Self-reported symptoms and motor tests via telemetry in a 36-month levodopa-carbidopa intestinal gel infusion trial

Objective To investigate if a home environment test battery can be used to measure effects of Parkinson’s disease (PD) treatment intervention and disease progression. Background Seventy-seven patients diagnosed with advanced PD were recruited in an open longitudinal 36-month study at 10 clinics in Sweden and Norway; 40 of them were treated with levodopa-carbidopa intestinal gel (LCIG) and 37 patients were candidates for switching from oral PD treatment to LCIG. They utilized a mobile device test battery, consisting of self-assessments of symptoms and objective measures of motor function through a set of fine motor tests (tapping and spiral drawings), in their homes. Both the LCIG-naïve and LCIG-non-naïve patients used the test battery four times per day during week-long test periods. Methods Assessments The LCIG-naïve patients used the test battery at baseline (before LCIG), month 0 (first visit; at least 3 months after intraduodenal LCIG), and thereafter quarterly for the first year and biannually for the second and third years. The LCIG-non-naïve patients used the test battery from the first visit, i.e. month 0. Out of the 77 patients, only 65 utilized the test battery; 35 were LCIG-non-naïve and 30 LCIG-naïve. In 20 of the LCIG-naïve patients, assessments with the test battery were available during oral treatment and at least one test period after having started infusion treatment. Three LCIG-naïve patients did not use the test battery at baseline but had at least one test period of assessments thereafter. Hence, n=23 in the LCIG-naïve group. In total, symptom assessments in the full sample (including both patient groups) were collected during 379 test periods and 10079 test occasions. For 369 of these test periods, clinical assessments including UPDRS and PDQ-39 were performed in afternoons at the start of the test periods. The repeated measurements of the test battery were processed and summarized into scores representing patients’ symptom severities over a test period, using statistical methods. Six conceptual dimensions were defined; four subjectively-reported: ‘walking’, ‘satisfied’, ‘dyskinesia’, and ‘off’ and two objectively-measured: ‘tapping’ and ‘spiral’. In addition, an ‘overall test score’ (OTS) was defined to represent the global health condition of the patient during a test period. Statistical methods Change in the test battery scores over time, that is at baseline and follow-up test periods, was assessed with linear mixed-effects models with patient ID as a random effect and test period as a fixed effect of interest. The within-patient variability of OTS was assessed using intra-class correlation coefficient (ICC), for the two patient groups. Correlations between clinical rating scores and test battery scores were assessed using Spearman’s rank correlations (rho). Results In LCIG-naïve patients, mean OTS compared to baseline was significantly improved from the first test period on LCIG treatment until month 24. However, there were no significant changes in mean OTS scores of LCIG-non-naïve patients, except for worse mean OTS at month 36 (p<0.01, n=16). The mean scores of all subjectively-reported dimensions improved significantly throughout the course of the study, except ‘walking’ at month 36 (p=0.41, n=4). However, there were no significant differences in mean scores of objectively-measured dimensions between baseline and other test periods, except improved ‘tapping’ at month 6 and month 36, and ‘spiral’ at month 3 (p<0.05). The LCIG-naïve patients had a higher within-subject variability in their OTS scores (ICC=0.67) compared to LCIG-non-naïve patients (ICC=0.71). The OTS correlated adequately with total UPDRS (rho=0.59) and total PDQ-39 (rho=0.59). Conclusions In this 3-year follow-up study of advanced PD patients treated with LCIG we found that it is possible to monitor PD progression over time using a home environment test battery. The significant improvements in the mean OTS scores indicate that the test battery is able to measure functional improvement with LCIG sustained over at least 24 months.

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.

The relationship between self-efficacy and resting blood pressure in spousal Alzheimer's caregivers

Objective. To examine whether high levels of self-efficacy for problem-focused coping were significantly related to several resting BP measures in spousal Alzheimer's disease caregivers. Design. Cross-sectional. Methods. Participants included 100 older caregivers (mean age = 73.8 ± 8.14 years) providing in home care for a spouse with Alzheimer's disease. All participants completed a 13-item short form of the Coping Self-Efficacy Scale and underwent an in-home assessment where a visiting nurse took the average of three serial BP readings. Multiple regression was used to examine the relationship between self-efficacy and mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) after controlling for age, gender, smoking history, body mass index, the care recipient's clinical dementia rating, diabetes, alcohol use, and the use of antihypertensive medications. Results. Overall, high levels of self-efficacy for problem-focused coping were associated with lower MAP, SBP, and PP. Self-efficacy for problem-focused coping was marginally associated with resting DBP, but not significant. In addition, we conducted secondary analyses of the other two self-efficacy scales to explore the relationship between each dimension and MAP. We found that there were no significant relationships found between MAP and self-efficacy for stopping unpleasant thoughts/emotions or self-efficacy for getting social support. Conclusions. The present study adds to the current body of literature by illustrating the possibility that higher self-efficacy can have physiological advantages, perhaps by buffering chronic stress's impact on resting BP. Another contribution of the current study is its attempt to understand the role of each individual component of self-efficacy. These findings invite future research to investigate whether caregivers might experience cardiovascular benefits from interventions aimed at enhancing self-efficacy.

German validation of the Conners Adult ADHD Rating Scales–self-report (CAARS-S) I: Factor structure and normative data

Attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood. Instruments for diagnosing ADHD in childhood are well validated and reliable, but diagnosis of ADHD in adults remains problematic. Attempts have been made to develop criteria specific for adult ADHD, resulting in the development of self-report and observer-rated questionnaires. To date, the Conners Adult ADHD Rating Scales (CAARS) are the international standard for questionnaire assessment of ADHD. The current study evaluates a German version of the CAARS self-report (CAARS-S).

German validation of the Conners Adult ADHD Rating Scales (CAARS) II: reliability, validity, diagnostic sensitivity and specificity

The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.

Self-Reported Memory Symptoms with Coronary Artery Disease: A Prospective of CABG Patients and Nonsurgical Controls

Background. Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery. Methods. Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months. At each follow-up time, participants were asked about changes since the previous evaluation in areas of memory, calculations, reading, and personality. A Functional Status Questionnaire (FSQ) and self-report measure of symptoms of depression (CES-D) were also completed. Results. The frequency of self-reported changes in memory, personality, and reading at 3 months was significantly higher among CABG patients than among nonsurgical controls. By contrast, there were no differences in the frequency of self-reported symptoms relating to calculations or overall rating of functional status. After adjusting for a measure of depression (CES-D rating score), the risk for self-reported memory changes remained nearly 5 times higher among the CABG patients than control subjects. The relative risk of developing new self-reported memory symptoms between 3 and 12 months was 2.5 times higher among CABG patients than among nonsurgical controls (CI 1.24 – 5.02), and the overall prevalence of memory symptoms at 12 months was also higher among CABG patients (39%) than controls (14%). Conclusions. The frequency of self-reported memory symptoms 3 and 12 months after baseline is significantly higher among CABG patients than control patients with comparable risk factors for coronary and cerebrovascular disease. These differences could not be accounted for by symptoms of depression. The self-reported cognitive symptoms appear to be relatively specific for memory, and may reflect aspects of memory functioning that are not captured by traditional measures of new verbal learning and memory. The etiology of these self-reported memory symptoms remains unclear, but our findings as well as those of others, may implicate factors other than cardiopulmonary bypass itself.

Body image rating scales to assess obesity

Obesity prevalence in the U.S. has increased during the last three decades with major impact on public health. Screening for obesity in a population with unknown weight status can be time- and resource-consuming, but the information is valuable for prioritizing and allocating scarce resources. The challenge remains to properly assess obesity with the available methods. Body Image Rating Scales (BIRS) have initially been developed to assess body image disturbances, but also seem useful as an alternative method in assessing obesity prevalence. Several different BIRS exists. In this project I reviewed the literature that exists regarding the use of BIRS, and its advantages and limitations for the assessment of obesity status with regards to BMI. The result yielded nine publications that examined eight different scales and their correlation with BMI, ranging from r=.59 for self-reported BMI to r=.94 for measured BMI. One concern is the lack of standardization of this method to assess obesity, given the range of different scales. While many methods for obesity assessment are available, the simplicity, ease of use and cost-effectiveness of BIRS make it very appealing. BIRS remain a potentially attractive option to assess the weight status of a large population with minimal requirements in assets and time, especially in situations where measuring instruments are not available, or when height or weight could not be recalled.^

