A web-based system for visualizing upper limb motor performance of Parkinson’s disease patients

Objective To design, develop and set up a web-based system for enabling graphical visualization of upper limb motor performance (ULMP) of Parkinson’s disease (PD) patients to clinicians. Background Sixty-five patients diagnosed with advanced PD have used a test battery, implemented in a touch-screen handheld computer, in their home environment settings over the course of a 3-year clinical study. The test items consisted of objective measures of ULMP through a set of upper limb motor tests (finger to tapping and spiral drawings). For the tapping tests, patients were asked to perform alternate tapping of two buttons as fast and accurate as possible, first using the right hand and then the left hand. The test duration was 20 seconds. For the spiral drawing test, patients traced a pre-drawn Archimedes spiral using the dominant hand, and the test was repeated 3 times per test occasion. In total, the study database consisted of symptom assessments during 10079 test occasions. Methods Visualization of ULMP The web-based system is used by two neurologists for assessing the performance of PD patients during motor tests collected over the course of the said study. The system employs animations, scatter plots and time series graphs to visualize the ULMP of patients to the neurologists. The performance during spiral tests is depicted by animating the three spiral drawings, allowing the neurologists to observe real-time accelerations or hesitations and sharp changes during the actual drawing process. The tapping performance is visualized by displaying different types of graphs. Information presented included distribution of taps over the two buttons, horizontal tap distance vs. time, vertical tap distance vs. time, and tapping reaction time over the test length. Assessments Different scales are utilized by the neurologists to assess the observed impairments. For the spiral drawing performance, the neurologists rated firstly the ‘impairment’ using a 0 (no impairment) – 10 (extremely severe) scale, secondly three kinematic properties: ‘drawing speed’, ‘irregularity’ and ‘hesitation’ using a 0 (normal) – 4 (extremely severe) scale, and thirdly the probable ‘cause’ for the said impairment using 3 choices including Tremor, Bradykinesia/Rigidity and Dyskinesia. For the tapping performance, a 0 (normal) – 4 (extremely severe) scale is used for first rating four tapping properties: ‘tapping speed’, ‘accuracy’, ‘fatigue’, ‘arrhythmia’, and then the ‘global tapping severity’ (GTS). To achieve a common basis for assessment, initially one neurologist (DN) performed preliminary ratings by browsing through the database to collect and rate at least 20 samples of each GTS level and at least 33 samples of each ‘cause’ category. These preliminary ratings were then observed by the two neurologists (DN and PG) to be used as templates for rating of tests afterwards. In another track, the system randomly selected one test occasion per patient and visualized its items, that is tapping and spiral drawings, to the two neurologists. Statistical methods Inter-rater agreements were assessed using weighted Kappa coefficient. The internal consistency of properties of tapping and spiral drawing tests were assessed using Cronbach’s α test. One-way ANOVA test followed by Tukey multiple comparisons test was used to test if mean scores of properties of tapping and spiral drawing tests were different among GTS and ‘cause’ categories, respectively. Results When rating tapping graphs, inter-rater agreements (Kappa) were as follows: GTS (0.61), ‘tapping speed’ (0.89), ‘accuracy’ (0.66), ‘fatigue’ (0.57) and ‘arrhythmia’ (0.33). The poor inter-rater agreement when assessing “arrhythmia” may be as a result of observation of different things in the graphs, among the two raters. When rating animated spirals, both raters had very good agreement when assessing severity of spiral drawings, that is, ‘impairment’ (0.85) and irregularity (0.72). However, there were poor agreements between the two raters when assessing ‘cause’ (0.38) and time-information properties like ‘drawing speed’ (0.25) and ‘hesitation’ (0.21). Tapping properties, that is ‘tapping speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’ had satisfactory internal consistency with a Cronbach’s α coefficient of 0.77. In general, the trends of mean scores of tapping properties worsened with increasing levels of GTS. The mean scores of the four properties were significantly different to each other, only at different levels. In contrast from tapping properties, kinematic properties of spirals, that is ‘drawing speed’, ‘irregularity’ and ‘hesitation’ had a questionable consistency among them with a coefficient of 0.66. Bradykinetic spirals were associated with more impaired speed (mean = 83.7 % worse, P < 0.001) and hesitation (mean = 77.8% worse, P < 0.001), compared to dyskinetic spirals. Both these ‘cause’ categories had similar mean scores of ‘impairment’ and ‘irregularity’. Conclusions In contrast from current approaches used in clinical setting for the assessment of PD symptoms, this system enables clinicians to animate easily and realistically the ULMP of patients who at the same time are at their homes. Dynamic access of visualized motor tests may also be useful when observing and evaluating therapy-related complications such as under- and over-medications. In future, we foresee to utilize these manual ratings for developing and validating computer methods for automating the process of assessing ULMP of PD patients.

