• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 50
  • 40
  • 34
  • 24
  • 23
  • 4
  • 2
  • 2
  • 2
  • 1
  • 1
  • 1
  • Tagged with
  • 197
  • 31
  • 29
  • 20
  • 18
  • 18
  • 17
  • 16
  • 14
  • 12
  • 12
  • 12
  • 12
  • 12
  • 11
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
131

Mental ill health in nursing and midwifery education : a critical discourse analysis

Hargan, Janine M. January 2017 (has links)
Students diagnosed with long-term mental health conditions have been the focus of policy development for over a decade. Student mental health is on the increase and universities are legally obliged to make reasonable adjustments for disabled students. Therefore it is crucial that nursing and midwifery education provides an inclusive learning environment, while maintaining fitness to practice standards. The focus of this study was to explore how discourses of mental health, reasonable adjustments and fitness standards influence nursing and midwifery education for students with a mental health condition. Principles of Wodak’s (2001) critical discourse analysis approach, which gives prominence to dominant discourses, their justifications and persuasive nature was utilised. Ten key written texts and 23 semi-structured interviews with students, lecturers and clinical mentors were conducted to acquire the constructions of mental health, reasonable adjustments and fitness requirements. The findings show that the dominant discourses attributed to students experiencing mental ill health were around medicine, difference and blame, all of which reinforced mental health stigma. In addition, mental health discourses within both verbal and written texts were not underpinned by disability discourses, allowing the exclusion of students who disclose mental ill health from accessing reasonable adjustments. In conclusion, students considered to have a mental health label faced discriminatory barriers and legislative and regulatory requirements of equality were not implemented.
132

Zpracování návrhu pozemkové úpravy pro zvolené katastrální území / Projection of land consolidation for selected cadastral area

HÜTTNER, Martin January 2017 (has links)
This diploma thesis deals with a draft of a complex land adjustment within a chosen cadastral municipality. After choosing the specific cadastral municipality, a local survey and a subsequent description of a current condition of the area followed. On the basis of this information, an analysis of current problems and shortages was carried out. These problems were solved by a draft of required measures within a plan of common facilities. An assessment of land adjustment area had to precede the draft preparation itself. The last operation was to deal with demands of three chosen owners for whom a draft of new land arrangement was created.
133

Em busca de habitabilidade: adequações inseridas no conjunto habitacional Boa Sorte em Coimbra, MG / Searching for habitability: adaptations inserted in Boa Sorte low-income housing state, Coimbra, MG

