Improved score tests in symmetric linear regression models

The class of symmetric linear regression models has the normal linear regression model as a special case and includes several models that assume that the errors follow a symmetric distribution with longer-than-normal tails. An important member of this class is the t linear regression model, which is commonly used as an alternative to the usual normal regression model when the data contain extreme or outlying observations. In this article, we develop second-order asymptotic theory for score tests in this class of models. We obtain Bartlett-corrected score statistics for testing hypotheses on the regression and the dispersion parameters. The corrected statistics have chi-squared distributions with errors of order O(n(-3/2)), n being the sample size. The corrections represent an improvement over the corresponding original Rao`s score statistics, which are chi-squared distributed up to errors of order O(n(-1)). Simulation results show that the corrected score tests perform much better than their uncorrected counterparts in samples of small or moderate size.

Small-Sample Corrections for Score Tests in Birnbaum-Saunders Regressions

In this article, we deal with the issue of performing accurate small-sample inference in the Birnbaum-Saunders regression model, which can be useful for modeling lifetime or reliability data. We derive a Bartlett-type correction for the score test and numerically compare the corrected test with the usual score test and some other competitors.

Three Bartlett-type corrections for score statistics in symmetric nonlinear regression models

We present simple matrix formulae for corrected score statistics in symmetric nonlinear regression models. The corrected score statistics follow more closely a chi (2) distribution than the classical score statistic. Our simulation results indicate that the corrected score tests display smaller size distortions than the original score test. We also compare the sizes and the powers of the corrected score tests with bootstrap-based score tests.

From Data Snore, to Data Score: Communicating Library Assessment Data Visually through Infographics

This presentation was offered as part of the CUNY Library Assessment Conference, Reinventing Libraries: Reinventing Assessment, held at the City University of New York in June 2014.

Simultaneous prediction of symptom severity and cause in data from a test battery for Parkinson patients, using machine learning methods

The main purpose of this thesis project is to prediction of symptom severity and cause in data from test battery of the Parkinson’s disease patient, which is based on data mining. The collection of the data is from test battery on a hand in computer. We use the Chi-Square method and check which variables are important and which are not important. Then we apply different data mining techniques on our normalize data and check which technique or method gives good results.The implementation of this thesis is in WEKA. We normalize our data and then apply different methods on this data. The methods which we used are Naïve Bayes, CART and KNN. We draw the Bland Altman and Spearman’s Correlation for checking the final results and prediction of data. The Bland Altman tells how the percentage of our confident level in this data is correct and Spearman’s Correlation tells us our relationship is strong. On the basis of results and analysis we see all three methods give nearly same results. But if we see our CART (J48 Decision Tree) it gives good result of under predicted and over predicted values that’s lies between -2 to +2. The correlation between the Actual and Predicted values is 0,794in CART. Cause gives the better percentage classification result then disability because it can use two classes.

The most severe parkinsonian patients are most improved with duodenal levodopa infusion

Objectives:To find variables correlated to improvement with intraduodenal levodopa/carbidopa infusion (Duodopa) in order to identify potential candidates for this treatment. Two clinical studies comparing Duodopa with oral treatments in patients with advanced Parkinson’s disease have shown significant improvement in percent on-time on a global treatment response scale (TRS) based on hourly and half-hourly clinical ratings and in median UPDRS scores.Methods:Data from study 1 comparing infusion with Sinemet CR (12 patients, Nyholm et al, Clin Neuropharmacol 2003; 26(3): 156-163) and study 2 comparing infusion with individually optimised conventional combination therapies (18 patients, Nyholm et al, Neurology, in press) were used. Measures of severity were defined as total UPDRS score and scores for sections II and III, percent functional on-time and mean squared error of ratings on the TRS and as mean of diary questions about mobility and satisfaction (only study 2). Absolute improvement was defined as difference in severity, and relative improvement was defined as percent absolute improvement/severity on oral treatment. Pearson correlation coefficients between measures of improvement and other variables were calculated.Results:Correlations (r2>0.28, p<0.05) between severity during oral treatment and absolute improvement on infusion were found for: Total UPDRS, UPDRS III and TRS ratings (studies 1 and 2) and for diary question 1 (mobility) and UPDRS II (study 2). Correlation to relative improvement was found for total UPDRS (study 2, r2=0.47). Figure 1 illustrates absolute improvement in total UPDRS vs. total UPDRS during oral treatment (study 2).Conclusion:Correlating different measures of severity and improvement revealed that patients with more severe symptoms were most improved and that the relation between severity and improvement was linear within the studied groups. The result, which was reproducible between two clinical studies, could be useful when deciding candidates for the treatment.

