Experiencing Cancer in Appalachian Kentucky

Nothing tells the story of people working together better than a community quilt. A diversity of talents, colors, and materials brought together through skill and shared purpose. Perhaps never before have we as Americans needed a stronger reminder that many hands make short work of big problems. The work presented here by the L.A.U.N.C.H. Collaborative offers a new framework for health care that could be compared to a digital quilt, powered by community-based participatory design, with lived expertise and the newest advances in broadband-enabled connected health solutions. This work demonstrates the value and need to engage local communities and what can be learned when beneficiaries and traditional caregivers work together to develop healthcare solutions

Barn-Raising on the Digital Frontier: The L.A.U.N.C.H. Collaborative

A meta-analysis of oncology papers from around the world revealed that cancer patients who lived more than 50 miles away from hospital centers routinely presented with more advanced stages of disease at diagnosis, exhibited lower adherence to prescribed treatments, presented with poorer diagnoses, and reported a lower quality of life than patients who lived nearer to care facilities. Connected health approaches—or the use of broadband and telecommunications technologies to evaluate, diagnose, and monitor patients beyond the clinic—are becoming an indispensable tool in medicine to overcome the obstacle of distance

Bone Mineral Density in HIV-Negative Men Participating in a Tenofovir Pre-Exposure Prophylaxis Randomized Clinical Trial in San Francisco

Pre-exposure prophylaxis (PrEP) trials are evaluating regimens containing tenofovir-disoproxil fumarate (TDF) for HIV prevention. We determined the baseline prevalence of low bone mineral density (BMD) and the effect of TDF on BMD in men who have sex with men (MSM) in a PrEP trial in San Francisco.We evaluated 1) the prevalence of low BMD using Dual Energy X-ray Absorptiometry (DEXA) in a baseline cohort of 210 HIV-uninfected MSM who screened for a randomized clinical trial of daily TDF vs. placebo, and 2) the effects of TDF on BMD in a longitudinal cohort of 184 enrolled men. Half began study drug after a 9-month delay to evaluate changes in risk behavior associated with pill-use. At baseline, 20 participants (10%) had low BMD (Z score≤-2.0 at the L2-L4 spine, total hip, or femoral neck). Low BMD was associated with amphetamine (OR = 5.86, 95% CI 1.70-20.20) and inhalant (OR = 4.57, 95% CI 1.32-15.81) use; men taking multivitamins, calcium, or vitamin D were less likely to have low BMD at baseline (OR = 0.26, 95% CI 0.10-0.71). In the longitudinal analysis, there was a 1.1% net decrease in mean BMD in the TDF vs. the pre-treatment/placebo group at the femoral neck (95% CI 0.4-1.9%), 0.8% net decline at the total hip (95% CI 0.3-1.3%), and 0.7% at the L2-L4 spine (95% CI -0.1-1.5%). At 24 months, 13% vs. 6% of participants experienced >5% BMD loss at the femoral neck in the TDF vs. placebo groups (p = 0.13).Ten percent of HIV-negative MSM had low BMD at baseline. TDF use resulted in a small but statistically significant decline in BMD at the total hip and femoral neck. Larger studies with longer follow-up are needed to determine the trajectory of BMD changes and any association with clinical fractures.ClinicalTrials.gov: NCT00131677

Socializing deixis : interaction and context in the study of child language

In this thesis, I discuss what an approach to the study of socialization and deixis could look like, and illustrate some of the insights to be drawn from such research. First, in outlining some of the foundational work that has been done on deixis, I identify some of the central problems that any work on deixis must address, especially those relating to the relationship between meaning and context. Next, I conduct a case study of a particular deictic term, the Isthmus Zapotec presentative/directive ja'a. Based on the data I have collected, I draw some preliminary conclusions about how ja'a is used by children in interaction. Ja'a has both presentative and directive functions, distinguished in part by their relative presupposition/constitution of the deictic field ; these two functions may also be accompanied by different kinds of gestures that similarly range from presupposing to creative of the indexing site. Furthermore, ja'a is one specific medium through which children are socialized to attend to intersubjectivity as a feature of context. I argue that deictic terms in general are an important resource for children to learn about indexical relations and the cohabited world. In the final part of the thesis I discuss how research on language socialization can lend to deixis more sophisticated theories of participation frameworks, interaction, and gesture; while research on deixis can lend to socialization studies a more sophisticated theory of contex

