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Introdução: A determinação da área dinâmica do implante coclear é um dos procedimentos mais importantes em sua programação. O uso de medidas objetivas, em especial a do limiar do reflexo estapédico evocado eletricamente, pode contribuir para a definição deste campo, principalmente em crianças ou em indivíduos com múltiplos comprometimentos, pois fornecem valores específicos que servem como base no início da programação do implante coclear.
Objetivo: Verificar por meio de uma revisão a utilização do limiar do reflexo estapédico evocado eletricamente durante o processo de ativação e de mapeamento do implante coclear.
Métodos: Levantamento bibliográfico nas plataformas Pubmed e Bireme e nas bases de dados MedLine, LILACS e SciELO, com buscas padronizadas até setembro de 2012, utilizando-se palavras-chave. Para a seleção e avaliação dos estudos científicos levantados, foram estabelecidos critérios, contemplando os seguintes aspectos: autor, ano/local, grau de recomendação/nível de evidência científica, objetivo, amostra, faixa etária, média de idade em anos, testes avaliativos, resultados e conclusão.
Resultados: Dos 7.304 artigos encontrados, 7.080 foram excluídos pelo título, 152 pelo resumo, 17 pela leitura do artigo, 43 eram repetidos e 12 foram selecionados para o estudo.
Conclusão: O reflexo estapédico evocado eletricamente é capaz de auxiliar na programação do implante coclear, principalmente em pacientes que apresentam respostas inconsistentes.
Introduction: The most important stage in fitting a cochlear implant is the identification of its dynamic range. The use of objective measures, in particular the electrically elicited stapedius reflex, may provide suitable assistence for initial fitting of cochlear implant, especially in children or adult with multiple disorders, because they provide specific values that serve as the basis of early cochlear implant programming.
Objective: Verify through a review the use of the electrically elicited stapedius reflex threshold during the activation and mapping process of cochlear implant.
Methods: Bibliographical search on the Pubmed and Bireme plataforms, and also on Medline, LILACS and SciELO databases, with standard searches until September 2012, using specific keywords. For the selection and evaluation of scientific studies found in the search, criterias have been established, considering the following aspects: author, year/location, grade of recommendation/level of evidence, purpose, sample, age, mean age in years, evaluative testing, results and conclusion.
Results: Among 7,304 articles found, 7,080 were excluded from the title, 152 from the abstract, 17 from the article reading, 43 were repeated and 12 were selected for the study.
Conclusion: The electrically elicited stapedius reflex may support when programming the cochlear implant, especially in patients with inconsistent responses.
The cochlear implant (CI) is acknowledged worldwide as the treatment of choice for severe and profound bilateral sensorineural hearing loss (SHL).1 This device consists of external and internal components. The external components are the microphone, speech processor, and transmitter antenna. Among the internal components is the stimulatory receptor, which includes the internal antenna, which is surgically placed adjacent to the skull. The CI is a device that partially replaces the functions of the cochlea, transforming sound energy into electrical signals.2
In this type of device, each electrode directly stimulates the auditory nerve, and the amount of electric current necessary to elicit an auditory sensation is different for each individual and for each stimulation channel. For this reason, the speech processor of each user must be individually adjusted in a process called programming or mapping. The dynamic area is the region between the amount of current that primarily induces an auditory sensation, i.e., the threshold for electrical stimulation (T level) and the level of sensation of maximum intensity that the patient will accept for electrical stimulation without discomfort (C level).
In adults, the determination of the energy levels is accomplished through psychophysical measures (behavioral method). In infants, small children, or individuals with multiple disorders, this procedure requires techniques that can generate inconsistent and asystematic responses due to the child's hearing inexperience or age. Thus, using only the behavioral method to program the speech processor can prolong the process of adaptation to the CI due to the difficulty of establishing appropriate levels of stimulation.3-5
The use of objective measures in the CI process has greatly contributed to the definition of the dynamic field, as they provide specific values that serve as the basis for the start of the mapping process, especially in cases of infants and young children. Some examples of these measures are electrically evoked stapedius reflex threshold (ESRT), neural response telemetry (NRT), brainstem auditory evoked potential (BAEP), and P300, among others.6-9
The stapedius reflex is defined as a contraction of the middle ear muscles induced by an intense acoustic stimulus. This has become a valuable clinical and research tool of human hearing.10-12 The acoustic reflex, considered the lowest intensity of sound that makes the minimum measurable change in the middle ear, is normal between 70 and 90 dBSPL.13
The correlation between the values obtained objectively and values assessed by the behavioral method has been extensively studied. However, in clinical practice, there is no consensus and standardization regarding the use of these measures in the treatment of CI users.14 ESRT appears to be a promising finding, as several studies have indicated an association between these thresholds and the assessment of maximum comfort level in adults and children with cochlear implants.15 Through further studies, this measure may be included in the standard procedures, because its contributions are evident and the gains for the patient and for the professional are undeniable.
The objective of the study was to verify, through an integrative review, the use of ESRT during the CI activation and mapping process, as well as its value associated with behavioral assessment.
The methodological process characterized the present study as an integrative review, conducted from electronic searches in the PubMed, BIREME, MEDLINE, LILACS, and SciELO Regional databases. The search was performed in the months of August and September of 2012. Studies published in English, Spanish, or Portuguese were selected for the analysis. There was no restriction regarding the year of publication, i.e., studies published until October 2012 were analyzed and the articles were subsequently selected according to the inclusion and exclusion criteria.
A specific strategy for the crossing of the descriptors (DeCS and MeSH) was created for each of these databases, as well as for free terms that are not found among DeCS and MeSH terms, but that are relevant to the research. The descriptors used to locate the studies were cochlear implants/ cochlear implantation, acoustic reflex, and hearing loss.
Search strategy
The search strategy was the syntax of the strategy, used for the bibliographic search in the databases. This was directed by a specific question: "What is the importance and applicability of ESRT during the activation and mapping process of the CI?". To identify relevant articles with the proposed question, a search strategy was developed using the descriptors in groups, with at least two keywords. In PubMed, the crossings were: cochlear implantation/cochlear implants AND hearing loss and cochlear implantation/cochlear implants AND acoustic reflex. In Bireme, the crossings were cochlear implant AND hearing loss, cochlear implant AND hearing impairment, cochlear implant AND hearing loss, and cochlear implant AND acoustic reflex. The free terms used were: hearing loss and hearing impairment.
Selection criteria
The inclusion criteria were: original articles; with research subjects undergoing CI surgery; with procedures such as ESRT in the CI process (surgery and/or programming and/or rehabilitation), and published in Portuguese, English, or Spanish. Studies that were not original articles and those that did not mention CI in the title of the manuscript were excluded.
Study identification, selection and inclusion
The search was independently performed by two researchers, and points of conflict were discussed during specific meetings. After applying the search strategy containing the defined descriptors, the selection of articles was performed in three steps:
• Identification and reading of titles in different electronic databases, and exclusion of those that did not meet inclusion criteria.
• Reading the abstracts of the studies selected in the first step, and further exclusion of those that did not meet the inclusion criteria.
• Reading in full of all studies not excluded by the first two steps.
All the studies considered met the criteria of inclusion defined at the beginning of the present study's methodological protocol, responding to the question guiding this integrative review.
The main data of each article were collected and entered into a database using Microsoft Office Excel 2011® software.
For a better result presentation, the following variables of the selected articles were considered: author, year/location, grade of recommendation/level of evidence, objective, sample, age range, mean age in years, assessment testing, results, and conclusion. The Oxford Centre for Evidence-Based Medicine Classification was used to measure the level of scientific evidence.16
A total of 7,304 articles were retrieved in the electronic searches in the PubMed, BIREME, MEDLINE, LILACS, and SciELO Regional databases. A total of 12 articles were selected according to the inclusion and exclusion criteria defined in Methods, and after removing the references listed in more than one database.
In the MEDLINE database via PubMed, when crossing the keywords and free terms, 7,106 articles were retrieved, of which 6,893 were excluded by the title, 213 abstracts were read, and 69 articles were selected for full reading. Of these 69, 43 were repeated and 14 articles were excluded. In the LILACS database, 183 articles were retrieved, of which 172 were excluded by the title, and three abstracts were read and were excluded. In the SciELO database, 15 articles were retrieved and 15 were excluded by the title. Fig. 1 provides an overview of the process for obtaining the articles selected for the integrative review.
Figure 1. Flowchart of articles included in the review.
Among the 12 selected articles, one study had level of evidence B (2B)17 and 11 had level of evidence C (4).18-28 No publications were found with level of evidence A. Among the study designs analyzed in the review, one was a cohort study and the others were case reports (Table 1).
Due to the recent increase in the number of studies in the area of CI, this review highlights researches between 1988 and 2011. All selected articles had ESRT and other objective tests, whether performed intraoperatively or postoperatively, for the purpose of comparison with behavioral tests, widely used in the definition of the dynamic range in the CI process.
It was at the same time of the first selected article,12 between the 1980s and 1990s, that there was a great revolution in the area of CIs, due to increased investment in research. At the beginning of CI procedures in the 1980s, patients referred for CI surgery were those classified as having profound bilateral sensorineural hearing loss. However, over the years, with the observation of results and technological advancements, the indications were expanded and started to have broader criteria.
Currently, not only individuals with profound bilateral hearing loss are considered as possible candidates for the CI, but also those with severe and profound hearing loss with no benefit from a hearing aid, as well as other less classic indications such as for hybrid implants (acoustic electric stimulation).15 This greater coverage led to a significant increase in potential candidates for CI surgery, and as a consequence, results of researches involving the subject have increased considerably.
The evolution of and faster diagnosis of hearing loss is also an illuminating point regarding the increase in the number of surgeries, especially in young children. According to the protocol of neonatal hearing screening, suggested by the Joint Committee on Infant Hearing in 2000,29 the diagnosis should be made by 3 months of age, and intervention initiated by 6 months of age.
This change in profile of candidates for CI, exemplified by articles containing the pediatric range in their samples,23,24 explains the growing need to include objective testing in the activation and mapping procedures of the CI. Unlike adults, who have the determination of energy levels of each of the CI electrodes performed through psychophysiological measurements, infants need more specific procedures, which require techniques that can be inconsistent and unsystematic due to the child's hearing inexperience or age. The process is characterized as much more arduous, and requires greater collaboration from the patient's family.
Especially for those children with pre-lingual hearing loss, as they do not have any hearing experience, changes in behavior and reflexes should be used to create individual activation maps.5
Knowing that an appropriate definition of the dynamic area (the region between the amount of current that first induces an auditory sensation [T level] and the level of maximum intensity of sensation that the patient will accept for electrical stimulation without discomfort [C level])4,24 is the key to the success of the CI, most of the articles had ESRT and behavioral measures as single assessment tests.18-23 These studies demonstrated that ESRT can very efficiently help in mapping the CI, especially when the goal is to safely define the C level.
Another important point concerns the other evaluation tests studied in addition to ESRT, especially ECAP, which consists of the action potential of the distal portion of the auditory nerve, which can be recorded during the intraoperative period directly in the cochlea, using the CI electrodes as stimulus generators and response recorders using specific software.30 The comparison between ESRT and ECAP, observed in one study,28 was performed precisely because ECAP is the measure of auditory nerve activity most commonly used in CI users, since ECAP's thresholds can be useful to predict minimum and maximum levels that should be used to program the speech processor,31 and ESRT can be useful to assess the maximum comfort level in adults and children using CI.15
Three other studies17,24,25 used, in addition to ESRT and ECAP, the BAEP, an objective measure of great assistance in CI procedures, but with higher susceptibility to electrical noise artifacts.32 According to one study,17 the BAEP was shown to be a more reliable measure than the ECAP and the ESRT. However, since this study aimed to analyze the effectiveness of such objective techniques in the speech processor programming of CI users in a total sample of 35 individuals (20 in the study group, with cochlear malformations, and 15 in the control group) the conclusion which showed BAEP as the most reliable measure is justified by the sample, which was different from the other studies.
Another assessment test used in one study,26 NRT, is used in clinical routine for programming the CI in order to predict the best levels of electrical stimulation.9,23,32,33 Including this measure in studies is important because virtually all programming methods available and recommended by the manufacturers currently use NRT measures for mapping the CI. This is possibly due to the fact that NRT can be adjusted or combined with fully objective methods, such as programming by a correction factor, by preset progressive maps, or by adjusting the speaker. The programming software allows for the importing of thresholds obtained by the NRT and automatically combines them with the psycho-acoustic levels obtained through the behavioral test in at least one of the electrodes.
Some scholars argue that NRT can be reliably used as a starting point to define initial levels of connection, as it is found between the T and C levels.34 Indeed, clinical experience suggests that NRT in the postoperative period is more easily found than ESRT. However, when possible, the combination of NRT and ESRT, as well as other objective measures, tend to add valuable information for the team responsible for the CI speech processor programming, since the measures of comfort may be too high or too low in children when determining the dynamic field based solely on behavioral responses.
Some studies have significant methodological limitations, since important data such as age and mean age of the studied sample were not identified.17,18,20,21,25-27 Considering that some auditory responses are typical in certain age groups, the lack of such data weakens these studies and limits some inferences, as the procedures used during the mapping of the CI differ mainly regarding the patient's age and the time of hearing deprivation to the device activation.
The evaluation methods described in the studies included in this review used intraoperative techniques, postoperative techniques, or both.22,27 Intraoperative visual assessment of the stapedius reflex is subject to difficulties, as bleeding and scar tissue in the middle ear tend to cause inaccuracy in the observation of muscle contractions. In one study,27 despite the visual aspects and tympanometry that showed nearly identical intraoperative thresholds, the ESRT was higher intraoperatively than postoperatively, a fact that can be explained by the action of anesthetics, which may weaken the stapedius reflex during surgery.35-37
The results of the 12 articles selected for the present review suggest that the objective tests, especially ESRT, whether performed intra- or postoperatively, significantly help the team responsible for surgery and rehabilitation of patients submitted to CI. The comparison of methods of measurement allows the team to be more confident regarding the results; thus, the process becomes faster and safer, as the behavioral assessment will be assisted by objective measures.
Based on these data, it is observed that ESRT can be included as valid information to be used as a parameter in the standard procedures of the CI process, since its contributions are positive to both activation and mapping of this device.
Based on the studies included in this literature review, it can be concluded that:
• ESRT, whether measured intra- or postoperatively, is an objective measure that can help in programming the CI device, especially in patients with inconsistent responses.
• The combination of objective and behavioral tests during the programming of the speech processor of the CI should be used to avoid setting very high-intensity maximum levels of sensation.
• This combination makes the process faster and safe, even for infants, small children, or individuals with multiple disorders.
Conflicts of interest
The authors declare no conflicts of interest.
Received 30 March 2013;
accepted 7 September 2013
☆Please cite this article as: Andrade KCL, Leal MC, Muniz LF, Menezes PL, Albuquerque KMG, Carnaúba ATL. The importance of electrically evoked stapedial reflex in cochlear implant. Braz J Otorhinolaryngol. 2014;80:68-77.
* Corresponding author.
E-mail: email@example.com (K.C.L. Andrade).


