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Quant investing screener of handwriting

Опубликовано в Cpp investment board logo | Октябрь 2, 2012

quant investing screener of handwriting

The early ideas of factor investing and quantitative finance were using the aforementioned workflow tools such as visualization, screening and email. 6. screening individuals for hearing loss or middle ear pathology using mathematics; and qualitative and quantitative research methodologies. This study aims to validate the 'Systematic Screening of Handwriting A quantitative measure of handwriting dysfluency for assessing tardive dyskinesia. MPI PM INVESTING IN MUTUAL FUNDS Meeting control performance is select ". After all, Windows: Introducing after the the destination network and certificate in ServiceDesk Plus. Easily exploitable stunnel 8 Web Data.

Paired t-tests and Wilcoxon signed rank tests were used to look for systematic differences within and between raters and between test moments. Intrarater, interrater and test-retest reliability were evaluated using the Intraclass Correlation Coefficient ICC for single measures in a two-way random effects model with absolute agreement for the total SOS-score, size and speed.

In case of abnormally distributed data, Spearman correlation coefficients were used to indicate reliability. Bland Altman plots were constructed to visualize the mean difference between two raters or tests for SOS score, size and speed. In addition, the percentage of agreement was calculated. SPSS version 23 was used for all analyses.

Demographics and clinical characteristics of the participants are specified in Table 1. Groups did not differ for age, handedness and MMSE score. These indicated greater fine motor skill problems in PD compared to healthy controls. No significant differences were found for handwriting quality or size. Significant correlations, ranging from poor to moderate, showed that a higher SOS-score, smaller writing size and slower writing speed all correlated with worse fine motor skills, as measured by the Purdue Pegboard test, in patients with PD Table 2.

In healthy controls, slower writing speed also correlated with worse performance on the Purdue Pegboard test Table 2. Additionally, a significant correlation was found between the MMSE score and writing speed in PD patients, with slower writing in more cognitively challenged patients.

No bias could be detected, as points distributed equally around zero for SOS-score, size and speed. For the SOS-score and size, overall scores fell within the limits of agreement. With regards to speed, two points were outside the limits of agreement in the interrater analysis.

In addition, the limits of agreement were larger for test-retest analysis. Interrater reliability was excellent for SOS-score and speed for both the patient and control group Table 3. Spearman correlation coefficients for writing size were also very good. More detailed analysis revealed that rater 1 gave a significantly lower SOS-score and larger size for both groups compared to rater 2 with small to medium effect sizes.

No systematic difference was found for speed. Test-retest reliability was also excellent for SOS-score and speed with a very high Spearman correlation coefficient for writing size. No systematic differences were observed between sets of scores Table 3.

For intrarater reliability a comparable pattern could be observed for both raters, with excellent reliability for SOS-score, size and speed for both groups S1 Table. Detailed analysis showed a discrepancy between the Kappa statistic 0. As out of SOS-tests received a score of zero from both raters, data distribution influenced the final Kappa statistic.

The present study was conducted to validate the SOS-test for PD and to evaluate whether it is a useful test to detect and monitor writing difficulties. An important innovative feature of this test is that it evaluates natural writing, addressing internally generated motor performance which is typically affected by PD.

In addition, it only takes five minutes to complete and very little material is necessary, making it a useful standardized screening tool for clinical practice. Clear differences were observed between patients with PD and healthy controls with regards to SOS-score, size and speed, with patients performing worse on all three aspects, even though they were optimally medicated at the time of testing. Contrary to previously used evaluation methods [ 8 — 10 , 14 ], the SOS-test evaluates prolonged writing, increasing the chance of capturing the automaticity deficit observed in PD [ 27 ].

Automatic movements have undergone a considerable amount of practice and are executed without attention directed towards the details of the movements. This type of habitual movement is known to highly rely on the functioning of the striatum, explaining the PD-specific difficulties as striatal dopamine depletion is a disease hallmark [ 28 ].

Analysis of the quality items revealed that fluency in writing and regularity of letter height were more affected in PD. The latter is in line with earlier findings, based on tablet technology, showing increased variability of writing size and decreasing letter height during writing in patients with PD while both in the on- and off-phase of the medication cycle [ 29 — 31 ]. Even though writing fluency in the current study was determined by means of sudden changes in movement directions, difficulties with writing fluency were shown previously in PD by means of an increased normalized jerk during writing-like movements [ 4 , 32 , 33 ].

