Patient perceptions of balance in prostate cancer screening decision aids

Purpose. Recent reports reveals that studies of decision aids reported concern about the balance and accuracy of information included in decision aids. This study explores measures of balance in patient decision aids through a review of prostate cancer screening decision aid studies and analysis of patients’ rating of a patient decision aid for prostate cancer screening. ^ Methods. A data-abstraction form was used to collect the key characteristics, pertaining to balance, of studies included in the review. The key characteristics included (1) sample characteristics (age, race, family history of prostate cancer, and education), (2) description of the decision aid and how it was implemented, and (3) if a measure of balance was used for process evaluation and the rating. A summary table was used to report the findings. Deidentified data was received from a decision aid control trial and logistic regression analysis was used to test the association between the dependent variable (balance) and the independent variables (age, family history, race, screening preference at baseline, education, health insurance status). ^ Conclusion. Three sociodemographic variables remained significant in the final regression model: African American race, education and PSA history. Further research is needed to determine if these variables can predict a man’s perception of balance in prostate cancer screening decision aids. If a patient’s perceptions of balance can be predicted based on specific characteristics, patient report may not be the most objective method of evaluating the acceptability of a decision.^

Strontium isotope ratios of planktonic foraminifera from sediment samples acroos the K/T boundary

Seawater 87Sr/86Sr values increase abruptly by 28 * 10**-6 across the Cretaceous/Tertiary boundary (KTB). This small, but rapid shift is superimposed on the larger scale structure of the seawater Sr isotope curve. The time scale of radiogenic Sr addition appears to be too rapid to reconcile with sources associated with volcanism, and we show that the amount of Sr required to produce even this small increase is too large to be derived from: (1) a KT bolide of the size constrained by the Ir anomaly, (2) continental crust ejecta from the impact of such a bolide, (3) soot from global wildfires initiated by an impact, or (4) any combination of these sources. The probable source of the radiogenic Sr is enhanced continental weathering, but the high rate of increase appears to rule out processes such as sea level regression, glaciation or tectonism. A plausible mechanism for rapid addition of radiogenic Sr to the oceans is enhanced weathering associated with globally distributed acid rain (pH c. 1) which is a proposed by-product of a bolide impact (Prinn and Fegley, 1987, doi:10.1016/0012-821X(87)90046-X).

SOPHIA CPV module round robin: power rating at CSOC

In the frame of the European project SOPHIA a concentrator photovoltaic (CPV) module measurement round robin has been initiated. The round robin includes measurements of four CPV modules at seven different test laboratories located in Europe. IV curves of the modules are measured with different measurement equipment under various climatic conditions. The aim of this activity is to perform at each site a rating of the modules at concentrator standard operating conditions CSOC according to IEC 62670-1. The outcome of the round robin is intended for direct feedback to the current draft standard IEC 62670-3 “Concentrator Photovoltaic (CPV) Performance Testing - Performance Measurements and Power Rating”. The paper discusses initial results from the first three partners that have already finished the measurements up to now.

Método experimental para la caracterización de las diferentes tecnologías de integración arquitectónica de la energía fotovoltaica en condiciones de funcionamiento real = Experimental method for characterization of several building integrated photovoltaic technologies under real working conditions