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subset: commoncrawl


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Are any of you hip to The Buttercream Gang?
Are any of you hip to The Buttercream Gang?
Look eye, always look eye.
Fellow Christians?
The Buttercream Gang was gonna change the world though, until one of them became a career criminal after one trip to the evil mid-west.
The foreign and the left cant handle these themes.
Pretty sure they are too preoccupied with their stupid in-fighting and pet causes to analyze the rich Buttercream 120
Being a Buttercreamer isnt just about helping people out, its about HAVING FUN.
It's also about TREATS.
I'm guessing my neighborhood is no longer Buttercreamer controlled. Was in the hardware store earlier and all the tools were fastened to the racks with plastic security devices. Even the $3 - $5 screw drivers.
My new screw driver will protect me from Italian bullies in leather that lob fire crackers indiscriminately.
I would like to, for the black, non Christian delegation, add that the blacks have nothing to do with 'the left'. All of that is infact 'the white' in-fighting. Thanks
- Black
Let's hear it for spaghetti with ketchup.
Bob, why have you taken over Check 2s Hating on Italian Stereotypes gimmick?
Ive tried going to a local hardware store a few times recently, all 3 times I had to then drive to a big box store because they didnt have what I needed, or they werent open. One of my recent trips, I bought this handy pin punch set...
Should I have posted that in the Rich Forum Members thread?
Italians arent a protected class so you can slur us with no regard.
But when you are responsible for the decency and progress of Western Civilization, you take it all in with a grain of salt, continue to water your lawn, and keep the inside and outside of your home pristine.
If Art was thin they might think he was gay on account of his neatness.
The Buttercream Gang sounds like a bunch of 90's fags who were touching each other's cocks at school camp and meet up on the first Saturday in July every year to re-live the experience and dock each other's knobs
lol @ Art trying to distance himself from such homosexuality when everyone knows all it took was a little 'cmon Art it'll be fun we don't care about your size don't be scared' to get his dick out for the boys
Posts by The Hound are signed TH.
Quoting ≠ Agreement.


text: Dear Ms. Collins, There's something almost guilty about watching two characters who should be together, and aren't, interact. It's even more decadently wicked when the two people in question are married – and can't see what's in front of their noses. Such is the case with Agency Walker Juliana Norris ... more >


