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Brown (1977) states a similar view: "Presumably antibiotic drops for ear infection norfloxacin 400mg with visa, the person with high self-esteem is able to antimicrobial ointment order norfloxacin 400 mg on line reach out beyond himself more freely antibiotic resistance deaths discount norfloxacin 400 mg on line, to infection knee replacement discount norfloxacin 400 mg without prescription be less inhibited, and because of his ego strength, to make the necessary mistakes involved in language learning with less threat to his ego" (p. The less self-confident person may understand the input but not acquire, just as the self-conscious person may filter (or avoid) in other domains. Two other personality factors, not related to self-confidence, are also predicted to relate to success in second language. Attitude toward the classroom and teacher may relate to both acquisition and learning. The student who feels at ease in the classroom and likes the teacher may seek out intake by volunteering (he may be a "high input generator"; Seliger, 1977), and may be more accepting of the teacher as a source of intake (for exceptionally clear discussion of this point, see Stevick, 1976, chapters 6-8). Positive attitudes toward the classroom 23 and teacher may also be manifestations of self-confidence and/or integrative motivation, and for this reason may also relate to acquisition. In addition, we would expect students with such attitudes to apply themselves more, resulting in more learning. In addition, students who have an analytic orientation should do better in conscious language learning. Subjects who report themselves as more "analytic" or who show test behavior reflecting and analytic cognitive style. Attitude and aptitude will be statistically independent, as they relate to very different and independent parts of the language performance and internalization model. Carroll (1963) reported that aptitude is not related to whether or not a person "likes foreign language study" (p. The aptitude factor will show a strong relationship to second language proficiency in "monitored" test situations and when conscious learning has been stressed in the classroom. First, the validity of aptitude tests is usually determined by correlating scores with grades in foreign language classes and/or with pencil and paper grammar tests (Pimsleur, 1966; Carroll, 1963). Similarly, Gardner (1960) concludes that "language aptitude appears to be of major importance in the acquisition of second language skills acquired through instruction" (p. Gardner, Smythe, Clement, and Gliksman (1976) also confirmed that aptitude related much more to classroom skills (grades) than to communicative skills (speech) in French as a foreign language in grades 7 to 11 in various English-speaking communities in Canada. The effects of aptitude on performance in general was stronger for older students, a finding we shall return to later. Also of interest is Bialystok and Frohlich (1977), who studied ninth- and tenth-graders studying French in Toronto. In one or two schools examined, aptitude correlated with self-reports of conscious monitoring (r = 0. Finally, recall that Carroll defined aptitude as rate of learning, that is, students with higher aptitude will appear to learn faster than students with lower aptitude. This predicts that aptitude will show its strongest effects in a short, well-taught course (Carroll, 1963). Note in this regard that conscious learning may provide a short-cut to performance in a second language. As mentioned elsewhere (Krashen, 1978b; Krashen, 1977a), "learners" can use an acquisition-free mode of performance consisting of first language surface structure plus the Monitor. High-aptitude students should be more likely to be able to utilize this mode and thus may show more rapid initial progress. Over the long term, however, subconscious language acquisition is far superior, as the user of L1 surface structure plus the Monitor is 25 severely limited in terms of the range of structures that can be produced as well as in fluency of performance. The relationship between attitude and proficiency in second language will be strongest when (a) subjects or performers have had sufficient intake for acquisition (see also Oller, 1977, Hypothesis 6) and (b) when Monitor-free measures of proficiency are used. Attitudinal effects are predicted to be present whenever any acquired competence at all is used in performance. To briefly review the Canadian situation, Gardner and Lambert (1959), using seventy-five eleventh-grade high school students in Montreal, found integrative motivation to be a stronger predictor of French achievement than instrumental motivation. Gardner (1960) expanded these results with eighty-three tenth-grade students of French. Moreover, he concluded that the integrative motivation was especially important "for the development of communicative skills" (p. In a similar setting, Gardner, Smythe, Clement, and Gliksman (1976) confirmed the importance of integrative motivation in grades 7 to 11 French classes in Montreal. They found that measures of integrative motivation tended