Analysis of Phonetic Balance in Standard English Passages.

Purpose A common way of eliciting speech from individuals is by using passages of written language that are intended to be read aloud. Read passages afford the opportunity for increased control over the phonetic properties of elicited speech, of which phonetic balance is an often-noted example. No comprehensive analysis of the phonetic balance of read passages has been reported in the literature. The present article provides a quantitative comparison of the phonetic balance of widely used passages in English. Method Assessment of phonetic balance is carried out by comparing the distribution of phonemes in several passages to distributions consistent with typical spoken English. Data regarding the distribution of phonemes in spoken American English are aggregated from the published literature and large speech corpora. Phoneme distributions are compared using Spearman rank order correlation coefficient to quantify similarities of phoneme counts in those sources. Results Correlations between phoneme distributions in read passages and aggregated material representative of spoken American English ranged from .70 to .89. Correlations between phoneme counts from all passages, literature sources, and corpus sources ranged from .55 to .99. All correlations were statistically significant at the Bonferroni-adjusted level. Conclusions Passages considered in the present work provide high, but not ideal, phonetic balance. Space exists for the creation of new passages that more closely match the phoneme distributions observed in spoken American English. The Caterpillar provided the best phonetic balance, but phoneme distributions in all considered materials were highly similar to each other.

Stakeholder engagement in methodological research: Development of a clinical decision support tool.

INTRODUCTION: Shared patient-clinician decision-making is central to choosing between medical treatments. Decision support tools can have an important role to play in these decisions. We developed a decision support tool for deciding between nonsurgical treatment and surgical total knee replacement for patients with severe knee osteoarthritis. The tool aims to provide likely outcomes of alternative treatments based on predictive models using patient-specific characteristics. To make those models relevant to patients with knee osteoarthritis and their clinicians, we involved patients, family members, patient advocates, clinicians, and researchers as stakeholders in creating the models. METHODS: Stakeholders were recruited through local arthritis research, advocacy, and clinical organizations. After being provided with brief methodological education sessions, stakeholder views were solicited through quarterly patient or clinician stakeholder panel meetings and incorporated into all aspects of the project. RESULTS: Participating in each aspect of the research from determining the outcomes of interest to providing input on the design of the user interface displaying outcome predications, 86% (12/14) of stakeholders remained engaged throughout the project. Stakeholder engagement ensured that the prediction models that form the basis of the Knee Osteoarthritis Mathematical Equipoise Tool and its user interface were relevant for patient-clinician shared decision-making. CONCLUSIONS: Methodological research has the opportunity to benefit from stakeholder engagement by ensuring that the perspectives of those most impacted by the results are involved in study design and conduct. While additional planning and investments in maintaining stakeholder knowledge and trust may be needed, they are offset by the valuable insights gained.

The use of patient-specific equipoise to support shared decision-making for clinical care and enrollment into clinical trials.

BACKGROUND: To enhance enrollment into randomized clinical trials (RCTs), we proposed electronic health record-based clinical decision support for patient-clinician shared decision-making about care and RCT enrollment, based on "mathematical equipoise." OBJECTIVES: As an example, we created the Knee Osteoarthritis Mathematical Equipoise Tool (KOMET) to determine the presence of patient-specific equipoise between treatments for the choice between total knee replacement (TKR) and nonsurgical treatment of advanced knee osteoarthritis. METHODS: With input from patients and clinicians about important pain and physical function treatment outcomes, we created a database from non-RCT sources of knee osteoarthritis outcomes. We then developed multivariable linear regression models that predict 1-year individual-patient knee pain and physical function outcomes for TKR and for nonsurgical treatment. These predictions allowed detecting mathematical equipoise between these two options for patients eligible for TKR. Decision support software was developed to graphically illustrate, for a given patient, the degree of overlap of pain and functional outcomes between the treatments and was pilot tested for usability, responsiveness, and as support for shared decision-making. RESULTS: The KOMET predictive regression model for knee pain had four patient-specific variables, and an r 2 value of 0.32, and the model for physical functioning included six patient-specific variables, and an r 2 of 0.34. These models were incorporated into prototype KOMET decision support software and pilot tested in clinics, and were generally well received. CONCLUSIONS: Use of predictive models and mathematical equipoise may help discern patient-specific equipoise to support shared decision-making for selecting between alternative treatments and considering enrollment into an RCT.

Measurement of fetal heart rate variability on an electronic monitor using a prototype electronic ruler.

OBJECTIVE: To develop a prototype electronic ruler for assessment of fetal heart rate (FHR) variability on an electronic monitor and test its reliability and accuracy. STUDY DESIGN: A prototype electronic ruler was designed and developed for assessment of FHR variability on electronic monitors. The electronic ruler consisted of horizontal bands that were sized and colored to embed the four FHR variability categories. The reliability and accuracy of using the electronic ruler to assess FHR variability was studied with expert clinicians. RESULTS: Intrarater and interrater reliability was moderate for both the electronic ruler and paper strips. The amplitude measurement accuracy of expert variability assessment compared with a gold standard was significantly improved (p < 0.001) with the electronic ruler versus paper strips. The accuracy of subjects' FHR variability category responses compared with the gold standard revealed no significant difference (p = 0.50) using either display type. CONCLUSION: Performance of the electronic ruler was equivalent to paper strips, which may aid assessment of variability on electronic monitors as paper strips become less prevalent.