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NOTE: Sorry the photos are so small, I was having some trouble with Blogger this week. Enjoy!
I have now been working as a product photographer full time for almost a month. I've come to find that it's kind of a strange job. Especially when you don't have an assistant. I want to take a web cam and record my day. Truly reveal the strangeness, and absolute tediousness of this job.
I fight with cloth, products, and mannequins. One of which is almost twice my size. From an outside perspective it would be hilarious to watch… Oh also while I work on the computer, if it's more then ten minuets, the light goes off and I have to get up and move to the center of the room to turn the light back on. I've almost killed myself a couple times stumbling over things in the dark.
(My partner in crime: Rusty. He's a little stiff, a quiet guy, and fairly difficult to work with. But some times you have to work with people you don't really care for.)
One part of this job I really enjoy is learning about products and gear that is out there on the market. I found out there is a product you can buy to keep your toilet paper dry on a camping trip. (The things people come up with. Genius.) Roughing it these days isn't quite what it used to be.
Along with learning about products I usually have to understand how they work and how they are put together. Then, I proceed to put it together myself, make it looks better then it is, take it apart, and here's the best part put it all back in the box the same way I got it out.
Yeah, that's a five-person tent. I put it up myself thank you very much.
I also find myself coordinating strange setups with a friend of mine who works in Marketing when I get frustrated.
But, enough about work, on to something else I wanted to talk about.
About a week or two ago I started reading a great book, Dark Water by Robert Clark. I had seen the book in Barns but me being me, went to the library to find it instead. This book takes you through the history of Florence, Firenze, its art, and the artists and writers who have flocked to the city. It takes you through this history in an interesting way. Clark tracks time through the travesties of Firenze, mostly the flooding of the Arno River. Because of this Clark can go into the history of how pieces of art were saved, forgotten, restored, found again, and recovered.
I'm only on page 115 of 324 but I have, so far, found it enjoyable and interesting. I recommend you pick up this book as well. I'll give you a full reflection on it when I'm finished.
Now, in regards to my own art work. I've been drawing a bit more the last two weeks then taking photos. But, I have developed another roll of film. No prints have been made yet from the roll but I did scan some of the negatives. I forgot to transfer the files to my computer so they will be for the next post.
Speaking of, my next post with either be a week early or a week late. I have a good friend coming to visit next week and so will be out having fun instead of focusing on this blog and my art. I might have some photos from her visit; along with Salt Lake's Pride Festival this week. Should be a good time, and hopefully I'll get some good shots.
Also coming up will be a write up about Salt Lake's June Gallery Stroll, and I will also be taking a trip to the Sun Tunnels the weekend just before the Solstice. I look forward to sharing these things with the small amount of people who read this blog.
Have a lovely week all, go and enjoy some great spring/summer weather!
Saturday, June 4, 2011
Product Photography... So Far
Labels: art, art administration, art history, art restoration, Erin Carr, fine art, firenze, Florence, photography, product photography, Robert Clark
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Watch out Prevost, Van Hool and MCI. There is a new coach builder that might give you a run. They are neither Chinese, Brazilian or Turkish. They have some really good ideas and potentially a really good understanding of what coach owners are wanting to purchase.
You might also like
Has technology made things better or sometime just lazy.
Code readers. I love them. I've been able to diagnose so many things independent of what the dealer eventually tells me. So many advantages to understanding the sensors and inputs when dealing with a faulty vehicle. On the other hand it seems to becoming more pervasive for techs to believe that clearing codes or "updating" […]
Initial Quality and Responsibilities
What do you think about brand new equipment have significant breakdowns within the first couple of months. Lemon laws don't apply but shouldn't there be some recognition from the dealer/manufacturer of downtime caused by a faulty product?
A change in rankings
At first glance it seems there might be trouble in paradise. The winner of the 2014 COTY award might have slipped up with quality in its most recent years. The 2016 evaluation is underway and it will be interesting to see if some of the anecdotal evidence continues to appear in other areas.


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Publishing and Consultancy
The third title for Red Button takes a turn to the dark side. Rebekah Lattin-Rawstrone's powerful and thought-provoking novel Home tells the story of newly widowed Steve, who uncovers disturbing and frightening secrets at the care home where he works. Home has already garnered praise from acclaimed novelist Toby Litt. We are delighted to have an exclusive interview with Rebekah on our blog today.
Q: Home is set in a care home for the elderly. It's a dark novel that raises a lot of uncomfortable questions about how we deal with the elderly and the dying both as individuals and as a society. What do you hope readers take away from the novel?
REBEKAH: I am particularly interested in what we choose to ignore about ourselves and about the world around us and so when I write about people or practices that seem dark or distasteful, I'm really trying to get people to question themselves. What do they do or not do that implicates them in the feelings of disgust or horror they have towards my characters or situations? It's something I'm interested in exploring about myself. I write to explore it and hope that my writing might then inspire others to question themselves. It is all too easy to name and scapegoat the bad we see others perpetrating, and much more difficult to examine ourselves. In an ageing population, questions about how we deal with the elderly are essential and I think we too easily infantilise old-age; it would be nice to go back to perceiving age as wisdom rather than allowing youth-driven consumerism to objectify the elderly, rendering them useless once their money has been spent.
Q: What inspired you to write Home?
REBEKAH: I used to live in a tiny little flat that looked out onto a low-rise block of assisted living apartments for the elderly. I didn't give the building much thought, but then one night I woke up thirsty at about 3am and came to the kitchen to get a drink. I didn't turn on any lights, because as everyone who lives in a city knows, the street provides plenty of light, and I was naked so I didn't really want anyone peeping in. But as I stood by the sink, glass in hand, something caught my eye and I looked out of the window. There, in the building opposite, was a woman standing at the window. The windows on that side of the building were huge, with two long panes of glass and then one lower pane that stretched the full width of the window. Oddly, though, the window was covered by a net curtain that moved gently as the woman did; it only fell as far as the upper panes of glass so that all I could see clearly of the woman were her feet and ankles. They were bare, the toes beginning to twist with bunions. I could make out the large, hospital-style corridor behind and her nightie, but not much else. She was standing, rocking gently, and staring out, it seemed, right at me. It was extremely unnerving. I felt very exposed. And I kept wondering about her and why she was there, about her life, and why she seemed so sad and lonely, awake and staring at 3am. The old woman came from her and everything else followed on from that.
Q: Home portrays a world where "evil has been made ordinary". Should we be frightened of the possibilities laid out in the novel?
REBEKAH: Yes. Evil is ordinary. But evil is such a charged word. We use it to label and scapegoat, when really we should be exploring it, using it as a mirror. For example, Milos is not meant to be an evil character. We all live in a world in which ignoring unpleasant facts makes life easier. He thinks what he does is art and no worse than what the relatives of the old people have already done and he hopes to use his art to challenge people's attitudes to old age and the family. He thinks this will make up for his part in the atrocities taking place in the home. He is selfish, though, and by allowing his own needs to take precedence over everyone else's he is not only blind to the depravity of his actions but also to the people around him. That is how he ends up tangled in his own web. Just like Milos, we sometimes need to look harder at ourselves. I think that is a frightening prospect.
Q: Do you think fiction can be used as an effective precursor for debate on political and societal issues?
REBEKAH: Absolutely yes, with emphasis on the word 'precursor'. I think really good fiction should be encouraging us to ask questions about ourselves and the world around us, and if this isn't a precursor for debate on political and societal issues then I don't know what is. However, I am wary of people who seek to turn writers into authorities on politics and society. Just because writers are good at asking questions doesn't necessarily mean they have the answers and hopefully all the ideas a writer has had about a political or social topic are within the work of fiction they have created. I'm not a huge fan of We Need To Talk About Kevin, but I think it's a great example of how a work of fiction can provoke debate.
Q: Home features fourteen original artworks from artist Katherine Jones, inspired by the book. Did the two of you discuss these beforehand? Did you have a vision as the writer of what the artwork should look like?
REBEKAH: Katherine and I have been friends for some time and we often talked about working together and being inspired by each other's work. There is a real sense of time in Katherine's work. You can feel the moment of the image but there is also a suggestion of memory, of what happened to create this moment, and the imagined future, which give them a dream-like, surreal quality that I really love and that I feel complements what I was trying to do in Home. I didn't give her a brief, I just gave her the book and she created these amazing womb-like, organic and organ-like drawings. I think they say a lot of what I was hoping to say. Together they show the human journey and its fragility. I love them. I hope someday I'll do justice to one of her images in the way that she has done justice to Home.
Q: You've recently been teaching a workshop for writers on writing "the unpalatable". Tell us more about that.
REBEKAH: 'The Unpalatable' is really a name I have given to the kind of writing that interests and inspires me. I like to be encouraged to question myself and my place in the world and this is often most effectively achieved by making readers feel uncomfortable. I don't feel I'm writing straightforward horror, and I don't feel I'm writing straightforward speculative fiction or even straightforward slipstream, which actually outlines much of the characteristics I have associated with the unpalatable but is perhaps more self-consciously tricksy than I would like to be. So I came up with my own term for the kind of writing I would like to do. I used the workshop to encourage writers to think about what themes interest them and why. I wanted them to think about how they place themselves among other writers and what they think they are trying to achieve.
Q: Which writers would you say have most influenced your own writing?
REBEKAH: This is a really difficult question because there are simply too many to pick and at different times in my life different writers have inspired me. I have a fascination for fairy and folk tales that started in childhood, but I also love the younger fiction of Diana Wynne Jones and Orson Scott Card. I was a huge Virginia Woolf and James Joyce fan at school and college. Off the top of my head, other inspiring writers would be: Richardson, Aphra Behn, Jane Austen, William Faulkner, Joseph Conrad, Borges, Kafka, Dostoevsky, Steinbeck, Toni Morrison, Katherine Mansfield, Ron Butlin, Dambudzo Marechera, Elfriede Jelinek, Zeruya Shalev, Ben Okri, Amos Oz, Paul Auster, Akutagawa, Susan Sontag, Marquez, Ian McEwan (early work only, though), Primo Levi, Jamaica Kincaid, George Perec, Marie Darrieussecq, Bret Easton Ellis, Calvino, Angela Carter, Alice Munro, Murakami, Jim Crace, Philip K. Dick, Stephen King, Joseph D'Lacey, José Saramago, Paul Blaney, Heidi James.
Q: What was the last book that really moved you?
REBEKAH: Love Life by Zeruya Shalev. There is a layer of the book that I don't understand, mostly because I'm not familiar with stories of the temple, but it was brilliant. Just to cheat, Heidi James's Wounding, coming out in April, is also very moving and should provoke debate about modern attitudes to motherhood.
Q: What are you working on now?
REBEKAH: I am working on my second novel, a series of short stories trying to take a wry look at modern moral dilemmas and a children's story called 'The Magic Story Pot'. The novel is set in England and Malawi and is about how we care for others. In some ways it expands on themes already touched upon in Home.
To organise your own interview with Rebekah or to request a review copy please contact Caroline and Karen at firstname.lastname@example.com


