In communities without older standardized sign languages, deaf people develop their own sign languages and strategies for communicating. These languages vary across several dimensions, including ...their age, their distribution within the wider spoken linguistic community, and the size of the signing community. Each of these characteristics interacts with the formal and distributional properties of the sign languages that emerge. This study concerns one property of young sign languages used in Nebaj, a community in Guatemala. Specifically, I document the degree of lexical overlap between signers who interact in small local ecologies as well as signers who are part of the same larger linguistic community but do not interact with each other directly. I use the Jaccard similarity index to quantify lexical overlap and find that signers who interact frequently have higher rates of lexical overlap than rates of lexical overlap for all signers. This adds to a growing literature that documents sign languages in diverse communicative settings and suggests that interaction is associated with different levels of lexical overlap or variation. Unique features of the communicative histories of signers of young sign languages are also discussed as factors that contribute to variable rates of lexical overlap in this community.
The task of transitioning from one interlocutor to another in conversation – taking turns – is a complex social process, but typically transpires rapidly and without incident in conversations between ...adults. Cross-linguistic similarities in turn timing and turn structure have led researchers to suggest that it is a core antecedent to human language and a primary driver of an innate “interaction engine.” This review focuses on studies that have tested the extent of turn timing and turn structure patterns in two areas: across language modalities and in early language development. Taken together, these two lines of research offer predictions about the development of turn-taking for children who are deaf or hard of hearing (DHH) acquiring sign languages. We introduce considerations unique to signed language development – namely the heterogenous ecologies in which signed language acquisition occurs, suggesting that more work is needed to account for the diverse circumstances of language acquisition for DHH children. We discuss differences between early sign language acquisition at home compared to later sign language acquisition at school in classroom settings, particularly in countries with national sign languages. We also compare acquisition in these settings to communities without a national sign language where DHH children acquire local sign languages. In particular, we encourage more documentation of naturalistic conversations between DHH children who sign and their caregivers, teachers, and peers. Further, we suggest that future studies should consider: visual/manual cues to turn-taking and whether they are the same or different for child or adult learners; the protracted time-course of turn-taking development in childhood, in spite of the presence of turn-taking abilities early in development; and the unique demands of language development in multi-party conversations that happen in settings like classrooms for older children versus language development at home in dyadic interactions.
In this study, we document the coordination of eye gaze and manual signing in a local sign language from Nebaj, Guatemala. We analyze gaze patterns in two conversations in which signers described the ...book Frog Where Are You to an interlocutor. The signers include a deaf child who narrated the book to a hearing interlocutor and her grandfather, who is also deaf, as he described the same book to his hearing grandson during a separate conversation. We code the two narratives for gaze target and sign type, analyzing the relationship between eye gaze and sign type as well as describing patterns in the sequencing of eye gaze targets. Both signers show a strong correlation between sign type and the direction of their eye gaze. As in previous literature, signers looked to a specialized medial space while producing signs that enact the action of characters in discourse in contrast to eye gaze patterns for non-enacting signs. Our analysis highlights both pragmatic–interactional and discursive–narrative functions of gaze. The pragmatic–interactional use of gaze primarily relates to the management of visual attention and turn-taking, while the discursive–narrative use of gaze marks the distinction between narrator and character perspective within stretches of narration.
Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing ...weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 - -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 - 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 - -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7-6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 - -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 - -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 - -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5-16.7) %TWL and 25.6 (16.0-35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8-1.8) % and 9.0 (3.9-14.0) U/L. The pooled SAE rate was 4.1%.
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.
Highlights • It can be difficult to detect substance use disorders in emergency department patients. • This study compared scores on the SOAPP-R screening tool with PDMP data. • The sensitivity of ...SOAPP-R for detecting high-risk PDMP criteria was low (54%). • Negative predictive value was high, so it may be a useful screening tool in the ED.