to correlate more highly with their "speech" measure than with grades. Also, integrative motivation was a better predictor of French proficiency than was instrumental motivation. From their analysis they concluded that those who dropped French were not simply the less "able" students. While drop-outs did tend to get lower grades and show lower aptitude, the primary motivation for the 26 stay-ins appeared to be integrative: stay-ins showed more integrative motivation, as well as overall motivation to learn French. They were also perceived by observers to be more "interested" in the French lesson. Finally, Bialystok and Frohlich (1977) reported that measures of integrative motivation correlated with achievement in a test of reading comprehension for ninth- and tenth- grade students of French in Toronto. This study also reported a positive and significant correlation between integrative motivation and aptitude, which is counter to prediction no. As mentioned above, integrative motivation has also been found to relate to proficiency in English as a second language in the United States, another situation in which intake is available outside the classroom. In this case, however, "indirect" methods of measuring integrative motivation have been shown to be necessary. Spolsky suggests that foreign students may not want to "admit to motives which suggest they wish to leave their own country permanently" (p. While these students cited 27 instrumental reasons as primary for studying English, Oller et al. These situations include those where opportunities to get intake outside the classroom are rare, such as foreign-language learning in the United States. Gardner and Lambert (1972) investigated high-school learning of French in three American communities in Maine, Connecticut, and Louisiana, and only a weak relationship was found in Connecticut. Instrumental motivation may take precedence as a predictor of achievement where there is a special urgency about second language acquisition and where there appears to be little desire to "integrate". As mentioned earlier, instrumental motivation could mean a great deal of interaction in such situations, entailing more intake. The presence of a higher affective filter, however, would predict less success in the long run, however. Two important studies show instrumental motivation to be superior in such situations: Lukmani (1972) found that for female Marathi speakers in Bombay "who belonged to the comparatively non-Westernized section of Bombay society" proficiency in English, as measured by a Cloze test, was more related to instrumental motivation than to integrative. Lukmani concluded that her subjects saw themselves "based in their own country but reaching out to modern ideas and life styles" (p. Gardner and Lambert (1972) reached similar conclusions for English as a second language in the Philippines. In the Philippines English is the language of education and business, but is rarely spoken in the home. Gardner and Lambert found that instrumental motivation was a better predictor of overall English proficiency, but also found a clear relationship between the presence of integrative motivation and "aural-oral" skills, supporting part (b) of this prediction. Oller, Baca, and Vigil (1977) report on a case where integrative 28 motivation played no role because of political ill-feelings. Sixty Mexican-American females were surveyed in New Mexico, all from low-income families. The subjects who were more proficient in English (a Cloze test was used) tended to rate Americans lower on certain personality traits that are valued by the subjects (religious, sensitive, shy, considerate). Recall that these factors are predicted to be strongest in intake-rich situations, and will emerge most clearly in Monitor-free tests, but will be present to at least some extent when subconscious acquisition is involved. There appears to be a consistent relationship between various forms of anxiety and language proficiency in all situations, formal and informal. These studies have shown a relationship between low anxiety and language acquisition: Carroll (1963) noted a small negative correlation (r = -0. Gardner, Smythe, Clement, and Gliksman (1976) reported that classroom anxiety correlated with speech skills as well as grades in French as a foreign language in grades 7 to 11 in Canada. There was a trend for low anxiety to be more closely related to speech (Monitor-free) test than to grades. Naimon, Frohlich, Stern, and Todesco (1978) found that for their subjects (French students in grades 8 to 12 in Toronto) classroom anxiety, a high fear of rejection and similar feelings may be related to failure. Also, a composite variable consisting of certainty in hand-raising, reaction to being called on without hand-raising, and embarrassment in speaking French, called "overall classroom personality" related to achievement on an imitation test (r = 0. Wittenborn, Larsen, and Vigil (1945; reported in Pimsleur, Mosberg, and Morrison, 1962) studied college French and Spanish students, and found that low and high achievers may be distinguished by level of anxiety as well as a degree of self-confidence.