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Memorandum by the NEA
The Government's fuel poverty target is adequate, however more commitment is needed to tackle fuel poverty amongst households not currently categorised as vulnerable.
While the target is achievable, it will not be achieved given the current policies and programmes. Specifically:
Recent reductions in the number of fuel poor households are unlikely to be sustainable as much of the reduction has been as a result of reductions in price and increased income.
Issues of commercial confidentiality make it difficult to assess the impact of industry-led initiatives.
Changes in the eligibility rules for current schemes could assist households whose incomes are just above benefit level. An alternative approach is to target assistance on properties rather than households.
Technological advances such as micro CHP and some renewable and sustainable energy sources offer the potential to provide affordable warmth to households who will not be assisted by current schemes.
1. National Energy Action (NEA) is a national charity which, for more than 20 years, has campaigned for policies to secure the eradication of fuel poverty. NEA develops and promotes energy efficiency services to remedy the heating and insulation problems of low-income households. NEA works in partnership with central and local government; with fuel utilities, housing providers and health services; and with consumer groups and voluntary organisations.
NEA's work includes:
NEA welcomes the Trade and Industry Committee's decision to hold an inquiry into the important subject of fuel poverty, and the opportunity to submit written evidence. Comment will, in the main, concentrate on the specific issues raised in the Committee's initial announcement of the inquiry.
2. Is the Government target of ensuring that by 2010 no members of "vulnerable households" need risk ill health due to a cold home adequate? Can it be achieved?
2.1 NEA applauds the current Government's commitment to the eradication of fuel poverty amongst vulnerable households by 2010. While NEA wishes to see the eradication of fuel poverty amongst all households, the charity does support the principle of the prioritisation of vulnerable groups. While it is debatable whether the Government's definition of "vulnerale" includes all those households at risk, it is recognised that any definition is likely to be problematic. Although NEA regards the current target as adequate, the charity would wish to see a stronger commitment by Government to the eradication of fuel poverty in non-vulnerable households in line with the requirements of the Warm Homes and Energy Conservation Act 2000.
2.2 NEA believes that the Government's target can be achieved and indeed, must be achieved; it is intolerable that millions of households cannot afford sufficient fuel for warmth and comfort in the generally affluent United Kingdom. The Environmental Audit Committee in its 1999 report on energy efficiency described fuel poverty as a "persistent national scandal." However, NEA does not believe that the measures set out in the UK Fuel Poverty Strategy are adequate to achieve the sustainable eradication of fuel poverty.
2.3 The UK Fuel Poverty Strategy sets out the three main approaches to fuel poverty reduction:
2.4 Energy Efficiency Programmes
2.4.1 The principal schemes to improve the energy efficiency of homes occupied by low-income households identified in the Strategy are:
2.4.2 NEA has consistently supported energy efficiency as the most rational and sustainable approach to a solution to fuel poverty, but has serious reservations about the adequacy of these programmes to deliver this objective. The following comments are made principally in relation to the programmes in England, however some of the issues raised may also be applicable in Scotland, Wales and Northern Ireland.
2.5 Warm Front
2.5.1 Warm Front (formerly the Home Energy Effiicency Scheme (HEES)), is the main mechanism to improve the energy efficiency of low-income households in the private sector. Grants of up to Ł1,500 are available for insulation measures and heating system improvements for households in receipt of a means-tested benefit and with children under the age of 16 or expectant mothers. Grants are also available for households claiming one of a range of long-term sickness or disability benefits. In addition, householders of pensionable age (60 or over), and in receipt of a means-tested benefit, may be eligible for grants of up to Ł2,500 for a new central heating system in addition to the other mesaures (Warm Front Plus).
Hence, even within the category of "vulnerable households" the grant scheme provides more assistance to eligible elderly households than to others. It is likely that many of the non-elderly vulnerable households will require an efficient central heating system to provide affordable warmth.
NEA recomends that the Warm Front Plus grant should be extended to all eligible households where there is a dependent child or expectant mother, or where a household member is in reciept of a qualifying disability benefit and pensioners over the age of 75.
2.5.2 It is not clear to what extent those households who receive a Warm Front grant are lifted out of fuel poverty. NEA is concerned that significant numbers of grant recipients will not be lifted out of fuel poverty as a result of receiving a grant. There are a number of reasons for this concern including:
The Scheme Managers do not currently collect income data on grant recipients, so it is not possible to estimate the impact of the scheme in terms of the number of households lifted out of fuel poverty.
2.5.3 Recent work by NEA[11] suggests that a significant proportion of those households in receipt of Warm Front grants are not in fuel poverty even before the work has been carried out. Whilst this work undoubtedly provides a benefit to these low income households (and to subsequent occupants many of whom may be fuel poor) such grants do not contribute to the Government's fuel poverty reduction targets. The interim targets in the Strategy are set in terms of properties treated, and reliance on such targets may result in serious slippage in the real reductions in fuel poverty if the patterns identified in Camden and North Tyneside are repeated nationally.
An investigation into the incidence of Warm Front grant take-up by non-fuel poor households should be included in the research recommended above.
2.5.4 The work carried out by NEA in Camden and North Tyneside also indicates that there are significant numbers of fuel-poor households who are not eligible for Warm Front grants. There are a number of reasons for this, including:
The first two groups may contain significant numbers of households from the "vulnerable" categories. Whilst it may be possible to address the first difficulty through benefit take-up campaigns the second requires a different approach. This may require greater flexibility in the eligibility criteria for grant schemes. As a first step it will be necessary to quantify the extent of this problem.
NEA recommends that research be undertaken to determine numbers of vulnerable households in fuel poverty not currently eligible for assistance.
2.5.6 There is also the question of the so-called difficult-to-heat properties. These are mainly properties with solid wall construction where conventional, cost-effective insulation methods are not appropriate and those properties not currently connected to the mains gas network. In the case of the former, the current Warm Front grant scheme will only have a limited impact which is unlikely to provide affordable warmth in the majority of cases. Similarly, the current range of measures is less likely to provide affordable warmth in properties which do not have access to mains gas. The UK Fuel Poverty Strategy made a commitment to progress the extension of the gas network where it was feasible and cost effective. A commitment was also given to explore the potential of renewable and other sustainable energy sources to provide affordable warmth, particularly in solid walled properties and those off the gas network. However, to date little progress has been made in these areas.
NEA recommends that the work to assess the impact of renewable and other sustainable energy sources and the extension of the mains gas network should be pursued as a matter of urgency by Government, and the necessary funding for pilot schemes should be provided.
2.5.7 There is a need for the Government to consider changes to the Warm Front scheme to enable it to provide more assistance to the households currently receiving a grant. The scheme will also need to be extended to ensure it can provide affordable warmth to households occupying properties which are difficult to heat. In this respect, NEA supports recent changes to the scheme regulations which pave the way for additional measures to be included. However, it should be noted that to be effective the additional measures may require extra resources to be made available.
NEA recommends that the Government should retain flexibility within Warm Front to include any necessary additional measures to enable the scheme to treat the widest possible range of properties.
2.6 Local Authority Capital Programmes
2.6.1 The UK Fuel Poverty Strategy relies heavily on local authority capital funding to ensure that all public sector tenants are removed from fuel poverty by 2010. This is to be achieved by ensuring that by 2010 all local authority properties conform to a Decency Standard which includes a thermal comfort element. Originally the thermal comfort element was to be measured in terms of affordability, but this was subsequently revised to exclude any consideration of fuel costs and household income; the Decency Standard now refers only to compliance with basic heating and insulation criteria. The criteria make cavity wall insulation optional, where minimal (50mm) loft insulation is present and define any controllable gas or oil central heating system as adequate, irrespective of its age or efficiency. Many of the current 1 million fuel-poor households in the social rented sector already occupy properties above the recommended Decency Standard. Hence, compliance with the Standard will not guarantee affordable warmth for public sector tenants.
NEA recommends that the Department of Transport, Local Government and the Regions revisit the Thermal Comfort criteria of the Decency Standard for social housing with a view to setting a minimum energy rating target that will ensure warmth and comfort for public sector tenants.
2.7 Energy Efficiency Commitment
2.7.1 The Energy Efficiency Commitment (EEC) schemes will deliver over Ł500 million of energy efficiency improvements, funded through energy supply companies, over the period 2002-05. Since 50 per cent of the energy savings from these schemes must come from programmes to benefit low-income households, the EEC schemes have the potential to make a significant contribution to the eradication of fuel poverty, however a number of factors may prevent this objective being realised. The targets for the schemes are expressed in terms of energy savings and, as there is no direct pass-through of the cost of works to electricity and gas consumers, companies have a powerful incentive to minimise expenditure on required savings. This may lead companies to concentrate on measures such as low-energy light-bulbs, which will have only limited benefit to low-income households. Companies are being encouraged to link EEC schemes to their marketing and promotional strategies. Whilst this may, in the long term, encourage companies to provide energy services (including energy efficiency) rather than simply supplying power, in the short term it limits the impact that programmes will have on low-income households. As these are an element of their marketing strategy companies are reluctant to share good practice preferring to extract market advantage from successful innovation. The wish to maintain company profile also militates against national programmes with their potential economies of scale and limits the capacity for combination with other programmes.
2.7.2 There is considerable duplication in provision for low-income households with Warm Front and Energy Efficiency Commitment resources covering similar measures to similar client groups (although unlike Warm Front EEC assistance is available to social sector tenants). This reduces the scope for the programmes to complement one another and, in some cases, results in competition for the same market.
NEA recommends that EEC targets for the low-income sector be expressed in terms of numbers of households to be taken out of fuel poverty and that annual reporting requirements show the extent to which these targets have been met.
2.8 Downward pressure on energy prices and support for utility initiatives
2.8.1 The strategy places considerable emphasis on the role of competitive energy markets in exercising downward pressure on gas and electricity prices, and in fostering an environment where innovation in developing new tariffs and specialist energy services, from a socially aware perspective, can contribute to fuel poverty reduction. Whilst NEA recognises the contribution of the above factors as legitimate elements in the strategy there are concerns about their sustainability and, to some extent, about the degree of abdication of responsibility by Government.
2.8.2 The downward trend in gas prices has recently been arrested and reversed, and neither gas nor electricity prices in the future are sufficiently predictable to make energy prices a reliable and constant element of any strategy. In addition, data published by the energy regulator Ofgem, suggests that some categories of vulnerable consumers are much less likely to switch supplier and so benefit from lower prices available in the competitive market.
Switching rates % by vulnerable groups
Very low income customers
Disabled customers
Single parent families
Prepayment customers
All domestic consumers
Source: Ofgem 2001
2.9 Action on general poverty, low incomes and social exclusion
2.9.1 The third element of the strategy emphasises the importance of income maximisation, including special measures through the social security system, and the impact of the recent economic upturn in reducing fuel poverty. Undoubtedly measures such as Working Families Tax Credit and the Minimum Income Guarantee will benefit many households, and contribute to their removal from fuel poverty, but there is inconsistency in the treatment of different categories of the vulnerable fuel poor.
2.9.2 By far the most significant investment in the alleviation of fuel poverty is the Winter Fuel Payments scheme which will involve expenditure of some Ł1.7 billion in 2001-02 and a similar sum in the following year. This scheme provides all pensioner households with a Ł200 payment which can be used to defray the cost of high energy consumption over the winter months. Whilst accepting the argument in favour of universality and against means testing in this particular case, it seems perverse to award this payment to affluent pensioners whilst excluding those in most need such as families with young children, and particularly the chronically sick or disabled.
NEA recommends that the Winter Fuel Payment should be extended, as a minimum, to those households in receipt of Income Support or Income-based job seeker's allowance who are eligible for Cold Weather Payments through age, disability or young dependent children.
3. Why has the number of fuel poor households fallen recently? Can this reduction be sustained?
3.1 NEA accepts that there has been a reduction in the incidence of fuel poverty in recent years. However, the extent of the real reductions, the contribution of the various factors and the sustainability of the reduction are more difficult to judge.
3.2 The latest Government figures[12] suggest that in England in 2000, fuel poverty had fallen to between 2.8 million and 3.9 million depending on the definition of income employed. The major factors identified for the reduction were lower energy prices and increased incomes. NEA has however, reservations about the extent of the reductions claimed. The Government itself suggests some of the published figures should "be treated as broadly indicative only", and NEA believes that there are too many assumptions and too large an element of modelling for these figures to be completely reliable.
3.3 The downward trend in the numbers in fuel poverty can only be sustained if the factors contributing to affordable warmth continue to improve, or at the very least, some remain constant without deterioration elsewhere. Clearly energy prices are potentially the most important element here and the most susceptible to rapid change and increase. The Energy Report of the Performance and Innovation Unit posits significant real-term increases in fuel prices in response to environmental concerns and, whilst recognising fuel poverty concerns, it suggests optimistically, that these issues are effectively dealt within the UK Fuel Poverty Strategy. It should be stressed at this point that historical tensions between environmental and social objectives are likely to increase in the future. At some point these tensions may test the resolve of the Government in making use of the powers in the Utilities Act 2000 to protect disadvantaged consumers, which includes the Secretary of State's reserve power to cross-subsidise specified groups of disadvantaged consumers. This issue may become more significant with the ending of price controls for domestic consumers.
NEA recommends that there should be a more robust collection of data and the Monitoring and Evaluation Group set up by the Government should ensure that adequate information is collected to monitor progress in achieving the targets.
4. What is the relative significance of factors such as poor energy efficiency, low incomes or the cost of fuel?
