When the same form does not have the same function: how mothers’ lexical repetitions shape the children’s emerging linguistic and interactional skills

One of the main problems recipients and speakers have to face when using lexical repetitions is to distinguish the action the speaker is doing when uttering a repetition. The multi-functionality of repetitions makes it harder to explain some of the ambiguities involved in their analysis, and it calls for an analytic division between different actions done by repetitions in which the same form may be used for different functions. Following the interactional phonetics methodological approach, this thesis integrates the methodology of Conversation Analysis and instrumental and impressionistic phonetics to show how mothers and their children negotiate the action done by mothers’ repetitions of the children’s previous turns in everyday Brazilian Portuguese conversations. Repetitions to affirm are used as a way of approving the children’s articulatory performance and labeling ability. Here the repetition matches the children’s prior turn pitch pattern and have minimised phonetic differences. Repetitions to correct pronunciation are produced with significant difference in articulation and pitch pattern, as compared to the child’s prior realisation. The phonetic cues are understood by the children as an invitation to correct their prior turn. Mothers’ repetitions to correct the child’s lexical choice are produced with a distinctive rise-fall intonation contour. The children treat the repetitions as a hearing trouble on the mother’s side, while the mothers’ subsequent talk provides evidence that in fact she had designed the repetition with the aim of correcting the children’s lexical choice. Repetitions to request confirmation are produced also with a rise-fall contour. Mothers and children seem to orient to the repetition in the same way, since both treat them as a request of confirmation. The results show that the children’s ability to understand repetitions addressing pronunciation problems, to affirm and to request confirmation come before the ability to understand repetitions that address problems of lexical choice

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially