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.

Road network and GPS tracking with data processing and quality assessment

GPS technology has been embedded into portable, low-cost electronic devices nowadays to track the movements of mobile objects. This implication has greatly impacted the transportation field by creating a novel and rich source of traffic data on the road network. Although the promise offered by GPS devices to overcome problems like underreporting, respondent fatigue, inaccuracies and other human errors in data collection is significant; the technology is still relatively new that it raises many issues for potential users. These issues tend to revolve around the following areas: reliability, data processing and the related application. This thesis aims to study the GPS tracking form the methodological, technical and practical aspects. It first evaluates the reliability of GPS based traffic data based on data from an experiment containing three different traffic modes (car, bike and bus) traveling along the road network. It then outline the general procedure for processing GPS tracking data and discuss related issues that are uncovered by using real-world GPS tracking data of 316 cars. Thirdly, it investigates the influence of road network density in finding optimal location for enhancing travel efficiency and decreasing travel cost. The results show that the geographical positioning is reliable. Velocity is slightly underestimated, whereas altitude measurements are unreliable.Post processing techniques with auxiliary information is found necessary and important when solving the inaccuracy of GPS data. The densities of the road network influence the finding of optimal locations. The influence will stabilize at a certain level and do not deteriorate when the node density is higher.

The effects of taxing truck distance on CO2 emissions from transports in retailing

To finance transportation infrastructure and to address social and environmental negative externalities of road transports, several countries have recently introduced or consider a distance based tax on trucks. In the competitive retail market such tax can be expected to lower the demand and thereby reduce CO2 emissions of road transports. However, as we show in this paper, such tax might also slow down the transition towards e-tailing. Considering that previous research indicates that a consumer switching from brick-and-mortar shopping to e-tailing reduces her CO2 emissions substantially, the direction and magnitude of the environmental net effect of the tax is unclear. In this paper, we assess the net effect in a Swedish regional retail market where the tax not yet is in place. We predict the net effect on CO2 emissions to be positive, but off-set by about 50% because of a slower transition to e-tailing.

Estimated lifetimes of road pavements in Sweden using time-to-event analysis

Maintenance planning of road pavement requires reliable estimates of roads’ lifetimes. In determining the lifetime of a road, this study combines maintenance activities and road condition measurements. The scope of the paper is to estimate lifetimes of road pavements in Sweden with time to event analysis. The model used includes effects of pavement type, road type, bearing capacity, road width, speed limit, stone size and climate zone, where the model is stratified according to traffic load. Among the nine analyzed pavement types, stone mastic had the longest expected lifetime, 32 percent longer than asphalt concrete. Among road types, ordinary roads with cable barriers had 30 percent shorter lifetime than ordinary roads. Increased speed lowered the lifetime, while increased stone size (up to 20 mm) and increased road width lengthened the lifetime. The results are of importance for life cycle cost analysis and road management.

Does road network density matter in optimally locating facilities?

Optimal location on the transport infrastructure is the preferable requirement for many decision making processes. Most studies have focused on evaluating performances of optimally locate p facilities by minimizing their distances to a geographically distributed demand (n) when p and n vary. The optimal locations are also sensitive to geographical context such as road network, especially when they are asymmetrically distributed in the plane. The influence of alternating road network density is however not a very well-studied problem especially when it is applied in a real world context. This paper aims to investigate how the density level of the road network affects finding optimal location by solving the specific case of p-median location problem. A denser network is found needed when a higher number of facilities are to locate. The best solution will not always be obtained in the most detailed network but in a middle density level. The solutions do not further improve or improve insignificantly as the density exceeds 12,000 nodes, some solutions even deteriorate. The hierarchy of the different densities of network can be used according to location and transportation purposes and increase the efficiency of heuristic methods. The method in this study can be applied to other location-allocation problem in transportation analysis where the road network density can be differentiated. 

How does the use of different road networks effect the optimal location of facilities in rural areas?

The p-median problem is often used to locate P service facilities in a geographically distributed population. Important for the performance of such a model is the distance measure. Distance measure can vary if the accuracy of the road network varies. The rst aim in this study is to analyze how the optimal location solutions vary, using the p-median model, when the road network is alternated. It is hard to nd an exact optimal solution for p-median problems. Therefore, in this study two heuristic solutions are applied, simulating annealing and a classic heuristic. The secondary aim is to compare the optimal location solutions using dierent algorithms for large p-median problem. The investigation is conducted by the means of a case study in a rural region with an asymmetrically distributed population, Dalecarlia. The study shows that the use of more accurate road networks gives better solutions for optimal location, regardless what algorithm that is used and regardless how many service facilities that is optimized for. It is also shown that the simulated annealing algorithm not just is much faster than the classic heuristic used here, but also in most cases gives better location solutions.

