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.

Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Optimization of cable cycles : a trade-off between reliability and cost

This paper elaborates the routing of cable cycle through available routes in a building in order to link a set of devices, in a most reasonable way. Despite of the similarities to other NP-hard routing problems, the only goal is not only to minimize the cost (length of the cycle) but also to increase the reliability of the path (in case of a cable cut) which is assessed by a risk factor. Since there is often a trade-off between the risk and length factors, a criterion for ranking candidates and deciding the most reasonable solution is defined. A set of techniques is proposed to perform an efficient and exact search among candidates. A novel graph is introduced to reduce the search-space, and navigate the search toward feasible and desirable solutions. Moreover, admissible heuristic length estimation helps to early detection of partial cycles which lead to unreasonable solutions. The results show that the method provides solutions which are both technically and financially reasonable. Furthermore, it is proved that the proposed techniques are very efficient in reducing the computational time of the search to a reasonable amount.

'Off with his head!' : Inexplicable Faith in Bulgakov's Master and Margarita

Examining how, in the novel, Bulgakov shows the conflict between logic and faith through the actions of his characters : the characters who are logical are generally not portrayed as wise and are said to not appreciate, nor understand, faith.

Hacked Off in the Web

According to a new report (http://tinyurl.com/2g6ghps), if you are on the Web at all you’re not safe from hackers, phishers, and spammers (oh my!). The Norton Cybercrime Report: The Human Impact (http://cybercrime.newslinevine.com/) of 7,000 Web users tells us that 65% of all users globally, and 73% of U. S. users, have been hacked in some sort of cybercrime. Globally, the U. S. ranks very high but in this case we’re not first in line. China wins Number One with 83% of its users web-abused in some manner. These are figures to give one pause.

As mudanças na organização da produção na indústria gáfica do Grande ABC: um estudo sobre o segmento off set

O presente trabalho tem por objetivo caracterizar a indústria gráfica do ponto de vista da gestão, tecnologia, inovação e competição. A economia ao longo de sua história foi marcante por alguma situação peculiar que a caracterizasse. Em particular a partir da década de 1960 acompanhamos o crescimento em larga escala na região do Grande ABC onde, a indústria automobilística e seus fornecedores necessitaram de maior estrutura e apoio para as suas operações, provocando alterações nos modos de atuação das empresas industriais no país. Nessa mesma direção pelas necessidades criadas à época, a indústria gráfica na região do ABC também teve seu crescimento para atender a demanda e, criando o caráter da regionalidade e se fortalecendo economicamente. Entretanto a partir da década de 1980 com as crises econômicas e a abertura de mercado, houve uma redução nos postos de trabalho, mas as empresas também alteraram as formas de produzir. O trabalho de campo foi apoiado num referencial teórico baseado na revisão bibliográfica e um roteiro de entrevistas que orientou a coleta de dados. Na presente pesquisa foram realizadas entrevistas com os sujeitos relacionados e verificação de documentos. A análise realizada buscou confrontar os dados coletados e sistematizados com o quadro conceitual utilizado para a elaboração da pesquisa, possibilitando apurar as principais transformações verificadas no segmento estudado, bem como oferecendo embasamento para a tomada de decisão dos atores econômicos envolvidos com o desenvolvimento da indústria gráfica no Grande ABC.

The trade-off between incentives and endogenous risk

Standard models of moral hazard predict a negative relationship between risk and incentives, but the empirical work has not confirmed this prediction. In this paper, we propose a model with adverse selection followed by moral hazard, where effort and the degree of risk aversion are private information of an agent who can control the mean and the variance of profits. For a given contract, more risk-averse agents suppIy more effort in risk reduction. If the marginal utility of incentives decreases with risk aversion, more risk-averse agents prefer lower-incentive contractsj thus, in the optimal contract, incentives are positively correlated with endogenous risk. In contrast, if risk aversion is high enough, the possibility of reduction in risk makes the marginal utility of incentives increasing in risk aversion and, in this case, risk and incentives are negatively related.

Productivity of nations: a stochastic frontier approach to TFP decomposition

This Paper Tackles the Problem of Aggregate Tfp Measurement Using Stochastic Frontier Analysis (Sfa). Data From Penn World Table 6.1 are Used to Estimate a World Production Frontier For a Sample of 75 Countries Over a Long Period (1950-2000) Taking Advantage of the Model Offered By Battese and Coelli (1992). We Also Apply the Decomposition of Tfp Suggested By Bauer (1990) and Kumbhakar (2000) to a Smaller Sample of 36 Countries Over the Period 1970-2000 in Order to Evaluate the Effects of Changes in Efficiency (Technical and Allocative), Scale Effects and Technical Change. This Allows Us to Analyze the Role of Productivity and Its Components in Economic Growth of Developed and Developing Nations in Addition to the Importance of Factor Accumulation. Although not Much Explored in the Study of Economic Growth, Frontier Techniques Seem to Be of Particular Interest For That Purpose Since the Separation of Efficiency Effects and Technical Change Has a Direct Interpretation in Terms of the Catch-Up Debate. The Estimated Technical Efficiency Scores Reveal the Efficiency of Nations in the Production of Non Tradable Goods Since the Gdp Series Used is Ppp-Adjusted. We Also Provide a Second Set of Efficiency Scores Corrected in Order to Reveal Efficiency in the Production of Tradable Goods and Rank Them. When Compared to the Rankings of Productivity Indexes Offered By Non-Frontier Studies of Hall and Jones (1996) and Islam (1995) Our Ranking Shows a Somewhat More Intuitive Order of Countries. Rankings of the Technical Change and Scale Effects Components of Tfp Change are Also Very Intuitive. We Also Show That Productivity is Responsible For Virtually All the Differences of Performance Between Developed and Developing Countries in Terms of Rates of Growth of Income Per Worker. More Important, We Find That Changes in Allocative Efficiency Play a Crucial Role in Explaining Differences in the Productivity of Developed and Developing Nations, Even Larger Than the One Played By the Technology Gap