Silva, Elisangela Ferreira 01 July 2011 (has links)
Made available in DSpace on 2015-03-26T13:28:04Z (GMT). No. of bitstreams: 1 texto completo.pdf: 3371538 bytes, checksum: cd75e6774cb31997ff12e7963d165844 (MD5) Previous issue date: 2011-07-01 / This work approaches housing and urban problems regarding to housing production with social interest and its response on the housing appropriation process by the dweller searching for habitability. It is analyzed adaptations inserted in Boa Sorte low-income housing estate, implanted in Coimbra/MG in order to guide further housing projects to be implanted in countryside towns with similar characteristics. This study is a descriptive and explicative research work, and the variables and indicators were defined from literature review and for field data collection it was used a toll called spatial readings . For technical data survey and for obtaining user satisfaction degree related to housing, tools commonly used in post-occupation evaluation research was used. For analysis, data were grouped according to housing categories: pragmatic, symbolic and functional. The results show that the identified adaptations are physical and use adjustments, evidencing that there is a passive and active adaptation process from the dweller in relation to his or her house. Original housings had their useful area increased, most of them as self-building without technical guidance, whose enhancement and addition of environment were for attending specific needs of each family and in a certain way are related to cultural costumes typical of countryside town people. It was also identified insertion of physical elements and addition, alteration and replacement of sanitary and electrical systems because of problems presented by them. Some architectural problems and diseases reveal the low functional and building performance of the houses. It is concluded by the need of going over housing problems in relation to meeting minimal dwelling standards, especially when implanted in countryside towns with a small number of inhabitants because the social-cultural characteristics of the population and soil value, which interferes in the final cost per unity, are different when compared to units in big cities. / Esta pesquisa aborda a problemática urbana e habitacional quanto à produção da habitação de interesse social e seu reflexo no processo de apropriação da moradia pelo morador em busca de habitabilidade. São analisadas as adequações inseridas no conjunto habitacional Boa Sorte, implantado no município de Coimbra/MG, de forma a orientar futuros projetos habitacionais a serem implantados em cidades do interior com características similares. Trata-se de uma pesquisa de caráter descritivo e explicativo, sendo que, as variáveis e os indicadores foram definidos a partir da revisão de literatura e para a coleta de dados em campo foi utilizado o instrumento denominado leituras espaciais . Para o levantamento de dados técnicos e obtenção do grau de satisfação dos usuários em relação à moradia, foram aplicadas ferramentas comumente utilizadas em pesquisa de avaliação pós-ocupação (APO). Para análise, os dados foram agrupados segundo as categorias de habitabilidade: pragmática, simbólica e funcional. Os resultados revelam que as adequações identificadas são tanto físicas quanto de uso, comprovando que há um processo de adaptação ativa e passiva do morador em relação à sua residência. As habitações originais tiveram sua área útil aumentada, a maioria sob a forma de autoconstrução sem orientação técnica, cujas ampliações e acréscimos de ambientes destinaram-se a atender a necessidades particulares de cada família, e que, de certa forma, estão relacionadas a hábitos culturais típicos de moradores de cidades do interior. Também foram identificados a inserção de elementos físicos e materiais de revestimento, a adição, alteração e substituição de elementos dos sistemas hidrossanitários e elétrico por apresentarem deficiências. Alguns conflitos arquitetônicos e manifestações patológicas observadas revelam o baixo desempenho funcional e construtivo das unidades habitacionais. Conclui-se pela necessidade de revisão dos programas habitacionais quanto ao atendimento de padrões mínimos de habitabilidade, principalmente quando implantados em cidades do interior e de pequeno porte, já que as características socioculturais da população e o valor do solo que interfere no custo final por unidade, são diferentes quando comparados aos das grandes cidades.
134

Zpracování plánu společných zařízení pro komplexní pozemkovou úpravu / Projection of common facilities plan for the complex land consolidation

HNÍDKOVÁ, Petra January 2018 (has links)
The aim of this diploma thesis is the elaboration of a plan of common facilities for complex land adjustments. The territory in question is Horní Slověnice cadastral estates. The theoretical part deals with the description of land modifications, exploration works and the definition of common facilities. Its focus is on arrangements for accessing the estates, for soil protection against erosion, for protection and creation of the environment and water management measures. The practical part characterizes the selected area and offers description of the most important issues within the common facilities in the given locality.
135

Intégration des effets de site dans les méthodes d'estimation probabiliste de l'aléa sismique / Integration of Site Effects into Probabilistic Seismic Hazard Assessment.Integration of site effects into probabilistic seismic hazard methods.