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Doxycycline should not be given to chil- dren younger than 8 years of age unless the benefts of therapy are greater than the risks of dental staining (see Tetracyclines, p 801). Patients with endocarditis should receive intravenous high-dose penicillin G for at least 4 weeks. Because the occurrence of S moniliformis after a rat bite is approximately 10%, some experts recom- mend postexposure administration of penicillin. People with frequent rodent exposure should wear gloves and avoid hand-to- mouth contact during animal handling. Most infants are infected during the frst year of life, with virtually all having been infected at least once by the second birthday. Signs and symptoms of bronchiolitis may include tachypnea, wheezing, cough, crackles, use of accessory muscles, and nasal faring. Lethargy, irritability, and poor feeding, sometimes accompanied by apneic episodes, may be presenting manifestations in these infants. More serious disease involv- ing the lower respiratory tract may develop in older children and adults, especially in immunocompromised patients, the elderly, and in people with cardiopulmonary disease. The virus uses attachment (G) and fusion (F) surface glycoproteins for virus entry; these surface proteins lack neuraminidase and hemagglutinin activities. Numerous genotypes have been identifed in each subgroup, and strains of both subgroups often cir- culate concurrently in a community. The clinical and epidemiologic signifcance of strain variation has not been determined, but evidence suggests that antigenic differences may affect susceptibility to infection and that some strains may be more virulent than others. Transmission usually is by direct or close contact with contaminated secretions, which may occur from exposure to large-particle droplets at short distances (typically <3 feet) or fomites. Infection among health care personnel and others may occur by hand to eye or hand to nasal epithelium self-inoculation with contaminated secretions. The period of viral shedding usually is 3 to 8 days, but shedding may last longer, espe- cially in young infants and in immunosuppressed people, in whom shedding may continue for as long as 3 to 4 weeks. In chil- dren, the sensitivity of these assays in comparison with culture varies between 53% and 96%, with most in the 80% to 90% range. As with all antigen detection assays, the predictive value is high during the peak season, but false-positive test results are more likely to occur when the incidence of disease is low, such as in the summer in temperate areas. Therefore, antigen detection assays should not be the only basis on which the beginning and end of monthly immunoprophylaxis is deter- mined. In most outpatient settings, specifc viral testing has little effect on management. Whether children with bronchiolitis who are coinfected with more than one virus experience more severe disease is not clear. Viral isolation from nasopharyngeal secretions in cell culture requires 1 to 5 days (shell vial techniques can produce results within 24 to 48 hours), but results and sensitivity vary among laboratories. Conventional serologic testing of acute and convalescent serum specimens cannot be relied on to confrm infection in young infants in whom sensitivity may be low. Continuous measurement of oxygen saturation may 1 detect transient fuctuations in oxygenation; supplemental oxygen is recommended when oxyhemoglobin saturation persistently falls below 90% in a previously healthy infant. However, a consistent decrease in need for mechanical ventilation, decrease in length of stay in the pediatric intensive care unit, or reduction in days of hospitalization among ribavirin recipients has not been demonstrated. The aerosol route of administration, concern about potential toxic effects among exposed health care personnel, and conficting results of effcacy trials have led to infrequent use of this drug. Some physicians elect to use bronchodilator therapy because of concern that reactive airway disease may be misdiag- nosed as bronchiolitis. Limited data suggest nebulized, hypertonic saline may be associated with improvement in clinical scores and decrease length of hospitalization. The roles of other therapies such as helium/oxygen, nasal continuous positive pressure, and surfactant are under investigation, but these are not recommended at this time. Palivizumab is administered intramuscularly at a dose of 15 mg/kg once every 30 days. In some reports, palivizumab administration in a home-based program has been shown to improve compliance and to reduce exposure to microbial pathogens compared with administration in offce- or clinic-based settings. Additional doses of palivizumab should not be given to any patient with a history of a severe allergic reaction following a previous dose. Economic analyses fail to demonstrate overall savings in health care dollars because of the high cost if all at-risk infants receive prophylaxis. Five monthly doses of palivizumab will provide more than 20 weeks of protective serum antibody concentration. For infants who qualify for 5 doses, initiation of immunoprophylaxis in November and continuation for a total of 5 monthly doses will provide protection into April and is recommended for most areas of the United States. If prophylaxis is initiated in October, the ffth and fnal dose should be administered in February. Northwest Florida has an onset in mid- November, which is consistent with other areas of the United States. Data are limited regarding the effectiveness of palivizumab during the second year of life. Individual patients may beneft from decisions made in consultation with neona- tologists, pediatric intensivists, pulmonologists, or infectious disease specialists. Infants born at 29 weeks, 0 days through 31 weeks, 6 days of gestation may beneft most from prophylaxis up to 6 months of age. Other factors have been associated with an increased risk of severe disease and hospitalization. A risk-scoring tool developed from a Canadian prospective study of infants born at 33 through 35 weeks’ gestation revealed that multiple risk factors needed to be present before a signifcant increase in hospital- ization risk was seen. Available data do not allow for defnition of a subgroup of infants who are at risk of prolonged hospitalization and admission to the intensive care unit. Multiple births younger than 1 year of age do not qualify as fulflling this risk factor. Infants in this gestational age category should receive prophylaxis only until they reach 3 months of age and should receive a maximum of 3 monthly doses; many will receive only 1 or 2 doses before they reach 3 months of age. Administration of palivizumab is not rec- ommended after 3 months of age for patients in this category (Tables 3. Breastfeeding should be encouraged for all infants in accordance with recommendations of the American Academy of Pediatrics. High-risk infants should be kept away from crowds and from situations in which exposure to infected people cannot be controlled. In addition, all infants (beginning at 6 months of age) and their contacts (beginning when the child is born) should receive infuenza vaccine as well as other recommended age-appropriate immunizations. Immunoprophylaxis may be considered for infants who have either con- genital abnormalities of the airway or a neuromuscular condition that compromises handling of respiratory secretions. Infants and young children in this category should receive a maximum of 5 doses of palivizumab during the frst year of life. Because a mean decrease in palivizumab serum concentration of 58% was observed after surgical procedures that use cardiopulmonary bypass, for children who still require prophylaxis, a postoperative dose of palivizumab (15 mg/kg) should be considered as soon as the patient is medically stable. Palivizumab prophylaxis has not been evaluated in randomized trials in immunocompromised children. Although specifc recommenda- tions for immunocompromised patients cannot be made, infants and young children with severe immunodefciencies (eg, severe combined immunodefciency or advanced acquired immunodefciency syndrome) may beneft from prophylaxis. In addition, insuffcient data exist to determine the effectiveness of palivizumab use in this patient population. Therefore, a recommendation for routine prophylaxis in patients with cystic fbrosis cannot be made.