Uma avaliação da economia convencional ou abandonando-se o trade off eficiência equidade

O objetivo desta proposta é discutir os limites da análise walrasiana convencional e apresentar uma alternativa a ela. Os limites daquela análise são o de supor custos zero de transação e normas e preferências dos agentes dados exogenamente. A visão alternativa considera que muitas e importantes transações no capitalismo, chamados relações contestadas, demandam custos de controle e monitoramento, e podem gerar endogenamente diferentes formas de comportamentos. Estas condições podem dar lugar a fundamentos alternativos para as análises micro e macroeconômicos bem como ver implicações importantes para as políticas de estabilização.

"Se meu jipe falasse" : a experiência de consumo dos usuários de veículos off road

Este estudo adota a perspectiva experiencial, trazendo a noção de consumo hedônico e de experiência de consumo para o âmbito do marketing e do comportamento do consumidor. Partese do pressuposto de que entender o consumo exige ir além do processo de decisão de compra e admitir que aquilo que os consumidores fazem e a forma como utilizam os bens adquiridos também influencia seus comportamentos. Mas, acima de tudo, exige a visão do consumidor como um indivíduo emocionalmente envolvido com o consumo, processo pelo qual estímulos sensoriais, a imaginação e aspectos emotivos são procurados e apreciados. A investigação teve por objetivo compreender a experiência dos consumidores em situações de uso e consumo dos produtos através da análise dos elementos que a compõem: o contexto, os estímulos sensoriais, os processos cognitivos, as respostas afetivas, as atividades e o processo de avaliação do produto e da experiência em si. A categoria de produtos escolhida foi a de veículos fora-de-estrada, em função do potencial multiuso e da possibilidade de proporcionar desde simples viagens a grandes aventuras. Para atingir os objetivos propostos foi utilizada a Técnica de Elicitação Fotográfica (PET), que permitiu à pesquisadora se aproximar da experiência real vivenciada pelos consumidores através das imagens visuais que os mesmos foram solicitados a trazer para as entrevistas. Os resultados encontrados apontam não apenas para a riqueza e o profundo entendimento a respeito dos consumidores possibilitado pela análise de suas experiências, mas também o quanto a estimulação visual pode ser uma grande aliada dos pesquisadores quando o objetivo da investigação é entender comportamentos de consumo, a relação das pessoas com seus objetos de desejo, as relações sociais que são possibilitadas através das posses e como as experiências em si (e não apenas as características funcionais dos produto) contribuem para a expressão da identidade, auto-conceito e estilo de vida dos consumidores.

A note on convergence of Peck-Shell and Green-Lin mechanisms in the Diamond-Dybvig model

We study the effects of population size in the Peck-Shell analysis of bank runs. We find that a contract featuring equal-treatment for almost all depositors of the same type approximates the optimum. Because the approximation also satisfies Green-Lin incentive constraints, when the planner discloses positions in the queue, welfare in these alternative specifications are sandwiched. Disclosure, however, it is not needed since our approximating contract is not subject to runs.

Microfinanças no Brasil : afinal, existe um trade-off entre o foco na pobreza e a sustentabilidade financeira?

A pesquisa investigou teórica e empiricamente se os programas de microcrédito são capazes de estender empréstimos para as pessoas pobres sem contar com subsídios. Para tanto, foi realizada uma extensa revisão de literatura, que abordou as características do mercado de (micro)crédito e algumas experiências internacionais inspiradas basicamente no modelo desenvolvido pelo Banco Grameen de Bangladesh. Em seguida, os argumentos referentes ao dilema explorado na dissertação foram organizados de maneira a permitir ao leitor encontrar e compreender as diferentes posições e evidências até então documentadas. Por fim, lançou-se mão de estudos de caso de quatro programas brasileiros com a intenção de evidenciar um possível dilema entre foco e sustentabilidade financeira. A constatação foi de que as instituições brasileiras têm enfrentado dificuldades nas duas frentes, já que nenhuma apresentou sustentabilidade financeira e um compromisso explícito com a redução da pobreza. De qualquer maneira, há duas ressalvas dignas de nota. A primeira é a de que a conclusão do trabalho não é definitiva. A escassez de dados dificultou sobremaneira as avaliações e, com isso, impõe muita cautela antes de qualquer conclusão sobre os programas selecionados e sobre a eficácia do microcrédito como instrumento de combate à pobreza. A segunda ressalva diz respeito à definição de pobreza utilizada nos estudos de caso. Se a pobreza for concebida como carência de oportunidades, o microcrédito assume outra dimensão, ainda que os programas não tenham conciliado foco na pobreza com sustentabilidade financeira. Seguindo nessa linha, o trabalho concluiu que os programas brasileiros têm obtido algum sucesso para aliviar a pobreza relativa e auxiliado a geração de autonomia dos participantes.