A avaliação miofuncional orofacial é etapa fundamental no processo de diagnóstico na área de motricidade orofacial (MO), possibilita a compreensão das condições anatômicas e funcionais do sistema estomatognático, permitindo estabelecer o raciocínio terapêutico e definir encaminhamentos. Vários autores escreveram a respeito da necessidade da prática baseada em evidências e recomendaram o uso de protocolos validados para o diagnóstico, bem como para a terapia. Atualmente, três protocolos de avaliação miofuncional orofacial estão validados e publicados. São eles: o The Nordic Orofacial Test-Screening NOT-S, o Protocolo de Avaliação Miofuncional Orofacial com Escores - AMIOFE, validado para crianças, o qual caracteriza as condições musculares e funcionais com base nos escores, permitindo definir não apenas a presença ou ausência, mas também o grau de distúrbio miofuncional orofacial (DMO) e o protocolo de Avaliação Miofuncional Orofacial com Escores Ampliados - AMIOFE-A. O AMIOFE já foi usado para diagnóstico e análise da evolução de tratamentos em sujeitos jovens e adultos com desordem temporomandibular (DTM), porém não foi validado para esta população. O objetivo do presente estudo foi analisar a validade de critério, a validade de construto, e a confiabilidade intra e entre - examinadores, assim como valores de sensibilidade (S), especificidade (E), valores preditivos (VP+ e VP-) e prevalência (P) do AMIOFE para jovens e adultos. Participaram 50 sujeitos com DTM (GDTM) e 30 sujeitos sem DTM (CA), todos avaliados e selecionados a partir do exame clínico com o RDC/TMD. A validade de critério do protocolo AMIOFE foi analisada pela comparação com o protocolo NOT-S. A validade de construto foi analisada pela: (a) comparação do GDTM ao CA, para verificar a capacidade do AMIOFE em diferenciar sujeitos com e sem DMO; (b) comparação do grupo com DTM antes e após TMO, a fim de analisar a habilidade do AMIOFE para mensurar as mudanças ocorridas em decorrência do tratamento. Para tanto, os dados da avaliação miofuncional orofacial dos dez sujeitos com DTM que receberam terapia miofuncional orofacial (GT) foram comparados na fase diagnóstica e na fase final após 120 dias de tratamento. Dois examinadores, fonoaudiológos devidamente treinados e calibrados, denominados E1 e E2, realizaram as avaliações. De acordo com os resultados houve correlação negativa significante entre os protocolos AMIOFE e NOT-S (r= -0,86, p < 0,01). A validade de construto do AMIOFE foi demonstrada pela capacidade do AMIOFE refletir as condições miofuncionais orofaciais normais e alteradas pelas diferenças observadas entre os escores dos grupos CA e GDTM, nos itens aparência/postura, mobilidade e nas funções de mastigação e deglutição (p < 0,05). O AMIOFE foi capaz de mensurar as mudanças ocorridas entre a FD e a FF do tratamento proposto. A força de concordância medida pelo Kappa Ponderado (Kw) entre-examinadores E1 e E2 variou de razoável a moderada, e os valores de confiabilidade foi 0,88, considerado bom (r = 0,78, P< 0,01). A concordância intra-examinador para E2 variou de razoável a moderada e a confiabilidade para aplicação do AMIOFE foi de 0,92, isto é, excelente (r = 0,84, P< 0,01). A concordância para a aplicação do protocolo NOTS, variou de razoável a boa, e a confiabilidade foi de 0,89 (r = 0,80, P< 0,01). Para os demais índices, foram encontrados os seguintes valores utilizando a mediana e os percentis, apresentados respectivamente, S (80,5 - 65,38), E (80,0 - 92,59), VP+ (76,0 - 80,95), VP- (83,7 - 84,74) e P (46,2 - 26,25). De acordo com os resultados concluiuse que o protocolo AMIOFE é válido, confiável e proporciona um diagnóstico com boa 10 margem de acerto, tanto para os casos positivos como negativos. Sua aplicação clínica e em pesquisas é viável devido à própria construção do protocolo que fornece a indicação do escore a ser atribuído, com base na descrição semântica que o acompanha. / The clinical orofacial myofunctional evaluation is a fundamental step in the diagnosis process of orofacial myofunctional area, making possible to understand the anatomical and functional conditions of the stomatognathic system, allowing to establish the therapeutic reasoning and define the referrals. Several authors have written about the need for an evidence-based practice (EBP), recommending the use of validated protocols for diagnosis, well as therapy. Currently, three miofunctional protocols are validated and published. They are: The Nordic Orofacial Test-Screening NOT-S, the protocol of orofacial myofunctional evaluation with scores - OMES, validated for children, characterizing the functional and muscular condition based on scores, allowing to define not only the presence or absence, but also the degree of orofacial myofunctional disorders, and the protocol of orofacial myofunctional evaluation with scores expanded (OMES-E). The OMES has been used for diagnosis and to analyze the treatment evolution in young subjects and adults with temporomandibular disorder (TMD), but was not validated for this population. The aim of the present report is to assess the criterion validity, construct validity, and the intra- and inter-examiner, as well as sensitivity (S), specificity (SP), predictive values (PV+ and PV-) and prevalence (P) of OMES for adult. 50 subjects with TMD (GDTM) and 30 subjects without TMD (CA) participated, all them evaluated and selected from the clinical examination with RDC/TMD. The criterion validity of the protocol OMES was analyzed by comparing it with the NOT-S protocol. Construct validity was assessed by: (a) comparing GTMD to CA, to verify the OMES ability to differentiate subjects with and without DMO; (b) comparing the group with DTM before and after TMO, to analize the AMIOFE hability to measure changes due to treatment. For this, the orofacial myofunctional evaluation data from the ten subjects with DTM that received orofacial myofunctional therapy (GT) were compared in the diagnostic phase and the final stage after 120 days of treatment. Two examiners, speech therapists trained and calibrated, called E1 and E2, performed the evaluation. According to the results there was a significant negative correlation between the protocols OMES and NOT-S (r= -0,86, p < 0,01). The construct validity of OMES was demonstrated by the ability of OMES reflect the normal and altered myofunctional orofacial condictions by the differences between the groups scores GTMD and CA, in the items appearance / posture, mobility and in the functions of deglutition and mastication (p < 0,05). The OMES was able to measure the changes between FD and FF of the proposed treatment. The agreement the linear mensure by weighted Kappa coefficient (Kw) inter-examiner E1 e E2 ranged between reasonable to moderate, and the value of reliability was 0,88, considered good (r = 0,78, P< 0,01). The agreement intra-examiner for E2 ranged from reasonable to moderate and the reliability to AMIOFE application was 0,92, ie, excellent (r = 0,84, P< 0,01). The agreement for NOT-S protocol application ranged from reasonable to good, and the reliability was 0,89 (r = 0,80, P< 0,01). For the others items, were found the following values using the median and the percentile, presented respectively, S (80,5 - 65,38), SP (80,0 - 92,59), PV+ (76,0 - 80,95), PV- (83,7 - 84,74) e P (46,2 - 26,25). According to the results, concluded that the OMES protocol is valid, and provides a reliable diagnosis with a good margin of success, for both positive and negative cases. Clinical application and in research is feasible because of the actual construction of the protocol provides indication of the score to be assigned, based on semantic description that accompanies it.

A definição de valores de referência a partir de sujeitos saudáveis é fundamental como parâmetro para o diagnóstico na área da saúde. Os objetivos deste estudo foram estabelecer valores de referência para a condição miofuncional orofacial, para as forças orofaciais e para a eficiência mastigatória, por meio de um escore de padronização e analisar as relações entre as variáveis, após estabelecer um índice de desempenho para as forças orofaciais e eficiência mastigatória. De um total de 316 sujeitos, foram selecionados 50 participantes, 21 homens e 29 mulheres, de 18 a 40 anos, sem desordem temporomandibular, sem distúrbio miofuncional orofacial e em normoclusão (classe I de Angle). Os sujeitos foram avaliados por meio do Protocolo de Avaliação Miofuncional Orofacial com Escores (AMIOFE) para investigação da condição miofuncional orofacial. As forças isométricas máximas de mordida direita e esquerda, das bochechas direita e esquerda, da língua na região anterior e dorso e dos lábios foram avaliadas por um dinamômetro eletrônico Kratos® e os valores foram registrados em Newtons (N). Para todas as forças foram realizadas 3 medidas e obtida a média. A eficiência mastigatória foi analisada pelo método colorimétrico com beads, obtendo-se a concentração de fucsina em micrograma por mililitro (µg/ml). A eficiência foi avaliada em situação de mastigação habitual, mastigação unilateral direita e esquerda, durante 20 segundos cada. Para todas as variáveis foi calculado o escore Z, para identificação de seus valores de referência e os pontos de corte que diferenciou os sujeitos normais e alterados; os valores das forças orofaciais e da eficiência mastigatória destes sujeitos foram transformados em índice de desempenho, para 34 sujeitos da amostra que foram considerados normais. O erro casual do método foi calculado para todas as variáveis. Para análise estatística foi utilizado o teste de correlação de Spearman, por meio do Programa MedCalc® e o nível de significância adotado foi p<0,05. Os valores médios de referência estabelecidos a partir do escore Z foram: para a condição miofuncional orofacial 95,79 ± 3,74; para a média da força de mordida direita e esquerda 431,08 ± 138,01N; para a média da força de bochechas direita e esquerda 17,92 ± 7,44N; para a força de língua na região anterior 9,45 ± 4,01N; para a força de língua na região de dorso 13,44 ± 5,46N; para a força de lábios 4,31 ± 1,48N; para a eficiência mastigatória habitual 0,72 ± 0,31µg/ml; para a eficiência mastigatória a direita 0,71 ± 0,30µg/ml e para a eficiência mastigatória a esquerda 0,78 ± 0,37µg/ml. Não foram encontradas correlações entre os índices de desempenho das forças orofaciais e da eficiência mastigatória (r=0,102, p>0,05), entre o índice de desempenho das forças orofaciais e a condição miofuncional orofacial (r=-0,005, p>0,05), nem entre o índice de desempenho da eficiência mastigatória e a condição miofuncional orofacial (r=0,059, p>0,05). Não foi observado neste estudo relação entre a biomecânica orofacial e a eficiência mastigatória. / The definition of reference values of healthy subjects is a fundamental parameter for the diagnosis in health. The aims of this study were to establish reference values based on standardized score for the orofacial myofunctional condition, for the orofacial strength and for the masticatory efficiency, and to analyze the relationships between them, after establishing a performance index for orofacial strength and masticatory efficiency. From a total of 316 subjects, 50 participants were selected, 21 men and 29 women, ranging from 18 to 40 years old, without temporomandibular disorder, no orofacial myofunctional disorder and presenting normal occlusion. Subjects were assessed using the Orofacial Myofunctional Evaluation Protocol with Scores (OMES) to investigate the orofacial myofunctional condition. The orofacial strength evaluated were maximal isometric bite forces on the right and left sides, maximal isometric cheeks strength on the right and left sides, maximal isometric tongue strength on the anterior and dorsum region and maximal isometric lips strength using an electronic dynamometer