What corpus data reveal about the Position of Antecedent Strategy: anaphora resolution in Spanish monolinguals and L1 English-L2 Spanish bilinguals.

This study investigates the acquisition of anaphora resolution (AR) in Spanish as a second language (L2). According to the Position of Antecedent Strategy (PAS), in native Spanish null pronominal subjects are biased toward subject antecedents, whereas overt pronominal subjects show a "flexible" bias (typically toward non-subject but also toward subject antecedents). The PAS has been extensively investigated in experimental studies, though little is known about real production. We show how naturalistic production (corpus methods) can uncover crucial factors in the PAS that have not been explored in the experimental literature. We analyzed written samples from the CEDEL2 corpus: L1 English-L2 Spanish adult late-bilingual learners (intermediate, lower-advanced and upper-advanced proficiency levels) and a control group of adult Spanish monolinguals (N = 75 texts). Anaphors were manually annotated via a fine-grained, linguistically-motivated tagset in UAM Corpus Tool. Against traditional assumptions, our results reveal that (i) the PAS is not a privileged mechanism for resolving anaphora; (ii) it is more complex than assumed (in terms of the division of labor of anaphoric forms, their antecedents and the syntactic configuration in which they appear); (iii) the much-debated "flexible" bias of overt pronouns is apparent since they are hardly produced and are replaced by repeated NPs, which show a clear non-subject antecedent bias; (iv) at the syntax-discourse interface, the PAS is constrained by information structure in more complex ways than assumed: null pronouns mark topic continuity, whereas overtly realized referential expressions (overt REs: overt pronouns and NPs) mark topic shift. Learners show more difficulties with topic continuity (where they redundantly use overt pronouns) than with topic shift (where they normally disambiguate by using overtly realized REs), thus being more redundant than ambiguous, in line with the Pragmatic Principles Violation Hypothesis (PPVH) (Lozano, 2016). We finally argue that the insights from corpora should be implemented into experiments. The triangulation of corpus and experimental methods in bilingualism ultimately provides a clearer understanding of the phenomenon under investigation.

From Corpora to Experiments: Methodological Triangulation in the Study of Word Order at the Interfaces in Adult Late Bilinguals (L2 learners).

This paper shows the need to triangulate different approaches in Bilingualism and Second Language Acquisition (SLA) research to fully understand late bilinguals' interlanguage grammars. Methodologically, we show how experimental and corpus data can be (and should be) triangulated by reporting on a corpus study (Lozano and Mendikoetxea in Biling Lang Cognit 13(4):475-497, 2010) and a new follow-up offline experiment investigating Subject-Verb inversion (Subject-Verb/Verb-Subject order) in L1 Spanish-L2 English (n = 417). Theoretically, we follow a recent line in psycholinguistic approaches to Bilingualism and SLA research (Interface Hypothesis, Sorace in Linguist Approaches Biling 1(1):1-33, 2011). It focuses on the interface between syntax and language-external modules of the mind/brain (syntax-discourse [end-focus principle] and syntax-phonology [end-weight principle]) as well as a language-internal interface (lexicon-syntax [unaccusative hypothesis]). We argue that it is precisely this multi-faceted interface approach (corpus and experimental data, core syntax and the interfaces, representational and processing models) that provides a deeper understanding of (i) the factors that favour inversion in L2 acquisition in particular and (ii) interlanguage grammars in general.

The Development of Anaphora Resolution at the Syntax-Discourse Interface: Pronominal Subjects in Greek Learners of Spanish.

This study explores the development of anaphora resolution (AR) in late sequential bilinguals, namely, adult Greek learners of Spanish at three proficiency levels (intermediate, lower advanced, upper advanced). The use of an overt/null pronominal subject anaphor is investigated in three discourse contexts: topic-continuity (a single antecedent requiring a null pronoun), contrastive-focus (two same-gender potential antecedents requiring an overt pronoun to avoid ambiguity) and emphatic (three same-gender potential antecedents showing unclear preference for either overt or null pronoun). Crucially, AR behaves similarly in Greek and Spanish. Results from an offline contextualised acceptability judgement task show that similarity between the learner's first (L1) and second (L2) languages does not necessarily facilitate the learning task. Even very advanced learners show deficits, which are selective since not all discursive contexts are equally affected. The results are better accounted for by general pragmatic economy principles: Learners prefer being redundant (overuse of overt pronouns in topic-continuity contexts) to ambiguous (acceptance of null pronouns in contrastive-focus contexts). Such tolerance for redundancy may reflect a more general pragmatic tendency, as also reported in child L1 development, adult L2 development and also in native grammars.

