First-principle data-driven models for assessment of motor disorders in Parkinson’s disease

Parkinson’s disease (PD) is an increasing neurological disorder in an aging society. The motor and non-motor symptoms of PD advance with the disease progression and occur in varying frequency and duration. In order to affirm the full extent of a patient’s condition, repeated assessments are necessary to adjust medical prescription. In clinical studies, symptoms are assessed using the unified Parkinson’s disease rating scale (UPDRS). On one hand, the subjective rating using UPDRS relies on clinical expertise. On the other hand, it requires the physical presence of patients in clinics which implies high logistical costs. Another limitation of clinical assessment is that the observation in hospital may not accurately represent a patient’s situation at home. For such reasons, the practical frequency of tracking PD symptoms may under-represent the true time scale of PD fluctuations and may result in an overall inaccurate assessment. Current technologies for at-home PD treatment are based on data-driven approaches for which the interpretation and reproduction of results are problematic.  The overall objective of this thesis is to develop and evaluate unobtrusive computer methods for enabling remote monitoring of patients with PD. It investigates first-principle data-driven model based novel signal and image processing techniques for extraction of clinically useful information from audio recordings of speech (in texts read aloud) and video recordings of gait and finger-tapping motor examinations. The aim is to map between PD symptoms severities estimated using novel computer methods and the clinical ratings based on UPDRS part-III (motor examination). A web-based test battery system consisting of self-assessment of symptoms and motor function tests was previously constructed for a touch screen mobile device. A comprehensive speech framework has been developed for this device to analyze text-dependent running speech by: (1) extracting novel signal features that are able to represent PD deficits in each individual component of the speech system, (2) mapping between clinical ratings and feature estimates of speech symptom severity, and (3) classifying between UPDRS part-III severity levels using speech features and statistical machine learning tools. A novel speech processing method called cepstral separation difference showed stronger ability to classify between speech symptom severities as compared to existing features of PD speech. In the case of finger tapping, the recorded videos of rapid finger tapping examination were processed using a novel computer-vision (CV) algorithm that extracts symptom information from video-based tapping signals using motion analysis of the index-finger which incorporates a face detection module for signal calibration. This algorithm was able to discriminate between UPDRS part III severity levels of finger tapping with high classification rates. Further analysis was performed on novel CV based gait features constructed using a standard human model to discriminate between a healthy gait and a Parkinsonian gait. The findings of this study suggest that the symptom severity levels in PD can be discriminated with high accuracies by involving a combination of first-principle (features) and data-driven (classification) approaches. The processing of audio and video recordings on one hand allows remote monitoring of speech, gait and finger-tapping examinations by the clinical staff. On the other hand, the first-principles approach eases the understanding of symptom estimates for clinicians. We have demonstrated that the selected features of speech, gait and finger tapping were able to discriminate between symptom severity levels, as well as, between healthy controls and PD patients with high classification rates. The findings support suitability of these methods to be used as decision support tools in the context of PD assessment.

Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Short fiction of Thomas Hardy: an exploration and assessment

Hardy's novels and poetry have received extensive criticism, in due proportion to their merit. Hardy's short stories, however, have been virtually excluded from the annals of Hardy criticism, even though Hardy wrote over forty short stories, several of which are truly outstanding. In part, the reason for this neglect is because of the neglected state of the short story in Victorian England. Short fiction, published mainly only in periodicals and never collected in volume form, was obscured to a large extent by the highly popular serial novel. This thesis examines Thomas Hardy's short stories in the context of both the Victorian period and the Victorian short story genre, and explores the ways in which Thomas Hardy improved upon and deviated from some of the common types of short fiction being written in his day.