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First antimicrobial cleaner quality 400 mg norfloxacin, he could have been a member of a "pull-out" class in school are antibiotics for acne good norfloxacin 400mg without a prescription, either in English as a second language or in one or more subject-matters infection ios cheap norfloxacin 400 mg. This segregation from native speakers of English treatment for dogs collapsing trachea norfloxacin 400mg sale, distasteful to some, would have at least encouraged a simpler "teacher-talk" from his instructors, as all students in the class would have been less than fully competent speakers of English. Second, we could have provided Ricardo with opportunities to meet native speakers of English (for one method, see Krashen, 1978e). As long as such a foreign student peer group had different first languages, this would have provided Ricardo with "interlanguage" input, another simpler code. This is, I believe, a question of immense theoretical and applied interest, as fundamental as any in our field. Before discussing possible approaches to answering this question, some brief definitions are in order. We will focus on three sorts of simple codes that second language acquirers are apt to come into 120 contact with. It is, of course, fairly will described in the literature, but not dealt with as input. As documented by Hatch, Shapira, and Wagner-Gough (1978), this may happen after prolonged contact with second language speakers. The sort of foreigner-talk that is relevant to our discussion is the simplified input native speakers may give to less than fully competent speakers of their language in communicative situations. It may range from the sort of foreigner-talk described by Ferguson (1975), aimed at very low-level speakers and characterized by pidginization-type grammatical changes, to very mild alterations in speech. Whether these codes help the acquirer or not is an empirical question, and it is the purpose of this paper to suggest two possible approaches to investigating this issue. Each approach has its weaknesses-nevertheless, combined and perhaps supplemented, they may eventually help us to answer this basic question. First, one can approach the question directly and ask whether acquirers who have had access to such codes actually acquire faster, and whether those who have not had access to these codes have had a harder time with second language acquisition. Another approach is to determine, from analysis of simple codes, whether they are linguistically appropriate for language acquisition. Some space is devoted below toward beginning investigation in both of these approaches. This is followed by discussion of some practices and attitudes in current language pedagogy. The Gross Approach the gross approach, or the "Good Language Learner" approach, is 121 similar to "known group validity". Case histories are examined in order to determine whether those acquirers who encountered any of the three sorts of simple codes described above had more success in second language acquisition, and whether those with less experience with these codes did worse. I will therefore describe one case history, not as definitive evidence for or against the efficacy of simple codes in second language acquisition, but as a sample, an illustrative example of how this sort of data, despite the inevitable confounds and difficulties inherent with self-report, might shed light on this question. We first analyze the two Indo-European language with respect to the amount of simple input S. The class was conducted entirely in German due to the presence of a linguistically heterogeneous student body. He also experienced a fair amount of teacher-talk in French, during a 1-month course in Paris at the Alliance Francaise, and more recently as a student in the Pucciani-Hamil method in French as a foreign 122 language in Los Angeles. During his first few months in Austria, he was a member of a "foreign-student peer group" composed of foreign students from many different countries. Since the only language these students had in common was German, it was the lingua franca of the group. While he can express himself in French and easily read fairly difficult material, he reports serious problems in listening comprehension and less feel for phrasing and finding the right word. To this point, this case history suggests that teacher-talk and interlanguage-talk may be useful for attaining low-intermediate levels of competence, and that foreigner- talk may provide a bridge to high intermediate and advanced levels of competence. The only formal instruction he received was as a Peace Corps trainee for 2 months in the United States. The language of the classroom was English, and the class focused on explanation of the Amharic writing system and rules of grammar. While he feels he has "acquired" Hebrew, and has some feel for correctness in that language, his Amharic feels artificial to him: he relies a great deal on English surface syntax with Amharic vocabulary, applying whatever grammar rules he remembers when he can, and understands only the simplest conversations. The Amharic-Hebrew contrast is