Spiral drawing during self-rated dyskinesia is more impaired than during self-rated off

Background: A mobile device test battery, consisting of a patient diary collection section with disease-related questions and a fine motor test section (including spiral drawing tasks), was used by 65 patients with advanced Parkinson's disease (PD)(treated with intraduodenal levodopa/carbidopa gel infusion, Duodopa®, or candidates for this treatment) on 10439 test occasions in their home environments. On each occasion, patients traced three pre-drawn Archimedes spirals using an ergonomic stylus and self-assessed their motor function on a global Treatment Response Scale (TRS) ranging from -3 = very 'off' to 0 = 'on' to +3 = very dyskinetic. The spirals were processed by a computer-based method that generates a "spiral score" representing the PD-related drawing impairment. The scale for the score was based on a modified Bain & Findley rating scale in the range from 0 = no impairment to 5 = moderate impairment to 10 = extremely severe impairment. Objective: To analyze the test battery data for the purpose to find differences in spiral drawing performance of PD patients in relation to their self-assessments of motor function. Methods: Three motor states were used in the analysis; OFF state (including moderate and very 'off'), ON state ('on') and a dyskinetic (DYS) state (moderate and very dyskinetic). In order to avoid the problem of multiple test occasions per patient, 200 random samples of single test occasions per patient were drawn. One-way analysis of variance, ANOVA, test followed by Tukey multiple comparisons test was used to test if mean values of spiral test parameters, i.e. the spiral score and drawing completion times (in seconds), were different among the three motor states. Statistical significance was set at p<0.05. To investigate changes in the spiral score over the time-of-day test sessions for the three motor states, plots of statistical summaries were inspected. Results: The mean spiral score differed significantly across the three self-assessed motor states (p<0.001, ANOVA test). Tukey post-hoc comparisons indicate that the mean spiral score (mean ± SD; [95% CI for mean]) in DYS state (5.2 ± 1.8; [5.12, 5.28]) was higher than the mean spiral score in OFF (4.3 ± 1.7; [4.22, 4.37]) and ON (4.2 ± 1.7; [4.17, 4.29]) states. The mean spiral score was also significantly different among individual TRS values of slightly 'off' (4.02 ± 1.63), 'on' (4.07 ± 1.65) and slightly dyskinetic (4.6 ± 1.71), (p<0.001). There were no differences in drawing completion times among the three motor states (p=0.509). In the OFF and ON states, patients drew slightly more impaired spirals in the afternoon whereas in the DYS state the spiral drawing performance was more impaired in the morning. Conclusion: It was found that when patients considered themselves as being dyskinetic spiral drawing was more impaired (nearly one unit change in a 0-10 scale) compared to when they considered themselves as being 'off' and 'on'. The spiral drawing at patients that self-assessed their motor state as dyskinetic was slightly more impaired in the morning hours, between 8 and 12 o'clock, a situation possibly caused by the morning dose effect.

To what extent are CO2 emissions from intra-urban shopping trips by cars affected by drivers’ travel behaviour and store location?

Transportation is seen as one of the major sources of CO2 pollutants nowadays. The impact of increased transport in retailing should not be underestimated. Most previous studies have focused on transportation and underlying trips, in general, while very few studies have addressed the specific affects that, for instance, intra-city shopping trips generate. Furthermore, most of the existing methods used to estimate emission are based on macro-data designed to generate national or regional inventory projections. There is a lack of studies using micro-data based methods that are able to distinguish between driver behaviour and the locational effects induced by shopping trips, which is an important precondition for energy efficient urban planning. The aim of this study is to implement a micro-data method to estimate and compare CO2 emission induced by intra-urban car travelling to a retail destination of durable goods (DG), and non-durable goods (NDG). We estimate the emissions from aspects of travel behaviour and store location. The study is conducted by means of a case study in the city of Borlänge, where GPS tracking data on intra-urban car travel is collected from 250 households. We find that a behavioural change during a trip towards a CO2 optimal travelling by car has the potential to decrease emission to 36% (DG), and to 25% (NDG) of the emissions induced by car-travelling shopping trips today. There is also a potential of reducing CO2 emissions induced by intra-urban shopping trips due to poor location by 54%, and if the consumer selected the closest of 8 existing stores, the CO2 emissions would be reduced by 37% of the current emission induced by NDG shopping trips.