Decision Support Systems And Promoting Socially Just Environmental Management

The Mauri Model DMF is unique in its approach to the management of water resources as the framework offers a transparent and inclusive approach to considering the environmental, economic, social and cultural aspects of the decisions being contemplated. The Mauri Model DMF is unique because it is capable of including multiple-worldviews and adopts mauri (intrinsic value or well-being) in the place of the more common monetised assessments of pseudo sustainability using Cost Benefit Analysis. The Mauri Model DMF uses a two stage process that first identifies participants’ worldviews and inherent bias regarding water resource management, and then facilitates transparent assessment of selected sustainability performance indicators. The assessment can then be contemplated as the separate environmental, economic, social and cultural dimensions of the decision, and collectively as an overall result; or the priorities associated with different worldviews can be applied to determine the sensitivity of the result to different cultural contexts or worldviews.

On common agency with informed principals

This thesis consists of three chapters that have as unifying subject the frame-work of common agency with informed principals. The first two chapters analyze the economic effects of privately informed lobbying applied to tariff protection (Chapter 1) and to customs unions agreements (Chapter 2). The third chapter investigates the choice of retailing strutures when principals (the producers) are privately informed about their production costs. Chapter 1 analyzes how lobbying affects economic policy when the interest groups have private information. I assume that the competitiveness of producers are lobbies private information in a Grossman and Helpman (1994) lobby game. This allows us to analyze the e¤ects of information transmission within their model. I show that the information transmission generates two informational asymmetry problems in the political game. One refers to the cost of signaling the lobby's competitiveness to the policy maker and the other to the cost of screening the rival lobby's competitiveness from the policy maker. As an important consequence information transmission may improve welfare through the reduction of harmful lobbying activity. Chapter 2 uses the framework of chapter 1 to study a customs union agreement when governments are subject to the pressure of special interest groups that have better information about the competitiveness of the industries they represent. I focus on the agreement's effect on the structure of political influence. When join a customs union, the structure of political pressure changes and with privately informed lobbies, a new effect emerges: the governments can use the information they learn from the lobby of one country to extract rents from the lobbies of the other country. I call this the "information transmission effect". This effect enhances the governments'bargaining power in a customs union and makes lobbies demand less protection. Thus, I find that information transmission increases the welfare of the agreement and decreases tari¤s towards non-members. I also investigate the incentives for the creation of a customs union and find that information transmission makes such agreement more likely to be politically sustainable. Chapter 3 investigates the choice of retailing structure when the manufacturers are privately informed about their production costs. Two retailing structures are analyzed, one where each manufacturer chooses her own retailer (exclusive dealing) and another where the manufacturers choose the same retailer (common agency). It is shown that common agency mitigates downstream competition but gives the retailer bargaining power to extract informational rents from the manufacturers, while in exclusive dealing there is no downstream coordination but also there are no incentives problem in the contract between manufacture and retailer. A pre- liminary characterization of the choice of the retailing structure for the case of substitute goods shows that when the uncertainty about the cost increases relatively to the size of the market, exclusive dealing tends to be the chosen retailing structure. On the other hand, when the market is big relatively to the costs, common agency emerges as the retailing structure. This thesis has greatly benefited from the contribution of Professors Humberto Moreira and Thierry Verdier. It also benefited from the stimulating environment of the Toulouse School of Economics, where part of this work was developed during the year of 2007.

A BDI-based approach for the assessment of driver's decision-making in commuter scenarios