consistent with the hypothesis that simple codes like teacher-talk and interlanguage-talk are extremely useful in attaining initial levels of fluency, in acquiring (as opposed to learning). Again, this one case history is presented only as an example, and others are necessary to determine just how universal these experiences are. Linguistic Analysis of Simple Codes We turn now to a different approach, the linguistic analysis of simple codes. This analysis is done with one goal in mind: to determine whether the inputs provided by teacher-talk, interlanguage-talk, and foreigner-talk are linguistically appropriate, that is, whether they can serve as true "intake" for language acquisition. To do this, we will first examine caretaker speech, language addressed to young children acquiring their first language, and discuss how this simple code might encourage language acquisition on the part of the child. We will then compare our conclusions for caretaker speech with what is known of the simple codes we are dealing with here. It is known to be composed of shorter sentences, it is more intelligible, contains utterances that are more well formed, with less subordination, has a more restricted vocabulary, and refers to a more restricted range of topics. Of course, "the finding that mother-ese exists cannot by itself show that it influences language growth" (Newport, Gleitman, and Gleitman, 1977; p. If caretaker speech does help, or "catalyze" language acquisition, it may do so by supplying crucial input, what the child needs at that moment, without the distraction of excess noise, or language the child does not understand. I present first three "facts" about child language acquisition and caretaker speech, followed by a personal interpretation as to how and why caretaker speech might be effective. Following this, we explore the question of whether the simple codes the second language performer might encounter work the same way. First, it is by now a well-established finding that structures are acquired in a relatively predictable order for children acquiring a given language (for English, see Brown, 1973; Klima and Bellugi, 1966; and the excellent review in Clark and Clark, 1977). This is not to say that order of acquisition is absolutely invariant, that children will acquire all grammatical structures in a strict linear order; rather, there are clear tendencies and one can talk about an "average" order of acquisition. The third "fact" of interest to us here is that according to scholars working in the area of child language acquisition, the relative "simplicity" of caretaker speech is probably not due to any conscious effort on the part of the caretaker to teach language. Rather, caretakers modify their speech in order to communicate with children, in order to control their behavior, in order to make them understand what they are saying. That is, if a child is at stage i, that child can progress to stage i + 1 along the "natural sequence" (where i and i + 1 may be a block of structures; more correctly the child who has just acquired the members of i can then acquire a member of i + 1) by understanding language containing i + 1. The child understands language containing structure that is a bit beyond him or her with the aid of context. The fact that caretaker 126 speech is so well rooted in the "here and now" probably provides this helpful context to a great extent. The size of the net, however, is not as large as is the case in adult-adult speech. A very interesting hypothesis is that the net of structure cast by caretaker speech in an attempt to communicate with the child is of optimal size. A wider net might contain too much noise, too much language that is not understood by the child, for optimum acquisition. A more narrow net, a "finely-tuned" net hitting i +1 and little else, may also be less efficient. Second, the wider, roughly-tuned net guarantees that i + 1 will always be covered. On the other hand, the caretaker net is not so wide that the child has difficulty understanding, and "tunes out" (see, for example, Shipley, Smith, and Gleitman, 1969). In doing that, you will, without thinking about it, make 100 or maybe 1000 alterations in your speech and action. There is no set of rules of how to talk to a child that can even approach what you unconsciously know. In Chapter 8 it was claimed that speaking is theoretically unnecessary for acquisition, but may serve to encourage appropriate input (input with the proper size "net"). Acquisition (as opposed to learning), it was claimed, is the result of input, or intake, not actual production. We turn now to simple codes the second language acquirer might face, to see whether they might have an effect similar to that of caretaker speech on second language acquisition. Simple Codes and Second Language Acquisition All three simple codes discussed above, teacher-talk, interlanguage-talk, and foreigner-talk, are clearly attempts to communicate. The question we thus need to ask is whether the "net" they cast is the same size, and whether they might have the same effect as caretaker speech on language acquisition.


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