Cost-effectiveness of peer role play and standardized patients in undergraduate communication training.

BACKGROUND The few studies directly comparing the methodological approach of peer role play (RP) and standardized patients (SP) for the delivery of communication skills all suggest that both methods are effective. In this study we calculated the costs of both methods (given comparable outcomes) and are the first to generate a differential cost-effectiveness analysis of both methods. METHODS Medical students in their prefinal year were randomly assigned to one of two groups receiving communication training in Pediatrics either with RP (N = 34) or 19 individually trained SP (N = 35). In an OSCE with standardized patients using the Calgary-Cambridge Referenced Observation Guide both groups achieved comparable high scores (results published). In this study, corresponding costs were assessed as man-hours resulting from hours of work of SP and tutors. A cost-effectiveness analysis was performed. RESULTS Cost-effectiveness analysis revealed a major advantage for RP as compared to SP (112 vs. 172 man hours; cost effectiveness ratio .74 vs. .45) at comparable performance levels after training with both methods. CONCLUSIONS While both peer role play and training with standardized patients have their value in medical curricula, RP has a major advantage in terms of cost-effectiveness. This could be taken into account in future decisions.

Impact of case-relevant and case-irrelevant communication within the surgical team on surgical-site infection

BACKGROUND Surgical-site infections (SSIs) are the most common complications after surgery. An influence from talking and distractions during surgery on patient outcomes has been suggested, but there is limited evidence. The aim of this prospective observational study was to assess the relationship between intraoperative communication within the surgical team and SSI, and between intraoperative distractions and SSI. METHODS This prospective observational study included patients undergoing elective, open abdominal procedures. For each procedure, intraoperative case-relevant and case-irrelevant communication, and intraoperative distractions were observed continuously on site. The influence of communication and distractions on SSI after surgery was assessed using logistic regressions, adjusting for risk factors. RESULTS A total of 167 observed procedures were analysed; their mean(s.d.) duration was 4·6(2·1) h. A total of 24 SSIs (14·4 per cent) were diagnosed. Case-relevant communication during the procedure was independently associated with a reduced incidence of organ/space SSI (propensity score-adjusted odds ratio 0·86, 95 per cent c.i. 0·77 to 0·97; P = 0·014). Case-irrelevant communication during the closing phase of the procedure was independently associated with increased incidence of incisional SSI (propensity score-adjusted odds ratio 1·29, 1·08 to 1·55; P = 0·006). Distractions had no association with SSI. CONCLUSION More case-relevant communication was associated with fewer organ/space SSIs, and more case-irrelevant communication during wound closure was associated with incisional SSI.

Contributions to the contextualization of human-machine spoken interaction systems