Automatic and objective assessment of alternating tapping performance in Parkinson’s disease

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson’s disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions (‘speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’) and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson’s Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.

Meeting the Standards: An Analysis of Eight Grade Educational Assesment Test Scores in Maine

This paper examines the impact of socioeconomic factors on eighth grade achievement test scores in the face of federal and state initiatives for educational reform in Maine. We use student-level data over a five year period to provide a framework for understanding the policy implications of these initiatives. We model performance on standardized tests using a seemingly unrelated regressions approach and then determine the likelihood of meeting the standards defined by the adequate yearly progress requirements of the No Child Left Behind Act and Maine Learning Results initiatives. Our results indicate that the key factors influencing a student’s test scores include the education of a student’s parents, special services received for learning disabilities, and alternative measures of academic achievement.

Changes in test scores distribution for students of the fourth grade in Brazil: a relative distribution analysis for the years 1997 to 2005

To assess the quality of school education, much of educational research is concerned with comparisons of test scores means or medians. In this paper, we shift this focus and explore test scores data by addressing some often neglected questions. In the case of Brazil, the mean of test scores in Math for students of the fourth grade has declined approximately 0,2 standard deviation in the late 1990s. But what about changes in the distribution of scores? It is unclear whether the decline was caused by deterioration in student performance in upper and/or lower tails of the distribution. To answer this question, we propose the use of the relative distribution method developed by Handcock and Morris (1999). The advantage of this methodology is that it compares two distributions of test scores data through a single distribution and synthesizes all the differences between them. Moreover, it is possible to decompose the total difference between two distributions in a level effect (changes in median) and shape effect (changes in shape of the distribution). We find that the decline of average-test scores is mainly caused by a worsening in the position of all students throughout the distribution of scores and is not only specific to any quantile of distribution.

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.

Higher salaries, more teaching, better performance? The effects of the introduction of the minimum salary for teachers in Brazil

De acordo com a literatura empírica, há fortes evidências de que, após o controle de características socioeconômicas dos alunos, a qualidade dos professores é o fator mais importante para explicar o desempenho do aluno em testes padronizados. No entanto, não há consenso sobre como sistemas públicos de ensino podem melhorar a qualidade dos professores. Será que o pagamento de salários mais elevados a professores da rede pública impactam a qualidade dos professores nas escolas públicas? O Governo Federal brasileiro introduziu, em 2009, piso salarial nacional para os professores de escolas públicas, provocando um perceptível aumento exógeno dos salários dos professores municipais. O principal objetivo desta tese é avaliar os impactos de curto prazo da elevação linear e incondicional do salário do professor na qualidade da educação. Devido à ausência de dados secundários sobre o valor do salário-base de professores entre 2008 e 2013, tivemos que realizar um levantamento com as Secretarias Municipais de Educação para reunir informação sobre a estrutura da carreira docente e sobre os salários-bases nesse período. Com base em nossa pesquisa de campo, o primeiro capítulo investiga a conformidade dos sistemas municipais de ensino ao piso salarial nacional para professores de redes públicas. Encontramos que fatores não observáveis/observados são determinantes para explicar a variabilidade salarial verificada entre os municípios e o cumprimento da lei, o que embasa nossa estratégia de identificação com base em métodos de diferença em diferenças, combinados com pareamento com base em escore de propensão. O segundo capítulo centra-se na estimativa do impacto da elevação dos salários dos professores sobre a proficiência dos alunos de 5º ano do ensino fundamental municipal. De acordo com estes resultados, o aumento salarial incondicional não gerou uma expansão da proficiência escolar dos alunos, pelo menos no curto prazo. Embora não tenham sido detectados impactos na aprendizagem dos alunos, alguns mecanismos de transmissão do aumento salarial para melhores resultados educacionais podem já ter sido ativados. Assim, o principal objetivo do terceiro capítulo é avaliar o impacto dos aumentos de salário sobre a qualidade dos professores atuais e dos potenciais futuros professores. Avaliamos o impacto de aumentos de salário sobre o desempenho dos professores no ENADE, uma proxy de sua qualidade, e sobre a atratividade dos cursos de ensino superior associados à carreira docente. Essa atratividade é medida por meio da qualidade dos que entram nos respectivos cursos superiores, de acordo com seu desempenho no Enem. Neste último capítulo, aplicamos modelo de Tripla-Diferenças visando controlar dois tipos de potenciais fatores de confusão: (i) mudanças no desempenho dos professores (potenciais futuros professores) entre grupos de municípios, que foram submetidos ao tratamento e os que não foram tratados, que nada têm a ver com a política; e (ii) as alterações no desempenho de todos os professores (alunos) que vivem no município em que houve a elevação salarial devido à introdução da lei. As estimativas obtidas indicam que a elevação salarial gerou efeitos leves sobre a qualidade dos professores e sobre a atratividade dos cursos relacionados à carreira docente.