Kratos®. The values were recorded in Newton (N). The mean value of three trials of each orofacial strength was obtained. The masticatory efficiency was analyzed by colorimetric method with beads. The fuchsine concentration in micrograms per milliliter (µg/ml) was obtained. The masticatory efficiency was evaluated in three conditions: habitual, right and left unilateral chewing, for 20 seconds each one. For all variables, the Z scores were calculated to determine the reference values and cutoff values that differentiate the normal and abnormal subjects. The orofacial strength and masticatory efficiency values were transformed into the performance index, for 34 participants that were defined as normal subjects. The random error was calculated for all variables. Statistical analysis was performed using Spearman correlation test, using the MedCalc® program and the level of significance was p<0.05. The reference values (mean and standard deviation), established from the Z score, were 95.79 ± 3.74 for the orofacial myofunctional condition; 431.08 ± 138.01N for the maximal isometric bite force; 17.92 ± 7.44N for the maximal isometric cheeks strength; 9.45 ± 4.01N for the maximal isometric tongue strength in the anterior region; 13.44 ± 5.46N for the maximal isometric tongue strength in the dorsum region; 4.31 ± 1.48N for the maximal isometric lips strength; 0.72 ± 0.31µg/ml for the habitual masticatory efficiency; 0.71 ± 0.30µg/ml for the right masticatory efficiency, 0.78 ± 0.37µg/ml for the left masticatory efficiency. No correlations were found neither between the orofacial strength performance index and masticatory efficiency performance index (r=0.102, p>0.05), the orofacial strength performance index and orofacial myofunctional condition (r=-0.005, p>0.05), nor between the masticatory efficiency performance index and orofacial myofunctional condition (r=0.059, p>0.05). There was no relationship between the biomechanics orofacial and masticatory efficiency in this study.

Na literatura, há apenas um protocolo de avaliação miofuncional orofacial validado, o Protocolo de avaliação miofuncional orofacial com escores (AMIOFE) (Felício e Ferreira, 2008). Apesar da reconhecida importância da avaliação perceptiva esta apresenta certas limitações devido à sua subjetividade, além disso, a maior precisão nos resultados é obtida com escalas numéricas de avaliação mais amplas. As escalas numéricas e o número de itens a serem avaliados pelo protocolo AMIOFE foram ampliados, visando possibilitar a detecção e registro de pequenas diferenças nas características físicas e nos comportamentos orofaciais entre-sujeitos e variações intra-sujeito ao longo do tempo. Os objetivos deste estudo foram descrever o Protocolo AMIOFE ampliado (AMIOFE-A), analisar a validade, a confiabilidade e a concordância, bem como investigar os valores de sensibilidade, de especificidade e preditivos do protocolo proposto. A amostra para o presente estudo foi composta de imagens registradas e vídeo de 50 crianças, 25 meninos (média de idade=8,4 anos, desvio padrão=1,8) e 25 meninas (media de idade=8,2 anos, desvio padrão=1,7). Três fonoaudiólogas preparadas para avaliação miofuncional orofacial foram escolhidas após a análise da habilidade delas para usar o protocolo AMIOFE. Para a análise da validade de critério do protocolo AMIOFE-A as crianças foram avaliadas individualmente pela análise das imagens gravadas em DVD pelos protocolos AMIOFE e AMIOFE-A. Para a complementação da validade de critério foi realizada a testagem da confiabilidade e da concordância de aplicação e/ou de interpretação do AMIOFE-A. Foram empregados os testes estatísticos de correlação de Spearman e o método de confiabiliadade Split-half, com nível de significância a 0,05, também foi calculado o coeficiente Kappa ponderado linear (Kw), os valores de sensibilidade (S), a especificidade (E), os valores preditivos (VP+ e VP-) e a prevalência (P). Houve correlação estatisticamente significante entre as avaliações realizadas com os protocolos AMIOFE e AMIOE-A, os valores, de acordo com os examinadores, foram E1 (r=0,81, p<0,01), E2 (r=0,79, p<0,01) e E3 (r=0,94, p<0,01). A concordância entre os protocolos foram para E1 de 0,89, de 0,88 para E2, e de 0,97 para E3. Os valores dos coeficientes de correlação e de confiabilidade entre o testereteste com o AMIOFE-A foram: E1 (r=0,86, 0,93), E2 (r=0,75, 0,86) e E3 (r=0,80, 0,89). Os valores dos coeficientes de correlação e de confiabilidade entre examinadoras com o AMIOFE-A foram: E1 x E2 (r=0,74, 0,84), E1 x E3 (r=0,70, 0,83), todos com p<0,01. A força de concordância do Kw para a aplicação do protocolo AMIOFE-A, tanto para as análises teste-reteste quanto para as entre examinadores, predominantes foram moderada e boa. Para o protocolo AMIOFE-A foram encontradas médias dos valores de S de 0,91, de E de 0,77, dos VP+ de 0,87 e VP- de 0,85. A prevalência média dos distúrbios miofuncionais orofaciais foi de 0,58. Os resultados permitiram concluir que o Protocolo AMIOFE-A é válido e confiável para avaliação miofuncional orofacial e possui boas sensibilidade e especificidade, bem como bons valores preditivos positivo e negativo. / In the literature, there is only one instrument validated for the clinical evaluation of the orofacial myofunctional condition of children, the Orofacial Myofunctional Evaluation Protocol with Scores (OMES) (Felício and Ferreira, 2008). In spite of recognized importance of the perceptible evaluation this present some limitations because your subjectivity, and, the increase of precision in the results is provided with numerical scales with more information. The numerical scales and the items number evaluations for OMES protocol were extended, with aim for possibility the detection and note of difference smalls in the characteristics physics and in the orofacial behaviors entre-subjects and variation intra-subject in the time. This study had with