The design and development of spoken interaction systems has been a thoroughly studied research scope for the last decades. The aim is to obtain systems with the ability to interact with human agents with a high degree of naturalness and efficiency, allowing them to carry out the actions they desire using speech, as it is the most natural means of communication between humans. To achieve that degree of naturalness, it is not enough to endow systems with the ability to accurately understand the user’s utterances and to properly react to them, even considering the information provided by the user in his or her previous interactions. The system has also to be aware of the evolution of the conditions under which the interaction takes place, in order to act the most coherent way as possible at each moment. Consequently, one of the most important features of the system is that it has to be context-aware. This context awareness of the system can be reflected in the modification of the behaviour of the system taking into account the current situation of the interaction. For instance, the system should decide which action it has to carry out, or the way to perform it, depending on the user that requests it, on the way that the user addresses the system, on the characteristics of the environment in which the interaction takes place, and so on. In other words, the system has to adapt its behaviour to these evolving elements of the interaction. Moreover that adaptation has to be carried out, if possible, in such a way that the user: i) does not perceive that the system has to make any additional effort, or to devote interaction time to perform tasks other than carrying out the requested actions, and ii) does not have to provide the system with any additional information to carry out the adaptation, which could imply a lesser efficiency of the interaction, since users should devote several interactions only to allow the system to become adapted. In the state-of-the-art spoken dialogue systems, researchers have proposed several disparate strategies to adapt the elements of the system to different conditions of the interaction (such as the acoustic characteristics of a specific user’s speech, the actions previously requested, and so on). Nevertheless, to our knowledge there is not any consensus on the procedures to carry out these adaptation. The approaches are to an extent unrelated from one another, in the sense that each one considers different pieces of information, and the treatment of that information is different taking into account the adaptation carried out. In this regard, the main contributions of this Thesis are the following ones: Definition of a contextualization framework. We propose a unified approach that can cover any strategy to adapt the behaviour of a dialogue system to the conditions of the interaction (i.e. the context). In our theoretical definition of the contextualization framework we consider the system’s context as all the sources of variability present at any time of the interaction, either those ones related to the environment in which the interaction takes place, or to the human agent that addresses the system at each moment. Our proposal relies on three aspects that any contextualization approach should fulfill: plasticity (i.e. the system has to be able to modify its behaviour in the most proactive way taking into account the conditions under which the interaction takes place), adaptivity (i.e. the system has also to be able to consider the most appropriate sources of information at each moment, both environmental and user- and dialogue-dependent, to effectively adapt to the conditions aforementioned), and transparency (i.e. the system has to carry out the contextualizaton-related tasks in such a way that the user neither perceives them nor has to do any effort in providing the system with any information that it needs to perform that contextualization). Additionally, we could include a generality aspect to our proposed framework: the main features of the framework should be easy to adopt in any dialogue system, regardless of the solution proposed to manage the dialogue. Once we define the theoretical basis of our contextualization framework, we propose two cases of study on its application in a spoken dialogue system. We focus on two aspects of the interaction: the contextualization of the speech recognition models, and the incorporation of user-specific information into the dialogue flow. One of the modules of a dialogue system that is more prone to be contextualized is the speech recognition system. This module makes use of several models to emit a recognition hypothesis from the user’s speech signal. Generally speaking, a recognition system considers two types of models: an acoustic one (that models each of the phonemes that the recognition system has to consider) and a linguistic one (that models the sequences of words that make sense for the system). In this work we contextualize the language model of the recognition system in such a way that it takes into account the information provided by the user in both his or her current utterance and in the previous ones. These utterances convey information useful to help the system in the recognition of the next utterance. The contextualization approach that we propose consists of a dynamic adaptation of the language model that is used by the recognition system. We carry out this adaptation by means of a linear interpolation between several models. Instead of training the best interpolation weights, we make them dependent on the conditions of the dialogue. In our approach, the system itself will obtain these weights as a function of the reliability of the different elements of information available, such as the semantic concepts extracted from the user’s utterance, the actions that he or she wants to carry out, the information provided in the previous interactions, and so on. One of the aspects more frequently addressed in Human-Computer Interaction research is the inclusion of user specific characteristics into the information structures managed by the system. The idea is to take into account the features that make each user different from the others in order to offer to each particular user different services (or the same service, but in a different way). We could consider this approach as a user-dependent contextualization of the system. In our work we propose the definition of a user model that contains all the information of each user that could be potentially useful to the system at a given moment of the interaction. In particular we will analyze the actions that each user carries out throughout his or her interaction. The objective is to determine which of these actions become the preferences of that user. We represent the specific information of each user as a feature vector. Each of the characteristics that the system will take into account has a confidence score associated. With these elements, we propose a probabilistic definition of a user preference, as the action whose likelihood of being addressed by the user is greater than the one for the rest of actions. To include the user dependent information into the dialogue flow, we modify the information structures on which the dialogue manager relies to retrieve information that could be needed to solve the actions addressed by the user. Usage preferences become another source of contextual information that will be considered by the system towards a more efficient interaction (since the new information source will help to decrease the need of the system to ask users for additional information, thus reducing the number of turns needed to carry out a specific action). To test the benefits of the contextualization framework that we propose, we carry out an evaluation of the two strategies aforementioned. We gather several performance metrics, both objective and subjective, that allow us to compare the improvements of a contextualized system against the baseline one. We will also gather the user’s opinions as regards their perceptions on the behaviour of the system, and its degree of adaptation to the specific features of each interaction. Resumen El diseño y el desarrollo de sistemas de interacción hablada ha sido objeto de profundo estudio durante las pasadas décadas. El propósito es la consecución de sistemas con la capacidad de interactuar con agentes humanos con un alto grado de eficiencia y naturalidad. De esta manera, los usuarios pueden desempeñar las tareas que deseen empleando la voz, que es el medio de comunicación más natural para los humanos. A fin de alcanzar el grado de naturalidad deseado, no