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Pleas of loyal Piggy and Simon have no effect. Suddenly the three boys are startled by unearthly wailing — it is Percival, who fell asleep and now had awaken to find himself alone. A pilot catapults but is killed in the air and lands on the island with his parachute entangled in vines. Cords fix his body in sitting position with its head down. At each wind gust the parachute flaps like monstrous wings and the body moves; it seems to be lifting its head. Twins, who are on duty at the fire, see it and run to the platform, shouting about the beast, exaggerated by darkness and their fear. In the morning Ralph calls yet another assembly to discuss the matter.
They decide to explore the only unvisited part of the island, a granite rock that is nearly separated from the rest of the island, nicknamed the Castle Rock. While Piggy and kids remain at the beach, other boys conduct their investigation. Ralph goes to climb the Castle Rock by himself, Jack follows some minutes later. After not finding any beasts there, other boys join them, delighted by their new adventure, and want to play here for a while.
Ralph insists that they should return and maintain their signal fire. Boys are reluctant but Ralph persists, so they go to the fire site, led by Jack. He is disappointed at realization that they all are dirty and their hair is uncut. These thoughts naturally lead him to weighting chances of rescue, which are pretty low now. While Ralph is staring into the sea, Simon comes to talk and gives a prophecy of sort, telling Ralph that he will come home. Now the jungle slows them down. Simon volunteers to go back to Piggy to warn that others would not be back until nightfall. The investigation party reaches its goal after dark. Jack boasts that he will continue to search for the beast alone, so Ralph and Roger decide to go with him.
Other boys leave, heading to platform. Jack continues his boasting and mocking, so Ralph, tired of this, taunts him to go on alone. Jack does exactly this and returns scared. Investigators flee home. Jack is angered, so he tries to raise the issue of impeachment. Boys refuse to vote against Ralph, so Jack runs off into jungle. Simon proposes to face the beast together, but everyone is just too scared to go. Piggy supplies a decision of their problem: instead of keeping the signal fire in proximity of the beast they can build it right here, on the beach.
While they are busy with this, most boys escape to join Jack, and Simon goes to his secret place. Jack and his hunters gain another success by killing a nursing sow. They put its head on a stick as an offering to the beast. Simon has a hallucination and hears the pig head talking to him, revealing its name, the Lord of Flies. The talking pig head confirms the fact that Simon is already aware of: the evil, the beast is in themselves. Simon losses consciousness. While the storm is building, Simon awakes from his fit and goes to see the beast. He recognizes the true nature of it and releases the body, so it would be still.
His walk is slow, for he is exhausted. Jack, behaving like a real tribal chief, generously allows them to eat, and when everyone is stuffed, asks them if they would join his tribe or stay with Ralph. Tension becomes unbearable but the storm is breaking, so boys are frightened and nobody cares about election. Jack commands to dance, and everyone joins in, even Ralph and Piggy. Scared and hypnotized by their own chanting, boys kill Simon and retreat because of the rain strengthens. His body is left on the beach and washed away by night tide. Storm wind fills the parachute and the dead body is carried over the island and into the sea. Boys are scared and run away, screaming.
Jack enjoys his dictatorship, amusing himself by tying and beating one of those who angered him somehow. Their fire went off in the rain, so they need to steal more burning branches. Along with this strategy development Jack also tries to persuade his tribe members that they did not kill the beast, just beaten it hard. Moreover, he says the beast came to Castle Rock in disguise and is capable to change its appearance; this calms them down a little, diverting their thoughts from the fact that they killed one of their own kind.
During this planning and theological discussion, Ralph and his followers decide to keep the fire burning only at daytime, because smoke is invisible at nights, but mostly because there is not enough boys capable to supply the necessary wood for burning: Sam and Eric are already exhausted and Piggy was physically weak from the very beginning, being fat and suffering from asthma. It seems ridiculous, but it is an orderly thing to do. Samneric are scared but follow nevertheless.
