The article reports the results of a cross‐sectional study of 67 short autobiographical essays by U.S. students of Russian at 4 levels of study. The Novice and Intermediate level descriptions in the ACTFL Proficiency Guidelines for Writing characterize the writing under study, but the Guidelines still require further empirical testing. Linguistic measures that differentiated the groups included fluency and syntactic fluency, but not accuracy, calling into question the tendency of foreign language writing research and pedagogy to focus on grammatical accuracy. Finally, the article calls for further research into second and foreign language (L2) writing that accounts for different languages (truly foreign as well as cognate; non‐English as well as English), different developmental levels (beginning as well as advanced), and different learning situations (foreign language learning as well as second language learning).

A more coordinated and systematised approach needs to be developed. Collaboration and communication between midwives and child and family health nurses is essential if the needs of families are to be addressed during this transition period.

Massive acetaminophen (N-acetyl-p-aminophenol; APAP) ingestion is characterized by a rapid onset of mitochondrial dysfunction, including metabolic acidosis, lactemia, and altered mental status without hepatotoxicity which may not respond to the standard doses of N-acetylcysteine (NAC). A 64-year-old woman without medical history presented comatose after an ingestion of 208 tablets of Tylenol PM™ (APAP 500 mg and diphenhydramine 25 mg). The initial APAP concentration measured 1,017 µg/mL (therapeutic range 10-30 µg/mL), and elevated anion gap metabolic acidosis, lactemia, and 5-oxoprolinemia were detected. High-dose intravenous (IV) NAC, 4-methylpyrazole (4-MP), and hemodialysis (HD) were initiated. She was transferred to a liver transplant center and continued both NAC and HD therapies until complete resolution of metabolic acidosis and coma without developing hepatitis. She was discharged without sequelae. This is the fourth highest APAP concentration recorded in a surviving patient. Moreover, this is the first report of a novel “triple therapy” using NAC, 4-MP, and HD in the setting of massive APAP ingestion that presents with coma, elevated anion gap metabolic acidosis, and lactemia. Emergency physicians should recognize these critically ill patients and consider high-dose NAC, 4-MP, and HD to be initiated in the emergency department (ED).

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