Aristizabal, Claudia 19 March 2018 (has links)
Les travaux de cette thèse s'inscrivent dans l'objectif général de fournir des recommandations sur la façon d'intégrer les effets du site dans l'évaluation probabiliste des risques sismiques, mieux connue sous le nom de PSHA, une méthodologie connue et utilisée à l'échelle mondiale pour estimer l'aléa et le risque sismiques à l'échelle régionale et locale. Nous passons donc en revue les méthodes disponibles dans la littérature pour obtenir la courbe d'aléa sismique en surface d'un site non-rocheux, en commençant par les méthodes les plus simples et plus génériques (partiellement probabiliste), jusqu'aux méthodes site-spécifiques (partiellement et entièrement probabilistes) qui nécessitent une caractérisation du site de plus en plus poussée, rarement disponible sauf cas exceptionnel comme par exemple le site test d'Euroseistest. C'est justement sur l'exemple de ce site que sont donc comparées un certain nombre de ces méthodes, ainsi qu'une nouvelle.La spécificité et la difficulté de ces études PSHA "site-spécifiques" vient du caractère non-linéaire de la réponse des sites peu rigides, ainsi que du fait que le rocher de référence contrôlant cette réponse est souvent très rigide. Les aspects "ajustement rocher dur" et "convolution" de l'aléa sismique au rocher avec la fonction d'amplification ou la fonction transfert (empirique ou numérique) d’un site font donc l'objet d'une attention particulière dans ces études comparatives. Un cadre général est présenté sur la façon de prendre en compte simultanément les caractéristiques spécifiques au site, la variabilité aléatoire complète ou réduite ("single station sigma"), les ajustements hôte-cible et le comportement linéaire / non linéaire d'un site, où nous expliquons toutes les étapes, corrections, avantages et difficultés que nous avons trouvés dans le processus et les différentes façons de les mettre en oeuvre.Cette étude comparative est divisée en deux parties: la première porte sur les méthodes non site-spécifiques et les méthodes hybrides site-spécifique (évaluation probabiliste de l'aléa au rocher et déterministe de la réponse de site), la seconde porte sur deux approches prenant en compte la convolution aléa rocher / réponse de site de façon probabiliste. Un des résultats majeurs de la première est l'augmentation de l'incertitude épistémique sur l'aléa en site meuble comparé à l'aléa au rocher, en raison du cumul des incertitudes associées à chaque étape. Un autre résultat majeur commun aux deux études est l'impact très important de la non-linéarité du sol dans les sites souples, ainsi que de la façon de les prendre en compte: la variabilité liée à l'utilisation de différents codes de simulation NL apparaît plus importante que la variabilité liée à différentes méthodes de convolution 100% probabilistes. Nous soulignons l'importance d'améliorer la manier d’inclure les effets du site dans les méthodes de l’estimation de l’aléa sismique probabiliste ou PSHA, et nous soulignons aussi l'importance d'instrumenter des sites actifs avec des sédiments meubles, comme l'Euroseistest, afin de tester et valider les modèles numériques.Finalement, on présente un résumé des résultats, des conclusions générales, de la discussion sur les principaux problèmes méthodologiques et des perspectives d'amélioration et de travail futur.Mots-clés: Effets du site, incertitude épistémique, PSHA, single station sigma, ajustements hôte-cible, effets linéaires et non linéaires, réponse de site / The overall goal of this research work is of provide recommendations on how to integrate site effects into Probabilistic Seismic Hazard Assessment, better known as PSHA, a well-known and widely used methodology. Globally used to estimate seismic hazard and risk at regional and local scales. We therefore review the methods available in the literature to obtain the seismic hazard curve at the surface of a soft soil site, starting with the simplest and most generic methods (partially probabilistic), up to the full site-specific methods (partially and fully probabilistic), requiring an excellent site-specific characterization, rarely available except exceptional cases such as the case of Euroseistest site. It is precisely on the example of this site that are compared a number of these methods, as well as a new one. And it is precisely at the Euroseistest that we performed an example of application of the different methods as well as a new one that we propose as a result of this work.The specificity and difficulty of these "site-specific" PSHA studies comes from the non-linear nature of the response of the soft sites, as well as from the fact that the reference rock controlling this response is often very rigid. The "rock to hard rock adjustment" and "convolution" aspects of the rock seismic hazard, together with the amplification function or the transfer function (empirical or numerical) of a site are therefore the subject of particular attention in these studies. comparative studies. A general framework is presented on how to simultaneously take into account the site-specific characteristics, such as the complete or reduced random variability ("single station sigma"), host-to -target adjustments and the linear / nonlinear behavior of a site, where we explain all the followed steps, the different corrections performed, the benefits and difficulties that we found in the process and the ways we sort them and discussing them when the answer was not straight forward.This comparative study is divided into two parts: the first deals with non-site-specific methods and site-specific hybrid methods (probabilistic evaluation of rock hazard and deterministic of the site response). The second deals with two approaches taking into account the convolution of rock hazard and the site response in a probabilistically way. One of the major results of the first is the increase of the epistemic uncertainty on the soft site hazard compared to the rock hazard, due to acumulation of uncertainties associated to each step. Another major common result to both studies is the very important impact of non-linearity on soft sites, as well as the complexity on how to account for them: the variability associated with the use of different non-linear simulation codes appears to be greater than the method-to-method variability associated with the two different full convolution probabilistic methods. We emphasize on the importance of improving the way in which the site effects are included into probabilistic seismic hazard methods, PSHA. And we also emphasize on the importance of instrumenting active sites with soft sediments, such as the Euroseistest, to test and validate numerical models.Finally, a summary of the results, the general conclusions, discussion of key methodological issues, and perspectives for improvement and future work are presented.Keywords: Site Effects, Epistemic Uncertainty, PSHA, single station sigma, host to target adjustments, linear and nonlinear site effects, soil site response.
136