Detecting false testimonies in reputation systems using self-organizing maps

It has been demonstrated that rating trust and reputation of individual nodes is an effective approach in distributed environments in order to improve security, support decision-making and promote node collaboration. Nevertheless, these systems are vulnerable to deliberate false or unfair testimonies. In one scenario, the attackers collude to give negative feedback on the victim in order to lower or destroy its reputation. This attack is known as bad mouthing attack. In another scenario, a number of entities agree to give positive feedback on an entity (often with adversarial intentions). This attack is known as ballot stuffing. Both attack types can significantly deteriorate the performances of the network. The existing solutions for coping with these attacks are mainly concentrated on prevention techniques. In this work, we propose a solution that detects and isolates the abovementioned attackers, impeding them in this way to further spread their malicious activity. The approach is based on detecting outliers using clustering, in this case self-organizing maps. An important advantage of this approach is that we have no restrictions on training data, and thus there is no need for any data pre-processing. Testing results demonstrate the capability of the approach in detecting both bad mouthing and ballot stuffing attack in various scenarios.

Determination of spectral variations by means of component cells useful for CPV rating and design

A methodology is presented to determine both the short-term and the long-term influence of the spectral variations on the performance of Multi-Junction (MJ) solar cells and Concentrating "This is the peer reviewed version of the following article: R. Núñez, C. Domínguez, S. Askins, M. Victoria, R. Herrero, I. Antón, and G. Sala, “Determination of spectral variations by means of component cells useful for CPV rating and design,” Prog. Photovolt: Res. Appl., 2015., which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1002/pip.2715/full. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving [http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms]." Photovoltaic (CPV) modules. Component cells with the same optical behavior as MJ solar cells are used to characterize the spectrum. A set of parameters, namely Spectral Matching Ratios (SMRs), is used to characterize spectrally a particular Direct Normal Irradiance (DNI) by comparison to the reference spectrum (AM1.5D-ASTM-G173-03). Furthermore, the spectrally corrected DNI for a given MJ solar cell technology is defined providing a way to estimate the losses associated to the spectral variations. The last section analyzes how the spectrum evolves throughout a year in a given place and the set of SMRs representative for that location are calculated. This information can be used to maximize the energy harvested by the MJ solar cell throughout the year. As an example, three years of data recorded in Madrid shows that losses lower than 5% are expected due to current mismatch for state-of-the-art MJ solar cells.

Parenting and adolescent self-regulation

This study examined the relationship between adolescents' academic and non-academic self-regulation (SR), authoritative parenting (as demonstrated by high levels of Involvement, Strictness, and Autonomy Granting), and parent self-efficacy in four areas. Participants were 214 Australian high school students and their parents. There was a moderate correlation (r = 0.63) between academic and non-academic SR. Adolescents and their parents differed significantly in their perceptions of parenting behaviours, with parents rating themselves higher than their children on Involvement, Autonomy Granting, and Strictness behaviours. A model of the relationships between the constructs was developed showing a strong path from parent self-efficacy to both academic and non-academic SR via high parental Involvement (as perceived by adolescents). Strict parenting and the granting by parents of psychological autonomy to their adolescent children did not appear to be important in the development of young people's self-regulatory behaviours. (C) 2004 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Twin study of adolescent genetic susceptibility to mosquito bites using ordinal and comparative rating data

Ordinal and comparative rating measures of mosquito attraction and mosquito bite frequency and symptoms were administered in a self-report questionnaire format to a sample of 197 monozygotic and 326 dizygotic Australian adolescent twin pairs at age 12 between 1992 and 1999, in order to investigate the environmental and possibly genetic determinants of variation between individuals. Repeat measures were obtained from the twin pairs at age 14. Ordinal variable measures, although providing some support for genetic effects on mosquito susceptibility, were affected by low repeatability. However, analysis of a comparative rating variable compared with your twin, who is bitten by mosquitoes more often? indicated a strong genetic influence on frequency of being bitten by mosquitoes, with no significant differences observed between males and females. Comparative rating questionnaire items are a potentially valuable tool for complementing and improving the results obtained from more conventional absolute measures. (C) 2000 Wiley-Liss, Inc.