Jack returns from hunt and tells Ralph to go back in his part of the island. Piggy interrupts them by reminding of their purpose. Ralph says again about the need of signal fire, but savages only laugh. Jack orders his army to grab twins and tie them. This spurs a fistfight between him and Ralph. Piggy interrupts again, stating that he holds the conch and thus has a right to speak. He scorns his mates about their savagery and childish behavior when Roger purposely releases a huge boulder in his direction. Piggy is killed on the spot, his crushed body falls on cliffs and is immediately washed into the sea. Somebody throws a spear at Ralph and he flees.
Facing the perspective to spend the night alone in his shelter, he decides to return to Castle Rock and try to persuade savages once more. This sight disgusts and scares Ralph, so he knocks it on the ground and takes its stake with him as a weapon. Approaching Castle Rock, he runs into Samneric being on the watch. Next day a promised manhunt begins. Savages are chasing Ralph through the whole island, throw several boulders to kill him or make him leave his hiding place and finally set the island forest on fire, never thinking about what they will eat tomorrow. Ralph desperately tries to outrun both the tribe and the fire and reaches the beach. Here he stumbles into a British naval officer in full regalia. By the end of the preschool years, typically developing children have large and rich vocabularies that they use to communicate a wide range of topics including abstract or hypothetical ideas using complex grammatical constructions e.
We do not include either measures or benchmarks for this developmental phase excluding measures not designed for children below the age of 48 months as our focus is primarily on younger children with ASD. First Words This phase represents the emergence of spoken language covering the age range of 12 — 18 months in typically developing children. To conclude that a child has reached the First Words phase, he or she must meet the following criteria within each of the following domains: Phonology : meets one of the two phonological criteria presented in Table 1 based on a NLS; and Vocabulary : meets criterion for number of different words used on the NLS, or the age-equivalent criterion on a parent report measure, or the age-equivalent criterion on a direct assessment measure; and Pragmatics : Meets criterion of a minimum of 2 communicative functions, including use of spoken language to comment.
Word Combinations The phase covers the age range of 18 — 30 months in typically developing children. The following criteria define meeting the benchmarks for this phase: Phonology : meets one of the four phonological criteria presented in Table 1 based on a NLS; Vocabulary : meets criterion for number of different words used on the NLS or the age-equivalent criterion on a parent report measure, or the age-equivalent criterion on a direct assessment measure. These measures may be used as an alternative to cover the vocabulary and grammar domains for this phase. Grammar : meets the criteria on the NLS, parent report, or direct assessment measures see above listed; Pragmatics : meets criterion for one of the 3 measures based on the NLS or the age-equivalent score on a parent report measure.
Sentences This phase covers the broad age range from 30 to 48 months in typically developing children. Vocabulary : meets criterion for number of different words used on the NLS or the age-equivalent criterion on a direct assessment measure. Grammar : meets criterion for a 36 month age-equivalent score on a direct assessment measure or the MLU criterion on a NLS. Pragmatics : meets criterion based on an elicited narrative, or the criterion for a conversational NLS, or a month age-equivalent on parent report or direct assessment measures.
Conclusions This report represents the consensus of our working group based on discussions carried out over the course of 18 months. We recognize that the impetus for the use of the term came from studies suggesting that achieving functional speech by age five is an important prognostic indicator in children with ASD. In our view, given the significant changes in the age of diagnosis and the increased access to early intensive intervention, it is time to re-open the question of the timing and role of language acquisition as key prognostic indicators in ASD.
In evaluating treatment outcomes, we depend on objective measures, but we recognize that the measures available to us are imperfect. This is particularly evident when assessing the earliest phases of language in the emergence of words, grammatical combinations or the pragmatic uses of communication for which few if any standardized direct assessments are available for children under the age of two.
To address these limitations we encourage the use of measures derived from natural language samples and parent report. We recognize that the collection, transcription and coding of natural language samples involves increased labor costs in research and clinical settings. However, we believe this cost cannot be avoided if we are to ensure that the data gathered have the highest degree of validity possible. These may be used to guide intervention research as well as treatment offered in clinical settings. Using benchmarks from typical development also draws attention to those typical language milestones that should be targeted by early intervention programs.