Muntliga redovisningar på mellanstadiet : Elevers upplevelser och läraresundervisning och anpassningar. / Students' experiences about, teachers' teachings of and adjustments to oral presentations in grades 4-6.

Hagel Almér, Amanda January 2018 (has links)
In my study I will examine how students in grades 4-6 experience oral presentations, howteachers understand the students´ experiences and which factors they think affect these experiences.Finally I will look at how teachers teach about oral presentation and what adjustmentsthey make in relation to the studens´needs.I have used questionnaire forms that includes both multiple choice answers and open questions.These questionnaire forms have been given out to 36 students in grades 4, 5 and 6 attwo different schools. I have also had one on one interviews with three teachers who teachSwedish in grades 4-6.The results shows that the majority of the participating students experience negative feelingsconnected to oral presentations. The other participating students felt positive or neural aboutoral presentations. The factors that affects the experience of oral presentations for students´according to my study is: students´ earlier experiences, the class climate, how the audience actduring the presentation and how much time and teaching time is being directed towards thetools that students need to make a good presentation. The teachers teach in different ways buthave some elements in common. They all use examples to show good and bad presentations,then let the students practice different presentation skills and they try to give all the studentspractice in talking in front of the class as often as possible. The teachers make adjustments bytelling the students that many people find oral presentations challenging but with practice youcan feel better about this. They also make adjustments in how many and which people someof the students have to make the presentations in front of. The teachers worked with the wholeclass about how you are a good audience. / Min studie har som syfte att undersöka hur elever upplever muntliga redovisningar. Hur lärare uppfattar elevers upplevelser av muntliga redovisningar, vilka faktorer som påverkar deras upplevelser samt hur lärarna undervisar och anpassar sin undervisning till elevernas behov. Jag har använt mig av enkäter med flervalsfrågor där deltagarna hade möjlighet att ge egna kommentarer. Dessa enkäter har jag delat ut till 36 elever i årskurserna 4-6 på två olika skolor. Jag har också haft enskilda intervjuer med tre lärare. Resultaten från studien visar att majoriteten av eleverna upplever negativa känslor kopplade till muntliga redovisningar. Resterande upplever dem som positiva eller okej. Lärarna bekräf- tar detta genom sina iakttagelser. De faktorer som lärarna anser påverka eleverna upplevelser är elevernas tidigare erfarenheter, klassklimatet, hur åhörarna beter sig under redovisningarna samt hur mycket tid och undervisning som läggs på verktygen som behövs för att genomföra en bra redovisning. Lärarna arbetar olika, men några gemensamma nämnare är att visa visu- ella exempel på bra och mindre bra redovisningar, att träna olika delar och att stegvis bygga upp elevernas kunskaper. Anpassningarna som görs är bland annat att medvetandegöra elever om att många tycker att detta är jobbigt, anpassa gruppen som lyssnar eller låta eleven göra redovisningen för bara läraren. Vidare arbetar lärarna mycket med hela klassen om hur man är en bra och respektfull publik. Sammanfattningsvis görs vissa anpassningar för hela gruppen och andra görs på individnivå.
137