The rapid growth of urban areas has a significant impact on traffic and transportation systems. New management policies and planning strategies are clearly necessary to cope with the more than ever limited capacity of existing road networks. The concept of Intelligent Transportation System (ITS) arises in this scenario; rather than attempting to increase road capacity by means of physical modifications to the infrastructure, the premise of ITS relies on the use of advanced communication and computer technologies to handle today’s traffic and transportation facilities. Influencing users’ behaviour patterns is a challenge that has stimulated much research in the ITS field, where human factors start gaining great importance to modelling, simulating, and assessing such an innovative approach. This work is aimed at using Multi-agent Systems (MAS) to represent the traffic and transportation systems in the light of the new performance measures brought about by ITS technologies. Agent features have good potentialities to represent those components of a system that are geographically and functionally distributed, such as most components in traffic and transportation. A BDI (beliefs, desires, and intentions) architecture is presented as an alternative to traditional models used to represent the driver behaviour within microscopic simulation allowing for an explicit representation of users’ mental states. Basic concepts of ITS and MAS are presented, as well as some application examples related to the subject. This has motivated the extension of an existing microscopic simulation framework to incorporate MAS features to enhance the representation of drivers. This way demand is generated from a population of agents as the result of their decisions on route and departure time, on a daily basis. The extended simulation model that now supports the interaction of BDI driver agents was effectively implemented, and different experiments were performed to test this approach in commuter scenarios. MAS provides a process-driven approach that fosters the easy construction of modular, robust, and scalable models, characteristics that lack in former result-driven approaches. Its abstraction premises allow for a closer association between the model and its practical implementation. Uncertainty and variability are addressed in a straightforward manner, as an easier representation of humanlike behaviours within the driver structure is provided by cognitive architectures, such as the BDI approach used in this work. This way MAS extends microscopic simulation of traffic to better address the complexity inherent in ITS technologies.

Share bidding auctions, sliding scale royalty rates and the new brazilian regulatory framework for the pre-salt areas

O governo brasileiro recentemente aprovou uma legislação instituindo um novo marco regulatório para as reservas petrolíferas do pré-sal. Segundo as novas regras, estas áreas deverão ser licitadas mediante um leilão de partilha de lucro. Motivado por esta mudança, apresentamos um modelo de leilão de partilha sob afiliação, demonstrando a existência de um equilíbrio monótono em estratégias puras e caracterizando a solução. Alem disso, provamos que este mecanismo gera receita esperada maior ou igual a um leilão de primeiro preço usual. Em seguida, introduzimos no modelo uma função representando taxas de royalties que dependem do valor do objeto. Este instrumento permite uma elevação na receita esperada de ambos os modelos, fazendo com que a diferença entre eles encolha. Finalmente, analisando o novo marco regulatório sob o ponto de vista dos resultados obtidos, concluímos que o antigo modelo de concessão utilizado pelo governo brasileiro é mais adequado e lucrativo.

Impact assessment and quality analysis of corporate social responsability (CSR) programs of mining companies and their contribution to sustainable development in the communities they operate: case study Tenke Fungurume Mining SA in the Democratic Republic of Congo (DRC)

Purpose – This case study presents an impact assessment of Corporate Social Responsibility (CSR) programs of the TFM Company in order to understand how they contribute to the sustainable development of communities in areas in which they operate. Design/Methodology/Approach - Data for this study was collected using qualitative data methods that included semi-structured interviews and Focus Group Discussions most of them audio and video recorded. Documentary analysis and a field visit were also undertaken for the purpose of quality analysis of the CSR programs on the terrain. Data collected was analyzed using the Seven Questions to sustainability (7Qs) framework, an evaluation tool developed by the Mining, Minerals and Sustainable Development (MMSD) North America chapter. Content analysis method was on the other hand used to examine the interviews and FGDs of the study participants. Findings - Results shows that CSR programs of TFM SA do contribute to community development, as there have been notable changes in the communities’ living conditions. But whether they have contributed to sustainable development is not yet the case as programs that enhance the capacity of communities and other stakeholders to support these projects development beyond the implementation stage and the mines operation lifetime need to be considered and implemented. Originality/Value – In DRC, there is paucity of information of research studies that focus on impact assessment of CSR programs in general and specifically those of mining companies and their contribution to sustainable development of local communities. Many of the available studies cover issues of minerals and conflict or conflict minerals as mostly referred to. This study addressees this gap.

Reading comprehension in primary school: textbooks, curriculum and assessment

This study describes the reading comprehension processes present in the most widely sold textbooks at the fourth grade level in Portugal and discusses how they compare to international assessments of reading literacy. We adopted the Progress of International Reading Literacy Study framework to categorize the questions in the textbooks. Our analyses revealed that they focus heavily on the retrieval of explicitly stated information to the detriment of higher level comprehension skills. Portuguese fourth grade textbooks rarely challenge students to make connections between their knowledge and the ideas in the texts and to adopt a critical and evaluative reading stance. This is in sharp contrast to what students are asked to do in the Progress of International Reading Literacy Study, conducted every five years since 2001, and it may help explain the poor results Portuguese students have in national assessment and in PISA. The findings are discussed in light of the curriculum frameworks currently adopted in Portugal and suggestions are made as to how we can improve reading literacy achievement.