These definitions and benchmarks will allow comparisons of outcomes across different studies. Finally, we set ourselves a practical goal: to provide a common vocabulary for discussing language acquisition to a wide interdisciplinary professional and lay audience. The terms selected for the benchmarks are intended to be transparent, reflecting important language features that define them. For each benchmark, we have provided definitions for behavior that can be objectively assessed by a broad range of early intervention professionals. References American Psychiatric Association Diagnostic and statistical manual of mental disorders. Fourth Edition, Text Revision.
Pediatrics, , Carrow-Woolfolk, E. Comprehensive Assessment of Spoken Language. Bloomington, MN: Pearson Assessments. Charman, T. Predicting language outcome in infants with autism and pervasive developmental disorder. Dawson, G. Early intervention in autism: Effectiveness and common elements of current approaches. Guralnick Ed. Dawson, J. Fenson, L. Baltimore, MD: Paul H. Gardner, M.
Outcome and prognostic factors in infantile autism and similar conditions: A population-based study of 46 cases followed through puberty. Journal of Autism and Developmental Disorders, 17 , Goldman, R. Goldman-Fristoe Test of Articulation — 2. Hoff, E. Handbook of language development. Oxford: Blackwell. Howlin, P. Adult outcome for children with autism.
Journal of Child Psychology and Psychiatry, 45 , Kanner, L. Irrelevant and metaphorical language. American Journal of Psychiatry, , Koegel, R. Generalized responsivity and pivotal behavior. Horner, G. Koegel Eds. Baltimore: Paul H. Brookes Publishing Co. Kuehn, B. Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55 , Long, S. Computerized profiling Computer program version 6. Milwaukee, WI: Marquette University. Lord, C.
The Autism Diagnostic Observation Schedule-Generic: A standard measure of social and communication deficits associated with the spectrum of Autism. Journal of Autism and Developmental Disorders, 30, Luyster, R. Qui, S. Journal of Speech, Language, and Hearing Research, 50 , Language assessment and development in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38 , MacWhinney, B. Finally, the physical and psychological impact of working during a pandemic or epidemic on nurses needs to be recognised and made visible. Without this support nurses are likely to experience significant stress, anxiety, and physical side-effects all of which can lead to burnout and loss of nurses from the workforce.
Supplementary material associated with this article can be found, in the online version, at doi: National Center for Biotechnology Information , U. Int J Nurs Stud. Published online May 8. Author information Article notes Copyright and License information Disclaimer. All rights reserved. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source.
This article has been cited by other articles in PMC. Associated Data Supplementary Materials mmc1. Abstract Background Pandemics and epidemics are public health emergencies that can result in substantial deaths and socio-economic disruption. Objectives To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic. Design This review was conducted using the Joanna Briggs Institute methodology for systematic reviews. Results Thirteen qualitative studies were included in the review.
Conclusions Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. What is already known about the topic? Introduction Pandemics are simultaneous global transmission of emerging and re-emerging infectious disease epidemics affecting large amounts of people, often resulting in substantial deaths and social and economic disruption Madhav et al. Methods 2. Search outcomes The searches yielded a total of citations, of which, were duplicates Fig. Open in a separate window. Table 1 Critical Appraisal. Results 3.
Study characteristics Narratives from 13 qualitative studies involving nurses were included in the review Table 2. Table 2 Characteristics of Included Studies. Citation Country No. Chung et al. Corley et al. Ives et al. Koh et al. Shih et al. Wong et al. Supportive nursing teams providing quality care Supportive nursing teams providing quality care were derived from two categories, specifically; sense of duty, dedication to patient care and personal sacrifice; and professional collegiality. Sense of duty, dedication to patient care and personal sacrifice Overall, this review found that nurses, regardless of the circumstances, felt a great sense of professional duty to work during a pandemic Wong et al.
Professional collegiality Professional camaraderie amongst nursing colleagues working during a pandemic was high Ives et al. Acknowledging the physical and emotional impact Acknowledging the physical and emotional impact were derived from two categories, specifically; concerns for personal and family safety; and fear, vulnerability and psychological issues in the face of crisis. Concerns for personal and family safety Not unexpectedly, nurses experienced heightened anxiety for their own health while caring for infected patients during a pandemic Lam and Hung, , Holroyd and McNaught, , Kang et al. Fear, vulnerability and psychological issues in the face of crisis The perception of personal, social and economic consequences from the uncertainty of a pandemic led to psychological distress and fear among nurses working during a pandemic Shih et al.