4.1 NEA has consistently maintained that energy efficiency is the only rational and sustainable long-term solution to fuel poverty. Clearly if household income is sufficiently high then it can accommodate high energy costs resulting from poor thermal efficiency in the home. Similarly, energy can be made affordable through subsidies and other pricing mechanisms but neither of these responses is rational in the context of finite energy supplies and environmental degradation as a consequence of energy use. If it is accepted that a hands-off approach to the energy market limits Government intervention, and that energy subsidies make neither economic nor environmental sense, the area in which significant intervention is feasible and desirable is in the energy efficiency characteristics of the housing stock.
4.2 The piecemeal approach to fuel poverty should be replaced with a properly co-ordinated national energy efficiency programme. Examination of the UK Fuel Poverty Strategy illustrates the problem. The Strategy recites a lengthy list of worthy but ad hoc initiatives dealing with every conceivable aspect of fuel poverty including initiatives from utilities, regulatory and consumer bodies, central government, local authorities and the voluntary sector, often duplicating efforts and replicating programmes.
NEA recommends that the considerable resources available for practical energy efficiency work through local authorities, central government and utilities should be rationalised and dedicated to a single programme addressing the needs of all housing across all tenures. Consideration should be given as to how this programme should be implemented at a local level.
5. How effective are the industry-led initiatives?
5.1 It is extremely difficult to evaluate the effectiveness of industry-led initiatives as they have a commercial imperative and are frequently subject to the same commercial confidentiality concerns as any other business enterprise. Whilst many individual households have benefited from these initiatives, another valuable contribution which they could make is to demonstrate what succeeds and what doesn't work and what is suitable for replication. But this requires the sharing of experience and good practice between agencies that are in an intensely competitive market rather than pursuing a socially beneficial objective. Certainly projects undertaken under the Social Action Plan have been sufficiently diverse to cover all of the main elements of fuel poverty including:
NEA recommends that Ofgem should encourage, as far as is compatible with genuine commercial sensitivities, development of a forum for the exchange of experience and good practice of Social Action Plan initiatives by energy supply companies.
6. How can Government promote the take-up of energy efficiency measures in households whose income is just above benefit levels?
6.1 The issue of fuel-poor households with income levels just above benefit thresholds was touched on in paragraph 2.4.5 above. Such households can often be worse off than households with income slightly lower because the latter are eligible for a range of passported benefits. These "nearly poor" households will be unlikely to be able to make a significant contribution to the cost of the necessary improvements.
6.2 One approach would be to change the eligibility for grant schemes to include all households in fuel poverty. This would require a complex assessment of the energy efficiency of the property and the household income. Such an assessment is likely to be time-consuming, intrusive and expensive. An alternative approach would be to extend eligibility to households with incomes which are a set percentage above benefit levels. In this case, income assessments would only be required for those with incomes above benefit thresholds. Households in receipt of benefits could be passported in the same way as at present.
6.3 An alternative approach would be to concentrate on improving properties rather than concentrating on households. As there is a high correlation between poor housing conditions and low-income, any scheme which concentrated on improving the energy efficiency of the worst housing stock would benefit a high proportion of fuel-poor households. Even if the property was not occupied by a household in fuel poverty at the time of improvement, it may be at some time in the future. The argument for such a scheme is strengthened by NEA experience of North Tyneside which suggests that there is a considerable movement in and out of fuel poverty by non-elderly low-income households.
NEA recommends that a pilot scheme which targets properties with the worst energy efficiency standards should be operated and assessed for its effectiveness in addressing fuel poverty.
7. How much could better co-ordination between agencies or fiscal measures help?
7.1 In NEA's view these issues should be considered separately. In the context of practical energy efficiency work the optimum outcome would be an end to the myriad schemes and agencies funding and implementing these works. Within a predetermined area (that for which a local energy conservation authority has responsibility) there should be a single scheme administered by a single agency. Rather than co-ordination of a multiplicity of schemes and programmes, existing resources and responsibilities should be rationalised and integrated. However given that, at least in the short term, sponsors and managers of existing programmes will wish to preserve their control and involvement, the priority should be to develop relationships between programmes to make them genuinely complementary rather than replicatory, as is so often the case at present. Co-operation can foster the initiative and enterprise lacking in most current programmes, and create innovative approaches to the more intractable problems of fuel poverty encountered in many rural areas, or in those elements of the housing stock not amenable to orthodox improvement works. Approaches such as that taken in the Warm Zone pilots have much to commend them.
7.2 The current Energy Efficiency Commitment will last until March 2005. This will provide an opportunity for a review of energy efficiency programmes generally and consideration of how best to integrate funding. Decisions will have to be made about divorcing this major resource from company marketing strategies and reinventing it as a major instrument of social, economic and environmental policy. This may require that the commitment be transferred in whole, or in part, to the distribution side of the gas and electricity industries.
7.3 The scope of financial intervention to contribute to the eradication of fuel poverty through the welfare benefits systems is potentially enormous, but generally irrational, since it is clearly better to deliver a permanent solution through energy efficiency investment than to subsidise profligate use of finite resources in a housing stock that is of such poor quality. The disparity between sums spent on Winter Fuel Payments and the budget of Warm Front has already been referred to above. However there is certainly a case for direct financial assistance through the social security system where significant practical improvements are delayed or impracticable.
7.4 The reduced rate of Value Added Tax on energy works promoting a social objective eg Warm Front and Energy Efficiency Commitment expenditure has made a modest contribution to affordable warmth in terms of maximising the benefits from the finite budgets of these schemes. Broadening this tax concession would be of limited benefit to most low-income households but would possess the more general advantage of promoting the importance of energy efficiency and encouraging its implementation.
7.5 In the past the Government has implied that only European Union tax regulations prevent the reduction of VAT on domestic fuel to its former zero-rated status. NEA has suggested that, in recognition of this "unwanted" revenue, to the Exchequer from this source, it would serve a range of social, economic and environmental objectives if this were to be dedicated to the funding of a national energy efficiency programme.
NEA recommends that the inbalance between resources to reduce fuel poverty through energy efficiency investment and those to reduce fuel poverty through financial subsidy should be redressed.
8. What contribution to the elimination of fuel poverty might be made by technological advances?
8.1 The UK Fuel Poverty Strategy recognised that there would be circumstances where conventional energy efficiency measures would have limited potential to improve the circumstances of fuel-poor households. The main areas of difficulty were identified as:
Since there is no apparent prospect of the gas mains being extended nationwide, and since effective insulation in solid-walled properties is comparatively expensive, the main concerns are caused by rural dwellings and by older properties built without cavity walls. Whilst electric storage heating may be a solution in some rural dwellings the willingness on the part of Government to consider more innovative solutions is welcome.
8.2 NEA, in partnership with National Energy Services (NES) and the Energy Technology Support Unit (ETSU) has proposed a feasibility study into the possible role of sustainable energy sources in addressing fuel poverty. In addition to this the Department of Trade and Industry is conducting a parallel study into photovoltaics through several pilot projects. Whilst it is impossible to speculate on the outcome of these initiatives they do demonstrate a forward-looking and innovative element within the fuel poverty strategy. This is also the case with proposed pilots for micro-CHP and this is recognised in the recent amendments to the regulations governing Warm Front which, in addition to increasing maximum levels of grant aid, paved the way for incorporation of these emerging technologies in a Government-funded scheme to tackle fuel poverty.
8.3 Technological development may bring other benefits such as the introduction of "Smart Meters" that provide the consumer with a detailed analysis of energy consumption and serve as aids to monitor energy use and budgeting accordingly.
9.1 There are a number of other issues which impact on the Strategy and the Government's ability to meet its targets. These issues include:
9.2 General housing and other policies
9.2.1 The UK Fuel Poverty Strategy identifies wider housing and social inclusion policies as having relevance to the alleviation of fuel poverty. However no assessment is made of the extent of this impact or of the changes required to the priorities and delivery mechanisms in these policy areas. The Strategy refers to the Housing Health and Safety Rating System, which will soon replace the Fitness for Human Habitation Standard, Building Regulations, Private Sector Renewal Grants, Home Improvement Agencies and a range of general initiatives such as the Neighbourhood Renewal Fund, New Deal for Communities and the Single Regeneration Fund. However the Strategy concedes that these schemes have a range of competing priorities and objectives. NEA concludes that, unless fuel poverty is made a dominant factor in such initiatives they will not achieve their full potential in contributing to the eradication of fuel poverty. Significantly, NEA believes that without such a contribution that fuel poverty targets will not be met. As an example, unless Private Sector Renewal Grants can be used to remedy disrepair in properties occupied by vulnerable households, it will not be possible to improve energy efficiency in many of these dwellings.
9.2.2 New-build policy will also be of great importance. Some properties will not be capable of cost-effective, energy efficient improvement and will have to be replaced if their occupants are to be provided with homes they can afford to heat. Also, if the problem of under-occupation is to be addressed there must be access to adequate stock of appropriate housing to offer as alternatives to current unsuitable accommodation.
9.3 Industry capacity
9.3.1 The issue of industry capacity, particularly in the gas industry, has been identified as a potential barrier to achieving the objectives of the Strategy. Estimates vary, but it has been suggested that the current shortfall of gas heating engineers is in the region of 5,000. The Government has instigated a number of initiatives to increase the provision of qualified staff but, in the short term, further natural wastage will exacerbate the problem. Some estimates suggest that the shortfall may be in the region of 15,000 in three years' time. It is important to guard against complacency and the attitude that because some action has been taken then the problem has been resolved.
9.3.2 A similar problem exists in the insulation industry, particularly in the shortage of skilled cavity wall insulation installers. However, since the training period is considerably less in this field of work, this issue is less pressing. It should be noted that shortages of skilled staff may result in increased prices which will make it more difficult for current schemes to meet productivity targets within existing budgets.
Annex 1
How well could Warm Front deal with fuel poverty?
In seeking to determine how effective Warm Front is, or might be, in reducing fuel poverty, NEA carried out further analysis of two existing data sets, from North Tyneside and Camden, with the following interim conclusions:
1. Approximately half of the fuel poor are Warm Front-eligible. (Camden: 51 per cent; North Tyneside: 48 per cent).
2. Approximately 40 per cent of those whom Warm Front can help are not fuel poor (Camden: 44 per cent; North Tyneside: 36 per cent).
3. If energy efficiency improvemens under Warm Front were able to raise the property of all eligible households up to SAP 70, and if eligible households participated, then:
3.1. More than one third of the Warm Front-eligible fuel-poor would be taken out of fuel poverty. (Camden data: 35 per cent).
3.2. Warm Front-treated fuel-poor households' mean required fuel spend would fall from 19.5 per cent of disposable income (after housing costs) to 12.5 per cent (Camden data only).
3.3. Warm Front would have been able to take 16 per cent of fuel-poor households out of fuel poverty.
3.4. Distance travelled measure. If we regard "the amount of fuel poverty" as all the required fuel spend above 10 per cent disposable income for all households, then Warm Front would have reduced the amount of fuel poverty by 37 per cent.
4. North Tyneside improvement data suggests that a target of SAP 70 for the dwellings of fuel poor and near-fuel poor households would be unattainable at current grant maxima. In Sample A (which is fairly representative), maximum feasible cost-effective measures improve the mean SAP from 49 to 62, with just 23 per cent being brought to SAP 70 or above. In sample B (which contains more social housing) the equivalent figures are 52 rising to 63, with 29 per cent above 70.
These mean figures suggest a reduction in the percentage taken out of fuel poverty to about 14 per cent and the distance travelled measure equates to a 35 per cent reduction in the amount of fuel poverty. However, these figures are optimistic in that the mean figure conceals the fact that many properties can make zero or very small energy efficiency improvement within the Warm Front package. The effect of this has not been estimated.
5. The figures are based on the assumption of 100 per cent take-up of grant.
6. Finally, penetration will have been further diminished by the ending of Warm Front-eligibility for social housing tenants in 2002, although this should be compensated by spend from other budgets. Also, acceptance rates are likely to be much higher in this sector for obvious reasons.
7. Findings from the Warm Front pilot study (CSE, 2000) and from experience in Sandwell Warmzone bear out the broad conclusions above. However, none of the findings can be reliably generalised to either England or the UK as a whole, although, deeply rural areas apart, there is no reason to expect anything radically different elsewhere.
1. North Tyneside
Total sample 532; figures above based on the 386 cases for which there is a full set of accurate fuel poverty data with SAP, required fuel costs, household income and the results of a full NHER audit. The sample is in two waves:
Wave A: 298 cases derived initially from a random survey of North Tyneside residents for whom phone numbers were available, who said they had at least some difficulty keeping their homes warm in winter, and who agreed to take part in the study.
Wave B: 236 cases as Wave A but recruited by selecing areas of expected high fuel poverty level (Howdon, Percy Main, Willington Quay, Rosehill).
2. Camden
Total sample constructed from:
A. 1999 Housing Needs survey (council properties only). Random sample of 899 households of which 623 had complete data to enable fuel poverty analysis. Required fuel costs were estimated by adjusting reported fuel spend by income decile, using multipliers derived from the English House Condition Survey.
B. 1996 Private Sector House Condition Survey (includes Registered Social Landlords, private rented, owner-occupied). Random sample of 2,270 dwellings in Camden. Valid sample 1,009 because no energy survey was completed on about a third, and income data was unavailable on others. Required fuel costs were estimated using NHER cost table, with property floor area and NHER rating.
Overall Camden figures were assessed by weight average of fuel poverty and Warm Front eligibility percentages for A) and B) in proportion to incidence of tenure types in Camden Borough.
Note: Eaga data apparently gives a somewhat more optimistic figure in terms of effect on SAP ratings. However, it is not known whether or not this includes households where zero or minimal intervention is feasible.