Hoy en día, el proceso de un proyecto sostenible persigue realizar edificios de elevadas prestaciones que son, energéticamente eficientes, saludables y económicamente viables utilizando sabiamente recursos renovables para minimizar el impacto sobre el medio ambiente reduciendo, en lo posible, la demanda de energía, lo que se ha convertido, en la última década, en una prioridad. La Directiva 2002/91/CE "Eficiencia Energética de los Edificios" (y actualizaciones posteriores) ha establecido el marco regulatorio general para el cálculo de los requerimientos energéticos mínimos. Desde esa fecha, el objetivo de cumplir con las nuevas directivas y protocolos ha conducido las políticas energéticas de los distintos países en la misma dirección, centrándose en la necesidad de aumentar la eficiencia energética en los edificios, la adopción de medidas para reducir el consumo, y el fomento de la generación de energía a través de fuentes renovables. Los edificios de energía nula o casi nula (ZEB, Zero Energy Buildings ó NZEB, Net Zero Energy Buildings) deberán convertirse en un estándar de la construcción en Europa y con el fin de equilibrar el consumo de energía, además de reducirlo al mínimo, los edificios necesariamente deberán ser autoproductores de energía. Por esta razón, la envolvente del edifico y en particular las fachadas son importantes para el logro de estos objetivos y la tecnología fotovoltaica puede tener un papel preponderante en este reto. Para promover el uso de la tecnología fotovoltaica, diferentes programas de investigación internacionales fomentan y apoyan soluciones para favorecer la integración completa de éstos sistemas como elementos arquitectónicos y constructivos, los sistemas BIPV (Building Integrated Photovoltaic), sobre todo considerando el próximo futuro hacia edificios NZEB. Se ha constatado en este estudio que todavía hay una falta de información útil disponible sobre los sistemas BIPV, a pesar de que el mercado ofrece una interesante gama de soluciones, en algunos aspectos comparables a los sistemas tradicionales de construcción. Pero por el momento, la falta estandarización y de una regulación armonizada, además de la falta de información en las hojas de datos técnicos (todavía no comparables con las mismas que están disponibles para los materiales de construcción), hacen difícil evaluar adecuadamente la conveniencia y factibilidad de utilizar los componentes BIPV como parte integrante de la envolvente del edificio. Organizaciones internacionales están trabajando para establecer las normas adecuadas y procedimientos de prueba y ensayo para comprobar la seguridad, viabilidad y fiabilidad estos sistemas. Sin embargo, hoy en día, no hay reglas específicas para la evaluación y caracterización completa de un componente fotovoltaico de integración arquitectónica de acuerdo con el Reglamento Europeo de Productos de la Construcción, CPR 305/2011. Los productos BIPV, como elementos de construcción, deben cumplir con diferentes aspectos prácticos como resistencia mecánica y la estabilidad; integridad estructural; seguridad de utilización; protección contra el clima (lluvia, nieve, viento, granizo), el fuego y el ruido, aspectos que se han convertido en requisitos esenciales, en la perspectiva de obtener productos ambientalmente sostenibles, saludables, eficientes energéticamente y económicamente asequibles. Por lo tanto, el módulo / sistema BIPV se convierte en una parte multifuncional del edificio no sólo para ser física y técnicamente "integrado", además de ser una oportunidad innovadora del diseño. Las normas IEC, de uso común en Europa para certificar módulos fotovoltaicos -IEC 61215 e IEC 61646 cualificación de diseño y homologación del tipo para módulos fotovoltaicos de uso terrestre, respectivamente para módulos fotovoltaicos de silicio cristalino y de lámina delgada- atestan únicamente la potencia del módulo fotovoltaico y dan fe de su fiabilidad por un período de tiempo definido, certificando una disminución de potencia dentro de unos límites. Existe también un estándar, en parte en desarrollo, el IEC 61853 (“Ensayos de rendimiento de módulos fotovoltaicos y evaluación energética") cuyo objetivo es la búsqueda de procedimientos y metodologías de prueba apropiados para calcular el rendimiento energético de los módulos fotovoltaicos en diferentes condiciones climáticas. Sin embargo, no existen ensayos normalizados en las condiciones específicas de la instalación (p. ej. sistemas BIPV de fachada). Eso significa que es imposible conocer las efectivas prestaciones de estos sistemas y las condiciones ambientales que se generan en el interior del edificio. La potencia nominal de pico Wp, de un módulo fotovoltaico identifica la máxima potencia eléctrica que éste puede generar bajo condiciones estándares de medida (STC: irradición 1000 W/m2, 25 °C de temperatura del módulo y distribución espectral, AM 1,5) caracterizando eléctricamente el módulo PV en condiciones específicas con el fin de poder comparar los diferentes módulos y tecnologías. El vatio pico (Wp por su abreviatura en inglés) es la medida de la potencia nominal del módulo PV y no es suficiente para evaluar el comportamiento y producción del panel en términos de vatios hora en las diferentes condiciones de operación, y tampoco permite predecir con convicción la eficiencia y el comportamiento energético de un determinado módulo en condiciones ambientales y de instalación reales. Un adecuado elemento de integración arquitectónica de fachada, por ejemplo, debería tener en cuenta propiedades térmicas y de aislamiento, factores como la transparencia para permitir ganancias solares o un buen control solar si es necesario, aspectos vinculados y dependientes en gran medida de las condiciones climáticas y del nivel de confort requerido en el edificio, lo que implica una necesidad de adaptación a cada contexto específico para obtener el mejor resultado. Sin embargo, la influencia en condiciones reales de operación de las diferentes soluciones fotovoltaicas de integración, en el consumo de energía del edificio no es fácil de evaluar. Los aspectos térmicos del interior del ambiente o de iluminación, al utilizar módulos BIPV semitransparentes por ejemplo, son aún desconocidos. Como se dijo antes, la utilización de componentes de integración arquitectónica fotovoltaicos y el uso de energía renovable ya es un hecho para producir energía limpia, pero también sería importante conocer su posible contribución para mejorar el confort y la salud de los ocupantes del edificio. Aspectos como el confort, la protección o transmisión de luz natural, el aislamiento térmico, el consumo energético o la generación de energía son aspectos que suelen considerarse independientemente, mientras que todos juntos contribuyen, sin embargo, al balance energético global del edificio. Además, la necesidad de dar prioridad a una orientación determinada del edificio, para alcanzar el mayor beneficio de la producción de energía eléctrica o térmica, en el caso de sistemas activos y pasivos, respectivamente, podría hacer estos últimos incompatibles, pero no necesariamente. Se necesita un enfoque holístico que permita arquitectos e ingenieros implementar sistemas tecnológicos que trabajen en sinergia. Se ha planteado por ello un nuevo concepto: "C-BIPV, elemento fotovoltaico consciente