A relação do retorno das ações com o EVA, com o lucro residual e com as medidas contábeis tradicionais: um estudo empírico aplicado às empresas brasileiras de capital aberto / The relation between stock returns and EVA, residual income, mandated performance measures: a empirical study applied to Brazilian companies with open capital

Andrea Salvi 26 April 2007 (has links)
A ampla divulgação do conceito de valor econômico adicionado (EVA®) fez com que as empresas utilizassem essa medida de desempenho para evidenciar o quanto de valor foi adicionado aos seus proprietários. Essas empresas esperam que EVA®s positivos aumentem o valor da empresa no mercado. Nesse sentido, alguns estudos comprovaram uma relação forte entre o EVA® e o retorno das ações no mercado, confirmando que o EVA® positivo valoriza a empresa no mercado (FELTHAM et al, 2004; SILVEIRA et al, 2004). Entretanto, ao se analisarem as medidas contábeis tradicionais, como lucro líquido e fluxo de caixa operacional, encontra-se uma forte relação dessas medidas com o retorno das ações e uma fraca relação do EVA® com o retorno das ações (BIDDLE et al, 1997). Neste trabalho, foi aplicado o estudo de Biddle et al, para todas as empresas não-financeiras de capital aberto listadas na Bovespa, no período de 1997 a 2006. Foi apurado o lucro líquido, o fluxo de caixa operacional, o EVA® e o lucro residual (EVA® sem ajustes contábeis) e foi analisada a relação dessas medidas com o retorno das ações das empresas brasileiras. Foi analisada também a influência dos ajustes contábeis na explicação do retorno das ações, para o mesmo período. Os testes de regressões com efeito fixo e efeito aleatório para as amostras com as variáveis independentes ajustadas e não-ajustadas mostraram que o poder de explicação, medido pelo r-quadrado, encontrado nos testes foi muito baixo. Este resultado se aproximou do encontrado por Biddle et al e Feltham et al, fato este que não permitiu afirmar claramente o quanto as medidas de valor econômico e as medidas contábeis explicaram o retorno das ações e se afastou dos resultados encontrados por Silveira et al fato este que poderia evidenciar que o mercado brasileiro apresentou alguma eficiência na sua forma semi-forte. / The huge propagation of the EVA® (Economic Value Added) concept allows companies to use this performance measure to prove how much value was added for the owners. These companies hope positive EVA®s increase firm values in the market. In this direction, some studies prove a strong association between EVA® and stock returns, confirming that the positive EVA® valorizes companies in the market (Felthan et al, 2004; Silveira et al, 2004). However, when analyzing mandated performance measures, such as earning and operate cash flow, there is a strong association between these measures and the stock returns, and a weak association between EVA® and stock returns (Biddle et al, 1997). At this study, Biddle et al study was applied to all of no-financial companies with open capital listed at Bovespa, from 1997 to 2006. Earning, operate cash flow, EVA® and residual income (EVA® without accounting adjustments) were verified, and the association between these measures and Brazilian company stock returns was analyzed. The influence of accounting adjustments in the explanation of stock returns was analyzed too, in the same period of time. The tests of fixed effect regression and random effect regression for the samples with independent, adjusted and non-adjusted variables showed that the explanation power, measured by r-square, found in the tests, was very low. This result got closer to the results presented by Biddle et al, which did not allow clearly stating how much the economic value and accounting measures explain the stock returns. In the other hand, this result got far from the results presented by Silveira et al, which could prove that Brazilian market has some efficiency in its semistrong-form.
138

Man trollar med knäna och väcker inte den björn som sover : Några lärares syn på extra anpassningar

