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This article finds empirical evidence of second language (L2) interactional competence (IC) and its development by focusing on one of the interactional practices: self-repairing. Compared to prior repair IC studies which mainly have explored how L2 speakers deal with evident L2-related troubles in conversation, this study focuses on cases in which they deploy self-repair when there are no such linguistic problems in previous talk, taking Mauranen's (2006) dichotomy between retroactive and proactive self-repairs. After analyzing the conversation by L2 speakers with different oral proficiency, this study discovers whereas novice and intermediate speakers self-repair for correcting what is lexically or grammatically problematic, advanced speakers deploy self-repair mostly for pre-empting possible misunderstandings. Advanced speakers replace the previous items into words that are specific in the meaning range by fine-tuning the level of 'granularity' (Schegloff 2000) to avoid ambiguity and further other-initiated repair. The findings suggest that the development of L2 IC involves speakers' ability to detect potential problems in the eyes of the recipients and replace them in advance. [ABSTRACT FROM AUTHOR]

Background: Glioblastoma (GBM), one of the most prevalent brain tumor types, is correlated with an extremely poor prognosis. The extracellular matrix (ECM) genes could activate many crucial pathways that facilitate tumor development. This study aims to provide online models to predict GBM survival by ECM genes.Methods: The associations of ECM genes with the prognosis of GBM were analyzed, and the significant prognosis-related genes were used to develop the ECM index in the CGGA dataset. Furthermore, the ECM index was then validated on three datasets, namely, GSE16011, TCGA-GBM, and GSE83300. The prognosis difference, differentially expressed genes, and potential drugs were obtained. Multiple machine learning methods were selected to construct the model to predict the survival status of GBM patients at 6, 12, 18, 24, 30, and 36 months after diagnosis.Results: Five ECM gene signatures (AEBP1, F3, FLNC, IGFBP2, and LDHA) were recognized to be associated with the prognosis. GBM patients were divided into high– and low–ECM index groups with significantly different overall survival rates in four datasets. High–ECM index patients exhibited a worse prognosis than low–ECM index patients. Four small molecules (podophyllotoxin, lasalocid, MG-262, and nystatin) that might reduce GBM development were predicted by the Cmap dataset. In the independent dataset (GSE83300), the maximum values of prediction accuracy at 6, 12, 18, 24, 30, and 36 months were 0.878, 0.769, 0.748, 0.720, 0.705, and 0.868, respectively. These machine learning models were provided on a publicly accessible, open-source website (https://ospg.shinyapps.io/OSPG/).Conclusion: In summary, our findings indicated that ECM genes were prognostic indicators for patient survival. This study provided an online server for the prediction of survival curves of GBM patients.

With the global spread and deterioration of the coronavirus and monkeypox viruses, how to prevent the spread of infectious viruses in large public enclosed spaces has become a focus of public attention. This paper examined the distinctions between the evacuation of patients with infectious diseases and the evacuation of people in general disaster situations, using the outpatient center of a large hospital in China as the background. The three aspects of a new systematic method that is outlined in-depth step by step for solving this special patient evacuation problem are building the architectural space grid model, determining the objective function, and obtaining and comparing the optimization method. The shortest path is determined as the objective function, and three algorithms, namely the improved genetic algorithm, the traditional ant colony algorithm, and the Dijkstra algorithm, are used to optimize the path. While considering the number of people affected in the evacuation process, and together with the software running time as performance indexes, the results obtained from the three algorithms are evaluated, which shows that the patient evacuation path by Dijkstra’s algorithm is better. This study is of great relevance to hospitals, which gather more groups with low resistance and a higher possibility of virus infection, and it is also applicable to other large public places.

Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Context/objective: Pneumonia is the leading cause of death after acute spinal cord injury (SCI). High tidal volume ventilation (HVtV) is used in SCI rehabilitation centers to overcome hypoventilation while weaning patients from the ventilator. Our objective was to determine if HVtV in the acute post-injury period in SCI patients is associated with lower incidence of ventilator-associated pneumonia (VAP) when compared to patients receiving standard tidal volume ventilation., Design: Cohort study., Setting: Red Duke Trauma Institute, University of Texas Health Science Center at Houston, TX, USA., Participants: Adult Acute Cervical SCI Patients, 2011-2018., Interventions: HVtV., Outcome Measures: VAP, ventilator dependence at discharge, in-hospital mortality., Results: Of 181 patients, 85 (47%) developed VAP. HVtV was utilized in 22 (12%) patients. Demographics, apart from age, were similar between patients who received HVtV and standard ventilation; patients were younger in the HVtV group. VAP developed in 68% of patients receiving HVtV and in 44% receiving standard tidal volumes ( P  = 0.06). After adjustment, HVtV was associated with a 1.96 relative risk of VAP development (95% credible interval 1.55-2.17) on Bayesian analysis. These results correlate with a >99% posterior probability that HVtV is associated with increased VAP when compared to standard tidal volumes. HVtV was also associated with increased rates of ventilator dependence., Conclusions: While limited by sample size and selection bias, our data revealed an association between HVtV and increased VAP. Further investigation into optimal early ventilation settings is needed for SCI patients, who are at a high risk of VAP.