objective describe the OMES protocol extended (OMES-E), analyze the validity, the reliability and the correlation, as well as investigate the values of sensitivity, of specificity and predictive values of the OMES-E. The sample for the study compounded of images and videos of 50 children, 25 boys (mean age=8.4 years, standard deviation=1.8) and 25 girls (mean age=8.2 years, standard deviation=1.7). Three speech therapists (E1, E2 and E3) properly calibrated in orofacial myofuncional evaluation were choosed after analysis of ability of the examiners in to use the OMES protocol. To analysis of criterion validity of OMES-E protocol the children were evaluated individually for the analysis of images recorded on DVD for the protocols OMES and OMES-E. To complement the criterion validity was carried out the test of the correlations and of the reability of the applications and/or of the interpretation of the OMES-E. Statistical analysis was performed using the Statistics software based on the split-half reliability method, the level of significance was set at 0.05, Spearman correlation coefficient, the coefficient Kappa weighted linear (Kw), the sensitivity (S), specificity (E), predictive values (VP+ e VP-) and the prevalence (P) were also calculated. Was statistically significant correlation between the evaluations with the OMES and OMES-E protocols, the values, in agreement with the examiners, were E1 (r=0.81, p<0.01), E2 (r=0.79, p<0.01) and E3 (r=0.94, p<0.01). The reliability between protocols were to E1 0.89, to E2 0.88, and to E3 0.97. The correlations and reliability values between the testretest with the OMES-E were: E1 (r=0,86, 0,93), E2 (r=0.75, 0.86) e E3 (r=0.80, 0.89). The correlations and reliability values between examiners with the OMES-E were: E1 x E2 (r=0.74, 0.84), E1 x E3 (r=0.70, 0.83), all with p<0.01. The Kw strength of agreement to the OMES-E protocol apply, for the analyses test-retest and to analyses between examiners, predominant were moderate and good. To the OMES-E protocol were found mean values of 0.91 for the S, of 0.77 for the E, of 0.87 for the VP+ and of 0.85 for the VP-. The prevalence mean of myofuncional disorder was 0.58. The OMES-E protocol proved to be a valid and reliable instrument for orofacial myofuncional evaluation and have goods sensitivity and specificity, as well as predictive values.

La démarche d'évaluation des risques sanitaires inclue dans ses étapes l'évaluation de l'exposition professionnelle. S'agissant de l'exposition par inhalation, différents modèles sont disponibles pour caractériser ou estimer les niveaux d'exposition. Les objectifs de cette thèse sont d'étudier et comparer les principales démarches existantes, voire d'en développer de nouvelles, afin de participer à leur validation et de définir leur places respectives en complément de la métrologie quantitative. Un premier chapitre présente les modèles existants et décrit leurs principes et applications. Une méthode qualitative est développée puis comparée à d'autres démarches similaires ainsi qu'à des modèles empiriques afin d'étudier leurs performances dans la caractérisation ou la prédiction des expositions aux solvants de laboratoire (chapitre 2). Nous suggérons l'utilisation en première intention des méthodes qualitatives afin de définir les situations d'exposition prioritaires vis-à-vis desquelles les modèles empiriques peuvent secondairement servir à estimer un niveau d'exposition. Les modèles statistiques de régression linéaire sont étudiés à travers une application dans le secteur du compostage des déchets, confirmant leur capacité à caractériser des déterminants spécifiques de l'exposition (chapitre 3). Les modèles physiques mécanistiques sont testés afin de reproduire des profils temporels de concentration, puis utilisés de façon probabiliste pour estimer la distribution des expositions et des risques sanitaires (chapitre 4). Ces modèles permettent d'approcher la variabilité spatio-temporelle des expositions et d'identifier les mécanismes à l'origine des expositions. Les forces et limites de ces différentes approches sont comparées et des préconisations d'utilisation sont définies, assorties de perspectives de travail (chapitre 5). Mots clefs : exposition, risques, modèles, déterminants, prédictions, variabilité, incertitude. / The health risk assessment method involves the assessment of occupational exposure to pollutants. Restricted to inhalation exposure, several models can be used in order to either characterize or estimate exposure levels. The objectives are to study and compare the main existing models, and eventually to develop new ones, in order to help validating them and also to define their usefulness in addition to traditional individual monitoring. In a first chapter we present the existing models and describe their applications. A qualitative method is developed then compared to both other similar methods and empirical models in order to compare their performances in characterizing or predicting exposure to solvents in laboratories (chapter 2). From this work, we suggest the initial use of qualitative methods to define priority exposure scenarios, then the use of empirical models to predict inhalation exposure. Linear regression statistical models are studied in the field of waste composting, confirming their ability to identify specific determinants of exposure (chapter 3). Physical models are tested in order to reproduce observed time-varying exposure profiles, and then used to estimate the distribution of exposure and health risks (chapter 4). Such models are useful to describe the spatial and temporal variability of exposure, and help understanding the mechanisms of exposure. Strengths and weaknesses of all tested models are then compared and suggestions of use are made as well as work perspectives (chapter 5). Keywords: exposure, risks, models, determinants, predictions, variability, uncertainty.