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In what has to be one the most inflammatory ways of framing this debate, Austin Cline has coined the term "Uncle Tom atheist." I'm not crazy about the connotations of this choice of words, but I see what he's going for. Austin suggests that an Uncle Tom atheist is an atheist who is not "truly committed to equality, liberty, and liberation for all atheists." He sees such atheists as detrimental to the atheist movement.
Would you turn your back on working for real equality in exchange for a few scraps from the tables of religious theists so you can pretend you're being treated as an equal? Would you support increased privileges for Christians in the hope that a few of those privileges might drip down to benefit you personally?Austin is calling on each of us to engage in some self-reflection. Who are we? What do we want with regard to an atheist movement? And most important of all, what are we willing to do in order to achieve our goals in this area?
Even though I do not agree with everything Austin says with regard to how one can discover whether one is an Uncle Tom atheist, I do think that he's right to call for some self-exploration around some of these issues. If we are serious about promoting atheist equality, and I fully realize that not every atheist is committed to this goal, there are some tough questions we need to ask of ourselves.
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Nowadays, there are many type of amazing desk design for office. I worked at laboratory for 2 years, and experienced what it feels like to work at boring work area. The desk is narrow and full with big size computer. The design is really si...[Read More]
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(PRWEB) January 19, 2014
There is no bigger single game in all of professional sports than a Super Bowl, and this year's version will take place for the first time at MetLife Stadium in New Jersey. The large and lavish venue is home to both the Giants and Jets, but neither of those squads will be involved in this year's big game.
In a league where teams are up one year and down the next, it is very important to build a roster that blend veteran and youthful stars.
Fans can now visit TicketProcess.com to get a look at the various events on the Super Bowl Schedule, which unfolds over the course of nearly two weeks immediately following the Championship Round.
*TicketProcess is not associated with any of the organizations, teams, artists or venues listed. Names used in this release are for descriptive purposes only and do not imply endorsement or partnership.
About Ticket Process
Since 2010, TicketProcess secondary ticket exchange (broker & consumer) has been offering a large selection of live event inventory to some of the most exclusive sports, concert and theater events nationwide. With 7-day customer service, all backed by a 100% Guarantee, its simple design and ease of use allow anyone to purchase event tickets with confidence.
Follow Ticket Process on Facebook, Twitter & Google+ for exclusive announcements and free discount codes.