integrado", esto significa necesariamente conocer los efectos positivos o negativos (en términos de confort y de energía) en condiciones reales de funcionamiento e instalación. Propósito de la tesis, método y resultados Los sistemas fotovoltaicos integrados en fachada son a menudo soluciones de vidrio fácilmente integrables, ya que por lo general están hechos a medida. Estos componentes BIPV semitransparentes, integrados en el cerramiento proporcionan iluminación natural y también sombra, lo que evita el sobrecalentamiento en los momentos de excesivo calor, aunque como componente estático, asimismo evitan las posibles contribuciones pasivas de ganancias solares en los meses fríos. Además, la temperatura del módulo varía considerablemente en ciertas circunstancias influenciada por la tecnología fotovoltaica instalada, la radiación solar, el sistema de montaje, la tipología de instalación, falta de ventilación, etc. Este factor, puede suponer un aumento adicional de la carga térmica en el edificio, altamente variable y difícil de cuantificar. Se necesitan, en relación con esto, más conocimientos sobre el confort ambiental interior en los edificios que utilizan tecnologías fotovoltaicas integradas, para abrir de ese modo, una nueva perspectiva de la investigación. Con este fin, se ha diseñado, proyectado y construido una instalación de pruebas al aire libre, el BIPV Env-lab "BIPV Test Laboratory", para la caracterización integral de los diferentes módulos semitransparentes BIPV. Se han definido también el método y el protocolo de ensayos de caracterización en el contexto de un edificio y en condiciones climáticas y de funcionamiento reales. Esto ha sido posible una vez evaluado el estado de la técnica y la investigación, los aspectos que influyen en la integración arquitectónica y los diferentes tipos de integración, después de haber examinado los métodos de ensayo para los componentes de construcción y fotovoltaicos, en condiciones de operación utilizadas hasta ahora. El laboratorio de pruebas experimentales, que consiste en dos habitaciones idénticas a escala real, 1:1, ha sido equipado con sensores y todos los sistemas de monitorización gracias a los cuales es posible obtener datos fiables para evaluar las prestaciones térmicas, de iluminación y el rendimiento eléctrico de los módulos fotovoltaicos. Este laboratorio permite el estudio de tres diferentes aspectos que influencian el confort y consumo de energía del edificio: el confort térmico, lumínico, y el rendimiento energético global (demanda/producción de energía) de los módulos BIPV. Conociendo el balance de energía para cada tecnología solar fotovoltaica experimentada, es posible determinar cuál funciona mejor en cada caso específico. Se ha propuesto una metodología teórica para la evaluación de estos parámetros, definidos en esta tesis como índices o indicadores que consideran cuestiones relacionados con el bienestar, la energía y el rendimiento energético global de los componentes BIPV. Esta metodología considera y tiene en cuenta las normas reglamentarias y estándares existentes para cada aspecto, relacionándolos entre sí. Diferentes módulos BIPV de doble vidrio aislante, semitransparentes, representativos de diferentes tecnologías fotovoltaicas (tecnología de silicio monocristalino, m-Si; de capa fina en silicio amorfo unión simple, a-Si y de capa fina en diseleniuro de cobre e indio, CIS) fueron seleccionados para llevar a cabo una serie de pruebas experimentales al objeto de demostrar la validez del método de caracterización propuesto. Como resultado final, se ha desarrollado y generado el Diagrama Caracterización Integral DCI, un sistema gráfico y visual para representar los resultados y gestionar la información, una herramienta operativa útil para la toma de decisiones con respecto a las instalaciones fotovoltaicas. Este diagrama muestra todos los conceptos y parámetros estudiados en relación con los demás y ofrece visualmente toda la información cualitativa y cuantitativa sobre la eficiencia energética de los componentes BIPV, por caracterizarlos de manera integral. ABSTRACT A sustainable design process today is intended to produce high-performance buildings that are energy-efficient, healthy and economically feasible, by wisely using renewable resources to minimize the impact on the environment and to reduce, as much as possible, the energy demand. In the last decade, the reduction of energy needs in buildings has become a top priority. The Directive 2002/91/EC “Energy Performance of Buildings” (and its subsequent updates) established a general regulatory framework’s methodology for calculation of minimum energy requirements. Since then, the aim of fulfilling new directives and protocols has led the energy policies in several countries in a similar direction that is, focusing on the need of increasing energy efficiency in buildings, taking measures to reduce energy consumption, and fostering the use of renewable sources. Zero Energy Buildings or Net Zero Energy Buildings will become a standard in the European building industry and in order to balance energy consumption, buildings, in addition to reduce the end-use consumption should necessarily become selfenergy producers. For this reason, the façade system plays an important role for achieving these energy and environmental goals and Photovoltaic can play a leading role in this challenge. To promote the use of photovoltaic technology in buildings, international research programs encourage and support solutions, which favors the complete integration of photovoltaic devices as an architectural element, the so-called BIPV (Building Integrated Photovoltaic), furthermore facing to next future towards net-zero energy buildings. Therefore, the BIPV module/system becomes a multifunctional building layer, not only physically and functionally “integrated” in the building, but also used as an innovative chance for the building envelope design. It has been found in this study that there is still a lack of useful information about BIPV for architects and designers even though the market is providing more and more interesting solutions, sometimes comparable to the existing traditional building systems. However at the moment, the lack of an harmonized regulation and standardization besides to the non-accuracy in the technical BIPV datasheets (not yet comparable with the same ones available for building materials), makes difficult for a designer to properly evaluate the fesibility of this BIPV components when used as a technological system of the building skin. International organizations are working to establish the most suitable standards and test procedures to check the safety, feasibility and reliability of BIPV systems. Anyway, nowadays, there are no specific rules for a complete characterization and evaluation of a BIPV component according to the European Construction Product Regulation, CPR 305/2011. BIPV products, as building components, must comply with different practical aspects such as mechanical resistance and stability; structural integrity; safety in use; protection against weather (rain, snow, wind, hail); fire and noise: aspects that have become essential requirements in the perspective of more and more environmentally sustainable, healthy, energy efficient and economically affordable products. IEC