I don't see me like you see me, but is that a problem? Cultural influences on rating discrepancy in 360-degree feedback instruments

360-degree feedback from a variety of rater sources yields important information about leaders' styles, strengths and weaknesses for development. Results where observer ratings are discrepant (i.e., different) from self-ratings are often seen as indicators of problematic leadership relationships, skills, or lack of self-awareness. Yet research into the antecedents of such self-observer rating discrepancy suggests the presence of systematic influences, such as cultural values. The present study investigates the variation of rating discrepancies on three leadership skills (decision making, leading employees, and composure) in dependence of one exemplary culture dimension (power distance) on data from 31 countries using multilevel structural equation modelling. Results show that cultural values indeed predict self-observer rating discrepancies. Thus, systemic and contextual influences such as culture need to be taken into consideration when interpreting the importance and meaning of self-observer rating discrepancies in 360-degree instruments.

The role of self-regulation as a meta-competency in developing leaders: a longitudinal field experimental study

The question of how to develop leaders so that they are more effective in a variety of situations, roles and levels has inspired a voluminous amount of research. While leader development programs such as executive coaching and 360-degree feedback have been widely practiced to meet this demand within organisations, the research in this area has only scratched the surface. Drawing from the past literature and leadership practices, the current research conceptualised self-regulation, as a metacompetency that would assist leaders to further develop the specific competencies needed to perform effectively in their leadership role, leading to an increased rating of leader effectiveness and to enhanced group performance. To test this conceptualisation, a longitudinal field experimental study was conducted across ten months with a pre- and two post-test intervention designs with a matched control group. This longitudinal field experimental compared the difference in leader and team performance after receiving self-regulation intervention that was delivered by an executive coach. Leaders in experimental group also received feedback reports from 360-degree feedback at each stage. Participants were 40 leaders, 155 followers and 8 supervisors. Leaders’ performance was measured using a multi-source perceptual measure of leader performance and objective measures of team financial and assessment performance. Analyses using repeated measure of ANCOVA on pre-test and two post-tests responses showed a significant difference between leader and team performance between experimental and control group. Furthermore, leader competencies mediated the relationship between self-regulation and performance. The implications of these findings for the theory and practice of leadership development training programs and the impact on organisational performance are discussed.

AC self-bearing motors with a bridge configured winding

Magnetic levitation bearings eliminate friction, wear and the need for lubrication and so have high speed capability and potential for vibration control. One noteworthy development in the realm of magnetic levitation is the self-bearing or bearingless motor - an electromagnetic machine that supports its own rotor by way of magnetic forces generated by windings on its stator. Accordingly, various winding schemes have been proposed to accomplish the task of force production. This thesis proposes a novel concept of winding based on a bridge connection for polyphase self-bearing rotating electrical machines with the following advantages: • the connection uses a single set of windings and thus power loss is relatively low when compared with self-bearing motors with conventional dual set of windings. • the motor and levitation controls are segregated such that only one motor inverter is required for the normal torque production and levitation forces are produced by using auxiliary power supplies of relatively low current and voltage rating. The usual way of controlling the motor is retained. • there are many variant winding schemes to meet special needs. • independent power supplies for levitation control offer redundancy for fault tolerance. This thesis dwells specifically on the conceptual design and implementation of the proposed single set of windings scheme. The new connection has been verified to exhibit characteristics of a self-bearing motor via coupled-field finite element analysis: results are crosschecked analytically. Power loss and other aspects such as cost, design implementation are compared to support the newly proposed connection as a potential alternative to present designs.