Bifurcations and the Emergence of L2 Syntactic Structures in a Complex Dynamic System.

We report on a complex dynamic systems study of an untutored adult French learner's development of English syntax, specifically two non-finite adverbial constructions. The study was conducted over one academic year of 30 weeks. From an analysis of L2 speech samples collected weekly, certain patterns in the flux emerged. The learner's ensuing second language development is characterized by a series of bifurcations, stemming from forms competing for the same functional terrain. Each bifurcation is accompanied by turbulence as the system moves from one attractor state to another. The transition is characterized by loss of stability, an increase in variability, and a period of dysfluency. It is in the dynamic relationship of accuracy and fluency that novel syntactic forms emerge, both convergent with and divergent from dominant contextual patterns, with dominance established by consulting a well-known corpus of contemporary English. Non-linear development occurs with continuous and iterative exposure to and interaction in English-from relexification to adaptation and synchronization, animated by the learner's perception and memory of regular sequential associations, to pruning of divergent forms. What results over time is a branching hierarchy, connecting online processing with over time development. Multiple competing forms continue to co-exist in the learner's repertoire, which is likely more typical of adult L2 development than of L1 acquisition.

How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients.

The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice.Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications.At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ±â€Š12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ±â€Š17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively.Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs.There was no significant difference in word recognition, functional health literacy, and numeracy between rural and urban rheumatology patients.

The initial 18 months of the first multi-disciplinary regional Pulmonary Arterial Hypertension Clinic in Australia.

OBJECTIVE: To report the initial 18 months experience of the first multi-disciplinary regional Pulmonary Arterial Hypertension (PAH) Clinic in Australia. DESIGN: Prospective cohort study. SETTING: Community setting on the mid-north coast of New South Wales. PARTICIPANTS: A total of 47 patients (mean age±standard error of the mean: 71.8±1.8 years; male/female ratio 13/34). MAIN OUTCOME MEASURES: Diagnosis of PAH, exclusion of other causes of pulmonary hypertension, commencement of PAH-specific pharmacotherapy. RESULTS: Twenty-three (49%) patients were discharged back to their GP with pulmonary hypertension from a combination of ischaemic heart and/or lung disease. Three (6%) patients died from connective tissue disease (CTD)-related PAH with one death (2%) from ischaemic heart disease. Five (11%) patients remain on treatment (n=2, Bosentan for congenital heart disease-related PAH; n=1 Bosentan for CTD-related PAH; and n=1 Bosentan and n=1 Sildenafil for primary PAH). Fifteen (32%) patients have ongoing review for PAH related to CTD (n=11), carcinoid (n=1) and uncertain cause (n=3). CONCLUSION: Patients with CTD-related PAH have a poor prognosis. PAH should be considered in anyone with dyspnoea without obvious features of cardiac or pulmonary disease, especially in the setting of a CTD. Regional population centres are under-resourced with PAH specialty medical services. We have sought to address this by establishment of the first regional multi-disciplinary PAH Clinic in Australia.

PAX3 expression in primary melanomas and nevi.

Melanoma is responsible for an estimated 62,000 new American cancer diagnoses and is projected to cause nearly 8000 deaths in 2008 alone. Although the histogenesis of the tumor is not well understood, it is thought to originate from a rare melanocyte stem cell that resides in the skin. The transcription factor PAX3 has a well-established role in the development of melanocytes during embryogenesis, and has recently been characterized as a molecular switch in the mature melanocyte. Based on this function, PAX3 promotes a melanocytic phenotype but blocks terminal differentiation. This mechanism may also contribute to the uncontrolled cell growth and loss of terminal differentiation in melanomas. Here, we find PAX3 expression in 8/8 melanoma cell lines. We also find that PAX3 is commonly expressed in primary melanoma samples (21/58) but significantly less frequently in benign pigmented lesions (9/75). Further analysis of our melanoma set revealed that PAX3 expression is strongly correlated with younger patients with low or no evidence of sun damage. Our data suggest that PAX3-expressing melanomas may be less environmentally dependent and more genetically linked.