Made available in DSpace on 2015-03-05T17:05:25Z (GMT). No. of bitstreams: 0 Previous issue date: 12 / Nenhuma / Devido à crescente mudança econômica ocorrida nos últimos anos, as empresas mundiais passaram a conviver com um mercado globalizado de intensa e acirrada competição. Muitas delas acreditavam que uma forma de buscar a vantagem competitiva seria suficiente somente com a introdução de algumas iniciativas que trouxessem aumento de produtividade e qualidade. Alguns progressos aconteceram, levando as empresas apenas a um estágio de sobrevivência, mas nem sempre ao crescimento desejado. Muitos gestores, na expectativa de resolverem seus problemas de competitividade, tentaram aderir a novas formas de gestão de maneira impulsiva, muitas vezes sem planejamento e conhecimento da realidade das suas próprias empresas. Contudo, a utilização de práticas enxutas oriundas do Sistema Toyota de Produção (STP) se apresenta como solução alternativa capaz de proporcionar maior competitividade para as organizações. Dentro deste contexto geral, a presente dissertação objetiva a proposição de um método para medir o grau de execução d / Due to the increasing in economic change that has occurred in recent years, worldwide companies have to live with an intense and bitter global market competition. Many of them believed that one way of searching of competitive advantage would be sufficient only with the introduction of some initiatives that would bring productivity and quality growth. Some progress happened, leading companies only to a stage of survival, but not always the desired growth. Many managers, hoping to solve their problems of competitiveness, tried to join the new management in an impulsive way, often without planning and knowledge of the reality of their own companies. However, the use of lean practices derived from the Toyota Production System (TPS) is presented as an alternative capable of providing greater competitiveness for organizations. Within this general context, this thesis aims to propose a method to measure the degree of fulfillment of lean practices based on the study of a metal-mechanic company that doesn’t have forma

<p>This study explores the assessment practices of adult educators in Mamelodi Adult Learning Centers using a qualitative methodology. The study recognizes that assessment is an important activity within the education and training enterprise since it can be used to improve the quality of teaching as well as improve and support the learning process. The study sets out to investigate how Mamelodi adult educators conceptualize assessment / the skills levels of these educators / the nature of support and training these educators received to enhance their assessment practices / the different assessment methods employed by the adult educators to assess learners / and the educational validity and efficacy of these practices.</p>

Syftet med denna studie var att undersöka hur användningen av bedömningsmetoden cervikal auskultation (CA) ser ut hos dysfagilogopeder i Sverige. Våra frågeställningar var: Hur utspridd är metoden inom logopedkåren? Hur utspridd är metoden i landet? Vilka åsikter finns kring metoden bland logopeder i Sverige? Vilka undersökningsmetoder vid dysfagi används mest bland logopeder i Sverige? Totalt deltog 82 personer i studien. Data samlades in genom en webbenkät. Frågorna i enkäten var blandat öppna och slutna. Resultaten visade att 18 % av de svarande använde CA. Det fanns ett signifikant samband mellan hur ofta man använde metoden och hur säker man kände sig i bedömningen. Signifikans hittades också mellan hur ofta man använde CA och hur stor vikt man lade vid det man kom fram till med metoden när man gjorde sin totala bedömning. Större vikt tillskrevs även CA:s resultat av dem som kände sig säkra i att bedöma med CA. Resultaten visade också att ju fler år man hade använt metoden desto säkrare kände man sig i att göra bedömningar med den. Majoriteten av de som använde CA var självlärda eller hade lärt sig metoden genom kollegor. En tanke som uppkom var om logopeder i Sverige eventuellt tror att CA är menat att användas som enskild bedömningsmetod och därmed ersätta icke-instrumentell bedömning. CA tycks inte användas så frekvent i Sverige främst på grund av brister i evidens och tillförlitlighet men många ser fördelar som skulle motivera användning av CA som en del i icke-instrumentell bedömning. / The purpose of this study was to investigate the use of the assessment method cervical auscultation (CA) amongst speech and language pathologists (SLPs) in Sweden working with dysphagia. We wanted to find out: How widespread is the method in the SLP profession? How widespread is the method in the country? What opinions are there about the method amongst SLP´s in Sweden? What assessment methods within dysphagia are mostly used among SLP´s in Sweden? A total of 82 SLPs participated in the study. Data were collected through an online survey. The survey questions were of both quantitative and qualitative nature. The results showed that 18% of the respondents used CA. There was a significant correlation between the frequency of use of the method and how confident SLPs felt in the assessment. Significance was also found between the frequency of use of CA and how much importance SLPs assigned to what was discovered with the method when making the overall assessment. More importance was also ascribed to the results of CA from those who felt confident in assessing with the method. The results also showed that the longer SLPs had used the method, the more confident they felt in assessing with it. The majority of those who used CA were self-taught or had learned the method through colleagues. A thought that arose was whether the SLPs in Sweden possibly believe that CA is meant to be used as the sole method of assessment, replacing non-instrumental assessment. CA does not seem to be used frequently in Sweden, mainly because of lack of evidence and reliability but many see benefits that would justify the use of CA as part of the clinical assessment.