basta con dotar a los sistemas de la abilidad de comprender las intervenciones de los usuarios y reaccionar a ellas de manera apropiada (teniendo en consideración, incluso, la información proporcionada en previas interacciones). Adicionalmente, el sistema ha de ser consciente de las condiciones bajo las cuales transcurre la interacción, así como de la evolución de las mismas, de tal manera que pueda actuar de la manera más coherente en cada instante de la interacción. En consecuencia, una de las características primordiales del sistema es que debe ser sensible al contexto. Esta capacidad del sistema de conocer y emplear el contexto de la interacción puede verse reflejada en la modificación de su comportamiento debida a las características actuales de la interacción. Por ejemplo, el sistema debería decidir cuál es la acción más apropiada, o la mejor manera de llevarla a término, dependiendo del usuario que la solicita, del modo en el que lo hace, etcétera. En otras palabras, el sistema ha de adaptar su comportamiento a tales elementos mutables (o dinámicos) de la interacción. Dos características adicionales son requeridas a dicha adaptación: i) el usuario no ha de percibir que el sistema dedica recursos (temporales o computacionales) a realizar tareas distintas a las que aquél le solicita, y ii) el usuario no ha de dedicar esfuerzo alguno a proporcionar al sistema información adicional para llevar a cabo la interacción. Esto último implicaría una menor eficiencia de la interacción, puesto que los usuarios deberían dedicar parte de la misma a proporcionar información al sistema para su adaptación, sin ningún beneficio inmediato. En los sistemas de diálogo hablado propuestos en la literatura, se han propuesto diferentes estrategias para llevar a cabo la adaptación de los elementos del sistema a las diferentes condiciones de la interacción (tales como las características acústicas del habla de un usuario particular, o a las acciones a las que se ha referido con anterioridad). Sin embargo, no existe una estrategia fija para proceder a dicha adaptación, sino que las mismas no suelen guardar una relación entre sí. En este sentido, cada una de ellas tiene en cuenta distintas fuentes de información, la cual es tratada de manera diferente en función de las características de la adaptación buscada. Teniendo en cuenta lo anterior, las contribuciones principales de esta Tesis son las siguientes: Definición de un marco de contextualización. Proponemos un criterio unificador que pueda cubrir cualquier estrategia de adaptación del comportamiento de un sistema de diálogo a las condiciones de la interacción (esto es, el contexto de la misma). En nuestra definición teórica del marco de contextualización consideramos el contexto del sistema como todas aquellas fuentes de variabilidad presentes en cualquier instante de la interacción, ya estén relacionadas con el entorno en el que tiene lugar la interacción, ya dependan del agente humano que se dirige al sistema en cada momento. Nuestra propuesta se basa en tres aspectos que cualquier estrategia de contextualización debería cumplir: plasticidad (es decir, el sistema ha de ser capaz de modificar su comportamiento de la manera más proactiva posible, teniendo en cuenta las condiciones en las que tiene lugar la interacción), adaptabilidad (esto es, el sistema ha de ser capaz de considerar la información oportuna en cada instante, ya dependa del entorno o del usuario, de tal manera que adecúe su comportamiento de manera eficaz a las condiciones mencionadas), y transparencia (que implica que el sistema ha de desarrollar las tareas relacionadas con la contextualización de tal manera que el usuario no perciba la manera en que dichas tareas se llevan a cabo, ni tampoco deba proporcionar al sistema con información adicional alguna). De manera adicional, incluiremos en el marco propuesto el aspecto de la generalidad: las características del marco de contextualización han de ser portables a cualquier sistema de diálogo, con independencia de la solución propuesta en los mismos para gestionar el diálogo. Una vez hemos definido las características de alto nivel de nuestro marco de contextualización, proponemos dos estrategias de aplicación del mismo a un sistema de diálogo hablado. Nos centraremos en dos aspectos de la interacción a adaptar: los modelos empleados en el reconocimiento de habla, y la incorporación de información específica de cada usuario en el flujo de diálogo. Uno de los módulos de un sistema de diálogo más susceptible de ser contextualizado es el sistema de reconocimiento de habla. Este módulo hace uso de varios modelos para generar una hipótesis de reconocimiento a partir de la señal de habla. En general, un sistema de reconocimiento emplea dos tipos de modelos: uno acústico (que modela cada uno de los fonemas considerados por el reconocedor) y uno lingüístico (que modela las secuencias de palabras que tienen sentido desde el punto de vista de la interacción). En este trabajo contextualizamos el modelo lingüístico del reconocedor de habla, de tal manera que tenga en cuenta la información proporcionada por el usuario, tanto en su intervención actual como en las previas. Estas intervenciones contienen información (semántica y/o discursiva) que puede contribuir a un mejor reconocimiento de las subsiguientes intervenciones del usuario. La estrategia de contextualización propuesta consiste en una adaptación dinámica del modelo de lenguaje empleado en el reconocedor de habla. Dicha adaptación se lleva a cabo mediante una interpolación lineal entre diferentes modelos. En lugar de entrenar los mejores pesos de interpolación, proponemos hacer los mismos dependientes de las condiciones actuales de cada diálogo. El propio sistema obtendrá estos pesos como función de la disponibilidad y relevancia de las diferentes fuentes de información disponibles, tales como los conceptos semánticos extraídos a partir de la intervención del usuario, o las acciones que el mismo desea ejecutar. Uno de los aspectos más comúnmente analizados en la investigación de la Interacción Persona-Máquina es la inclusión de las características específicas de cada usuario en las estructuras de información empleadas por el sistema. El objetivo es tener en cuenta los aspectos que diferencian a cada usuario, de tal manera que el sistema pueda ofrecer a cada uno de ellos el servicio más apropiado (o un mismo servicio, pero de la manera más adecuada a cada usuario). Podemos considerar esta estrategia como una contextualización dependiente del usuario. En este trabajo proponemos la definición de un modelo de usuario que contenga toda la información relativa a cada usuario, que pueda ser potencialmente utilizada por el sistema en un momento determinado de la interacción. En particular, analizaremos aquellas acciones que cada usuario decide ejecutar a lo largo de sus diálogos con el sistema. Nuestro objetivo es determinar cuáles de dichas acciones se convierten en las preferencias de cada usuario. La información de cada usuario quedará representada mediante un vector de características, cada una de las cuales tendrá asociado un valor de confianza. Con ambos elementos proponemos una definición probabilística de una preferencia de uso, como aquella acción cuya verosimilitud es mayor que la del resto de acciones solicitadas por el usuario. A fin de incluir la información dependiente de usuario en el flujo de diálogo, llevamos a cabo una modificación de las estructuras de información en las que se apoya el gestor de diálogo para recuperar información necesaria para resolver ciertos diálogos. En dicha modificación las preferencias de cada usuario pasarán a ser una fuente adicional de información contextual, que será tenida en cuenta por el sistema en aras de una interacción más eficiente (puesto que la nueva fuente de información contribuirá a reducir la necesidad del sistema de solicitar al usuario información adicional, dando lugar en consecuencia a una reducción del número de intervenciones necesarias para llevar a cabo una acción determinada). Para determinar los beneficios de las aplicaciones del marco de contextualización propuesto, llevamos a cabo una evaluación de un sistema de diálogo que incluye las estrategias mencionadas. Hemos recogido diversas métricas, tanto objetivas como subjetivas, que nos permiten determinar las mejoras aportadas por un sistema contextualizado en comparación con el sistema sin contextualizar. De igual manera, hemos recogido las opiniones de los participantes en la evaluación acerca de su percepción del comportamiento del sistema, y de su capacidad de adaptación a las condiciones concretas de cada interacción.