Furthermore, it has to be noted that difficulties with fluency could be attributed to upper limb tremor, as 68 out of 87 patients presented with upper limb tremor. No significant differences were found for transitions between letters, the space between words or straightness of the sentences, which is in line with expectations, as these problems were also not reported earlier in PD raising the question whether these items may be redundant.

A correlation analysis was carried out to examine construct validity of the SOS-test. Weak to moderate correlations were found between the three main SOS outcome parameters and measures of manual dexterity. Writing is a complex motor skill that can be categorized as a form of manual dexterity, which is impaired in PD [ 24 , 31 ]. However, the current results also show that writing performance has distinct components that are different from other fine motor skills.

While writing is considered an automatically performed movement, the placing of pegs in the holes during the Purdue Pegboard test could be considered more goal-directed [ 28 ]. In addition, worse writing performance, specifically writing quality and speed, proved correlated with a longer disease duration and greater disease severity, confirming previous findings [ 1 ]. However, correlations in the current study were moderately high and there was merely a tendency towards a correlation between writing size and disease progression.

As such, the more severe patients with PD were probably under-represented in this cohort. Both correlations, however, point towards a good construct validity of the SOS-test. A correlation between writing performance on the SOS-test and cognition was also investigated, as cognitive difficulties are common in PD, even in the early stages [ 34 , 35 ]. We found that when patients experienced more cognitive difficulties, writing slowed down.

Working memory plays an important role in the handwriting process [ 36 ]. As working memory capacity was shown to be reduced in PD, this could explain why patients with lower MMSE scores wrote more slowly [ 37 , 38 ]. Although no longer significant after correction for multiple testing, healthy controls displayed a similar pattern, in line with cognitive impairments found as a result of healthy aging [ 39 ].

Overall, these findings point to the importance of intact cognition for writing speed and support the use of the SOS-test as a multi-component test of writing quality, rather than representing velocity alone. Finally, recent work from our group has shown that differences between patients with and without freezing of gait can be detected with the SOS-test [ 29 ] and that the SOS-test is sensitive enough to detect improvements in writing size after intensive amplitude training [ 40 ].

These results suggest that the SOS-test can be used to monitor writing difficulties with time and detect intervention effects in PD. Overall, results show an excellent intra- and interrater reliability for writing size and writing speed in PD and healthy controls.

This can most likely be attributed to the objective criteria that are used for scoring, indicating that the SOS-test can be reliably used in both groups. Analysis with Bland-Altman plots showed that, in general, points were distributed equally around zero. Although the reliability of the overall quality score was excellent, the individual items should be interpreted with caution, as reliability varied from slight to almost perfect agreement.

Test-retest reliability in patients was excellent for the SOS-score, size and speed. Bland-Altman plots showed that the limits of agreement were larger for writing speed. One possible explanation is that this reflects the inherent variability of test performance due to fluctuations of symptoms, as was recently also suggested for the Instrumented Timed Up and Go Test [ 41 ].

The current study showed that the SOS-test can distinguish between patients with PD and healthy controls, however, the correlations with disease severity were less clear. In addition, handwriting has been suggested as a possible non-invasive biomarker for PD diagnosis [ 7 ]. Therefore, it would be interesting to include a newly-diagnosed de novo PD group in future studies to test whether the SOS-test is sensitive enough to detect early deficits.

For this purpose, it would be necessary to assure consistency between side of onset and the hand with which the patient writes, as results revealed slower handwriting in patients who write with the hand that was initially affected. For this purpose, we suggest to not only score whether or not problems occur in a sentence, but also to take into account the number of problems in each sentence.

Scoring could also be made more sensitive by analyzing a larger portion of text. Previous work has shown strong correlations between writing speed on the SOS-test and on a writing tablet [ 42 , 43 ]. Secondly, recent research has suggested a partially different neural basis for consistent and progressive micrographia [ 44 ]. This suggests that a different rehabilitation approach might be necessary for either subtype.

Further research is warranted to determine whether the SOS-test can be used to detect this difference. Finally, future work is needed to uncover the possibilities of combining spontaneous writing with digitized tablets or pens [ 13 , 42 , 43 ]. Work is ongoing to validate these tools, but automation of calibration and analysis procedures need further refinement to allow clinical implementation unpublished data.

For now, we recommend to use the SOS-test in clinical practice with writing size as the main parameter for follow-up of PD patients due to the link between writing size and legibility of handwriting and the improvements found after intensive training. The quality score can provide additional information regarding fluency in letter formation and regularity of letter size.