Traffic and Road Sign Recognition

This thesis presents a system to recognise and classify road and traffic signs for the purpose of developing an inventory of them which could assist the highway engineers’ tasks of updating and maintaining them. It uses images taken by a camera from a moving vehicle. The system is based on three major stages: colour segmentation, recognition, and classification. Four colour segmentation algorithms are developed and tested. They are a shadow and highlight invariant, a dynamic threshold, a modification of de la Escalera’s algorithm and a Fuzzy colour segmentation algorithm. All algorithms are tested using hundreds of images and the shadow-highlight invariant algorithm is eventually chosen as the best performer. This is because it is immune to shadows and highlights. It is also robust as it was tested in different lighting conditions, weather conditions, and times of the day. Approximately 97% successful segmentation rate was achieved using this algorithm.Recognition of traffic signs is carried out using a fuzzy shape recogniser. Based on four shape measures - the rectangularity, triangularity, ellipticity, and octagonality, fuzzy rules were developed to determine the shape of the sign. Among these shape measures octangonality has been introduced in this research. The final decision of the recogniser is based on the combination of both the colour and shape of the sign. The recogniser was tested in a variety of testing conditions giving an overall performance of approximately 88%.Classification was undertaken using a Support Vector Machine (SVM) classifier. The classification is carried out in two stages: rim’s shape classification followed by the classification of interior of the sign. The classifier was trained and tested using binary images in addition to five different types of moments which are Geometric moments, Zernike moments, Legendre moments, Orthogonal Fourier-Mellin Moments, and Binary Haar features. The performance of the SVM was tested using different features, kernels, SVM types, SVM parameters, and moment’s orders. The average classification rate achieved is about 97%. Binary images show the best testing results followed by Legendre moments. Linear kernel gives the best testing results followed by RBF. C-SVM shows very good performance, but ?-SVM gives better results in some case.

Color detection and segmentation for road and traffic signs

This paper aims to present three new methods for color detection and segmentation of road signs. The images are taken by a digital camera mounted in a car. The RGB images are converted into IHLS color space, and new methods are applied to extract the colors of the road signs under consideration. The methods are tested on hundreds of outdoor images in different light conditions, and they show high robustness. This project is part of the research taking place in Dalarna University / Sweden in the field of the ITS.

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.

Insuring cleaner oceans: the economics of oil pollution prevention

The current system of controlling oil spills involves a complex relationship of international, federal and state law, which has not proven to be very effective. The multiple layers of regulation often leave shipowners unsure of the laws facing them. Furthemore, nations have had difficulty enforcing these legal requirements. This thesis deals with the role marine insurance can play within the existing system of legislation to provide a strong preventative influence that is simple and cost-effective to enforce. In principle, insurance has two ways of enforcing higher safety standards and limiting the risk of an accident occurring. The first is through the use of insurance premiums that are based on the level of care taken by the insured. This means that a person engaging in riskier behavior faces a higher insurance premium, because their actions increase the probability of an accident occurring. The second method, available to the insurer, is collectively known as cancellation provisions or underwriting clauses. These are clauses written into an insurance contract that invalidates the agreement when certain conditions are not met by the insured The problem has been that obtaining information about the behavior of an insured party requires monitoring and that incurs a cost to the insurer. The application of these principles proves to be a more complicated matter. The modern marine insurance industry is a complicated system of multiple contracts, through different insurers, that covers the many facets of oil transportation. Their business practices have resulted in policy packages that cross the neat bounds of individual, specific insurance coverage. This paper shows that insurance can improve safety standards in three general areas -crew training, hull and equipment construction and maintenance, and routing schemes and exclusionary zones. With crew, hull and equipment, underwriting clauses can be used to ensure that minimum standards are met by the insured. Premiums can then be structured to reflect the additional care taken by the insured above and beyond these minimum standards. Routing schemes are traffic flow systems applied to congested waterways, such as the entrance to New York harbor. Using natural obstacles or manmade dividers, ships are separated into two lanes of opposing traffic, similar to a road. Exclusionary zones are marine areas designated off limits to tanker traffic either because of a sensitive ecosystem or because local knowledge is required of the region to ensure safe navigation. Underwriting clauses can be used to nullify an insurance contract when a tanker is not in compliance with established exclusionary zones or routing schemes.

The Old Road

The plot consists of the progression which the characters undergo. For the old man, the plot is his movement away from the earthly existence of the farm and into the physical process of the seasons. For the older grandson, it is the movement away from the past, symbolized by the farm, and into the present symbolized by his marriage and coupling with society. For the younger grandson, the movement is from childhood to the maturity which being alone demands in order for him to survive.