Human growth, biological maturation, motor performance and contextual factors in Madeira children

The central aims of this study were: (1) to construct age- and gender-specific percentiles for motor coordination (MC), (2) to analyze the change, stability, and prediction of MC, (3) to investigate the relationship between motor performance and body fatness, and (4) to evaluate the relationships between skeletal maturation and fundamental motor skills (FMS) and MC. The data collected was from the ‘Healthy Growth of Madeira Children Study’ and from the ‘Madeira Child Growth Study’. In these studies, MC, FMS, skeletal age, growth characteristics, motor performance, physical activity, socioeconomic status, and geographical area were assessed/measured. Generalized additive models for location, scale and shape, mixed between-within subjects ANOVA, multilevel models, and hierarchical regression (blocks) were some of the statistical procedures used in the analyses. Scores on walking backwards and moving sideways improved with age. It was also found that boys performed better than girls on moving sideways. Normal-weight children outperformed obese peers in almost all gross MC tests. Inter-age correlations were calculated to be between 0.15 and 0.60. Age was associated with a better performance in catching, scramble, speed run, standing long jump, balance, and tennis ball throwing. Body mass index was positively associated with scramble and speed run, and negatively related to the standing long jump. Physical activity was negatively associated with scramble. Semi-urban children displayed better catching skills relative to their urban peers. The standardized residual of skeletal age on chronological age (SAsr) and its interaction with stature and/or body mass accounted for the maximum of 7.0% of variance in FMS and MC over that attributed to body size per se. SAsr alone accounted for a maximum of 9.0% variance in FMS and MC over that attributed to body size per se and interactions between SAsr and body size. This study demonstrates the need to promote FMS, MC, motor performance, and physical activity in children.

Morfologia externa, composição corporal e performance motora do praticante de atletismo madeirense : um estudo em atletas dos 11-17 anos de idade

Os objetivos centrais da presente pesquisa foram quatro: (1) recolher informação nos domínios do crescimento físico humano, composição corporal, tipo físico, aptidão física e prática desportiva do atleta infanto-juvenil praticante de atletismo; (2) estudar a variação associada à idade e ao sexo; (3) investigar as diferenças entre atletas e não-atletas; e (4) identificar os preditores da capacidade funcional. A amostra foi constituída por 105 praticantes de atletismo, 49 do sexo masculino e 56 do sexo feminino, com idades compreendidas entre os 11 e os 17 anos, de cinco clubes da Região Autónoma da Madeira. As variáveis de estudo incluíram a altura, o peso corporal, os diâmetros ósseos, os perímetros musculares, as pregas de adiposidade subcutânea, a massa isenta de gordura (MIG), a massa gorda, o tipo físico, os testes motores, e os anos e as horas de treino semanal. Os ‘scores’ Z, os testes t-student e Mann-Whitney U, a ANOVA e a regressão linear múltipla foram os procedimentos estatísticos utilizados nas análises. O atleta do sexo masculino foi mais alto, pesado, robusto e apresentou mais MIG do que o sexo feminino (p<0,05). Os atletas apresentaram um físico mesomorfo equilibrado (sexo masculino) e meso-endomorfo (sexo feminino). Os rapazes apresentaram valores significativamente superiores na aptidão física geral e específica, comparativamente às raparigas. As raparigas apresentaram melhores desempenhos no ‘sit and reach’(p<0,05). Os valores médios para a altura, peso corporal, testes motores e características da prática desportiva foram superiores nas atletas mais velhas (p<0,05). Os praticantes de atletismo apresentaram menos gordura subcutânea e melhores desempenhos no salto em comprimento sem corrida preparatória e corrida de 12 minutos, do que as não-atletas. A altura, a percentagem de gordura, os anos de prática desportiva e o número de horas de treino por semana foram os preditores que mais contribuíram para explicar a variância nos testes motores.Os resultados demonstraram um dimorfismo entre atletas do sexo masculino e feminino. O treino estava associado a melhores desempenhos nos testes motores e a valores mais baixos de gordura corporal. A altura, a gordura corporal e as características da prática desportiva foram importantes na predição da capacidade funcional.