standards, commonly used in Europe to certify PV modules (IEC 61215 and IEC 61646 respectively crystalline and thin-film ‘Terrestrial PV Modules-Design Qualification and Type Approval’), attest the feasibility and reliability of PV modules for a defined period of time with a limited power decrease. There is also a standard (IEC 61853, ‘Performance Testing and Energy Rating of Terrestrial PV Modules’) still under preparation, whose aim is finding appropriate test procedures and methodologies to calculate the energy yield of PV modules under different climate conditions. Furthermore, the lack of tests in specific conditions of installation (e.g. façade BIPV devices) means that it is difficult knowing the exact effective performance of these systems and the environmental conditions in which the building will operate. The nominal PV power at Standard Test Conditions, STC (1.000 W/m2, 25 °C temperature and AM 1.5) is usually measured in indoor laboratories, and it characterizes the PV module at specific conditions in order to be able to compare different modules and technologies on a first step. The “Watt-peak” is not enough to evaluate the panel performance in terms of Watt-hours of various modules under different operating conditions, and it gives no assurance of being able to predict the energy performance of a certain module at given environmental conditions. A proper BIPV element for façade should take into account thermal and insulation properties, factors as transparency to allow solar gains if possible or a good solar control if necessary, aspects that are linked and high dependent on climate conditions and on the level of comfort to be reached. However, the influence of different façade integrated photovoltaic solutions on the building energy consumption is not easy to assess under real operating conditions. Thermal aspects, indoor temperatures or luminance level that can be expected using building integrated PV (BIPV) modules are not well known. As said before, integrated photovoltaic BIPV components and the use of renewable energy is already a standard for green energy production, but would also be important to know the possible contribution to improve the comfort and health of building occupants. Comfort, light transmission or protection, thermal insulation or thermal/electricity power production are aspects that are usually considered alone, while all together contribute to the building global energy balance. Besides, the need to prioritize a particular building envelope orientation to harvest the most benefit from the electrical or thermal energy production, in the case of active and passive systems respectively might be not compatible, but also not necessary. A holistic approach is needed to enable architects and engineers implementing technological systems working in synergy. A new concept have been suggested: “C-BIPV, conscious integrated BIPV”. BIPV systems have to be “consciously integrated” which means that it is essential to know the positive and negative effects in terms of comfort and energy under real operating conditions. Purpose of the work, method and results The façade-integrated photovoltaic systems are often glass solutions easily integrable, as they usually are custommade. These BIPV semi-transparent components integrated as a window element provides natural lighting and shade that prevents overheating at times of excessive heat, but as static component, likewise avoid the possible solar gains contributions in the cold months. In addition, the temperature of the module varies considerably in certain circumstances influenced by the PV technology installed, solar radiation, mounting system, lack of ventilation, etc. This factor may result in additional heat input in the building highly variable and difficult to quantify. In addition, further insights into the indoor environmental comfort in buildings using integrated photovoltaic technologies are needed to open up thereby, a new research perspective. This research aims to study their behaviour through a series of experiments in order to define the real influence on comfort aspects and on global energy building consumption, as well as, electrical and thermal characteristics of these devices. The final objective was to analyze a whole set of issues that influence the global energy consumption/production in a building using BIPV modules by quantifying the global energy balance and the BIPV system real performances. Other qualitative issues to be studied were comfort aspect (thermal and lighting aspects) and the electrical behaviour of different BIPV technologies for vertical integration, aspects that influence both energy consumption and electricity production. Thus, it will be possible to obtain a comprehensive global characterization of BIPV systems. A specific design of an outdoor test facility, the BIPV Env-lab “BIPV Test Laboratory”, for the integral characterization of different BIPV semi-transparent modules was developed and built. The method and test protocol for the BIPV characterization was also defined in a real building context and weather conditions. This has been possible once assessed the state of the art and research, the aspects that influence the architectural integration and the different possibilities and types of integration for PV and after having examined the test methods for building and photovoltaic components, under operation conditions heretofore used. The test laboratory that consists in two equivalent test rooms (1:1) has a monitoring system in which reliable data of thermal, daylighting and electrical performances can be obtained for the evaluation of PV modules. The experimental set-up facility (testing room) allows studying three different aspects that affect building energy consumption and comfort issues: the thermal indoor comfort, the lighting comfort and the energy performance of BIPV modules tested under real environmental conditions. Knowing the energy balance for each experimented solar technology, it is possible to determine which one performs best. A theoretical methodology has been proposed for evaluating these parameters, as defined in this thesis as indices or indicators, which regard comfort issues, energy and the overall performance of BIPV components. This methodology considers the existing regulatory standards for each aspect, relating them to one another. A set of insulated glass BIPV modules see-through and light-through, representative of different PV technologies (mono-crystalline silicon technology, mc-Si, amorphous silicon thin film single junction, a-Si and copper indium selenide thin film technology CIS) were selected for a series of experimental tests in order to demonstrate the validity of the proposed characterization method. As result, it has been developed and generated the ICD Integral Characterization Diagram, a graphic and visual system to represent the results and manage information, a useful operational tool for decision-making regarding to photovoltaic installations. This diagram shows all concepts and parameters studied in relation to each other and visually provides access to all the results obtained during the experimental phase to make available all the qualitative and quantitative information on the energy performance of the BIPV components by characterizing them in a comprehensive way.