Projeto café do trabalhador como promotor de segurança alimentar e nutricional: avaliação da eficácia da unidade Natal-RN

The evaluation of public policies that promote Food Security and Nutrition (FSN) it s a multidisciplinary activity extremely relevant to the effectiveness of actions to legitimize the Human Right to Adequate Food (HRAF). This study aimed at assessing the effectiveness of the unit project Natal-RN Café do Trabalhador in promoting SAN to its users. The theoretical framework is based on the public and political and on the dimensions of the concept of FSN (quantity and quality-regularity). Through a qualitative approach, methodologically this was the work of an evaluation of efficiency of the unit Natal-RN of Café do Trabalhador project in light of the assumptions of the concept of SAN. Data collection was conducted through retrospective archival research in official documents of the project, semi-structured interviews with managers involved in its implementation (representative of the Secretary of State for Employment, Housing and Care of RN SETHAS and third party), socioeconomic questionnaire applied to the users of the unit, check the amount, regularity and quality of meals offered for 15 days (menu routine) using the descriptive form menu and form filling type checklist for verification of compliance with good practices . Methods of analysis, we used content analysis, descriptive statistics and compared to previously established parameters for the project. As categories of analysis were defined organizational arrangement, access, user, food quantity-regularity and food quality. The results show that, it was found in the category arrangement that will implement the project dismissed technical criteria for choosing the districts and the quantitative distribution of meals for each location. It was found that the valuation of the shares of the company outsources technical SETHA has not been performed. We observed in the access category, the unit has a strategic location, but lack of space in the refectory. The main obstacle to economic access for users is the lack of a register for the beneficiaries. In the category of users, it was identified that the clientele of the project it is predominantly men, with more than 51 years, low education, earning wages less 1 obtained through informal employment, which they move up through the unit transport collective, go to all days of operation due primarily to price. About the meals category quantity-regularity of food showed that the menu serves 95% of the desired needs, and that holidays and weekends are periods of disrupting the regularity of supply of meals. Regarding the category of food quality, it was found that the nutritional aspect on the menu are food sources rich in sodium, nitrates and low in fiber. In the aspect of hygiene and sanitation are the main limitations related to waste management, lack of exposure controls of food prepared and inadequacies of the physical structure. The results showed that in general and the institutional arrangement of the organs attached to the project should establish a systematic evaluation project is to establish as a promoter of and FSN overcome these obstacles

Diálogos e reflexão

The present work highlights the importance of Dialogue in dealing with situations of crisis, and human conflicts. It has a starting point in some ideas of David Bohm, and in so doing, it presents itself with the challenge of testing the premise that dialogical strategies, of thought and action, can make the human choices inherent to those situations, more coherent and creative. They also allow us to elucidate and grasp them, towards broader comprehension and resolution, while keeping the framework of consistent assessment. However, we believe that said strategies are not, necessarily, problem solvers. With that in mind, we expanded the notion of Dialogue , systematizing dialogical visions of the world, derived from the ideas of David Bohm, Paulo Freire and Mikhail Bakhtin, in which they give priority to the Dialogue component, in all human relations within crucial contexts. From the elaboration of that systemic and dialogical interface, in which Dialogue appears as common theme, and pervasive tool, we detected the emerging of ancillary themes such as Liberty , Consciousness , Creativity , Ethics and Responsibility . We see these themes as ways of comprehending Life, as each one embodies interests, needs and shared human motivations. We have articulated them as a network, and added to that the need of Reflection in conjunction with Dialogue as a watchful call for noticing the incoherence

