identified – a hypertextbook, an exercise creation activity, and a discussion forum – and the learning management system Moodle is chosen as delivery medium. The hypertextbook is based on the technical textbook written in English students already use. In order to foster text comprehension, the hypertextbook is enriched by hyperlinks and tooltips. Hyperlinks redirect students to webpages containing additional information both in English and in Italian, while tooltips show Italian equivalents of English technical terms. The exercise creation activity and the discussion forum foster interaction and collaboration among students, according to socio-constructivist principles. In the exercise creation activity, students collaboratively create a workbook, which allow them to deeply analyze and master the contents of the hypertextbook and at the same time create a learning tool that can help them, as well as future students, to enhance learning. In the discussion forum students can discuss their individual issues, content-related, English-related or e-learning environment-related, helping one other and offering instructors suggestions on how to improve both the hypertextbook and the workbook based on their needs.

Critical review of the use of erythropoietin in the treatment of anaemia during therapy for chronic hepatitis C

Combined pegylated interferon (PegIFN) and ribavirin represents the standard therapy for patients with chronic hepatitis C (CHC), which allows for sustained viral response (SVR) in up to 90% of patients depending on certain viral and host factors. Clinical studies have demonstrated the importance of adherence to therapy, that is, the ability of patients to tolerate and sustain a fully dosed therapy regimen. Adherence is markedly impaired by treatment-related adverse effects. In particular, haemolytic anaemia often requires dose reduction or termination of ribavirin treatment, which compromises treatment efficacy. Recent evidence points to a beneficial role of recombinant erythropoietin (EPO) in alleviating ribavirin-induced anaemia thereby improving quality of life, enabling higher ribavirin dosage and consequently improving SVR. However, no general consensus exists regarding the use of EPO for specific indications: its optimal dosing, treatment benefits and potential risks or cost efficiency. The Swiss Association for the Study of the Liver (SASL) has therefore organized an expert meeting to critically review and discuss the current evidence and to phrase recommendations for clinical practice. A consensus was reached recommending the use of EPO for patients infected with viral genotype 1 developing significant anaemia below 100 g/L haemoglobin and a haematocrit of <30% during standard therapy to improve quality of life and sustain optimal ribavirin dose. However, the evidence supporting its use in patients with pre-existing anaemia, non-1 viral genotypes, a former relapse or nonresponse, liver transplant recipients and cardiovascular or pulmonary disease is considered insufficient.

Clinical experience with the use of bivalirudin in a large population undergoing endovascular abdominal aortic aneurysm repair

PURPOSE: To retrospectively evaluate the safety and effectiveness of the use of bivalirudin, a direct thrombin antagonist, compared with unfractionated heparin in endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: Between March 1994 and September 2007, 740 consecutive patients (mean age, 75.7 y +/- 7.7; 69 women) underwent elective EVAR for infrarenal abdominal aortic aneurysm. Bivalirudin was used in 98 of these 740 (13.2%) and unfractioned heparin was used in the other 642 (86.8%). Complications were classified according to the Society of Vascular Surgery/International Society for Cardiovascular Surgery criteria. Major bleeding was defined as clinically overt blood loss resulting in a decrease of hemoglobin of more than 3 g/dL, any decrease in hemoglobin of more than 4 g/dL, transfusion of 2 U or more of red blood cells, or intracranial or retroperitoneal hemorrhage. RESULTS: Grade 1 major complications were observed in 161 of 642 patients (25.2%) in the heparin group and 12 of 98 patients (12.2%) in the bivalirudin group (P = .0046), whereas the incidences of grade 3 major complications were not significantly different between groups (P = .57). The rate of total complications was higher in the heparin group than in the bivalirudin group (247 of 642 [38.5%] vs 21 of 98 [21.4%]; P = .001). Major bleeding occurred in 10 of 98 patients (10.2%) receiving bivalirudin and in 91 of 642 patients (14.2%) receiving heparin (P = .34). One of 21 major complications (4.76%) in the bivalirudin group and 12 of 247 major complications (4.86%) in the heparin group were attributable to thrombosis (P = 1.0). CONCLUSIONS: Bivalirudin is a safe and feasible alternative to unfractionated heparin in patients undergoing EVAR.