Mobile systems for monitoring Parkinson's disease

A challenge for the clinical management of Parkinson's disease (PD) is the large within- and between-patient variability in symptom profiles as well as the emergence of motor complications which represent a significant source of disability in patients. This thesis deals with the development and evaluation of methods and systems for supporting the management of PD by using repeated measures, consisting of subjective assessments of symptoms and objective assessments of motor function through fine motor tests (spirography and tapping), collected by means of a telemetry touch screen device. One aim of the thesis was to develop methods for objective quantification and analysis of the severity of motor impairments being represented in spiral drawings and tapping results. This was accomplished by first quantifying the digitized movement data with time series analysis and then using them in data-driven modelling for automating the process of assessment of symptom severity. The objective measures were then analysed with respect to subjective assessments of motor conditions. Another aim was to develop a method for providing comparable information content as clinical rating scales by combining subjective and objective measures into composite scores, using time series analysis and data-driven methods. The scores represent six symptom dimensions and an overall test score for reflecting the global health condition of the patient. In addition, the thesis presents the development of a web-based system for providing a visual representation of symptoms over time allowing clinicians to remotely monitor the symptom profiles of their patients. The quality of the methods was assessed by reporting different metrics of validity, reliability and sensitivity to treatment interventions and natural PD progression over time. Results from two studies demonstrated that the methods developed for the fine motor tests had good metrics indicating that they are appropriate to quantitatively and objectively assess the severity of motor impairments of PD patients. The fine motor tests captured different symptoms; spiral drawing impairment and tapping accuracy related to dyskinesias (involuntary movements) whereas tapping speed related to bradykinesia (slowness of movements). A longitudinal data analysis indicated that the six symptom dimensions and the overall test score contained important elements of information of the clinical scales and can be used to measure effects of PD treatment interventions and disease progression. A usability evaluation of the web-based system showed that the information presented in the system was comparable to qualitative clinical observations and the system was recognized as a tool that will assist in the management of patients.

Automatic spiral analysis for objective assessment of motor symptoms in Parkinson's disease