Ischaemic stroke in incident dialysis patients.

BACKGROUND: Despite the high frequency of cardiovascular disease among the population on dialysis, there are few studies on ischaemic stroke and associated factors. The objective of the present study is to assess the prevalence of ischaemic stroke at the start of dialysis, its incidence in the course of follow-up and possible factors associated in its presentation. METHODS: All patients in our dialysis programme between 1 January 1999 and 31 December 2005 were included in the study and followed up until death, transplant, transfer out of our catchment area, or conclusion of the study on 31 December 2008. Factors analysed were age, gender, smoking habit, diabetes, hypertension, previous ischaemic stroke, ischaemic coronary disease, peripheral vascular disease and atrial fibrillation. Other factors measured in the first month of dialysis were haematocrit, urea, creatinine, lipids, calcium, phosphorus, parathyroid hormone and albumin. RESULTS: Of 449 patients included in the study (age 64.4 ± 16 years), 30 commenced dialysis having had previous stroke (prevalence 6.7%). In a follow-up of 38.77 ± 29 months, 34 patients presented with one or more strokes; an incidence of 2.41/100 patient-years. Greater age [odds ratio (OR): 1.05; 95% confidence interval (CI): 1.01-1.09; P = 0.007], diabetes (OR: 2.29; 95% CI: 1.15-4.55; P = 0.018) and presence of atrial fibrillation (OR: 3.11; 95% CI: 1.53-6.32; P = 0.002) were independent predictors of stroke occurrence. Conclusions. The prevalence of ischaemic stroke is high at the commencement of dialysis, and its incidence is elevated in the course of follow-up. As with the general population, atrial fibrillation is an important factor predictive of ischaemic stroke, and as such, the clinical implication is that prophylactic anti-coagulation therapy needs to be considered for these individuals.

In-hospital and 12-month postprocedural clinical outcome of coronary bifurcational lesion treatment with the endeavor stent.

BACKGROUND: The zotarolimus-eluting stent (ZES) has been documented as significantly reducing restenosis and target lesion revascularization (TLR) requirement compared to bare metal stents (BMS). METHODS: In this single-centered, prospective study we sought to evaluate the short- and medium-term outcomes of ZES placement in bifurcated coronary artery lesions. Between August 2006 and December 2007, 107 consecutive patients (110 bifurcations) were recruited to have ZES placement in the lesion. The provisional T stenting (PTS) technique was used in 96.3%. Angiographic success was 100% in main vessel (MV) cases and 97.2% in that of side branch (SB). RESULTS: With a mean follow-up of 12.4 +/- 1.77 (mean +/- SD) months there were four deaths, three from cardiac cause (2.85%). There were 18 patients (19 bifurcations) requiring TLR (17.59%) for clinical reasons. The only predictor of TLR was the use diameter of ZES

Atrial fibrillation in incident dialysis patients.

Despite the importance of cardiovascular disease in dialysis patients, the frequency of atrial fibrillation in incident dialysis patients has not been determined. We analyzed the prevalence of atrial fibrillation in patients starting dialysis over a 4-year period, its occurrence over the course of dialysis, and its influence on ischemic stroke and mortality. Factors predisposing to atrial fibrillation were noted, as was the influence of arrhythmia on mortality and presentation of ischemic stroke. Of the 256 patients studied, 31 had atrial fibrillation at the start of dialysis. Increased age, larger left atrium, and female gender were independently related to the presence of atrial fibrillation at dialysis inception. Of the 225 patients who were in sinus rhythm at the start of dialysis, 28 developed atrial fibrillation during a mean follow-up time of 2 years. The presence of valvular calcifications, bundle branch block, previous ischemic stroke, lower ejection fraction, higher pulse pressure, and lower hemoglobin concentration were predictors of the clinical evolution of atrial fibrillation. Overall, atrial fibrillation increased mortality risk 1.72-fold and ischemic stroke risk 9.8-fold. Therefore, it appears that atrial fibrillation is quite prevalent and its presence is associated with significant risk.

