To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The sociodemographic typology of sign languages classifies them based on the characteristics and configurations of their users. When considering homesign and sign languages in rural areas, this typology needs further refinement. Here, I present new concepts to enable this. The study is based on fieldwork with twelve deaf people in Western Highlands, Papua New Guinea, and review of studies worldwide. Sign language communities can be mapped as sign networks. Using this mapping, I propose a new typological category for languages with one central deaf user and many fluent hearing signers: nucleated network sign language. I use sign base analysis to determine lexical consistency between unconnected deaf signers in Western Highlands. The high level of consistency among largely unconnected deaf people is explained by a regional sign network connecting deaf and hearing signers. This research emphasises the role of both deaf and hearing signers in sign language emergence and maintenance. (Sign languages, social networks, sign networks, typology, homesign, rural sign languages, Papua New Guinea)*
COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalised patients is critical as the pandemic progresses. This observational cohort study aimed to characterise the independent associations between the clinical outcomes of hospitalised patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, UK between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Scale <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.
Behavioral economics is a subfield of behavioral psychology that integrates microeconomic principles with the experimental analysis of behavior. Decades of behavioral economic work have identified two concepts robustly related to issues of risky health decisions and behavioral addictions: discounting and operant demand. Discounting is the phenomenon wherein uncertain or delayed outcomes lose value, often resulting in myopic decisions (e.g., choosing short-term benefits of heroin use over long-term healthy behaviors). Operant demand describes organisms’ persistent efforts to maintain access to reward. Collectively, discounting and demand comprise the reinforcement pathology model of unhealthy behavior, wherein counterproductive discounting and excessive demand coalesce to render risky and unhealthy reward preferences. This reinforcement pathology model may help explain behavioral addictions, issues of dependence, and other behavioral issues. This chapter describes the history of discounting and demand, common behavioral economic tasks to derive indices of discounting and demand, the hypothetical purchasing task, and the range of applications to addictions, novel addictions, and nonaddictive behaviors in the literature, to date.
To identify, in caregivers of patients with Alzheimer’s disease (AD) dementia, factors associated with subjective (personal, physical, emotional, and social) and objective (informal caregiver time and costs) caregiver burden.
Prospective longitudinal European observational study: post-hoc analysis.
Community-dwelling patients in France and Germany aged ≥ 55 years (n = 969) with probable AD and their informal caregivers.
Mini-Mental State Examination (MMSE), Alzheimer’s Disease Cooperative Study—Activities of Daily Living (ADCS-ADL), 12-item Neuropsychiatric Inventory (NPI-12), Zarit Burden Interview (ZBI), informal caregiver basic and instrumental ADL hours (Resource Utilization in Dementia instrument), and informal caregiver costs. Mixed-effect models of repeated measures (MMRM) were run, including baseline and time-dependent covariates (change from baseline [CFB] to 18 months in MMSE, ADCS-ADL, and NPI-12 scores) associated with CFB in ZBI score/informal caregiver time over 36 months (analyzed using linear regression models) and informal caregiver costs over 36 months (analyzed using generalized linear models).
Greater decline in patient function (ADCS-ADL) over 18 months was associated with increased subjective caregiver burden (ZBI), hours, and costs over 36 months. Increased behavioral problems (NPI-12) over 18 months also negatively impacted ZBI. Cognitive decline (MMSE) over 18 months did not affect change in caregiver burden.
Long-term informal caregiver burden was driven by worsening functional abilities and behavioral symptoms but not cognitive decline, over 18 months in community-dwelling patients with AD dementia. Identifying the drivers of caregiver burden could highlight areas in which interventions may benefit both caregivers and patients.
Afterschool youth development programs (including, arts, leadership, and STEM programs) are significant learning contexts for adolescents. Participation in high-quality programs is related to the acquisition of cognitive, social-emotional, and occupational skills. It is notable that youth in programs report high motivation, markedly higher than in school. Furthermore, motivation increases over time and becomes more self-sustained. This chapter draws on our extensive qualitative interview research with youth and staff to examine questions about how programs – using a project-based learning model – facilitate high and sustained motivation. We find, first, that effective programs create an interpersonal environment of belonging and safety that allows youth to engage in high-functioning relationships, and that projects facilitate motivation because youth experience agency, increasing competency and comradery in their work. Second, although projects periodically confront youth with difficult challenges, which are sometimes overwhelming and can disrupt motivation, youth are typically resilient, and experienced leaders have well-developed strategies for helping youth navigate and learn from these experiences. Third, youth develop sustained motivation because they develop personal connections to program goals and learn techniques to regulate and preempt situations that disrupt motivation. Some youth report learning strategies to help them sustain motivation in the complex, open-ended work of projects.