A Short Physical Performance Battery (SPPB) como preditora da fragilidade em idosos residentes na comunidade

Introduction: The SPPB provides information about physical function and is a predictor of adverse events in the elderly. Frailty is a multidimensional syndrome that increases susceptibility to diseases and disability. However it may be possible to prevent or postpone frailty if is identified early. Our objective is to analyze SPPB s ability in screening for frailty a community-dwelling young elderly from cities with distinct socioeconomic conditions. Methods: Data were originated from community dwelling adults (65-74 years old) in Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64). SPPB was used to assess physical performance. Frailty was defined as the presence of ≥ 3 of these criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. One point was given for each criterion met, totalizing a frailty score ranged from 0 to 5. The Linear Regression and Receiver Operating Characteristics analyses were performed to evaluate the SPPB s screening ability. Results: Mean age was 69.48, 10.0% of the Saint Bruno s sample and 28.1% of Santa Cruz s were frail (p = 0.001), the SPPB score means were 9.6 and 8.5 respectively (p = 0.01). SPPB correlated with the frailty score (R2 = 0.33), with better results for Saint Bruno. A cutoff of 9 in SPPB had good sensitivity and specificity in discriminating frail from non frail in Saint Bruno (AUC = 0.81) but showed fair results in Santa Cruz (AUC = 0.61). Conclusion: The SPPB has moderate ability in predicting frailty among older adult s population, and is an useful test to identify people with good functionality and low frailty when SPPB scores are ≥9

Effects of feeding a multivalent polyclonal antibody preparation on feedlot performance, carcass characteristics, rumenitis, and blood gas profile in Bos indicus biotype yearling bulls

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of temperament and acclimation to handling on feedlot performance of Bos taurus feeder cattle originated from a rangeland-based cow-calf system

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The performance of conventional and fluorescence-based methods for occlusal caries detection An in vivo study with histologic validation

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diurnal variation in oral temperature, sleepiness and performance of high school girls

Evaluation of rhythmic fluctuations cf physical and mental variables should be of special significance for the understanding of students' performance and setting the schedules of school activities. The present study investigated the pattern of diurnal variation in oral temperature, sleepiness and performance of a group of adolescents undergoing a daytime school schedule. Eighteen girls (mean age 16 years-old), who attended the same class from 0715h to 1645h, were tested on seven days. They measured their oral temperature, quantified their sleepiness level by means of a visual analogue scale, and completed the following tests: letter cancellation test, addition test, and a simple motor task. One-way ANOVA statistics for repeated measures was used in order to verify the effect of test time on oral temperature,sleepiness and performance. Possible correlations between the level of sleepiness and performance were investigated by means of Spearman rank correlation. The results revealed significant time of day effect cn all variables, except for the number of addition errors. Oral temperature values showed an increase from morning to afternoon. Letter cancellation, motor task and addition scores increased from early morning to late afternoon, showing rapid fluctuations throughout the day. Sleepiness level was negatively correlated with letter cancellation scores during the first three tests of the day. In agreement with other work, the diurnal variation of oral temperature, letter cancellation and addition test showed an improvement as the day progressed. Sleepiness, on the other hand, decreased throughout the day, with the highest level associated with the first test of the day, suggesting a circadian pattern of variation rather than a cumulative effect due to school activities.

Determinants of educational performance in Uruguay, 2003-2006

Includes bibliography

Age-related differences in time-limit performance and force platform-based balance measures during one-leg stance

Poor posture control has been associated with an increased risk of falls and mobility disability among older adults. This study was conducted to assess the test-retest reliability and sensitivity to group differences regarding the time-limit (TLimit) of one-leg standing and selected balance parameters obtained with a force platform in older and young adults. A secondary purpose was to assess the relationship between TLimit and these balance parameters. Twenty-eight healthy older adults (age: 69±5years) and thirty young adults (age: 21±4years) participated in this study. Two one-leg stance tasks were performed: (1) three trials of 30s maximum and (2) one TLimit trial. The following balance parameters were computed: center of pressure area, RMS sway amplitude, and mean velocity and mean frequency in both the anterio-posterior and medio-lateral directions. All balance parameters obtained with the force platform as well as the TLimit variable were sensitive to differences in balance performance between older and young adults. The test-retest reliability of these measures was found to be acceptable (ICC: 0.40-0.85), with better ICC scores observed for mean velocity and mean frequency in the older group. Pearson correlations coefficients (r) between balance parameters and TLimit ranged from -0.16 to -0.54. These results add to the current literature that can be used in the development of measurement tools for evaluating balance in older and young adults. © 2013 Elsevier Ltd.