Future work should determine whether omitting the seemingly redundant items word space and straightness of the sentence would make the test more PD-specific without losing information, which would also aid future digitized versions. Finally, SOS writing speed is more informative about the degree of bradykinesia than handwriting legibility as such.

We conclude that the SOS-test is a reliable tool with excellent construct validity, warranting its use as a clinical handwriting test in PD. Future work needs to be done to refine the test and make it even more specific for this population with the potential to serve as a diagnostic and progression biomarker. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

PLoS One. Published online Mar 2. Bouwien C. Bruno Bergmans 5 Department of Neurology, A. Manabu Sakakibara, Editor. Author information Article notes Copyright and License information Disclaimer. Competing Interests: The authors have declared that no competing interests exist.

Received Nov 29; Accepted Feb This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article has been cited by other articles in PMC. S1 Fig: Bland-Altman plots for interrater and test-retest analysis. Panels A, B, D and E show less data points due to overlapping data.

Methods Handwriting performance of 87 patients and 26 healthy age-matched controls was examined using the SOS-test. Conclusion The SOS-test is a short and effective tool to detect handwriting problems in PD with excellent reliability.

Materials and methods Participants In this cross-sectional study 87 patients with PD and 26 healthy controls were tested. Procedure All participants performed the Dutch version of the SOS-test to assess daily life writing also available in English and German [ 15 ].

Systematic screening of handwriting difficulties For the SOS-test, all participants received a printed text, along with a blank piece of paper to copy the text. Open in a separate window. Fig 1. The SOS-test. Results Subjects Demographics and clinical characteristics of the participants are specified in Table 1. Table 1 General Characteristics. Fig 2. Difference between patients PD and healthy controls CT. Table 2 Correlation analysis.

Table 3 Reliability analysis of SOS-test main outcome variables. Table 4 Reliability analysis of subitems of the SOS quality score. Discussion The present study was conducted to validate the SOS-test for PD and to evaluate whether it is a useful test to detect and monitor writing difficulties. Construct validity Clear differences were observed between patients with PD and healthy controls with regards to SOS-score, size and speed, with patients performing worse on all three aspects, even though they were optimally medicated at the time of testing.

Reliability Overall, results show an excellent intra- and interrater reliability for writing size and writing speed in PD and healthy controls. Study limitations and recommendations The current study showed that the SOS-test can distinguish between patients with PD and healthy controls, however, the correlations with disease severity were less clear.

Conclusion We conclude that the SOS-test is a reliable tool with excellent construct validity, warranting its use as a clinical handwriting test in PD. S1 Fig Bland-Altman plots for interrater and test-retest analysis. TIF Click here for additional data file. DOCX Click here for additional data file.

Acknowledgments We are grateful to all participants of this study. Data Availability All relevant data are within the paper and its Supporting Information files. References 1. Micrographia and related deficits in Parkinson's disease: a cross-sectional study. BMJ Open. PloS one. Brain dopamine and kinematics of graphomotor functions. Hum Mov Sci. From micrographia to Parkinson's disease dysgraphia.

Mov Disord. Parkinson's disease patients undershoot target size in handwriting and similar tasks. J Neurol Neurosurg Psychiatry. Micrographia on free writing versus copying tasks in idiopathic Parkinson's disease. Parkinsonism Relat Disord. Abraham also uses surveys for other data gathering projects. For example, the clinic conducts annual OSHA-based audiology testing, involving approximately associates.

Each annual test is accompanied by a questionnaire addressing noise exposure, illness, or other variables affecting hearing. These are now completed online prior to the testing, saving clinic staff the time involved in manually entering this information. Reducing the disqualification rate for candidates has made a big difference in several areas. The clinic is also conserving resources.

Instead of tying up staff members with health record requests and reviews—which could take 30 minutes per patient—Trinity starts with more accurate data. For candidates, eliminating the frustration of traveling and being rejected is important.

Abraham says. For the trucking company, Dr. Abraham believes the benefits of a more personalized experience has impacted driver retention. The company has a turnover rate of less than two-thirds the industry average. In the future, Trinity plans to open 2 new clinics in Utah and Pennsylvania. And, Dr. Abraham has more immediate plans for SurveyMonkey at the Missouri clinic: the launch of a wellness survey that collects diet, fitness, and lifestyle data in the hopes of encouraging a healthier and happier workforce.

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