Objective: To develop a method for objective quantification of PD motor symptoms related to Off episodes and peak dose dyskinesias, using spiral data gathered by using a touch screen telemetry device. The aim was to objectively characterize predominant motor phenotypes (bradykinesia and dyskinesia), to help in automating the process of visual interpretation of movement anomalies in spirals as rated by movement disorder specialists. Background: A retrospective analysis was conducted on recordings from 65 patients with advanced idiopathic PD from nine different clinics in Sweden, recruited from January 2006 until August 2010. In addition to the patient group, 10 healthy elderly subjects were recruited. Upper limb movement data were collected using a touch screen telemetry device from home environments of the subjects. Measurements with the device were performed four times per day during week-long test periods. On each test occasion, the subjects were asked to trace pre-drawn Archimedean spirals, using the dominant hand. The pre-drawn spiral was shown on the screen of the device. The spiral test was repeated three times per test occasion and they were instructed to complete it within 10 seconds. The device had a sampling rate of 10Hz and measured both position and time-stamps (in milliseconds) of the pen tip. Methods: Four independent raters (FB, DH, AJ and DN) used a web interface that animated the spiral drawings and allowed them to observe different kinematic features during the drawing process and to rate task performance. Initially, a number of kinematic features were assessed including ‘impairment’, ‘speed’, ‘irregularity’ and ‘hesitation’ followed by marking the predominant motor phenotype on a 3-category scale: tremor, bradykinesia and/or choreatic dyskinesia. There were only 2 test occasions for which all the four raters either classified them as tremor or could not identify the motor phenotype. Therefore, the two main motor phenotype categories were bradykinesia and dyskinesia. ‘Impairment’ was rated on a scale from 0 (no impairment) to 10 (extremely severe) whereas ‘speed’, ‘irregularity’ and ‘hesitation’ were rated on a scale from 0 (normal) to 4 (extremely severe). The proposed data-driven method consisted of the following steps. Initially, 28 spatiotemporal features were extracted from the time series signals before being presented to a Multilayer Perceptron (MLP) classifier. The features were based on different kinematic quantities of spirals including radius, angle, speed and velocity with the aim of measuring the severity of involuntary symptoms and discriminate between PD-specific (bradykinesia) and/or treatment-induced symptoms (dyskinesia). A Principal Component Analysis was applied on the features to reduce their dimensions where 4 relevant principal components (PCs) were retained and used as inputs to the MLP classifier. Finally, the MLP classifier mapped these components to the corresponding visually assessed motor phenotype scores for automating the process of scoring the bradykinesia and dyskinesia in PD patients whilst they draw spirals using the touch screen device. For motor phenotype (bradykinesia vs. dyskinesia) classification, the stratified 10-fold cross validation technique was employed. Results: There were good agreements between the four raters when rating the individual kinematic features with intra-class correlation coefficient (ICC) of 0.88 for ‘impairment’, 0.74 for ‘speed’, 0.70 for ‘irregularity’, and moderate agreements when rating ‘hesitation’ with an ICC of 0.49. When assessing the two main motor phenotype categories (bradykinesia or dyskinesia) in animated spirals the agreements between the four raters ranged from fair to moderate. There were good correlations between mean ratings of the four raters on individual kinematic features and computed scores. The MLP classifier classified the motor phenotype that is bradykinesia or dyskinesia with an accuracy of 85% in relation to visual classifications of the four movement disorder specialists. The test-retest reliability of the four PCs across the three spiral test trials was good with Cronbach’s Alpha coefficients of 0.80, 0.82, 0.54 and 0.49, respectively. These results indicate that the computed scores are stable and consistent over time. Significant differences were found between the two groups (patients and healthy elderly subjects) in all the PCs, except for the PC3. Conclusions: The proposed method automatically assessed the severity of unwanted symptoms and could reasonably well discriminate between PD-specific and/or treatment-induced motor symptoms, in relation to visual assessments of movement disorder specialists. The objective assessments could provide a time-effect summary score that could be useful for improving decision-making during symptom evaluation of individualized treatment when the goal is to maximize functional On time for patients while minimizing their Off episodes and troublesome dyskinesias.

PokerMapper: : mapping executive functions, poker playing ability and responsible gambling in online environments

Research objectives Poker and responsible gambling both entail the use of the executive functions (EF), which are higher-level cognitive abilities. The main objective of this work was to assess if online poker players of different ability show different performances in their EF and if so, which functions are the most discriminating ones. The secondary objective was to assess if the EF performance can predict the quality of gambling, according to the Gambling Related Cognition Scale (GRCS), the South Oaks Gambling Screen (SOGS) and the Problem Gambling Severity Index (PGSI). Sample and methods The study design consisted of two stages: 46 Italian active players (41m, 5f; age 32±7,1ys; education 14,8±3ys) fulfilled the PGSI in a secure IT web system and uploaded their own hand history files, which were anonymized and then evaluated by two poker experts. 36 of these players (31m, 5f; age 33±7,3ys; education 15±3ys) accepted to take part in the second stage: the administration of an extensive neuropsychological test battery by a blinded trained professional. To answer the main research question we collected all final and intermediate scores of the EF tests on each player together with the scoring on the playing ability. To answer the secondary research question, we referred to GRCS, PGSI and SOGS scores.  We determined which variables that are good predictors of the playing ability score using statistical techniques able to deal with many regressors and few observations (LASSO, best subset algorithms and CART). In this context information criteria and cross-validation errors play a key role for the selection of the relevant regressors, while significance testing and goodness-of-fit measures can lead to wrong conclusions.   Preliminary findings We found significant predictors of the poker ability score in various tests. In particular, there are good predictors 1) in some Wisconsin Card Sorting Test items that measure flexibility in choosing strategy of problem-solving, strategic planning, modulating impulsive responding, goal setting and self-monitoring, 2) in those Cognitive Estimates Test variables related to deductive reasoning, problem solving, development of an appropriate strategy and self-monitoring, 3) in the Emotional Quotient Inventory Short (EQ-i:S) Stress Management score, composed by the Stress Tolerance and Impulse Control scores, and in the Interpersonal score (Empathy, Social Responsibility, Interpersonal Relationship). As for the quality of gambling, some EQ-i:S scales scores provide the best predictors: General Mood for the PGSI; Intrapersonal (Self-Regard; Emotional Self-Awareness, Assertiveness, Independence, Self-Actualization) and Adaptability  (Reality Testing, Flexibility, Problem Solving) for the SOGS, Adaptability for the GRCS. Implications for the field Through PokerMapper we gathered knowledge and evaluated the feasibility of the construction of short tasks/card games in online poker environments for profiling users’ executive functions. These card games will be part of an IT system able to dynamically profile EF and provide players with a feedback on their expected performance and ability to gamble responsibly in that particular moment. The implementation of such system in existing gambling platforms could lead to an effective proactive tool for supporting responsible gambling. 