Evaluación de la contribución y el impacto de las tecnologías del habla en la detección automática del Síndrome de la Apnea Obstructiva del Sueño = Contributions and impact assessment of speech technologies on the automatic detection of severe Obstructive Sleep Apnea syndrome

La presente Tesis analiza las posibilidades que ofrecen en la actualidad las tecnologías del habla para la detección de patologías clínicas asociadas a la vía aérea superior. El estudio del habla que tradicionalmente cubre tanto la producción como el proceso de transformación del mensaje y las señales involucradas, desde el emisor hasta alcanzar al receptor, ofrece una vía de estudio alternativa para estas patologías. El hecho de que la señal emitida no solo contiene este mensaje, sino también información acerca del locutor, ha motivado el desarrollo de sistemas orientados a la identificación y verificación de la identidad de los locutores. Estos trabajos han recibido recientemente un nuevo impulso, orientándose tanto hacia la caracterización de rasgos que son comunes a varios locutores, como a las diferencias existentes entre grabaciones de un mismo locutor. Los primeros resultan especialmente relevantes para esta Tesis dado que estos rasgos podrían evidenciar la presencia de características relacionadas con una cierta condición común a varios locutores, independiente de su identidad. Tal es el caso que se enfrenta en esta Tesis, donde los rasgos identificados se relacionarían con una de la patología particular y directamente vinculada con el sistema de físico de conformación del habla. El caso del Síndrome de Apneas Hipopneas durante el Sueno (SAHS) resulta paradigmático. Se trata de una patología con una elevada prevalencia mundo, que aumenta con la edad. Los pacientes de esta patología experimentan episodios de cese involuntario de la respiración durante el sueño, que se prolongan durante varios segundos y que se reproducen a lo largo de la noche impidiendo el correcto descanso. En el caso de la apnea obstructiva, estos episodios se deben a la imposibilidad de mantener un camino abierto a través de la vía aérea, de forma que el flujo de aire se ve interrumpido. En la actualidad, el diagnostico de estos pacientes se realiza a través de un estudio polisomnográfico, que se centra en el análisis de los episodios de apnea durante el sueño, requiriendo que el paciente permanezca en el hospital durante una noche. La complejidad y el elevado coste de estos procedimientos, unidos a las crecientes listas de espera, han evidenciado la necesidad de contar con técnicas rápidas de detección, que si bien podrían no obtener tasas tan elevadas, permitirían reorganizar las listas de espera en función del grado de severidad de la patología en cada paciente. Entre otros, los sistemas de diagnostico por imagen, así como la caracterización antropométrica de los pacientes, han evidenciado la existencia de patrones anatómicos que tendrían influencia directa sobre el habla. Los trabajos dedicados al estudio del SAHS en lo relativo a como esta afecta al habla han sido escasos y algunos de ellos incluso contradictorios. Sin embargo, desde finales de la década de 1980 se conoce la existencia de patrones específicos relativos a la articulación, la fonación y la resonancia. Sin embargo, su descripción resultaba difícilmente aprovechable a través de un sistema de reconocimiento automático, pero apuntaba la existencia de un nexo entre voz y SAHS. En los últimos anos las técnicas de procesado automático han permitido el desarrollo de sistemas automáticos que ya son capaces de identificar diferencias significativas en el habla de los pacientes del SAHS, y que los distinguen de los locutores sanos. Por contra, poco se conoce acerca de la conexión entre estos nuevos resultados, los sé que habían obtenido en el pasado y la patogénesis del SAHS. Esta Tesis continua la labor desarrollada en este ámbito considerando específicamente: el estudio de la forma en que el SAHS afecta el habla de los pacientes, la mejora en las tasas de clasificación automática y la combinación de la información obtenida con los predictores utilizados por los especialistas clínicos en sus evaluaciones preliminares. Las dos primeras tareas plantean problemas simbióticos, pero diferentes. Mientras el estudio de la conexión entre el SAHS y el habla requiere de modelos acotados que puedan ser interpretados con facilidad, los sistemas de reconocimiento se sirven de un elevado número de dimensiones para la caracterización y posterior identificación de patrones. Así, la primera tarea debe permitirnos avanzar en la segunda, al igual que la incorporación de los predictores utilizados por los especialistas clínicos. La Tesis aborda el estudio tanto del habla continua como del habla sostenida, con el fin de aprovechar las sinergias y diferencias existentes entre ambas. En el análisis del habla continua se tomo como punto de partida un esquema que ya fue evaluado con anterioridad, y sobre el cual se ha tratado la evaluación y optimización de la representación del habla, así como la caracterización de los patrones específicos asociados al SAHS. Ello ha evidenciado la conexión entre el SAHS y los elementos fundamentales de la señal de voz: los formantes. Los resultados obtenidos demuestran que el éxito de estos sistemas se debe, fundamentalmente, a la capacidad de estas representaciones para describir dichas componentes, obviando las dimensiones ruidosas o con poca capacidad discriminativa. El esquema resultante ofrece una tasa de error por debajo del 18%, sirviéndose de clasificadores notablemente menos complejos que los descritos en el estado del arte y de una única grabación de voz de corta duración. En relación a la conexión entre el SAHS y los patrones observados, fue necesario considerar las diferencias inter- e intra-grupo, centrándonos en la articulación característica del locutor, sustituyendo los complejos modelos de clasificación por el estudio de los promedios espectrales. El resultado apunta con claridad hacia ciertas regiones del eje de frecuencias, sugiriendo la existencia de un estrechamiento sistemático en la sección del tracto en la región de la orofaringe, ya prevista en la patogénesis de este síndrome. En cuanto al habla sostenida, se han reproducido los estudios realizados sobre el habla continua en grabaciones de la vocal /a/ sostenida. Los resultados son cualitativamente análogos a los anteriores, si bien en este caso las tasas de clasificación resultan ser más bajas. Con el objetivo de identificar el sentido de este resultado se reprodujo el estudio de los promedios espectrales y de la variabilidad inter e intra-grupo. Ambos estudios mostraron importantes diferencias con los anteriores que podrían explicar estos resultados. Sin embargo, el habla sostenida ofrece otras oportunidades al establecer un entorno controlado para el estudio de la fonación, que también había sido identificada como una fuente de información para la detección del SAHS. De su estudio se pudo observar que, en el conjunto de datos disponibles, no existen variaciones que pudieran asociarse fácilmente con la fonación. Únicamente aquellas dimensiones que describen la distribución de energía a lo largo del eje de frecuencia evidenciaron diferencias significativas, apuntando, una vez más, en la dirección de las resonancias espectrales. Analizados los resultados anteriores, la Tesis afronta la fusión de ambas fuentes de información en un único sistema de clasificación. Con ello es posible mejorar las tasas de clasificación, bajo la hipótesis de que la información presente en el habla continua y el habla sostenida es fundamentalmente distinta. Esta tarea se realizo a través de un sencillo esquema de fusión que obtuvo un 88.6% de aciertos en clasificación (tasa de error del 11.4%), lo que representa una mejora significativa respecto al estado del arte. Finalmente, la combinación de este clasificador con los predictores utilizados por los especialistas clínicos ofreció una tasa del 91.3% (tasa de error de 8.7%), que se encuentra dentro del margen ofrecido por esquemas más costosos e intrusivos, y que a diferencia del propuesto, no pueden ser utilizados en la evaluación previa de los pacientes. Con todo, la Tesis ofrece una visión