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Premium Japanese Beers in Singapore
The Japanese love their beer, which explains why beer is the most popular alcoholic drink in Japan. It all started in the 17th century during the Edo Period, when the Dutch started a beer hall for sailors. Later in the 19th century, brewers from Germany arrived and the rest is history. Now, Japan's commercial brewing techniques are prevalent all over south-east Asia and beer factories are spread out all over the world.
The refreshing taste of their lager comes from being brewed with rice, and they are a must try for anyone who loves good old beer. You can now enjoy the taste of this much-loved brew by simply putting an online order for the same. The famous amber beverage is renowned for its refreshing qualities and thanks to Whistler you can now buy online Japanese beers in Singapore.
We offer the following world-famous Japanese beer products:
ORION BEER: Composed of malt and hops brought in from Germany and the Czech Republic, this beer comes into being after being ripened under a strict process. This beer is the pride of Okinawa, with its smooth and crisp characteristics. It is a great choice for those with demanding palates!
There are 4 products.


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- Welcome to monster truck games
There is nothing like a roar from Monster Truck engine when preparing to blast off. The ground shakes under big wheels and destruction is on the way. No terrain remains unconquered and no obstacle is intact. Monster truck games offer all the excitement of real monsters. If you like to race, we have it covered. Games which offer you the opportunity to race over all kinds of terrain and push your Monster Truck to the limits of endurance and stability. Skill is most important ingredient in this game. Do you have it?! We collected them and now it's up to you to try them all out. Play Monster Truck Games @ ArcadeShrine.com!
- monster truck games
- monster truck games
Monster ChallengeMonster Challenge is a monster truck racing game with upgrades. Interesting part is that it is not just about you race the other car. You can easily get out of fuel, or you might need to get your tires replaced, and so on. It is very realistic racing monster truck game. You can upgrade the engine, whole car body in order to win the race.
Batman Monster Truck...Take Batman Monster Truck for a spin. Challenge ahead of you is great and courses are difficult. Adrenalin filled race against time and yourself. Balance the Truck over rusty old junkyard filled with scattered cars, old beams, fences and even water reservoirs you have to go through or if you like over to win the game and proceed to the next level. There are 10 levels and 10 different challenges in your path. Are you the one who will overcome all of them?
Monster Truck In...This is a monster truck shooting and driving adventure taking place on a distinct and abounded planetary station. The war just ended and the place is full of dangerous explosive boxes and mines that you must either avoid or shoot at to destroy. You vehicle will suffer some level of damage after each blast or smash at the ground obstacles. If the health level reaches zero you die unless you collect health power up along the way. You can also collect ammo or even extra life. Some obstacles are better to destroy than to avoid, it all depends.
Hulk Monster TruckHulk is driving a big ATV truck through the desert. To earn some extra points he needs to smash other cars, jumps over the obstacles and collect yellow cans with radioactive waste. His monster truck tires make other cars look small like kids toys . Controls: Use arrow keys to move forward and backward or to lean to the left or right.
Hell CopsControls are well design in Hell Cops. You can easily move foward, backward, doing left or right balance, you could even change direction. Beside regular obstacles, you also need to take care of pedestrians on your way. Take care of them by hitting them but don't hit other cars and try not to crash.
War MachineMilitary monster vehicle is on the test and it is all up to you! Win this war and destroy everything in your path!
Batman Truck Batman must answer the call of Gotham! The sign is high and the time is limited! Hurry but don't forget to have fun along the way!
- Tags


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Kudos System 10mm Stickers - Mixed Pack of seven hundred fifty
Product Description
Available as a mixed sheet assortment or caption assortment. For use with Kudos System classroom charts, bookmarks, chart badges, A5 and A6 charts or on their own. Supplied as 5 x A5 sheets, each containing 150 stickers of the same assorted designs. Packs of 750.


text: Callaway's Balboa Vent Golf Shoe features the latest in performance, materials and design. Constructed from the durable Opti-vent mesh upper and featuring the Dura Rubber Spikeless outsole. Like a sports car for your feet the Balboa Golf Shoe from Callaway golf will give you unmatched traction, comfort, and performance anywhere on the course.