Associação entre manometria ano-retal e neuropatia pudenda em pacientes com incontinência fecal

A incontinência fecal é a incapacidade de manter o controle da eliminação do conteúdo intestinal em local e tempo socialmente adequados, resultando em escape de gases e fezes. Esta condição acarreta grande prejuízo na vida social dos acometidos. A causa conhecida mais comum é o trauma perineal, porém em uma grande proporcão a incontinência é idiopática. A avaliação da função esfincteriana anal é fundamental para o diagnóstico e para a conduta terapêutica na incontinência fecal. Para o entendimento da fisiopatologia desta condição desenvolveram-se vários exames de investigação. A manometria ano-retal é considerado imprescindível na avaliação. A correlação dos dados da manometria com a gravidade da doença e com estudos eletrofisiológicos ainda não estão bem estabelecidos. O objetivo deste estudo é correlacionar os dados da manometria ano-retal e o estudo do tempo de latência motora terminal do nervo pudendo com a incontinência fecal e comorbidades. Foram estudados prospectivamente todos os pacientes com queixa clínica de incontinência fecal atendidos no ambulatório de Serviço de Coloproctologia do Hospital Nossa Senhora da Conceição, de Porto Alegre (RS), entre março de 1997 e junho de 2000. De todos os pacientes foram coletados dados da anamnese que os classificaram segundo escore de incontinência proposto por JORGE & WEXNER (1993). Todos foram submetidos a manometria ano-retal, estudo do tempo de latência motora terminal do nervo pudendo bilateralmente e exame proctológico. Foram excluídos os pacientes que não concluíram toda a investigação, com cirurgias colo-retais baixas prévias ou neoplasia de reto e canal anal. Para análise estatística, os pacientes foram separados em grupos segundo a manometria normal ou alterada (hipotonia), presença ou não de neuropatia de nervo pudendo, por idade e por sexo. Foram estudados 39 pacientes, 85,6% do sexo feminino com idade média de 60,1 anos (±12,89). A média do escore de incontinência fecal foi de 9,30±4,93. À manometria ano-retal, vinte e três pacientes (59%) apresentaram pressões reduzidas. As pressões foram significativamente mais elevadas nos pacientes do sexo masculino. O tempo de latência motora terminal do nervo pudendo (neuropatia) foi prolongado em 14 doentes (35,9%). A idade e o tempo de latência motora terminal do nervo pudendo correlacionaram-se significativamente, r=0,422, (P=0,007). A demais correlações entre idade, pressões da manometria, tempo de latência motora terminal do nervo pudendo e escore de incontinência não foram estatisticamente significativas.

