Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Action preparation helps and hinders perception of action.

Several theories of the mechanisms linking perception and action require that the links are bidirectional, but there is a lack of consensus on the effects that action has on perception. We investigated this by measuring visual event-related brain potentials to observed hand actions while participants prepared responses that were spatially compatible (e.g., both were on the left side of the body) or incompatible and action type compatible (e.g., both were finger taps) or incompatible, with observed actions. An early enhanced processing of spatially compatible stimuli was observed, which is likely due to spatial attention. This was followed by an attenuation of processing for both spatially and action type compatible stimuli, likely to be driven by efference copy signals that attenuate processing of predicted sensory consequences of actions. Attenuation was not response-modality specific; it was found for manual stimuli when participants prepared manual and vocal responses, in line with the hypothesis that action control is hierarchically organized. These results indicate that spatial attention and forward model prediction mechanisms have opposite, but temporally distinct, effects on perception. This hypothesis can explain the inconsistency of recent findings on action-perception links and thereby supports the view that sensorimotor links are bidirectional. Such effects of action on perception are likely to be crucial, not only for the control of our own actions but also in sociocultural interaction, allowing us to predict the reactions of others to our own actions.

The price of risk in construction projects: contingency approximation model (CAM)

Little attention has been focussed on a precise definition and evaluation mechanism for project management risk specifically related to contractors. When bidding, contractors traditionally price risks using unsystematic approaches. The high business failure rate our industry records may indicate that the current unsystematic mechanisms contractors use for building up contingencies may be inadequate. The reluctance of some contractors to include a price for risk in their tenders when bidding for work competitively may also not be a useful approach. Here, instead, we first define the meaning of contractor contingency, and then we develop a facile quantitative technique that contractors can use to estimate a price for project risk. This model will help contractors analyse their exposure to project risks; and help them express the risk in monetary terms for management action. When bidding for work, they can decide how to allocate contingencies strategically in a way that balances risk and reward.

Occupants' adaptive responses and perception of thermal environment in naturally conditioned university classrooms

A year-long field study of the thermal environment in university classrooms was conducted from March 2005 to May 2006 in Chongqing, China. This paper presents the occupants’ thermal sensation votes and discusses the occupants’ adaptive response and perception of the thermal environment in a naturally conditioned space. Comparisons between the Actual Mean Vote (AMV) and Predicted Mean Vote (PMV) have been made as well as between the Actual Percentage of Dissatisfied (APD) and Predicted Percentage of Dissatisfied (PPD). The adaptive thermal comfort zone for the naturally conditioned space for Chongqing, which has hot summer and cold winter climatic characteristics, has been proposed based on the field study results. The Chongqing adaptive comfort range is broader than that of the ASHRAE Standard 55-2004 in general, but in the extreme cold and hot months, it is narrower. The thermal conditions in classrooms in Chongqing in summer and winter are severe. Behavioural adaptation such as changing clothing, adjusting indoor air velocity, taking hot/cold drinks, etc., as well as psychological adaptation, has played a role in adapting to the thermal environment.

Constancy in the perception of speech when the level of room-reflections varies

A speech message played several metres from the listener in a room is usually heard to have much the same phonetic content as it does when played nearby, even though the different amounts of reflected sound make the temporal envelopes of these signals very different. To study this ‘constancy’ effect, listeners heard speech messages and speech-like sounds comprising 8 auditory-filter shaped noise-bands that had temporal envelopes corresponding to those in these filters when the speech message is played. The ‘contexts’ were “next you’ll get _to click on”, into which a “sir” or “stir” test word was inserted. These test words were from an 11-step continuum, formed by amplitude modulation. Listeners identified the test words appropriately, even in the 8-band conditions where the speech had a ‘robotic’ quality. Constancy was assessed by comparing the influence of room reflections on the test word across conditions where the context had either the same level of room reflections (i.e. from the same, far distance), or where it had a much lower level (i.e. from nearby). Constancy effects were obtained with both the natural- and the 8-band speech. Results are considered in terms of the degree of ‘matching’ between the context’s and test-word’s bands.