The presented doctoral thesis “Fly ash impact in forest ecosystems in Northeastern Germany - an assessment and regionalization approach” intends to (a) test if the field assessment of ferrimagnetic susceptibility can be used as cost efficient method to get information on fly ash deposition impacted chemical site properties. (b) develop a regionalization approach to bridge the gap from plot-wise assessed data to spatial management information. The thesis is a follow-up of extensive research activities by the Institute for Soil Science and Site Ecology on industrial deposition in Dübener Heide and Upper Lusatian region which started in the early 1960ies and were intensified from the middle of the 1990ies on. A central topic of these research activities was the assessment of the impact of fly ash deposition on chemical soil properties. A major challenge was to transfer the assessed chemical characteristics from plot to region and to aggregate the measured values to provide an information basis, which can be used for a site potential and risk oriented forest management. This challenge was picked up by the joint research project “ENFORCHANGE” (FKZ 0330634 K, German Federal Ministry of Education and Research). The presented thesis was carried out in the frame of this project during the period 2005 - 2009. The thesis was conceived as cumulative work, which includes ten papers in total. Five articles are published in peer-reviewed journals (ISI listed, 1 paper still in revision), and five are part of books or conference proceedings. • Chapter 1 “Introduction” gives an overview on the motivation, idea and structure of the thesis. • In chapter 2 “Aims and Scope of the presented work” information on the background and frame of the study within the project ENFORCHANGE is given. • Chapter 3 “Background and State of the Art” deals with the history of fly ash deposition in the model region Dübener Heide. • Chapter 4 “Material and Methods” gives information on fly ash and presents the spatial assessment design and the hereon based approaches for up-scaling and correlation of magnetic susceptibility with selected chemical characteristics. • Chapter 5 “Results” presents results of the spatial modeling and linear regression based approach to use ferrimagnetic susceptibility for predicting the contents of selected base cations, selected acid and heavy metal cations and Black Carbon. • Chapter 6 “Discussion and Conclusions” compares the assumptions and findings in the different articles, discusses contradictory findings and open questions and provides a comprehensive evaluation of the outcomes. Final conclusions are drawn and an outlook is given. A key finding of the thesis is that the industrial complex Bitterfeld was the most important source of fly ash deposited in the model region Dübener Heide. The power plant Zschornewitz plays only a minor role contrary to the research hypothesis formulated in ENFORCHANGE. Related to the targets of the thesis, spatial variation of magnetic susceptibility was predicted with high precision by a multiple linear regression model. A slightly differing set of model parameters  according to their explanatory value for three selected depth levels  improved the prediction quality. The selection of the parameters supported understanding the major drivers for magnetic particle deposition, storage, and vertical displacement in the forest soils. Humus layer (depth level 6-10 cm), horizontal distance to Bitterfeld and soil type (Podzol, semi-terrestrial sites) were the most important variables. These variables point to a slowed-down humus dynamic, which causes the accumulation of fly ash in the humus layer. In depth level 11 – 15 cm, variables such as “aspect” gain in importance, which describe the exposure against the major wind direction and thus indicate the probability and of deposition. For the mineral horizon (depth level 21-25 cm), exposition and especially stand properties are most important. The latter gives evidence for the intensity of deposition caused by surface roughness. Therefore, the variables “coniferous” and “mixed” stands were highly relevant for the model. Variable correlations between mass susceptibility and selected base cations, acid cations and heavy metals have been found. When using a linear regression model, a prediction of Ca and Mg and of Mn was possible. The model performance was lower for Fe, Al, Cd and Black Carbon. A possible reason was the use of different plot types: the assessment of magnetic susceptibility and chemical soil properties was well harmonized at the ENFORCHANGE plots considering the sampling material and sampling location. A comparable harmonization could not be achieved at a number of monitoring plots, which were included into the analysis to broaden the data base. Comparing the results from the linear regression model based prediction with the results achieved by multiple regression based spatial modeling lead to the conclusion that the mul¬tiple regression approach is more promising: by using other model parameters such as orographic, climatic or stand parameters together with magnetic susceptibility, the