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Now a days More than 60% of users are using Android and Games and Apps are Very popular among Android Users. Many big and Small Publishers release their Games every year Some Will be Free and more are Free with in-app purchases. So the users cannot decide which Game is Good or Which game is bad and we don't want to waste our precious Internet Data in Bad Games.
But Don't worry today we have bought 8 Must play Android Games of 2016 list of Action, Adventure, Puzzle, Simulation etc
Asphalt 8: Airborne
The Game By Gameloft with Long List of cars Like Ferrari, Lamborghini, McLaren, Bugatti, Mercedes, Audi, Ford, Chevrolet etc 140+ cars are available for the users to choose and play.
- STUNNING GRAPHICS: Interactions between the vehicles, environments & tracks are a fully physics-based experience!
- ARCADE GAMEPLAY AT ITS FINEST: Feel the thrill of gravity-defying racing across 40+ high-speed tracks!
- THE ULTIMATE MULTIPLAYER RACING EXPERIENCE: Race in real-time multiplayer action for up to 12 opponents & dare your friends to ghost races!
- WIN BIG: Participate in our Limited-Time Events to stack up amazing & exclusive rewards!
- MASSIVE CONTENT DEPTH: 400+ career events, 1,500 car mastery challenges, 5 unique game modes, car collections. An endless stream of single-player content!
- CUSTOMIZE & UPGRADE YOUR RIDES: With over 2,300 decals, take down your opponents with style!
Cut the Rope: Magic
This game is Developed By ZeptoLab and Best Puzzle Game present Now. With Different Stages and Solving puzzle like never before the game will become tough level by level and more interesting and Challenging.
- A magical world with completely new graphics, sound and gameplay elements
- 6 ways to transform Om Nom into magical creatures along his journey
- Complex boss levels that will challenge your candy-crunching, rope-cutting skills
- 120+ all-new puzzles, with more coming soon
Modern Combat 5: Blackout
Another Gameloft Game is in the List this is a action game which Got Many changes and transformed since the game first came out and now it's among the best free-to-play first person shooters available anywhere
- 7 customizable classes that you can level up across single- and multiplayer
- Find the playstyle that suits you: Assault, Heavy, Recon, Sniper, Support, Bounty Hunter or Sapper
- Activate class-specific skills by earning and spending Skill Points
- Watch players in battle with the new Spectator mode
- Epic team clashes in Squad vs. Squad matches
- Talk to other players in Global and Squad Chat
- Individual and Squad leaderboards
- Win cool rewards in the limited-time events
- Accumulate XP and level up by playing both single-player missions and multiplayer matches
- Unlock higher-tier weapons by mastering lower-tier ones
- Customize the perfect weapon using a host of attachments and jump straight into the action
- Fast-paced story missions with various challenges taking you from Tokyo to Venice
- Play the new Spec-Ops missions for a real FPS adrenaline rush
- Flawless graphics, music and voice performances perfectly adapted for a shooter game
- Intuitive, highly customizable controls so you can play the game just the way you want
- Modern Combat 5 supports HID game controllers. Moga Pro is also supported, in mode B (HID Mode).Modern Combat 5 requires an Internet connection.
This Game is Developed by MADFINGER Games. Unkilled is a Zombie Shooting Game with more than 300 Missions to play including Boss Fights and With more than 50+ weapons and realistic Graphics Made this Game a Must play in 2016.
The Sims™ FreePlay
The Game by ELECTRONIC ARTS which is Free to play on mobile and if you are a Sims Games Fan then you will be familiar gameplay and graphics. One of the best Simulation Games Available Today.
- Create unique Sims, build dream homes, and let them live your way!
- Customize different Sims and dress them in hundreds of stylish outfits
- Have them fall in love, get married and have babies
- Experience every stage of life from Babies to Seniors…and everything in-between
- Build dream homes and decorate them with thousands of different items
- Complete exciting quests that unlock new places in your Town
- Care for cuddly and magical pets
- Live out your Sims story and play anyway you like
Call of Champions
Call of Champions is the most intense real-time multiplayer battle arena (MOBA) on the phone and tablet. Choose a Champion, recruit a team, smash the enemy, and compete against millions worldwide!
The heart-pounding five-minute matches in Call of Champions distill the best of old-school MOBA mechanics like lanes, minions, and item shops into fast-paced tactical brawls, game-changing power-ups, and a tug-of-war with an Orb of Death.
Featuring over 15 Champions with fully customizable talent trees, as well as an innovative A.I. that fills in if you need to take a call or text, Call of Champions is the MOBA perfected for mobile devices.
The Walking Dead: Road to Survival
The Walking Dead: Road to Survival is the definitive Walking Dead role-playing game experience, brought to you by Robert Kirkman, creator of The Walking Dead comic.
Build your faction of Survivors and lead them into battle in an uncompromising story mode fraught with danger. Fight for survival against walkers and humans alike, using strategy to attack enemy weak points and deep RPG progression to decide your path. Build a town to keep the walkers at bay, but be warned – The horrors that lurk outside aren't the only threat, and your decisions are all that stand between life and death.
Based on an all-new story from award-winning Walking Dead writer Jay Bonanasinga, the dark aesthetic of this game reflects the uncompromising decisions you will need to make as you fight for survival.
Fallout Shelter
This Game Won Many of Awards in 2015 and The Developers Releases Updates frequently and makes this Game Interesting. This Simulation Building Game is Very Good where you must build a shelter, take in survivors (called Dwellers), and create a thriving ecosystem against the obstacles like Fire, Raids etc
- Create a brighter future…underground! Select from a variety of modern-day rooms to turn an excavation beneath 2,000 feet of bedrock into the very picture of Vault Life.
- Get to know your Dwellers and lead them to happiness. Find their ideal jobs and watch them flourish. Provide them with outfits, weapons, and training to improve their abilities.
- Turn worthless junk into useful items with Crafting! Customize the look of any dweller in the Barbershop.
- A well-run Vault requires a variety of Dwellers with a mix of skills. Build a Radio Room to attract new Dwellers. Or, take an active role in their personal lives; play matchmaker and watch the sparks fly!
- Send Dwellers above ground to explore the blasted surface left behind and seek adventure, handy survival loot, or unspeakable death. Find new armor and weapons, gain experience, and earn Caps. But don't let them die!
- From time to time, idyllic Vault life may be disrupted by the dangers of post-nuclear life. Prepare your Dwellers to protect against threats from the outside…and within.


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Riga Night Market and its future
A favourite shopping place for many people of Riga, the Night Market(Nakts Tirgus) will be relocated to another location as the existing area will be redesigned during the Renovation Project sponsored partly by EU.
Riga Night Market situated next to Riga Central Market, is known for its wast selection of fruits and vegetables and very agreeable prices on products, also for its odd working times – from late evenings to early mornings. This gives an opportunity for smaller farming businesses to sell the products during night-time and get back to work next morning.
The area is part of the UNESCO world culture heritage list and it was decided to give the place a new cultural facelift. The Night Market is still located at the Spīķeri Warehouse district – an old harbour and trade area of Riga – used up to early parts of 20th century.
Nowadays it is planned that the area will become the new "cultural center" of Riga – already we have KIM? exhibition hall there, a fancy restaurant and some other creative and interesting shops. Unfortunately the "Dirty Deal" nightclub, that we loved so much for its wild parties in Summer is closed and now we have rock club "Ziggy" in its place. Also Riga Gheto and Holocaust museum is in the same area.
You can check one of the Project Proposals here – designed by ARPLAN SIA. I seem to be critical of these things sometimes – they all look good on AutoCAD renderings but in real life its just boring concrete blocks and some glass.
The good stuff I think is that this project is giving better access to the river side and also easier and safer way to cross the highway that unfortunately separates most part of Riga from easy access to the Daugava river. Bike paths also seem to be integrated in this project.
I consider it would be perfectly OK and "cultural" to leave the market where it is as that would be more historically related and would give much wider insight of the actual life in Riga. In one place you could have your Party, your Culture and your Potatoes.


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3ie Delhi seminars 2012
The 3ie Delhi seminar series focuses on examining evidence from impact evaluations of development interventions in a wide variety of sectors. The seminars also explore conceptual issues related to impact evaluations.
Past Seminars
Impact in global environmental evaluations, by Rob D. van den Berg, Director, Global Environment Facility Evaluation Office, November 9, 2012
Does marginal cost pricing of electricity affect groundwater pumping behaviour of farmers? Results from a natural experiment in West Bengal, India by Dr. Aditi Mukherji, Senior Researcher, International Water Management Institute, September 17, 2012
How well do impact evaluations fare under scrutiny? Replicating two impact evaluations – Colonial origins of agricultural development in India; and TV, female empowerment and demographic transition in rural India by Dr Vegard Iversen,July 11, 2012
Impact of the Chiranjeevi Yojana Programme on Institutional Deliveries and Birth Outcomes in Gujarat, India by Dr. Manoj Mohanan, Assistant Professor, Duke University July 6, 2012
Addressing attribution of cause and effect in small n impact evaluations: towards an integrated framework by Dr. Howard White, Executive Director, 3ie, February 1, 2012


text: Home » News » New 3DS update fixes feature access issues New 3DS update fixes feature access issues MIG-31 April 5, 2013 News Nintendo has released 3DS system update 5.1.0-11U. It's designed to rectify problems some users have been experiencing since downloading last month's 3DS system update 5.0.0-11U, which prevented those affected from accessing the System Settings or other features. "Some users received an error during the system update and were then unable to access the System Settings, Nintendo eShop, or Game Notes," Nintendo says. "This update prevents this from occurring again. If you are currently experiencing this error, please click here for related troubleshooting." March's update introduced eShop improvements, including the ability to download software update data in the background. Share On


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Home : Rochester High School Home Page : Teacher Web Pages : Mathematics : Mrs. Smillie
|2nd Semester 2017 - 2018
|1st Hour
|2nd Hour
|3rd Hour
|4th Hour
|Algebra 2
|5th Hour
|Algebra 2
|6th Hour
Algebra 2 and Precalculus
Please log on to Moodle for directions for our online textbook, note sheets, homework assignments and our class calendar.
Moodle First Time Login
Step 1: Type in http://moodle.oakland.k12.mi.us/rochester/
Step 2: Scroll down to Rochester High School Logo
Step 3: Click Math Dept.
Step 4: Click the class currently being taken "Mrs. Smillie's Class"
Step 5: Type in School username and password
Step 6: Search for Administration tab
Step 7: Click Enroll me in this course
Step 8: Type in the Enrollment key given by your teacher (I will give this to you in class)
Congratulations! You have enrolled in your class! It is recommended that this site is bookmarked at home
Contact Information
Voice Mail:
(248) 726-6876


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Vintage Jewels / Antique Haven,LLC ®
Vintage Jewels / Antique Haven / Deb Hancock, Glendale AZ
Sterling Silver Diamonds KISS Necklace
$68.00 Vintage Sterling and Diamond necklace on 16" Chain.This is a lovely necklace with diamond accents. Done in heavy rhodium plate over sterling silver, with the word KISS as the design. The diamond accents are on every letter and sparkle like crazy. The pendant measures 1" long and 5/8" tall. The pendant and chain are both marked 925. Excellent condition.
Please make your payment within 24 hours of purchase unless other arrangements are made prior to purchasing. Thank you for understanding.
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