Do designers show categorical perception of typefaces?

Readers need to easily discriminate between different letters, so typefaces are designed to make these differences distinctive. But there is also a uniformity of style within a typeface. These styles are recognised by typographic designers and may be categorised to enable more efficient discrimination among typefaces. The manner in which designers perceive typefaces is explored using the paradigm of Categorical Perception (CP). A continuum of fonts is created by interpolating between two typefaces and two tasks (identification and discrimination) are used to test for CP. As the application of CP to typefaces is a new approach, various methodological issues are pursued. The experiments reveal that the conditions required to demonstrate CP are quite specific and CP was only evident in Times and Helvetica and not Garamond and Bodoni. Possible reasons for this difference are the characteristics of the two typefaces and their context of use. Speculation as to the purpose of CP in non-designers raises the under-researched question of how we identify letters in different typefaces when reading.

Defining user perception of distributed multimedia quality

This article presents the results of a study that explored the human side of the multimedia experience. We propose a model that assesses quality variation from three distinct levels: the network, the media and the content levels; and from two views: the technical and the user perspective. By facilitating parameter variation at each of the quality levels and from each of the perspectives, we were able to examine their impact on user quality perception. Results show that a significant reduction in frame rate does not proportionally reduce the user's understanding of the presentation independent of technical parameters, that multimedia content type significantly impacts user information assimilation, user level of enjoyment, and user perception of quality, and that the device display type impacts user information assimilation and user perception of quality. Finally, to ensure the transfer of information, low-level abstraction (network-level) parameters, such as delay and jitter, should be adapted; to maintain the user's level of enjoyment, high-level abstraction quality parameters (content-level), such as the appropriate use of display screens, should be adapted.

How level and type of deafness affects user perception of multimedia video clips

Our research investigates the impact that hearing has on the perception of digital video clips, with and without captions, by discussing how hearing loss, captions and deafness type affects user QoP (Quality of Perception). QoP encompasses not only a user's satisfaction with the quality of a multimedia presentation, but also their ability to analyse, synthesise and assimilate informational content of multimedia . Results show that hearing has a significant effect on participants’ ability to assimilate information, independent of video type and use of captions. It is shown that captions do not necessarily provide deaf users with a ‘greater level of information’ from video, but cause a change in user QoP, depending on deafness type, which provides a ‘greater level of context of the video’. It is also shown that post-lingual mild and moderately deaf participants predict less accurately their level of information assimilation than post-lingual profoundly deaf participants, despite residual hearing. A positive correlation was identified between level of enjoyment (LOE) and self-predicted level of information assimilation (PIA), independent of hearing level or hearing type. When this is considered in a QoP quality framework, it puts into question how the user perceives certain factors, such as ‘informative’ and ‘quality’.

The use of risk registers by project managers

The construction industry is widely recognised as being inherent with risk and uncertainty. This necessitates the need for effective project risk management to achieve the project objectives of time, cost and quality. A popular tool employed in projects to aid in the management of risk is a risk register. This tool documents the project risks and is often employed by the Project Manager (PM) to manage the associated risks on a project. This research aims to ascertain how widely risk registers are used by Project Managers as part of their risk management practices. To achieve this aim entailed interviewing ten PMs, to discuss their use of the risk register as a risk management tool. The results from these interviews indicated the prevalent use of this document and recognised its effectiveness in the management of project risks. The findings identified the front end and feasibility phases of a project as crucial stages for using risk registers, noting it as a vital ingredient in the risk response planning of the decision making process. Moreover, the composition of the risk register was also understood, with an insight into how PMs produce and develop this tool also ascertained. In conclusion, this research signifies the extensive use of the risk register by PMs. A majority of PMs were of the view that risk registers constitute an essential component of their project risk management practices. This suggests a need for further research on the extent to which risk registers actually help PMs to control the risks in a construction project, particularly residual risks, and how this can be improved to minimize deviations from expected outcomes.