prediction quality of the deposed agents could be improved and small scale variations in nutrient potentials and risks driven by fly ash deposition could be better recognized and made available for forest management decisions. / Die vorgelegte Doktorarbeit “Fly ash impact in forest ecosystems in Northeastern Germany - an assessment and regionalization approach” (Flugascheeinträge in Waldökosysteme in Nordostdeutschland  ein Erfassungs- und Regionalisierungsansatz) verfolgte die Ziele (a) zu testen, ob sich die Erfassung der ferrimagnetischen Suszeptibilität eignet, um kosteneffizient quantitative und / oder qualitative Informationen zu den eingetragenen Flugaschemengen und den in der Folge veränderten bodenchemischen Potenzialen zu erheben (b) zu testen, ob der Indikator „ferrimagnetische Suszeptibilität“ genutzt werden kann, um Informationen über Flugascheeinträge von der punktbezogenen Erfassung auf einen regionalen Maßstab hoch zu skalieren. Grundlage dieser Zielstellungen sind Forschungsarbeiten zu der Frage der langfristigen Wirksamkeit und ökologischen Bedeutung von Industrieexhalationen auf Waldökosysteme, die am Institut bereits in den 1960ziger Jahren begonnen wurden und verstärkt seit Mitte der 1990ziger Jahre fortgeführt wurden. Auf ihrer Basis wurde die Herausforderung eines kostengünstigen und flächenbezogenen Erhebungsansatzes identifiziert und formuliert. Die vorgelegte Arbeit ordnete sich in diese Forschungsarbeiten ein und führte sie im Rahmen des Verbundforschungsvorhabens ENFORCHANGE ((FKZ: 0330634 K, Bundesministerium für Bildung und Forschung) von 2005 - 2009 fort. Die Doktorarbeit ist als kumulative Arbeit angelegt, im Rahmen derer insgesamt 10 Publikationen zusammengefasst wurden. Davon sind 5 in internationalen Journalen bereits publiziert, akzeptiert oder in einem Fall in Begutachtung; 5 weitere Publikationen wurden ergänzend und auf speziellere Themen bezogen in Proceedings oder Buchbeiträgen publiziert. Die Arbeit gliedert sich in 5 Abschnitte: • Kapitel 1 (Einleitung) gibt einen kurzen Überblick zur Motivation und Struktur der Doktorarbeit. • In Kapitel 2 (Ziele und Rahmen der Arbeit) wird der Arbeitsansatz im Rahmen des Verbundforschungsvorhabens ENFORCHANGE vorstellt. • Kapitel 3 umfasst eine Auswertung von Veröffentlichungen zur Geschichte und den ökologischen Auswirkungen der Flugascheeinträge am Beispiel der Modellregion Dübener Heide. • In Kapitel 4 wird der methodische Ansatz der Arbeit vorgestellt, der von einem Vortest zur Eignung der Erfassung der magnetischen Suszeptibilität über die Ableitung eines flächigen Erhebungsansatzes bis hin zur Frage der Modellbildung und Korrelation mit chemischen Kenngrößen reicht. • Kapitel 5 beinhaltet die Ergebnisse der räumlichen Modellbildung und der Korrelation der magnetischen Suszeptibilität mit ausgewählten Basen-, Säure- und Schwermetallkationen sowie mit Schwarzem Kohlenstoff. • Kapitel 6 diskutiert, vergleicht und bewertet die Ergebnisse der den Veröffentlichungen zugrunde liegenden Studien und zieht ein abschließendes Resumé. Ein Schlüsselergebnis der vorgelegten Arbeit belegt, dass entgegen der ursprünglichen Arbeitshypothese des Projektverbundes ENFORCHANGE nicht das mehr als 100 Jahre alte Kraftwerk Zschornewitz die wesentliche Quelle für die Flugascheeinträge in der Modellregion Dübener Heide war, sondern der räumlich entfernter gelegene, aber deutlich größere Industriekomplex Bitterfeld. Bezogen auf die Zielsetzung der vorgelegten Arbeit, konnte mithilfe multipler Regressionsverfahren und auf Basis von Feldaufnahmen der ferrimagnetischen Suszeptibilität in einem regelmäßigen Stichprobenraster ein hoch auflösendes räumliches Modell gebildet werden. Unter Berücksichtigung weiterer Modellparameter, die schrittweise hinsichtlich ihres Erklärungswertes ausgewählt wurden, konnten mikrotopographische und vegetationsbedingte Informationen genutzt werden, um die räumliche Variabilität des magnetischen Signals differenziert darzustellen. Damit ergibt sich eine Planungsgrundlage, die die bisher genutzte, auf Waldschadensansprachen basierende Stratifizierung in Zonen unterschiedlicher Eintragsintensität mit Bezug zur Planungseinheit deutlich detaillierter untersetzt. Der Versuch, auf Flugascheeintragsmengen, respektive -vorräte zu schließen ließ sich hingegen auf Basis der verfügbaren Daten nicht umsetzen. Die Korrelationsbeziehungen der von Volumen- in den Massenbezug umgerechneten Suszeptibilität mit Basen-, Säure und Schwermetallkationen sowie Schwarzem Kohlenstoff fielen heterogen aus. Eine gute Vorhersage auf Basis eines linearen Regressionsmodells konnte für Ca, Mg und Mn getroffen werden, wohingegen die Modellqualität für Fe, Al sowie Cd und Schwarzen Kohlenstoff deutlich schlechter zu beurteilen war. Dies ergab sich zum einen aus der verfügbaren Datenbasis, die keine durchgängige Harmonisierung für die Erhebungen der Suszeptibilität und der chemischen Kennwerte erlaubte. Zum anderen geht diese Erkenntnis mit Ergebnissen aus der Regionalisierung einher, die einen Einbezug weiterer Modellparameter und die Nutzung multipler anstelle linearer Regressionsmodelle nahe legt.