Eficiência de diferentes ramais de pulverização e volumes de calda no controle de Brevipalpus phoenicis na cultura do café

Efficiency of different spraying lances and spraying volumes on the control of Brevipalpus phoenicis in coffee crops. The mite Brevipalpus phoenicis is found on coffee plantations in Brazil since the 1950's. Responsible for indirect losses due to its role as vector of a virus disease, this mite species often requires control measures, the most common based on mitecide spraying. It was evaluated the mortality of B. phoenicis due the coverage of spraying liquid applied on coffee plants, with two types of lances used in air assisted sprayers and four spraying. volumes. Treatments were applied with mitecide abamectin (Vertimec 18 CE (R) at 0.4 L per hectare), in volumes of 250, 400, 550 and 700 L per hectare, with two types of lances for the nozzles. The control efficiency against B. phoenicis, deposition and coverage by spray liquid on coffee plants was evaluated. Experimental delineation was in randomized blocks, with eight treatments plus a check plot in four replications. The statistical analysis was carried in a factorial scheme 2x4+1. No significant differences in the number of mites were found between treatments. As regards spraying liquid deposition, it was observed an increment with increasing spraying volumes, with the plant tops showing the best deposition of spraying liquid. The duplication of the lances (nozzle branches) resulted in a significant increase in control efficiency for B. phoenicis compared with conventional branch and with check plot, without dependence of spraying volume.

Assessment of micronutrient extractants from soils of Paraná, Brazil

In Brazil, plant-available micronutrients in the soil can be determined by several chemical extractants, the most common of which are dilute acid and chelating solutions. The purpose of this study was to assess the extractants 0.1 mol L-1 HCl, Mehlich-1, Mehlich-3 and DTPA for analysis of the micronutrients Cu, Zn, Fe, and Mn in soils from the state of Parana. In samples from 12 soils (0-20 cm layer), wheat was planted (Triticum aestivum), grown for 42 days after emergence, and then bean (Phaseolus vulgaris) for 38 days. At the end of each planting period, the soil was sampled again. All extractants tested to assess the availability of Cu, Zn, Fe, and Mn correlated with each other. The efficiency of the extractants HCl, Mehlich-3 and DTPA in assessing plant-available Cu was similar, unlike Mehlich-1, which proved less efficient. The extractants HCl, Mehlich-1 and Mehlich-3 were less efficient in estimating plant-available Zn and Fe, and the most indicated extractant is DTPA. The efficiency of the extractants HCl, Mehlich-1, Mehlich-3 and DTPA in assessing plant-available Mn in soils from Parana was similar.

Cardiovascular assessment of patients with Ullrich-Turner's Syndrome on Doppler echocardiography and magnetic resonance imaging

OBJECTIVE: To assess the cardiovascular features of Ullrich-Turner's syndrome using echocardiography and magnetic resonance imaging, and to correlate them with the phenotype and karyotype of the patients. The diagnostic concordance between the 2 methods was also assessed. METHODS: Fifteen patients with the syndrome were assessed by echocardiography and magnetic resonance imaging (cardiac chambers, valves, and aorta). Their ages ranged from 10 to 28 (mean of 16.7) years. The karyotype was analyzed in 11 or 25 metaphases of peripheral blood lymphocytes, or both. RESULTS: The most common phenotypic changes were short stature and spontaneous absence of puberal development (100%); 1 patient had a cardiac murmur. The karyotypes detected were as follows: 45,X (n=7), mosaics (n=5), and deletions (n=3). No echocardiographic changes were observed. In regard to magnetic resonance imaging, coarctation and dilation of the aorta were found in 1 patient, and isolated dilation of the aorta was found in 4 patients. CONCLUSION: The frequencies of coarctation and dilation of the aorta detected on magnetic resonance imaging were similar to those reported in the literature (5.5% to 20%, and 6.3% to 29%, respectively). This confirmed the adjuvant role of magnetic resonance imaging to Doppler echocardiography for diagnosing cardiovascular alterations in patients with Ullrich-Turner's syndrome.