Responsiveness of systematized organizational reaction Responsiveness of systematized, organizational reaction were derived from three categories, specifically; protection and safety; knowledge and communication; and organisational preparedness - provision of adequate leadership, staffing and policy. Protection and Safety The perceived lack of defensive resources, PPE , were contributing factors to nurses concerns and fears working during pandemics Ives et al. Knowledge and communication Rapidly changing advice and knowledge about the contagion increased the stress levels among nursing staff Ives et al.
Organisational preparedness - provision of adequate leadership, staffing and policy Occupational and organisational preparedness to deal with the pandemic impacted considerably on frontline nursing staff Holroyd and McNaught, , Wong et al. Discussion This review resulted in seven categories that produced three synthesized findings: 1 Supportive nursing teams providing quality care, 2 Acknowledging the physical and emotional impact, and 3 Responsiveness of systematised organizational reaction.
Study strengths and Limitations The strengths of the review included the use of the standardised JBI critical appraisal instrument for qualitative studies to assess the methodological quality of included studies. Conclusion The findings from this review suggest that there is a need for Governments, policy makers, nursing groups and health care organisations to actively engage in supporting nurses both during and following a pandemic or epidemic. Conflict of interest No conflict of interest has been declared by the authors.
Footnotes Supplementary material associated with this article can be found, in the online version, at doi: Supplementary materials Click here to view. References Anderson C. Teaching and supporting nursing students on clinical placements: Doing the right thing. Bukhari E. The Journal of Infection in Developing Countries. Self-state of nurses in caring for SARS survivors. Nursing Ethics. Journal of Clinical Nursing. Protecting healthcare workers in an acute care environment during epidemics: lessons learned from the SARS outbreak. International Journal of Caring Sciences. The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of a phenomenological study.
International Journal of Nursing Studies. Human swine influenza A [H1N1]: practical advice for clinicians early in the pandemic. Paediatric Respiratory Reviews. Journal of Advanced Nursing. A model for collegiality among staff nurses in acute care. The Journal of Nursing Administration. Providing care and facing death: nursing during Ebola outbreaks in central Africa. Journal of Transcultural Nursing. International Nursing Review.
Senior clinical nurses effectively contribute to the pandemic influenza public health response. Australian Journal of Advanced Nursing Online ; 28 3 Becoming a nurse faculty leader: Taking risks by doing the right thing. Nursing Outlook. BioMed Central. Emotional responses and coping strategies of nurses and nursing college students during COVID outbreak.
Imai T. SARS risk perceptions in healthcare workers, Japan. Emerging Infectious Diseases. Healthcare workers' attitudes to working during pandemic influenza: a qualitative study. BMC Public Health. Nurses' experiences of ethical preparedness for public health emergencies and healthcare disasters: a systematic review of qualitative evidence. Nursing Health Science. Working experiences of nurses during the Middle East respiratory syndrome outbreak. International Journal of Nursing Practice. Nurses' experiences of care for patients with Middle East respiratory syndrome-coronavirus in South Korea.
American Journal of Infection Control. Medical Care. Nurses' perceptions of risk from emerging respiratory infectious diseases: a Singapore study. Comprehensive systematic review of healthcare workers' perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. Perceptions of emergency nurses during the human swine influenza outbreak: a qualitative study. Int Emerg Nurs. Pandemics: risks, impacts, and mitigation. The experience of the SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: lessons learned.Judging Lord Hath Research Paper description, it was only a nightmare, but boys are immediately Lord Hath Research Paper in a Lord Hath Research Paper of this issue. Disconnected In The Film Elephant By Van Sant W. The Pros And Cons Of Numeracy functions of immediate Lord Hath Research Paper in autistic children. The review comprised of study Lord Hath Research Paper —unequivocal and 15 credible supplementary materialwhich formed seven Lord Hath Research Paper based on similarity in meaning. We do Lord Hath Research Paper include either measures Lord Hath Research Paper benchmarks for this developmental Lord Hath Research Paper excluding measures Lord Hath Research Paper designed for children below the age of 48 months as our focus is primarily on younger children with ASD.