The term repair refers to strategies deployed by language users to resolve breakdowns in communication. In this study, I ask what strategies for conversational repair are deployed, and who takes ...responsibility for their execution, when a language is used in a small local signing ecology. I focus on signers from a single family within a larger speech community that does not use a national signed language and analyze conversations from four dyads of signers who engaged in a director-matcher referential communication task. I find that for three of the four dyads, there is a preference for restricted repairs that closely matches studies of repair in other signed and spoken languages. I also find a strong connection between participant role and repair type—with matchers more likely to use other-initiated repairs while directors produced self-repairs. The findings from this study highlight the complex relationship between participant identities and pragmatic strategies and the complicated social function of different types of repair in interaction.
One structural dimension that varies across languages is the simultaneous or sequential expression of meaning. Complex predicates can layer meanings together simultaneously in a single-verb predicate ...(SVP) or distribute them sequentially in a multiple-verb predicate (MVP). We ask whether typological variability in this dimension might be a consequence of systematic patterns of diachronic change. We examine the distribution of markers of agency and number within the verb phrase (the predicate) in the earliest stages of a young, emerging sign language in Nicaragua, Lengua de Señas Nicaragüense (LSN), beginning with homesign systems like those from which LSN originated, and progressing through two decades of transmission to new learners. We find that: (i) LSN2 signers are more likely to produce MVPs than homesigners or LSN1 signers; (ii) in the MVPs they do produce, homesigners and LSN1 signers are more likely to produce predicates that mark both agency and number simultaneously on at least one of the verbs; LSN2 signers are just as likely to produce sequences with verbs that mark agency and number in sequentially separate verbs. We discuss how language acquisition, modality, and structure, as well as specific social factors associated with each of the groups, play a role in driving these changes, and how, over time, these patterns of change might yield the diversity of forms observed across spoken and signed languages today.
OBJECTIVES: To define the spectrum of chronic noncancer pain treated with opioid medications in 2 primary care settings, and the prevalence of psychiatric comorbidity in this patient population. We ...also sought to determine the proportion of patients who manifested prescription opioid abuse behaviors and the factors associated with these behaviors.
DESIGN: A retrospective cohort study.
SETTING: A VA primary care clinic and an urban hospital‐based primary care center (PCC) located in the northeastern United States.
PATIENTS: A random sample of VA patients ( n = 50) and all PCC patients (
n = 48) with chronic noncancer pain who received 6 or more months of opioid prescriptions during a 1‐year period (April 1, 1997 through March 31, 1998) and were not on methadone maintenance.
MEASUREMENTS: Information regarding patients' type of chronic pain disorder, demographic, medical, and psychiatric status, and the presence of prescription opioid abuse behaviors was obtained by medical record review.
MAIN RESULTS: Low back pain was the most common disorder accounting for 44% and 25% of all chronic pain diagnoses in the VA and PCC samples, respectively, followed by injury‐related (10% and 13%), diabetic neuropathy (8% and 10%), degenerative joint disease (16% and 13%), spinal stenosis (10% and 4%), headache (4% and 13%) and other chronic pain disorders (8% and 22%). The median duration of pain was 10 years (range 3 to 50 years) in the VA and 13 years in the PCC sample (range 1 to 49 years). Among VA and PCC patients, the lifetime prevalence rates of psychiatric comorbidities were: depressive disorder (44% and 54%), anxiety disorder (20% and 21%), alcohol abuse/dependence (46% and 31%), and narcotic abuse/dependence (18% and 38%). Prescription opioid abusive behaviors were recorded for 24% of VA and 31% of PCC patients. A lifetime history of a substance use disorder (adjusted odds ratio OR, 3.8; 95% confidence interval CI, 1.4 to 10.8) and age (adjusted OR, 0.94; 95% CI, 0.89 to 0.99) were independent predictors of prescription opioid abuse behavior.
CONCLUSIONS: A broad spectrum of chronic noncancer pain disorders are treated with opioid medications in primary care settings. The lifetime prevalence of psychiatric comorbidity was substantial in our study population. A significant minority of patients manifested prescription opioid abusive behaviors, and a lifetime history of a substance use disorder and decreasing age were associated with prescription opioid abuse behavior. Prospective studies are needed to determine the potential benefits as well as risks associated with opioid use for chronic noncancer pain in primary care.
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