clara sobre la relación entre el SAHS y el habla, evidenciando el grado de madurez alcanzado por la tecnología del habla en la caracterización y detección del SAHS, poniendo de manifiesto que su uso para la evaluación de los pacientes ya sería posible, y dejando la puerta abierta a futuras investigaciones que continúen el trabajo aquí iniciado. ABSTRACT This Thesis explores the potential of speech technologies for the detection of clinical disorders connected to the upper airway. The study of speech traditionally covers both the production process and post processing of the signals involved, from the speaker up to the listener, offering an alternative path to study these pathologies. The fact that utterances embed not just the encoded message but also information about the speaker, has motivated the development of automatic systems oriented to the identification and verificaton the speaker’s identity. These have recently been boosted and reoriented either towards the characterization of traits that are common to several speakers, or to the differences between records of the same speaker collected under different conditions. The first are particularly relevant to this Thesis as these patterns could reveal the presence of features that are related to a common condition shared among different speakers, regardless of their identity. Such is the case faced in this Thesis, where the traits identified would relate to a particular pathology, directly connected to the speech production system. The Obstructive Sleep Apnea syndrome (OSA) is a paradigmatic case for analysis. It is a disorder with high prevalence among adults and affecting a larger number of them as they grow older. Patients suffering from this disorder experience episodes of involuntary cessation of breath during sleep that may last a few seconds and reproduce throughout the night, preventing proper rest. In the case of obstructive apnea, these episodes are related to the collapse of the pharynx, which interrupts the air flow. Currently, OSA diagnosis is done through a polysomnographic study, which focuses on the analysis of apnea episodes during sleep, requiring the patient to stay at the hospital for the whole night. The complexity and high cost of the procedures involved, combined with the waiting lists, have evidenced the need for screening techniques, which perhaps would not achieve outstanding performance rates but would allow clinicians to reorganize these lists ranking patients according to the severity of their condition. Among others, imaging diagnosis and anthropometric characterization of patients have evidenced the existence of anatomical patterns related to OSA that have direct influence on speech. Contributions devoted to the study of how this disorder affects scpeech are scarce and somehow contradictory. However, since the late 1980s the existence of specific patterns related to articulation, phonation and resonance is known. By that time these descriptions were virtually useless when coming to the development of an automatic system, but pointed out the existence of a link between speech and OSA. In recent years automatic processing techniques have evolved and are now able to identify significant differences in the speech of OSAS patients when compared to records from healthy subjects. Nevertheless, little is known about the connection between these new results with those published in the past and the pathogenesis of the OSA syndrome. This Thesis is aimed to progress beyond the previous research done in this area by addressing: the study of how OSA affects patients’ speech, the enhancement of automatic OSA classification based on speech analysis, and its integration with the information embedded in the predictors generally used by clinicians in preliminary patients’ examination. The first two tasks, though may appear symbiotic at first, are quite different. While studying the connection between speech and OSA requires simple narrow models that can be easily interpreted, classification requires larger models including a large number dimensions for the characterization and posterior identification of the observed patterns. Anyhow, it is clear that any progress made in the first task should allow us to improve our performance on the second one, and that the incorporation of the predictors used by clinicians shall contribute in this same direction. The Thesis considers both continuous and sustained speech analysis, to exploit the synergies and differences between them. On continuous speech analysis, a conventional speech processing scheme, designed and evaluated before this Thesis, was taken as a baseline. Over this initial system several alternative representations of the speech information were proposed, optimized and tested to select those more suitable for the characterization of OSA-specific patterns. Evidences were found on the existence of a connection between OSA and the fundamental constituents of the speech: the formants. Experimental results proved that the success of the proposed solution is well explained by the ability of speech representations to describe these specific OSA-related components, ignoring the noisy ones as well those presenting low discrimination capabilities. The resulting scheme obtained a 18% error rate, on a classification scheme significantly less complex than those described in the literature and operating on a single speech record. Regarding the connection between OSA and the observed patterns, it was necessary to consider inter-and intra-group differences for this analysis, and to focus on the articulation, replacing the complex classification models by the long-term average spectra. Results clearly point to certain regions on the frequency axis, suggesting the existence of a systematic narrowing in the vocal tract section at the oropharynx. This was already described in the pathogenesis of this syndrome. Regarding sustained speech, similar experiments as those conducted on continuous speech were reproduced on sustained phonations of vowel / a /. Results were qualitatively similar to the previous ones, though in this case perfomance rates were found to be noticeably lower. Trying to derive further knowledge from this result, experiments on the long-term average spectra and intraand inter-group variability ratios were also reproduced on sustained speech records. Results on both experiments showed significant differences from the previous ones obtained from continuous speech which could explain the differences observed on peformance. However, sustained speech also provided the opportunity to study phonation within the controlled framework it provides. This was also identified in the literature as a source of information for the detection of OSA. In this study it was found that, for the available dataset, no sistematic differences related to phonation could be found between the two groups of speakers. Only those dimensions which relate energy distribution along the frequency axis provided significant differences, pointing once again towards the direction of resonant components. Once classification schemes on both continuous and sustained speech were developed, the Thesis addressed their combination into a single classification system. Under the assumption that the information in continuous and sustained speech is fundamentally different, it should be possible to successfully merge the two of them. This was tested through a simple fusion scheme which obtained a 88.6% correct classification (11.4% error rate), which represents a significant improvement over the state of the art. Finally, the combination of this classifier with the variables used by clinicians obtained a 91.3% accuracy (8.7% error rate). This is within the range of alternative, but costly and intrusive schemes, which unlike the one proposed can not be used in the preliminary assessment of patients’ condition. In the end, this Thesis has shed new light on the underlying connection between OSA and speech, and evidenced the degree of maturity reached by speech technology on OSA characterization and detection, leaving the door open for future research which shall continue in the multiple directions that have been pointed out and left as future work.