The Energy Performance of Buildings: Promises Still Unfulfilled. Egmont Paper No. 78, May 2015

EXECUTIVE SUMMARY All observers agree that energy efficiency must be the cornerstone of any serious EU energy strategy. In this general context, the EU building sector is critical. It represents about 40% of EU final energy consumption (residential houses, public/private offices, commercial buildings, etc.) and approximately 36% of EU CO2 emissions. This is massive. The EU has certainly not been inactive in this field. The Energy Performance in Buildings Directive 2002/91/EC (EPBD) was the first and the main instrument to address the problem of the energy performance of buildings. It has established numerous principles: a reliable methodology which enables the calculation and rating of the energy performance of buildings; minimum energy performance standards for new buildings and existing buildings under major renovation; energy performance certificates; regular inspection of heating and air-conditioning systems; and, finally, quality standards for inspections and energy performance certificates. They were strengthened in 2010 by the recast Directive 2010/31/EU. This directive also introduces a decisive concept for the development of the building sector: ‘nearly zeroenergy buildings’. In 2012, the new Energy Efficiency Directive 2012/27/EU dealt with other aspects. In the building sector, three of them are particularly important. They concern: (1) the establishment of long-term strategies for mobilizing investment in the renovation of the national building stocks; (2) the introduction of energy saving schemes for ‘designated’ energy companies with a view to reducing consumption among ‘final consumers’ by 1.5% annually; and (3), as an option, the setting up of an Energy Efficiency National Fund to support energy efficiency initiatives. This paper also briefly examines the different instruments put in place to disseminate information and consultation, and the EU funding for energy efficiency in buildings. Results, however, have remained limited until now. The improvement of the energy performance of buildings and the rhythm of renovation remain extremely weak. Member States’ unwillingness to timely and properly transpose and implement the Directives continues despite the high degree of flexibility permitted. The decentralized approach chosen for some specific aspects and the differentiation in the application of EPBD standards between Member States do not appear optimal either. Adequate financial schemes remain rare. The permanent deficit of qualified and trained personnel and the inertia of public authorities to make the public understand the stakes in this domain remain problematic. Hence the need to take new initiatives to reap the benefits that the building sector is meant to bring.