Wrang, Elisabeth January 2017 (has links)
Lagen om extra anpassningar, särskilt stöd och åtgärdsprogram trädde i kraft den 1 juli 2014. Denna lag påverkade all personal från förskola till gymnasium och till sin hjälp fick skolorna allmänna råd från Skolverket med kommentarer om hur arbetet med extra anpassningar ska utföras. Syftet med detta examensarbete är att bidra med lärdomar om gymnasielärares erfarenheter av och kunskaper om extra anpassningar. För att få reda på det har sex gymnasielärare intervjuats om sitt arbete med extra anpassningar. Deras svar har sedan tolkats utifrån tematisk analys. I denna studie framkommer det bland annat att ingen av lärarna har något dokument att följa som beskriver vad extra anpassningar är. Det framkommer en osäkerhet bland lärarna gällande vad begreppet extra anpassning innebär, likaså när det gäller hur de ska nå de omotiverade eleverna med hjälp av extra anpassningar, samt vid betygsättning av elever som fått extra anpassningar. Det verkar vara de informella samtalen och diskussionerna lärare emellan som främst ger de idéer och lösningar gällande extra anpassningar som efterfrågas av lärarna. Slutsatsen i min studie är bland annat att de lärare som jag intervjuat inte riktigt har de förutsättningar som behövs för att arbeta med de extra anpassningar som lagen föreskriver. När lärare behöver hjälp kring stödformen extra anpassning från elevhälsan är det inte alltid att de får det. Tydligt är också att information från Skolverket om vad extra anpassningar är, är bristfällig och svår att tolka för lärarna. / The Act on Additional Adjustments, Special Support and Action Programs came into force on July 1, 2014. This law affected all staff in preschool to upper secondary school and, in turn, the schools received general advice from the National Agency for Education with comments on how to work with additional adjustments. The purpose of this graduate project is to contribute lessons learned from secondary teachers' experience and knowledge of additional adjustments. To find this out, six secondary teachers have been interviewed about their work with additional adjustments. Their answers were after that interpreted based on thematic analysis. In this study, it is found that none of the teachers have any document describing what additional adjustments imply. There is an uncertainty among teachers regarding what additional adjustments means, and how to reach the unmotivated students with the help of additional adjustments, as well as in the assessment of pupils who have received additional adjustments. It seems to be the informal conversations and the discussions between teachers, that mainly gives the ideas and solutions regarding additional adaptations demanded by the teachers. The conclusion in my study is, among other things, that the teachers I interviewed do not really have the conditions needed to work on the additional adjustments required by the law. When teachers need help with the additional adjustment from pupil health, it is not always that they get it. Clearly, information from the National Agency for Education about what additional adjustment is, is insufficient and difficult to interpret for the teachers.
139

Contrôle prédictif des effets mécaniques de la fatigue musculaire : implication dans l'étude des modèles internes et des modes de coordination entre posture et mouvement / Predictive control of muscle fatigue mechanical effects : implications in the investigation of internal models and posture-movement coordination modes