Socializing deixis : interaction and context in the study of child language

In this thesis, I discuss what an approach to the study of socialization and deixis could look like, and illustrate some of the insights to be drawn from such research. First, in outlining some of the foundational work that has been done on deixis, I identify some of the central problems that any work on deixis must address, especially those relating to the relationship between meaning and context. Next, I conduct a case study of a particular deictic term, the Isthmus Zapotec presentative/directive ja'a. Based on the data I have collected, I draw some preliminary conclusions about how ja'a is used by children in interaction. Ja'a has both presentative and directive functions, distinguished in part by their relative presupposition/constitution of the deictic field ; these two functions may also be accompanied by different kinds of gestures that similarly range from presupposing to creative of the indexing site. Furthermore, ja'a is one specific medium through which children are socialized to attend to intersubjectivity as a feature of context. I argue that deictic terms in general are an important resource for children to learn about indexical relations and the cohabited world. In the final part of the thesis I discuss how research on language socialization can lend to deixis more sophisticated theories of participation frameworks, interaction, and gesture; while research on deixis can lend to socialization studies a more sophisticated theory of contex

Bilingual Spaces: Approaches to Linguistic Relativity in Bilingual Mexico

Bilingual speakers of Spanish and Juchitán Zapotec (JCH), two languages that have been said to differ substantially in their semantics for expressing information about space, offer a fresh perspective on the classic problem of linguistic relativity because they allow us to test the extent to which cognitive styles may be related to linguistic codes or to other socio-cultural variables. This dissertation aims to combine the theoretical and methodological approaches of linguistic anthropology with some more recent quantitative innovations from other disciplines in order to probe further the question of why cross-cultural variation in styles of cognition exists, and how people come to adopt their particular cognitive styles. In this dissertation, I argue that the typology of the language a speaker knows or is using at a given moment does not reliably predict patterns in spatial thinking. Instead, I argue that different conceptualizations of space emerge in interaction on the basis of different conceptualizations of multiple layers of context. I present evidence from a battery of semi-experimental tasks that demonstrates a mixed profile of spatial reasoning strategies in Juchitán. The distribution of these strategies did not correlate with language dominance or language used on the task. However, variability in frame of reference use by children participating in the elicitation tasks indexes cultural differences among the children, related not obviously to spatial conceptualization but to different narrative and gestural styles. I propose that the particular ways in which language is used and thought of in modern settings, especially the school, may driving conceptual change in Juchitán. This manifests both as language shift from JCH to Spanish, but also as conceptual shift independent of code. Variation in the use of “spatial frames of reference,” then, is potentially indicative of different ways of conceptualizing language in relation to context, and self in relation to world

Gesture and spatial frames of reference in bilingual Mexico

Open Materials for Marghetis, McComsey, and Cooperrider (accepted). Space in hand and mind: Gesture and spatial frames of reference in bilingual Mexico. Cognitive Science

Space in hand and mind: Gesture and spatial frames of reference in bilingual Mexico

Speakers of many languages prefer allocentric frames of reference (FoR) when talking about small-scale space, using words like ‘east’ or ‘downhill.’ Ethnographic work has suggested that this preference is also reflected in how such speakers gesture. Here, we investigate this possibility with a field experiment in Juchitán, Mexico. In Juchitán, a preferentially allocentric language (Isthmus Zapotec) co-exists with a preferentially egocentric one (Spanish). Using a novel task, we elicited spontaneous co-speech gestures about small-scale motion events (e.g., toppling blocks) in Zapotec-dominant speakers and in balanced Zapotec-Spanish bilinguals. Consistent with prior claims, speakers’ spontaneous gestures reliably reflected either an egocentric or allocentric FoR. The use of the egocentric FoR was predicted—not by speakers’ dominant language or the language they used in the task—but by mastery of words for ‘right’ and ‘left,’ as well as by properties of the event they were describing. Additionally, use of the egocentric FoR in gesture predicted its use in a separate non-linguistic memory task, suggesting a cohesive cognitive style. Our results show that the use of spatial FoRs in gesture is pervasive, systematic, and shaped by several factors. Spatial gestures, like other forms of spatial conceptualization, are thus best understood within broader ecologies of communication and cognition