A Note on the Use of Sum in the Logic of Proofs

The Logic of Proofs~LP, introduced by Artemov, encodes the same reasoning as the modal logic~S4 using proofs explicitly present in the language. In particular, Artemov showed that three operations on proofs (application~$\cdot$, positive introspection~!, and sum~+) are sufficient to mimic provability concealed in S4~modality. While the first two operations go back to G{\"o}del, the exact role of~+ remained somewhat unclear. In particular, it was not known whether the other two operations are sufficient by themselves. We provide a positive answer to this question under a very weak restriction on the axiomatization of LP.

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

CECOG experts' recommendations on the use of denosumab in the prevention of skeletal-related events in bone metastases of lung cancer

Purpose Skeletal-related events represent a substantial burden for patients with advanced cancer. Randomized, controlled studies suggested superiority of denosumab over zoledronic acid in the prevention of skeletal-related events in metastatic cancer patients, with a favorable safety profile. Experts gathered at the 2012 Skeletal Care Academy in Istanbul to bring forward practical recommendations, based on current evidence, for the use of denosumab in patients with bone metastases of lung cancer. Recommendations Based on current evidence, use of denosumab in lung cancer patients with confirmed bone metastases is recommended. It is important to note that clinical judgment should take into consideration the patient’s general performance status, overall prognosis, and live expectancy. Currently, the adverse event profile reported for denosumab includes hypocalcemia and infrequent occurrence of osteonecrosis of the jaw. Therefore, routine calcium and vitamin D supplementation, along with dental examination prior to denosumab initiation are recommended. There is no evidence for renal function impairment due to denosumab administration. At present, there is no rationale to discourage concomitant use of denosumab and surgery or radiotherapy.

Questions and answers regarding the use of rivaroxaban in daily practice.

Several new oral anticoagulants are now on the Swiss market and the general practitioner faces new challenges regarding the management of these new drugs. This consensus document aims to answer to the most frequently asked questions regarding rivaroxaban and covers different topics such as indications, initiation of treatment, drug-drug interactions and perioperative management.

The use of homeopathy in obstetrics in Switzerland

Objective In 1999, a first study conducted in the German speaking part of Switzerland revealed that homeopathy was used in 73% of the obstetrics. The aim of this follow-up study was to detect possible changes in the use of homeopathy since the first investigation, as well as to expand the survey to all regions of Switzerland in order to explore possible regional differences. Furthermore, the perceived positive and negative effects of homeopathy were of interest. Methods All maternity clinics (n = 119) and birthing centers (n = 25) in Switzerland were invited to participate in this online-survey (total N = 144). Results The data collection is still ongoing. Preliminary analyses show that of the 144 obstetrics contacted, 16 had shut down. 106 (82%) had returned the complete or partial questionnaire, whereof 86 (81%) were completed by maternity clinics and 20 (19%) by birthing centers. 70 (66%) questionnaires were returned from the German, 31 (29%) from the French and 5 (5%) from the Italian part of Switzerland. A total of 77 (73%) obstetrics indicated to apply homeopathy: 61 maternity clinics (71% of the responding ones) and 16 birth centers (80% of the responding ones). Clear regional differences in the use of homeopathy emerged: While 65 of the homeopathy-applying obstetrics were located in the German part of Switzerland (84% of the responding ones), only 11 (35% of the responding ones) and 1 (20% of the responding ones) were situated in the French and Italian regions respectively. More detailed results will be presented at the conference. Conclusion Preliminary results show that homeopathy is widely used in the obstetrics of Switzerland. Cultural differences appeared: Homeopathy is widely used in the German speaking part of Switzerland, while it is modestly employed in the French and Italian regions.

The use of evidence in public debates in the media: the case of Swiss direct-democratic campaigns in the health policy sector

This article analyses the reporting of evidence in Swiss direct-democratic campaigns in the health policy sector, assuming that an informed public helps democracy function successfully. A content analysis of the media’s news reporting shows that of 5030 media items retrieved, a reference to evidence is found in 6.8%. The voter receives evidence in the form of substantiating arguments, equally distributed among proponents and opponents. Experts have the highest chance of providing evidence, but appear most rarely. Integrating more evidence might provide voters with the diversity of arguments needed to make a truly informed decision.