User Experience in Human-Technology Interaction. Communication, context and evaluation methodology

En esta Tesis se presentan dos líneas de investigación relacionadas y que contribuyen a las áreas de Interacción Hombre-Tecnología (o Máquina; siglas en inglés: HTI o HMI), lingüística computacional y evaluación de la experiencia del usuario. Las dos líneas en cuestión son el diseño y la evaluación centrada en el usuario de sistemas de Interacción Hombre-Máquina avanzados. En la primera parte de la Tesis (Capítulos 2 a 4) se abordan cuestiones fundamentales del diseño de sistemas HMI avanzados. El Capítulo 2 presenta una panorámica del estado del arte de la investigación en el ámbito de los sistemas conversacionales multimodales, con la que se enmarca el trabajo de investigación presentado en el resto de la Tesis. Los Capítulos 3 y 4 se centran en dos grandes aspectos del diseño de sistemas HMI: un gestor del diálogo generalizado para tratar la Interacción Hombre-Máquina multimodal y sensible al contexto, y el uso de agentes animados personificados (ECAs) para mejorar la robustez del diálogo, respectivamente. El Capítulo 3, sobre gestión del diálogo, aborda el tratamiento de la heterogeneidad de la información proveniente de las modalidades comunicativas y de los sensores externos. En este capítulo se propone, en un nivel de abstracción alto, una arquitectura para la gestión del diálogo con influjos heterogéneos de información, apoyándose en el uso de State Chart XML. En el Capítulo 4 se presenta una contribución a la representación interna de intenciones comunicativas, y su traducción a secuencias de gestos a ejecutar por parte de un ECA, diseñados específicamente para mejorar la robustez en situaciones de diálogo críticas que pueden surgir, por ejemplo, cuando se producen errores de entendimiento en la comunicación entre el usuario humano y la máquina. Se propone, en estas páginas, una extensión del Functional Mark-up Language definido en el marco conceptual SAIBA. Esta extensión permite representar actos comunicativos que realizan intenciones del emisor (la máquina) que no se pretende sean captadas conscientemente por el receptor (el usuario humano), pero con las que se pretende influirle a éste e influir el curso del diálogo. Esto se consigue mediante un objeto llamado Base de Intenciones Comunicativas (en inglés, Communication Intention Base, o CIB). La representación en el CIB de intenciones “no claradas” además de las explícitas permite la construcción de actos comunicativos que realizan simultáneamente varias intenciones comunicativas. En el Capítulo 4 también se describe un sistema experimental para el control remoto (simulado) de un asistente domótico, con autenticación de locutor para dar acceso, y con un ECA en el interfaz de cada una de estas tareas. Se incluye una descripción de las secuencias de comportamiento verbal y no verbal de los ECAs, que fueron diseñados específicamente para determinadas situaciones con objeto de mejorar la robustez del diálogo. Los Capítulos 5 a 7 conforman la parte de la Tesis dedicada a la evaluación. El Capítulo 5 repasa antecedentes relevantes en la literatura de tecnologías de la información en general, y de sistemas de interacción hablada en particular. Los principales antecedentes en el ámbito de la evaluación de la interacción sobre los cuales se ha desarrollado el trabajo presentado en esta Tesis son el Technology Acceptance Model (TAM), la herramienta Subjective Assessment of Speech System Interfaces (SASSI), y la Recomendación P.851 de la ITU-T. En el Capítulo 6 se describen un marco y una metodología de evaluación aplicados a la experiencia del usuario con sistemas HMI multimodales. Se desarrolló con este propósito un novedoso marco de evaluación subjetiva de la calidad de la experiencia del usuario y su relación con la aceptación por parte del mismo de la tecnología HMI (el nombre dado en inglés a este marco es Subjective Quality Evaluation Framework). En este marco se articula una estructura de clases de factores subjetivos relacionados con la satisfacción y aceptación por parte del usuario de la tecnología HMI propuesta. Esta estructura, tal y como se propone en la presente tesis, tiene dos dimensiones ortogonales. Primero se identifican tres grandes clases de parámetros relacionados con la aceptación por parte del usuario: “agradabilidad ” (likeability: aquellos que tienen que ver con la experiencia de uso, sin entrar en valoraciones de utilidad), rechazo (los cuales sólo pueden tener una valencia negativa) y percepción de utilidad. En segundo lugar, este conjunto clases se reproduce para distintos “niveles, o focos, percepción del usuario”. Éstos incluyen, como mínimo, un nivel de valoración global del sistema, niveles correspondientes a las tareas a realizar y objetivos a alcanzar, y un nivel de interfaz (en los casos propuestos en esta tesis, el interfaz es un sistema de diálogo con o sin un ECA). En el Capítulo 7 se presenta una evaluación empírica del sistema descrito en el Capítulo 4. El estudio se apoya en los mencionados antecedentes en la literatura, ampliados con parámetros para el estudio específico de los agentes animados (los ECAs), la auto-evaluación de las emociones de los usuarios, así como determinados factores de rechazo (concretamente, la preocupación por la privacidad y la seguridad). También se evalúa el marco de evaluación subjetiva de la calidad propuesto en el capítulo anterior. Los análisis de factores efectuados revelan una estructura de parámetros muy cercana conceptualmente a la división de clases en utilidad-agradabilidad-rechazo propuesta en dicho marco, resultado que da cierta validez empírica al marco. Análisis basados en regresiones lineales revelan estructuras de dependencias e interrelación entre los parámetros subjetivos y objetivos considerados. El efecto central de mediación, descrito en el Technology Acceptance Model, de la utilidad percibida sobre la relación de dependencia entre la intención de uso y la facilidad de uso percibida, se confirma en el estudio presentado en la presente Tesis. Además, se ha encontrado que esta estructura de relaciones se fortalece, en el estudio concreto presentado en estas páginas, si las variables consideradas se generalizan para cubrir más ampliamente las categorías de agradabilidad y utilidad contempladas en el marco de evaluación subjetiva de calidad. Se ha observado, asimismo, que los factores de rechazo aparecen como un componente propio en los análisis de factores, y además se distinguen por su comportamiento: moderan la relación entre la intención de uso (que es el principal indicador de la aceptación del usuario) y su predictor más fuerte, la utilidad percibida. Se presentan también resultados de menor importancia referentes a los efectos de los ECAs sobre los interfaces de los sistemas de diálogo y sobre los parámetros de percepción y las valoraciones de los usuarios que juegan un papel en conformar su aceptación de la tecnología. A pesar de que se observa un rendimiento de la interacción dialogada ligeramente mejor con ECAs, las opiniones subjetivas son muy similares entre los dos grupos experimentales (uno interactuando con un sistema de diálogo con ECA, y el otro sin ECA). Entre las pequeñas diferencias encontradas entre los dos grupos destacan las siguientes: en el grupo experimental sin ECA (es decir, con interfaz sólo de voz) se observó un efecto más directo de los problemas de diálogo (por ejemplo, errores de reconocimiento) sobre la percepción de robustez, mientras que el grupo con ECA tuvo una respuesta emocional más positiva cuando se producían problemas. Los ECAs parecen generar inicialmente expectativas más elevadas en cuanto a las capacidades del sistema, y los usuarios de este grupo se declaran más seguros de sí mismos en su interacción. Por último, se observan algunos indicios de efectos sociales de los ECAs: la “amigabilidad ” percibida los ECAs estaba correlada con un incremento la preocupación por la seguridad. Asimismo, los usuarios del sistema con ECAs tendían más a culparse a sí mismos, en lugar de culpar al sistema, de los problemas de diálogo que pudieran surgir, mientras que se observó una ligera tendencia opuesta en el caso de los usuarios del sistema con interacción sólo de voz. ABSTRACT This Thesis presents two related lines of research work contributing to the general fields of Human-Technology (or Machine) Interaction (HTI, or HMI), computational linguistics, and user experience evaluation. These two lines are the design and user-focused evaluation of advanced Human-Machine (or Technology) Interaction systems. The first part of the Thesis (Chapters 2 to 4) is centred on advanced HMI system design. Chapter 2 provides a background overview of the state of research in multimodal conversational systems. This sets the stage for the research work presented in the rest of the Thesis. Chapers 3 and 4 focus on two major aspects of HMI design in detail: a generalised dialogue manager for context-aware multimodal HMI, and embodied conversational agents (ECAs, or animated agents) to improve dialogue robustness, respectively. Chapter 3, on dialogue management, deals with how to handle information heterogeneity, both from the communication modalities or from external sensors. A highly abstracted architectural contribution based on State Chart XML is proposed. Chapter 4 presents a contribution for the internal representation of communication intentions and their translation into gestural sequences for an ECA, especially designed to improve robustness in critical dialogue situations such as when miscommunication occurs. We propose an extension of the functionality of Functional Mark-up Language, as envisaged in much of the work in the SAIBA framework. Our extension allows the representation of communication acts that carry intentions that are not for the interlocutor to know of, but which are made to influence him or her as well as the flow of the dialogue itself. This is achieved through a design element we have called the Communication Intention Base. Such r pr s ntation of “non- clar ” int ntions allows th construction of communication acts that carry several communication intentions simultaneously. Also in Chapter 4, an experimental system is described which allows (simulated) remote control to a home automation assistant, with biometric (speaker) authentication to grant access, featuring embodied conversation agents for each of the tasks. The discussion includes a description of the behavioural sequences for the ECAs, which were designed for specific dialogue situations with particular attention given to the objective of improving dialogue robustness. Chapters 5 to 7 form the evaluation part of the Thesis. Chapter 5 reviews evaluation approaches in the literature for information technologies, as well as in particular for speech-based interaction systems, that are useful precedents to the contributions of the present Thesis. The main evaluation precedents on which the work in this Thesis has built are the Technology Acceptance Model (TAM), the Subjective Assessment of Speech System Interfaces (SASSI) tool, and ITU-T Recommendation P.851. Chapter 6 presents the author’s work in establishing an valuation framework and methodology applied to the users’ experience with multimodal HMI systems. A novel user-acceptance Subjective Quality Evaluation Framework was developed by the author specifically for this purpose. A class structure arises from two orthogonal sets of dimensions. First we identify three broad classes of parameters related with user acceptance: likeability factors (those that have to do with the experience of using the system), rejection factors (which can only have a negative valence) and perception of usefulness. Secondly, the class structure is further broken down into several “user perception levels”; at the very least: an overall system-assessment level, task and goal-related levels, and an interface level (e.g., a dialogue system with or without an ECA). An empirical evaluation of the system described in Chapter 4 is presented in Chapter 7. The study was based on the abovementioned precedents in the literature, expanded with categories covering the inclusion of an ECA, the users’ s lf-assessed emotions, and particular rejection factors (privacy and security concerns). The Subjective Quality Evaluation Framework proposed in the previous chapter was also scrutinised. Factor analyses revealed an item structure very much related conceptually to the usefulness-likeability-rejection class division introduced above, thus giving it some empirical weight. Regression-based analysis revealed structures of dependencies, paths of interrelations, between the subjective and objective parameters considered. The central mediation effect, in the Technology Acceptance Model, of perceived usefulness on the dependency relationship of intention-to-use with perceived ease of use was confirmed in this study. Furthermore, the pattern of relationships was stronger for variables covering more broadly the likeability and usefulness categories in the Subjective Quality Evaluation Framework. Rejection factors were found to have a distinct presence as components in factor analyses, as well as distinct behaviour: they were found to moderate the relationship between intention-to-use (the main measure of user acceptance) and its strongest predictor, perceived usefulness. Insights of secondary importance are also given regarding the effect of ECAs on the interface of spoken dialogue systems and the dimensions of user perception and judgement attitude that may have a role in determining user acceptance of the technology. Despite observing slightly better performance values in the case of the system with the ECA, subjective opinions regarding both systems were, overall, very similar. Minor differences between two experimental groups (one interacting with an ECA, the other only through speech) include a more direct effect of dialogue problems (e.g., non-understandings) on perceived dialogue robustness for the voice-only interface test group, and a more positive emotional response for the ECA test group. Our findings further suggest that the ECA generates higher initial expectations, and users seem slightly more confident in their interaction with the ECA than do those without it. Finally, mild evidence of social effects of ECAs was also found: the perceived friendliness of the ECA increased security concerns, and ECA users may tend to blame themselves rather than the system when dialogue problems are encountered, while the opposite may be true for voice-only users.