Test score disclosure and school performance

In this paper we test whether the disclosure of test scores has direct impacts on student performance, school composition and school inputs. We take advantage of the discontinuity on the disclosure rules of The National Secondary Education Examination (ENEM) run in Brazil by the Ministry of Education: In 2006 it was established that the 2005 mean score results would be disclosed for schools with ten or more students who took the exam in the previous year. We use a regression discontinuity design to estimate the e ects of test disclosure. Our results indicate that private schools that had their average scores released in 2005 outperformed those that did not by 0.2-0.6 in 2007. We did not nd same results for public schools. Moreover, we did not nd evidence that treated schools adjusted their inputs or that there was major changes in the students composition of treated schools. These ndings allow us to interpret that the main mechanism driving the di erences in performance was the increased levels of students', teachers' and principals' e ort exerted by those in schools that had scores publicized.

Valor prognóstico das cinéticas da procalcitonina e da proteína C reativa na pneumonia associada à ventilação mecânica

Introdução A pneumonia hospitalar é a principal causa de morte dentre as infecções hospitalares. A prevalência de pneumonia hospitalar em Unidades de Tratamento Intensivo (UTI) varia de 10 a 65%, com taxas de mortalidade que podem variar de 24 a 76%. A pneumonia associada à ventilação mecânica (PAV) é um determinante de mortalidade independente em pacientes submetidos à ventilação mecânica. A adequação do tratamento empírico precoce parece ser fundamental no prognóstico. Os critérios atualmente estabelecidos para avaliar adequação do tratamento empírico utilizam parâmetros clínicos, escores de gravidade e, principalmente, a sensibilidade do germe causador da infecção aos antibióticos administrados. Estes resultados balizam a necessidade de possíveis modificações no esquema antimicrobiano. A possibilidade de utilizar a Procalcitonina (PCT), a Proteína-C Reativa (CRP) e o escore SOFA (Avaliação de Falência de Órgãos Relacionada a Sepse), como indicadores de resposta do paciente, comparando seu status no dia do início do tratamento antimicrobiano (D0) com a evolução destes indicadores no quarto dia de tratamento (D4) abre a possibilidade de comparar o paciente com ele próprio, independente da exuberância da expressão da resposta inflamatória que ele possa desenvolver. Os resultados desta cinética entre D0 e D4 podem ser preditivos de gravidade de infecção, de eficiência antimicrobiana, e possivelmente de sobrevivência ou mortalidade hospitalar nos pacientes com suspeita de PAV. Objetivos Determinar e comparar o valor prognóstico de sobrevivência da cinética da PCT, da CRP, dos escores clínicos CPIS (Escore Clínico de Infecção Pulmonar) e SOFA, e do APACHE II (Avaliação da Fisiologia Aguda e da Saúde Crônica) na PAV entre o diagnóstico e o quarto dia de tratamento, quando a adequação do tratamento é avaliada. Pacientes e Métodos Realizamos um estudo de coorte prospectivo observacional que avaliou 75 pacientes internados no Centro de Tratamento Intensivo clínico-cirúrgico de adultos do Hospital de Clínicas de Porto Alegre que desenvolveram PAV no período de outubro de 2003 a agosto de 2005. Os pacientes com suspeita clínica de PAV que se adequaram aos critérios de inclusão e exclusão do estudo foram os candidatos a participar. Os familiares ou representantes dos pacientes receberam esclarecimentos por escrito acerca dos exames a serem realizados, bem como dos objetivos gerais da pesquisa. Os que aceitaram participar do estudo assinaram o termo de Consentimento Informado. O projeto foi aprovado pelo Comitê de Ética em Pesquisa do Hospital de Clínicas de Porto Alegre. No dia do diagnóstico de PAV foram coletados aspirado traqueal quantitativo, hemoculturas e sangue para a realização de dosagens de PCT, CRP, hemograma, plaquetas, creatinina, bilirrubinas, gasometria arterial e radiografia de tórax, com o objetivo de calcular o CPIS e o escore SOFA. No terceiro dia de tratamento foram novamente coletados aspirados traqueais quantitativos e os demais exames para o cálculo do CPIS. No quarto dia foi coletado sangue para dosagens de PCT, CRP e para os demais exames necessários para o cálculo do SOFA. Os pacientes foram acompanhados por 28 dias após o diagnóstico de PAV, quando foram considerados sobreviventes. Todos os pacientes que morreram antes do vigésimo oitavo dia foram considerados não-sobreviventes. Resultados Os níveis de PCT foram mais baixos nos sobreviventes em D0 (p=0.003) e em D4 (p=0.001). Os níveis de CRP não foram diferentes em sobreviventes e nãosobreviventes em D0 (p=0.77) e em D4 (p=0.14). O CPIS não pode diferenciar sobreviventes de não-sobrevientes em D0 (p=0.32) e em D3 (p=0.45). ΔCPIS decrescente não foi correlacionado a sobrevivência (p=0.59), o mesmo ocorrendo com CPIS <6 em D3 (p=0.79). Pacientes que morreram antes de D4 não puderam ter sua cinética calculada e foram considerados casos perdidos. Variáveis incluídas no modelo de regressão logística univariável para sobrevivência foram idade, APACHE II, ΔSOFA decrescente, ΔPCT decrescente e ΔCRP decrescente. Sobrevivência foi diretamente correlacionada a ΔPCT decrescente com RC = 5.67 (1.78;18.03) p = 0.003, ΔCRP com RC = 3.78 (1.24;11.50) p = 0.02, ΔSOFA decrescente com RC = 3.08 (1.02;9.26) p = 0.05 e escore APACHE II com RC = 0.92 (0.86;0.99) p = 0.02. O modelo de regressão logística multivariável para sobrevivência incluiu todas as variáveis participantes da análise univariável. Somente ΔPCT decrescente com RC = 4.43 (1.08;18.18) p = 0.04 e ΔCRP com RC = 7.40 (1.58;34.73) p = 0.01 permaneceram significativos. A avaliação da cinética dos marcadores inflamatórios e a associação com sobrevida no estudo mostraram que: - Em 95,1% dos sobreviventes houve queda dos níveis de PCT ou de CRP. - Em 61% dos sobreviventes ambos os níveis de PCT e de CRP caíram. Apenas 4,9% dos sobreviventes tiveram níveis de PCT e CRP crescentes. Com relação aos não-sobreviventes, 78.9% tiveram pelo menos um dos dois marcadores ou ambos com níveis crescentes. Conclusão As cinéticas da PCT e da CRP, obtidas pelas dosagens de seus níveis no dia do diagnóstico e no 4º dia de tratamento, podem predizer sobrevivência em pacientes com PAV. A queda dos níveis de pelo menos um destes marcadores ou de ambos indica maior chance de sobrevivência.