Monjo, Florian 08 July 2015 (has links)
La fatigue musculaire est un phénomène transitoire communément expérimenté dans la vie quotidienne. Principalement associée à un déficit de production de force, elle s’accompagne également d’une augmentation de l’effort mental à fournir pour déployer un niveau de force particulier. L’augmentation du taux de décharge des afférences nociceptives de petit diamètre (groupes III et IV) lors de contractions fatigantes modifie l’expression des commandes motrices – notamment en raison de processus inhibiteurs associés à leur intégration aux niveaux spinal et supraspinal – ce qui affecte finalement la production motrice. C’est la raison pour laquelle une intention motrice similaire avec et sans fatigue se traduira par des formes gestuelles différentes. Une problématique qui n’a jusque-là jamais été abordée dans la littérature concerne la capacité du Système Nerveux Central (SNC) à anticiper les effets de la fatigue musculaire de façon prédictive. Cette capacité prédictive sera étudiée dans ce travail de thèse au moyen de paradigmes expérimentaux faisant intervenir des processus de contrôle prédictifs de la posture, i.e. les Ajustements Posturaux Anticipés (APAs). Du fait que de nombreux travaux montrent que les APAs sont modulés en fonction des caractéristiques mécaniques du mouvement à venir, l’altération des capacités des muscles focaux grâce à des protocoles de fatigue maîtrisés nous a permis d’apprécier la capacité du SNC à en prédire les effets. Nous verrons que cette capacité est condition-dépendante, à savoir qu’elle dépend de la nature des contractions effectuées (volontaires vs. électro-induites) et du niveau de contraintes cognitives et temporelles imposées lors de la préparation du mouvement / Muscle fatigue is a transient and commonly experienced phenomenon. It is mainly associated with loss of force and leads to higher effort to produce a particular force level. The increased discharge rate of the nociceptive afferents (group III and IV) during fatiguing contractions alters motor command expression and finally motor production. An issue that has never been addressed in the literature is the Central Nervous System (CNS) capacity to anticipate muscle fatigue effects in a predictive fashion. This predictive capacity will be investigated thanks to experimental paradigms involving postural predictive processes of control, namely Anticipatory Postural Adjustments (APAs). Because numerous works show that APAs are modulated as a function of the mechanical properties of the upcoming movement, the induction of muscle fatigue at the levels of the focal muscles allowed us to appreciate the CNS capacity to predict muscle fatigue effects. We will demonstrate that this capacity is condition-dependent, i.e. it depends on the nature of the fatiguing contractions performed (voluntary vs. electro-induced) and on the level of cognitive and temporal constraints during movement preparation
140

Validation of automated threshold audiometry : a systematic review and meta-analysis

Mahomed, Faheema January 2013 (has links)
The need for hearing health care services across the world far outweighs the capacity to deliver these services with the present shortage of hearing health care personnel. Automated test procedures coupled with telemedicine may assist in extending services. Automated threshold audiometry has existed for many decades; however, there has been a lack of systematic evidence supporting its clinical use. The aim of this study was to systematically review the current body of peer-reviewed publications on the validity (test-retest reliability and accuracy) of automated threshold audiometry. A meta-analysis was thereafter conducted to combine and quantify the results of individual reports so that an overall assessment of validity based on existing evidence could be made for automated threshold audiometry. A systematic literature review and meta-analysis was conducted using peerreviewed publications. A multifaceted approach, covering several databases and employing different search strategies, was utilized to ensure comprehensive coverage and crosschecking of search findings. Publications were obtained using the following three databases: Medline, SCOPUS and PubMed, and by inspecting the reference list of relevant reports. Reports were selected based according to inclusion and an exclusion criterion, thereafter data extraction was conducted. Subsequently, the meta-analysis combined and quantified data to determine the validity of automated threshold audiometry. In total, 29 articles met the inclusion criteria. The outcomes from these studies indicated that two types of automated threshold testing procedures have been utilized, the ‘method of limits’ and ‘method of adjustments’. Reported findings suggest accurate and reliable thresholds when utilizing automated audiometry. Most of the reports included data on adult populations using air conduction testing, limited data on children, bone conduction testing and the effects of hearing status on automated threshold testing were however reported. The meta-analysis revealed that test-retest reliability for automated threshold audiometry was within typical testretest reliability for manual audiometry. Furthermore, the meta-analysis showed comparable overall average differences between manual and automated air conduction audiometry (0.4 dB, 6.1 SD) compared to test-retest differences for manual (1.3 dB, 6.1 SD) and automated (0.3 dB, 6.9 SD) air conduction audiometry. Overall, no significant differences (p>0.01; Summarized Data ANOVA) were obtained in any of the comparisons between test-retest reliability (manual and automated) and accuracy. Current evidence demonstrates that automated threshold audiometry can produce an accurate measure of hearing threshold. The differences between automated and manual audiometry fall within typical test-retest and inter-tester variability. Despite its long history however, validation is still limited for (i) automated bone conduction audiometry; (ii) automated audiometry in children and difficult-to-test populations and; (iii) automated audiometry with different types and degrees of hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / gm2014 / Speech-Language Pathology and Audiology / unrestricted

Page generated in 0.0778 seconds