Our preliminary investigation of the absorption and the photoluminescence response of selectively separated graphene quantum dots using centrifugation indicate that the photoluminescence is more sensitive to the size of the quantum dot than the absorption. We observed ∼143nm blueshift from 623nm to 480nm in the visible region of the photoluminescence with increasing successive centrifugation (decreasing size) and not in the corresponding absorption spectra in the visible region. However, for the first time, we observed a blueshift in the absorption spectra in the UV regions that is tentatively attributed to quantum confinement. Further detailed work is underway to confirm the blueshift in the absorption and correlate with deep UV photoluminescence and morphological quantification of the quantum dots size distribution using high resolution transmission electron microscope.
The West African Disaster Preparedness Initiative held a disaster preparedness tabletop exercise with representatives from the Economic Community of West African States (ECOWAS) in November 2015. The tabletop exercise was hosted by the Republic of Ghana’s National Disaster Management Organization and partners in Accra, Ghana.
ECOWAS Commission delegates and representatives from 10 member states were confronted with a series of simulated crises. Participants utilized existing national preparedness plans and web-based information technologies to research and communicate about internal disaster threats and those from neighboring countries. After each of the exercise’s three phases, facilitators distributed participant surveys.
A total of 106 individuals participated in the tabletop exercise. During the exercise, national teams utilizing well-developed disaster contingency plans and emergency operations center (EOC) standard operating procedures (SOPs) reached out to help less-prepared national teams. Key issues identified in the survey were language and cultural issues as barriers, effectiveness of disaster management agencies linked to heads of state, and the need for data sharing and real-time communication for situational awareness and multisector coordination.
This tabletop exercise helped improve and refine the ECOWAS regional and member states’ national SOPs that teams will employ to prepare for, respond to, and recover from future disasters. (Disaster Med Public Health Preparedness. 2019;13:400-404)
US Africa Command’s Disaster Preparedness Program (DPP), implemented by the Center for Disaster and Humanitarian Assistance Medicine, partnered with US Government agencies and international organizations to promote stability and security on the African continent by engaging with African Partner Nations’ (PN) civil and military authorities to improve disaster management capabilities. From 2008 to 2015, DPP conducted disaster preparedness and response programming with 17 PNs. DPP held a series of engagements with each, including workshops, strategic planning, developing preparedness and response plans, tabletop exercises, and prioritizing disaster management capability gaps identified through the engagements. DPP partners collected data for each PN to further capacity building efforts. Thus far, 9 countries have completed military pandemic plans, 10 have developed national pandemic influenza plans, 9 have developed military support to civil authorities plans, and 11 have developed disaster management strategic work plans. There have been 20 national exercises conducted since 2009. DPP was cited as key in implementation of Ebola response plans in PNs, facilitated development of disaster management agencies in DPP PNs, and trained nearly 800 individuals. DPP enhanced PNs’ ability to prepare and respond to crises, fostering relationships between international agencies, and improving civil-military coordination through both national and regional capacity building. (Disaster Med Public Health Preparedness. 2019;13:319–329)
The Ebola outbreak demonstrated the need for improved disaster response throughout West Africa. The West Africa Disaster Preparedness Initiative was a training and assessment effort led by US Africa Command and partners to strengthen capacities among 12 West African partner nations (PNs).
Series of 3-week training sessions with representatives from each PN were held from 13 July through 20 November 2015 at the Kofi Annan International Peacekeeping Training Centre in Accra, Ghana. A team conducted Disaster Management Capabilities Assessments (DMCAs) for each PN, including a review of key data, a survey for leaders, and in-person interviews of key informants.
All 12 PNs generated a national Ebola Preparedness and Response Plan and Emergency Operations Center standard operating procedures. DMCA metrics were generated for each PN. Top performers included Ghana, with a plan rated good/excellent, and Benin and Burkina Faso, which both achieved a satisfactory rating for their plans. More than 800 people from 12 nations were trained.
PNs have improved disaster management capabilities and awareness of their strengths and weaknesses. The Economic Community of West African States has increased its lead role in this and future planned initiatives. (Disaster Med Public Health Preparedness. 2017;11:431–438)
The Republic of Senegal Disaster Preparedness and Response Exercise was held from June 2-6, 2014, in Dakar, Senegal. The goal was to assist in familiarizing roles and responsibilities within 3 existing plans and to update the National Disaster Management Strategic Work Plan.
There were 60 participants in the exercise, which was driven by a series of evolving disaster scenarios. During the separate Disaster Management Strategic Work Plan review, participants refined a list of projects, including specific tasks to provide a “road map” for completing each project, project timelines, and estimated resource requirements. Project staff administered a survey to conference participants.
A total of 86% of respondents had improved knowledge of Senegal disaster plans as a result of the exercise. A total of 89% of respondents had a better understanding of their ministry’s role in disaster response, and 92% had a better understanding of the role of the military during a pandemic. Participants also generated ideas for disaster management system improvement in Senegal through a formal “gap analysis.”
Participants were in strong agreement that the exercise helped them to better understand the contents of their disaster response plans, build relationships across ministerial lines, and effectively enhance future disaster response efforts. (Disaster Med Public Health Preparedness. 2017;11:183–189)