Annual Contractor's Conference of the Artificial Kidney Program of the National Institute of Arthritis, Metabolism, and Digestive Diseases; proceedings

Mode of access: Internet.

Department of Energy : management problems require a long-term commitment to change : report to the Secretary of Energy /

"B-251352"--P. 1.

Department of Energy workforce reduction : community assistance can be better targeted : report to Congressional requesters /

"B-282320"--P. 1.

An Internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study

Purpose: This pilot study explored the feasibility and effectiveness of an Internet-based telerehabilitation application for the assessment of motor speech disorders in adults with acquired neurological impairment. Method: Using a counterbalanced, repeated measures research design, 2 speech-language pathologists assessed 19 speakers with dysarthria on a battery of perceptual assessments. The assessments included a 19-item version of the Frenchay Dysarthria Assessment (FDA; P. Enderby, 1983), the Assessment of Intelligibility of Dysarthric Speech (K. M. Yorkston & D. R. Beukelman, 1981), perceptual analysis of a speech sample, and an overall rating of severity of the dysarthria. One assessment was conducted in the traditional face-to-face manner, whereas the other assessment was conducted using an online, custom-built telerehabilitation application. This application enabled real-time videoconferencing at 128 kb/s and the transfer of store-and-forward audio and video data between the speaker and speech-language pathologist sites. The assessment methods were compared using the J.M.Bland and D.G.Altman (1986, 1999) limits-of-agreement method and percentage level of agreement between the 2 methods. Results: Measurements of severity of dysarthria, percentage intelligibility in sentences, and most perceptual ratings made in the telerehabilitation environment were found to fall within the clinically acceptable criteria. However, several ratings on the FDA were not comparable between the environments, and explanations for these results were explored. Conclusions: The online assessment of motor speech disorders using an Internet-based telerehabilitation system is feasible. This study suggests that with additional refinement of the technology and assessment protocols, reliable assessment of motor speech disorders over the Internet is possible. Future research methods are outlined.

Multiparametric evaluation of dysphonic severity

In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale.(1) The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.