Water is an irreplaceable resource, covering around two thirds of Earth´s surface, although only one percent is available for use. Except from households, other human activities such as agriculture and industries use water. Water use and pollution can make water unavailable to some users and places already exposed for water scarcity are especially vulnerable for such changes. Increased water use and factors such as climate change make water scarcity to a global concern and to protect the environment and humans it will be necessary to manage this problem. The concept of water footprint was introduced in 2002 as a tool to assess impact from freshwater use. Since then, many methods concerning water use and degradation have been developed and today there are several studies made on water footprint. Still, the majority of these studies only include water use. The aim of this study was to evaluate three different methods due to their ability to calculate water footprint for the production of trucks, with the qualification that the methods should consider both water use and emissions. Three methods were applied on two Volvo factories in Sweden, located in Umeå and Gothenburg. Investigations of water flows in background processes were made as a life cycle assessment in Gabi software. The water flows were thereafter assessed with the H2Oe, the Water Footprint Network and the Ecological scarcity method. The results showed that for the factory in Umeå the water footprint values were 2.62 Mm3 H2Oe, 43.08 Mm3 and 354.7 MEP per 30,000 cabins. The variation in units and values indicates that it is complicated to compare water footprints for products calculated with different methods. The study also showed that the H2Oe and the Ecological scarcity method account for the water scarcity situation. A review of the concordance with the new ISO standard for water footprint was made but none of the methods satisfies all criteria for elementary flows. Comparison between processes at the factories showed that a flocculation chemical gives a larger water footprint for the H2Oe and the Ecological scarcity method, while the water footprint for the WFN method and carbon footprint is larger for electricity. This indicates that environmental impact is considered different depending on method and that a process favorable regarding to climate change not necessarily is beneficial for environmental impact in the perspective of water use. / Vatten är en ovärderlig resurs som täcker cirka två tredjedelar av jordens yta men där endast en procent är tillgänglig för användning. Människan använder vatten till olika ändamål, förutom i hushåll används vatten bland annat inom jordbruk och industrier. Vattenanvändning och utsläpp av föroreningar kan göra vatten otillgängligt, vilket kan vara extra känsligt i de områden där människor redan lider av vattenbrist. Den ökade vattenanvändningen tillsammans med exempelvis klimatförändringar bidrar till att göra vattenbrist till en global angelägenhet och det kommer att krävas åtgärder för att skydda människor och miljö. År 2002 introducerades begreppet vattenfotavtryck som ett verktyg för att bedöma miljöpåverkan från vattenanvändning. Sedan dess har begreppet utvecklats till att inkludera många olika beräkningsmetoder men många av de befintliga studierna har uteslutit föroreningar och bara fokuserat på vattenkonsumtion. Syftet med denna rapport var att utvärdera tre olika metoder med avseende på deras förmåga att beräkna vattenfotavtryck vid produktion av lastbilar, med villkoret att metoderna ska inkludera både vattenkonsumtion och föroreningar. I studien användes tre metoder för att beräkna vattenfotavtrycket för två Volvo fabriker placerade i Umeå och Göteborg. En livscykelanalys utfördes i livscykelanalysverktyget Gabi, för att kartlägga vattenflöden från bakgrundsprocesser. Därefter värderades vattenflödena med metoderna; H2Oe, WFN och Ecological scarcity. Resultatet för fabriken i Umeå gav för respektive metod ett vattenfotavtryck motsvarande 2,62 Mm3 H2Oe, 43,08 Mm3 respektive 354,7 MEP per 30 000 lastbilshytter. Variationen i enheter och storlek tyder på att det kan vara svårt att jämföra vattenfotavtryck för produkter som beräknats med olika metoder. Studien visade att H2Oe och Ecological scarcity tar hänsyn till vattentillgängligheten i området. En granskning av metodernas överensstämmelse med den nya ISO standarden för vattenfotavtryck gjordes men ingen av metoderna i studien uppfyllde alla kriterier. Av de processer som ingår i fabrikerna visade det sig att vattenfotavtrycket för H2Oe och Ecological scarcity metoden var störst för en fällningskemikalie. För den tredje metoden och koldioxid var avtrycket störst för elektriciteten. Detta tyder på att olika metoder värderar miljöpåverkan olika samt att de processer som anses bättre ur miljösynpunkt för klimatförändringar inte nödvändigtvis behöver vara bäst vid vattenanvändning.

<p>This study explores the assessment practices of adult educators in Mamelodi Adult Learning Centers using a qualitative methodology. The study recognizes that assessment is an important activity within the education and training enterprise since it can be used to improve the quality of teaching as well as improve and support the learning process. The study sets out to investigate how Mamelodi adult educators conceptualize assessment / the skills levels of these educators / the nature of support and training these educators received to enhance their assessment practices / the different assessment methods employed by the adult educators to assess learners / and the educational validity and efficacy of these practices.</p>