Types of metaphor in civil engineering communication

La metáfora y otros mecanismos imaginativos subyacentes al pensa- miento y lenguaje humanos pueden ser utilizados en el discurso diario y especializado (Lakoff y Johnson 1980; Lakoff y Nuñez 2000). Asimismo pueden aparecer en la comunicación no verbal (Forceville y Urios-Aparisi 2009; Littlemore et al. Este volumen).Partiendo de estudios cognitivos y de la teoría de integración conceptual (Fauconnier 1997; Fauconnier y Turner 2002), este artículo examina la presencia de la metáfora en la ingeniería. Primeramente, se analiza un corpus lingüístico procedente de artículos de investigación de ingeniería civil. Los datos revelan el uso de la metáfora antropomórfica, sobre todo en expresiones relativas a la salud, como “diagnóstico”, “auscultación” o “proceso de curación”. Se exploran además ejemplos de ingeniería cuya fuente son proyecciones conceptuales corporales. Finalmente, abordamos la función de la metáfora visual bajo la teoría de integración conceptual mediante representaciones de ingeniería que evocan la anatomía humana o animal. Metaphor and other imaginative mechanisms that underlie human thought and language such as metonymy are used in everyday and specialised discourse (Lakoff and Johnson 1980; Lakoff and Nuñez 2000) They can also be involved in non- verbal forms of communication (Forceville and Urios-Aparisi 2009; Littlemore et al. this volume). Drawing on metaphor cognitive studies and on conceptual integration theory (Fauconnier 1997; Fauconnier and Turner 2002) this paper examines the occurrence of metaphor in engineering. First, we analyse results from a linguistic corpus formed by research papers from civil engineering journals. These data reveal the use of anthropomorphic metaphor, especially related to health or medical mappings such as “diagnosing”, “auscultation” or “curing”. Then, we explore how engineering notions are instantiated by bodily conceptual mappings according to conceptual integration theory. Finally, the function of visual metaphor is examined with conceptual integration theory by using engineering images evoking parts of human or animal anatomy.

Usability study for the design of a communicator for ICU patients with communication difficulties

Most of the patients that reside in the intensive care unit experience fear, frustration and high levels of anxiety as they are not able to communicate properly. In this sense, the use of communication tools can be helpful to reduce the frustration levels and also, to improve the efficiency and the speed of the communication. The objective of this work, is to design a tool that allows solving the communication problems that patients suffer when they are admitted in the intensive care unit. In order to achieve the objective of this work, a qualitative study that involved interviews with former patients, hospital staff members and family relatives was performed. Afterwards, the design of a prototype was developed to later conduct and analyze usability evaluations with former patients, hospital staff members and patients relatives. The results expose that participants of the usability evaluations were able to perform most of the tasks effectively.

Syntax processing by auditory cortical neurons in the FM–FM area of the mustached bat Pteronotus parnellii

Syntax denotes a rule system that allows one to predict the sequencing of communication signals. Despite its significance for both human speech processing and animal acoustic communication, the representation of syntactic structure in the mammalian brain has not been studied electrophysiologically at the single-unit level. In the search for a neuronal correlate for syntax, we used playback of natural and temporally destructured complex species-specific communication calls—so-called composites—while recording extracellularly from neurons in a physiologically well defined area (the FM–FM area) of the mustached bat’s auditory cortex. Even though this area is known to be involved in the processing of target distance information for echolocation, we found that units in the FM–FM area were highly responsive to composites. The finding that neuronal responses were strongly affected by manipulation in the time domain of the natural composite structure lends support to the hypothesis that syntax processing in mammals occurs at least at the level of the nonprimary auditory cortex.

Evolution of GABAergic circuitry in the mammalian medial geniculate body.

Many features in the mammalian sensory thalamus, such as the types of neurons, their connections, or their neurotransmitters, are conserved in evolution. We found a wide range in the proportion of gamma-aminobutyric acidergic (GABAergic) neurons in the medial geniculate body, from <1% (bat and rat) to 25% or more (cat and monkey). In the bat, some medial geniculate body subdivisions have no GABAergic cells. Species-specific variation also occurs in the somesthetic ventrobasal complex. In contrast, the lateral geniculate body of the visual system has about the same proportion of GABAergic cells in many species. In the central auditory pathway, only the medial geniculate body shows this arrangement; the relative number of GABAergic cells in the inferior colliculus and auditory cortex is similar in each species. The range in the proportion of GABAergic neurons suggests that there are comparative differences in the neural circuitry for thalamic inhibition. We conclude that the number of GABAergic neurons in thalamic sensory nuclei may have evolved independently or divergently in phylogeny. Perhaps these adaptations reflect neurobehavioral requirements for more complex, less stereotyped processing, as in speech-like communication.