Background: Acute kidney injury (AKI) is common in severely injured trauma patients and is associated with poor outcomes. A positive fluid balance is associated with AKI and poor long-term renal outcomes among general ICU and cardiac surgery patients. Currently, the optimal endpoint of resuscitation of severely injured trauma patients is unknown, which may result in excess fluid administration. We hypothesized that positive fluid balance is common after severe trauma and is associated with increased AKI development., Study Design: A cohort study of adult (≥16 years old) trauma patients requiring ICU admission from January 2017 to June of 2017 was conducted. Patients were excluded for early death, rhabdomyolysis, or previous history of end-stage renal disease or congestive heart failure. Acute kidney injury within 7 days of admission was defined according to Kidney Disease Improving Global Outcomes creatinine-based criteria. Univariate and multivariable analyses were performed., Results: Of 364 patients, 74% were male. The median age was 41 years (interquartile range [IQR] 27 to 59 years), and the median Injury Severity Score (ISS) was 18 (IQR 10 to 29). Positive fluid balance (>2 L) was observed in 49% of patients. Acute kidney injury was diagnosed in 105 (29%) patients. After adjustment, there was an increased risk of AKI with a positive fluid balance >2 L (relative risk [RR] 1.98 [95% CI 1.24 to 3.17]). Additionally, the risk of AKI incrementally increased by 1.22 with each liter fluid positive above a zero balance (95% CI 1.11 to 1.34)., Conclusions: Positive fluid balance in excess of 2 L at 48 hours occurs in half of severely injured trauma patients, and fluid positivity is independently and incrementally associated with AKI development. Fluid responsiveness should be investigated as an end point of post-traumatic resuscitation to prevent unnecessary fluid administration and subsequent AKI., (Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Acute kidney injury (AKI) after trauma is associated with poor outcomes. According to current guidelines, a diagnosis of AKI should be made based on an increase in serum creatinine from a reference value. However, a true reference is often unknown in patients presenting with traumatic injury. The aim of this study was to determine the optimal reference creatinine estimate for post-traumatic AKI diagnosis and staging. The optimal reference estimate was defined by a high incidence, strong prognostic ability, and incrementality at each stage., Study Design: This was a cohort study of adult trauma patients (older than 16 years) requiring ICU admission between 2009 and 2018 (n = 8,026) at a single Level I trauma center. AKI was determined using the following 4 reference creatinine estimates: Modified Diet of Renal Diseases (MDRD), Trauma MDRD, admission creatinine, and the first-day creatinine nadir. Inclusivity was assessed by incidence of AKI diagnosed with different reference creatinine estimates; prognostic ability was assessed by multivariable modified Poisson regression; and incrementality was assessed by correlation of mortality risk by AKI stage., Results: There was a wide range of AKI incidence, from 21% when using admission creatinine to 76% using the Trauma MDRD. The MDRD reference creatinine estimate resulted in an AKI incidence of 41% and a diagnosis that was both prognostic of mortality and incremental with each AKI stage. All other reference estimates resulted in AKI diagnoses that were either not prognostic or not incremental., Conclusions: Reference creatinine estimate determines the clinical importance of AKI diagnoses. In this study, the MDRD reference resulted in optimal AKI diagnoses., (Copyright © 2019 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the changes and influence factors for early postoperative pulmonary function of thoracotomy., Methods: Pre- and early postoperative pulmonary function was detected in 64 consecutive cases with optimal thoracotomy. Pain assessment was conducted before pulmonary function test, and the chief complaints of patients were recorded after the procedure. The changing curves of pulmonary function were made and the differences associated with groups, surgical styles, pain assessment, epidural analgesia, chief complaint and preoperative conditions were analyzed using SPSS10.0 medical statistic software., Results: Pulmonary function was severely lowered to (39 +/- 14)% of the base line on the first day. It was rehabilitated gradually, and recovered to (62 +/- 10)% of the base line on the 8th day. Epidural analgesia could improve pain relaxation and pulmonary function in some degree. Single-factor analysis showed that postoperative pain, postoperative day and surgical style were the significant influence factors for early postoperative pulmonary function. Multiple-factor analysis showed that preoperative pulmonary function, age and postoperative pain were the main factors, while surgical style had only weak effect on it., Conclusions: Early postoperative pulmonary function is severely impaired by thoracotomy. It rehabilitate gradually with time. Improvement of preoperative pulmonary function, reducing surgical procedure injuries, especially injury to respiratory muscle system, and enough postoperative pain relief are the most important means that will reduce pulmonary function impairment and consequently reduce postoperative pulmonary complications.