Predictors and prognostic value of myocardial injury following stent implantation.

BACKGROUND: Troponin I concentrations are frequently elevated following percutaneous coronary intervention (PCI) even in procedures without complications and are considered, by some, as predictive of long-term morbidity and mortality. We assessed whether post-PCI troponin I concentrations bore any relationship to clinical, angiographic and in-laboratory minor adverse events indicative of myocardial injury and evaluated, in follow-up, whether these levels are useful as a predictive markers of adverse events. METHODS: Patients (n=147) who were scheduled for PCI for stent placement were prospectively studied. In-laboratory events recorded were protracted chest pain, electrocardiographic changes, slow flows, dissections and lateral branch affectation. Troponin I and creatinine kinase MB fraction (CK-MB) mass were measured at baseline and post-procedure. Mean clinical follow-up was for 10.4+/-3.6 months. RESULTS: During PCI, at least one adverse event occurred in 34% of patients and, in 38% of them, there was an elevation of troponin I as compared to 5.1% of those patients without any adverse event (relative risk=7.4; P<0.001). Elevation of troponin I concentrations occurred in 16.3% of all patients, 79.2% associated with an AE. CK-MB was elevated in 15.6% of patients. On multivariate analysis, protracted chest pain, lateral branch involvement and slow flow remained statistically significant in relation to post-procedure elevations of troponin I concentrations. Clinical follow-up showed a poorer prognosis in patients who had had elevated troponin I concentrations. CONCLUSIONS: In-laboratory adverse event predict elevated post-procedure troponin I concentrations which are associated with myocardial injury. These elevations, in turn, predict poorer medium-term clinical outcomes.

Comparison of prognostic value of atrial fibrillation versus sinus rhythm in patients on long-term hemodialysis.

The influence of atrial fibrillation (AF) on the clinical pattern of patients with chronic renal insufficiency on hemodialysis remains unknown despite the cardiovascular pathology in these patients being well documented and being the primary cause of death in this patient population. The objective of this study was to compare the long-term outcome in those patients on our dialysis unit in sinus rhythm with those in AF.

Ought dialysis patients with atrial fibrillation be treated with oral anticoagulants?

BACKGROUND: Dialysis patients with atrial fibrillation have an increased thrombolic risk. Dicoumarin anticoagulant therapy is often considered contra-indicated in chronic renal insufficiency in which the risk of haemorrhage, though not defined, is perceived to be high. We assessed haemorrhage complications in dialysis patients receiving dicoumarin anticoagulant therapy to establish whether the haemorrhage risk justifies the contra-indication of anticoagulant therapy in patients with atrial fibrillation. PATIENTS AND METHODS: Over a period of a decade in our dialysis centre, 29 patients receiving anticoagulant therapy over a protracted period presented haemorrhage complications. These were classified with respect to severity and location and compared with 211 patients not receiving anticoagulant therapy. The relative risk of haemorrhage was calculated and was compared to risk of thrombo-embolism in dialysis patients with atrial fibrillation. RESULTS: Of the 29 patients, nine had 13 episodes of haemorrhage complications (26 episodes/100 patient-years). None was fatal, nor intra-cranial nor with serious clinical sequelae. In the group without anticoagulants, 29 patients had 39 haemorrhage complications (11 episodes/100 patient-years); four (10.2%) intra-cranial and all fatal. The relative risk of bleeding with anticoagulant therapy was 2.36 (95% confidence interval=1.19-4.27). CONCLUSIONS: (1) Dialysis patients with anticoagulant therapy presented with a higher risk of haemorrhage; (2) the relative risk of bleeding was double that of the dialysis population without anticoagulant therapy; (3) despite the high risk of haemorrhage that we observed, the high risk of thrombo-embolism and the attendant serious sequelae to which dialysis patients with atrial fibrillation are predisposed indicates that oral anticoagulation therapy ought not to be considered automatically contra-indicated in this patient group but that an exhaustive evaluation of the risk-benefit needs to be conducted on an individual patient basis.