Cell-cell communication regulates the effects of protein aspartate phosphatases on the phosphorelay controlling development in Bacillus subtilis.

Rap phosphatases are a recently discovered family of protein aspartate phosphatases that dephosphorylate the Spo0F--P intermediate of the phosphorelay, thus preventing sporulation of Bacillus subtilis. They are regulators induced by physiological processes that are antithetical to sporulation. The RapA phosphatase is induced by the ComP-ComA two-component signal transduction system responsible for initiating competence. RapA phosphatase activity was found to be controlled by a small protein, PhrA, encoded on the same transcript as RapA. PhrA resembles secreted proteins and the evidence suggests that it is cleaved by signal peptidase I and a 19-residue C-terminal domain is secreted from the cell. The sporulation deficiency caused by the uncontrolled RapA activity of a phrA mutant can be complemented by synthetic peptides comprising the last six or more of the C-terminal residues of PhrA. Whether the peptide controls RapA activity directly or by regulating its synthesis remains to be determined. Complementation of the phrA mutant can also be obtained in mixed cultures with a wild-type strain, suggesting the peptide may serve as a means of communication between cells. Importation of the secreted peptide required the oligopeptide transport system. The sporulation deficiency of oligopeptide transport mutants can be suppressed by mutating the rapA and rapB genes or by introduction of a spo0F mutation Y13S that renders the protein insensitive to Rap phosphatases. The data indicate that the sporulation deficiency of oligopeptide transport mutants is due to their inability to import the peptides controlling Rap phosphatases.

Communication in Cyberspace

This Article examines a problem in cybercrime law that is both persistent and pervasive. What counts as “communication” on the Internet? Defining the term is particularly important for crimes such as cyberstalking, cyberharassment, and cyberbullying, where most statutes require a showing that the alleged perpetrator “communicated” with the victim or impose a similar requirement through slightly different language. This Article takes up the important task of defining communication. As a foundation to our discussion, we provide the first comprehensive survey of state statutes and case law relating to cyberstalking, cyberharassment, and cyberbullying. We then examine the realities of the way people use the Internet to develop a definition of “communication” that reflects those realities. That is, we aim to provide effective tools by which prosecutors can address wrongful conduct without punishing innocuous behavior or chilling speech. We conclude by proposing a model statute that appropriately defines “communication.” We recommend that state legislatures adopt the statute or modify existing laws to match it in pertinent part and demonstrate how the statute would apply in a range of situations.

De-authoring or Authoring?: A plunge into the question of authorship and language in J.M. Coetzee's Foe

J. M. Coetzee's Foe is not only a post-colonial novel, but it is also a re-writing of a classic, and its main themes are language, authorship, power and identity. Moreover, Foe is narrated by a woman, while written by a male, Nobel prize winning South African author. The aim of my tesina is to focus on the question of authorship and the role of language in Foe. Without any claim to be exhaustive, in the first section I will examine some selected extracts of Coetzee's book, in order to provide an analysis of the novel. These quotations will mainly be its metalinguistic parts and will be analysed in the “theory” sections of my work, relying on literary theory and on previous works on the novel. Among others, I will cover themes such as the relationship between speech and writing, the connection between writing, history, and memory, the role of silence and alternative ways of communicating and the relationship between literary authority and truth. These arguments will be the foundation for my second section, in which I will attempt to shed a light on the importance of the novel from a linguistic point of view, but always keeping an eye on the implication that this has on authorship. While it is true that it is less politically-permeated than Coetzee's previous works, Foe is above all a “journey of discovery” in the world of language and authorship. In fact, it becomes a warning for any person immersed in the ocean of language since, while everyone naturally tends to trust speech and writing as the only medium through which one can get closer to the truth, authority never is a synonym of reliability, and language is a system of communication behind which structures of power, misconceptions, lies, and treacherous tides easily hide.

The pragmatics of computer-mediated communication between South African and Mexican drug traffickers

South Africa and Mexico are ripe with drug trafficking. The gangs and syndicates running the drug businesses in these two countries collaborate occasionally. Communication between these international drug business partners takes place on social media. Their main language of communication is English, mixed with some limited use of Spanish and Afrikaans. The key purpose of the interactions between the South African and Mexican parties is the organisation of their business activities. This study aims at examining how the drug traffickers position each other and themselves regarding their common business interest and how their relationship evolves throughout their interactions. Moreover, it is of interest to look at how these people make use of different social media and their affordances. For this a qualitative analysis of the interaction between two drug traffickers (one South African and one Mexican) on Facebook, Threema and PlayStation 4 was performed. Computer-mediated communication between these two main informants was studied at various stages of their relationship. Results show that at first the interaction between the South African and Mexican drug traffickers consists of interpersonal negotiations of power. The high risk of the drug business and gang/syndicate membership paired with intercultural frictions causes the two interlocutors to be extremely cautious and at the same time to mark their position. As their relationship develops and they gain trust in each other a shift to interpersonal negotiations of solidarity takes place. In these discursive practices diverse linguistic strategies are employed for creating relational effects and for positioning the other and the self. The discursive activities of the interactants are also identity practices. Thus, the two drug traffickers construct identities through these social practices, positioning and their interpersonal relationship.

Abstract of Mr. Walker's Texas speech delivered in the United States Senate, May 20, 1844.

Caption title.

Meeting in the middle: Improving communication in primary health care consultations with people with an intellectual disability

The increased presence and participation in Australian society of people with an intellectual disability provides challenges for the provision of primary health care. General practitioners (GPs) identify themselves as ill equipped to provide for this heterogeneous population. A major obstacle to the provision of appropriate health care is seen as inadequate communication between the GP and the person with an intellectual disability, who may or may not be accompanied by a carer or advocate. This qualitative study in which five GPs, three people with intellectual disability, seven carers and two advocates (parent and friend) were interviewed was conducted in Brisbane, Australia. The aim was to better understand the factors that have an impact upon the success of communication in a medical consultation. Findings suggested that GPs were concerned with the aspects of communication difficulties which influenced their ability to adequately diagnose, manage and inform patients. Implications for practice management were also identified. People with intellectual disability reported frustration when they felt that they could not communicate adequately with the GP and annoyance when they were not included in the communication exchange. Carers were strong advocates for the person with intellectual disability, but indicated insufficient skill and knowledge to provide the level of assistance required in the consultation. The outcome was a model of cooperation that outlined the responsibilities of all players in the medical encounter, prior to, during and after the event.