Assessment of motor speech disorders online: A pilot study

We have conducted a preliminary validation of an Internet-based telehealth application for assessing motor speech disorders in adults with acquired neurological impairment. The videoconferencing module used NetMeeting software to provide realtime videoconferencing through a 128 kbit/s Internet link, as well as the transfer of store-and-forward video and audio data from the participant to the clinician. Ten participants with dysarthria following acquired brain injury were included in the study. An assessment of the overall severity of the speech disturbance was made for each participant face to face (FTF) and in the online environment, in addition, a 23-item version of the Frenchay Dysarthria Assessment (FDA) (which measures motor speech function) and the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) (which gives the percentage word and sentence intelligibility, words per minute and a rating of communication efficiency) were administered in both environments. There was a 90% level of agreement between the two assessment environments for the rating of overall severity of dysarthria. A 70-100% level of agreement was achieved for 17 (74%) of the 23 FDA variables. On the ASSIDS there was a significant difference between the FTF and online assessments only for percentage word intelligibility. These findings suggest that Internet-based assessment has potential as a reliable method for assessing motor speech disorders.

Effect of uncorrected astigmatism on vision

PURPOSE: To examine the effect of uncorrected astigmatism in older adults. SETTING: University Vision Clinic METHOD: Twenty-one healthy presbyopes, aged 58.9±2.8 years, had astigmatism of 0.0 to -4.0 x 90?DC and -3.0DC of cylinder at 90?, 180? and 45? induced with spectacle lenses, with the mean spherical equivalent compensated to plano, in random order. Visual acuity was assessed binocularly using a computerised test chart at 95%, 50% and 10% contrast. Near acuity and reading speed were measured using standardised reading texts. Light scatter was quantified with the cQuant and driving reaction times with a computer simulator. Finally visual clarity of a mobile phone and computer screen was subjectively rated. RESULTS: Distance visual acuity decreased with increasing uncorrected astigmatic power (F=174.50, p<0.001) and was reduced at lower contrasts (F=170.77, p<0.001). Near visual acuity and reading speed also decreased with increasing uncorrected astigmatism power (p<0.001). Light scatter was not significantly affected by uncorrected astigmatism (p>0.05), but the reliability and variability of measurements decreased with increasing uncorrected astigmatic power (p<0.05). Driving simulator performance was also unaffected by uncorrected astigmatism (p>0.05), but subjective rating of clarity decreased with increasing uncorrected astigmatic power (p<0.001). Uncorrected astigmatism at 45? or 180? orientation resulted in a worse distance and near visual acuity, and subjective rated clarity than 90? orientation (p<0.05). CONCLUSION: Uncorrected astigmatism, even as low as 1.0DC, causes a significant burden on a patient’s vision. If left uncorrected, this could impact significantly on their independence, quality of life and wellbeing.

Application of analytic hierarchy process for measuring and comparing the global performance of intensive care units

Purpose: To develop a model for the global performance measurement of intensive care units (ICUs) and to apply that model to compare the services for quality improvement. Materials and Methods: Analytic hierarchy process, a multiple-attribute decision-making technique, is used in this study to evolve such a model. The steps consisted of identifying the critical success factors for the best performance of an ICU, identifying subfactors that influence the critical factors, comparing them pairwise, deriving their relative importance and ratings, and calculating the cumulative performance according to the attributes of a given ICU. Every step in the model was derived by group discussions, brainstorming, and consensus among intensivists. Results: The model was applied to 3 ICUs, 1 each in Barbados, Trinidad, and India in tertiary care teaching hospitals of similar setting. The cumulative performance rating of the Barbados ICU was 1.17 when compared with that of Trinidad and Indian ICU, which were 0.82 and 0.75, respectively, showing that the Trinidad and Indian ICUs performed 70% and 64% with respect to Barbados ICU. The model also enabled identifying specific areas where the ICUs did not perform well, which helped to improvise those areas. Conclusions: Analytic hierarchy process is a very useful model to measure the global performance of an ICU. © 2005 Elsevier Inc. All rights reserved.

Terms of abuse as expression and reinforcement of cultures

In this study terms of abuse are investigated in 11 different cultures. Spontaneous verbal aggression is to a certain extent reminiscent of the values of a certain culture. Almost 3000 subjects from Spain, Germany, France, Italy, Croatia, Poland, Great Britain, USA, Norway, Greece, and The Netherlands were asked to write down terms of abuse that they would use given a certain stimulus situation, and in addition, to give their rating of the offensive character of those terms. A total set of 12,000 expressions was collected. The frequencies of the expressions were established, and the total list of expressions was reduced to 16 categories. Results point to some etic taboos, like sexuality and lack of intelligence. On the other hand clear differences across cultures were found, which cannot easily be explained by existing classifications of national cultures. Explanations are provided in terms of dimensions on which the 11 cultures differ.