Template Score

Imagem componente do jogo “Musikinésia (http://www.loa.sead.ufscar.br/musikinesia.php)” desenvolvido pela equipe do Laboratório de Objetos de Aprendizagem da Universidade Federal de São Carlos (LOA/UFSCar).

Asthma Polymorphic Loci genotyping in Madeira population: identification of potential genetic markers of disease susceptibility, severity and clinical relevance

Asthma is a complex disease, influenced by both environmental and genetic factors. In this study, the analysis of multiple environmental factos assessed by questionnaire and the genotyping of SNPs IL131c.144 G/A, IL41590 C/T, IL41RP2 253183, ADRB21c.16 A/G, ADAM331V4 C/G, ADAM331S1 c.710 G/A, GSDML1236 C/T and STAT6121 C/T were performed in a sample of Madeiran asthmatic patients and their families, and their association to asthma susceptibility and severity was assessed. Family, environmental, social and individual factos such as the presence of rhinitis in one of the parents,the habitation conditions, the family smoking habits, individual food habits and allergen sensitivity, were found to account for asthma severity. IL41590*T and IL41RP2*183$ alleles as well as the combined genotypes IL41590*CT/IL41590*TT and IL41 RP2*253183/IL41RP2*253183 were associated to both asthma susceptibility and severity.GSDML1236*TT was found associated only to asthma severity.Allele ADAM331 V4*C was significantly overM transmitted to asthmatic offspring being linked with the disease by TDT. These findings suggest that in addition to environmental influences, IL41 590 C/T, IL41RP2 253183, ADAM331V4 C/G and GSDML1236 C/T SNPs may constitute important genetic factos contributing to asthmasusceptibility and/or severity in Madeira population.