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Three-dimensional vestibuloocular reflex of the monkey: optimal retinal image stabilization versus listing's law.

If the rotational vestibuloocular reflex (VOR) were to achieve optimal retinal image stabilization during head rotations in three-dimensional space, it must turn the eye around the same axis as the head, with equal velocity but in the opposite direction. This optimal VOR strategy implies that the position of the eye in the orbit must not affect the VOR. However, if the VOR were to follow Listing's law, then the slow-phase eye rotation axis should tilt as a function of current eye position. We trained animals to fixate visual targets placed straight ahead or 20 degrees up, down, left or right while being oscillated in yaw, pitch, and roll at 0.5-4 Hz, either with or without a full-field visual background. Our main result was that the visually assisted VOR of normal monkeys invariantly rotated the eye around the same axis as the head during yaw, pitch, and roll (optimal VOR). In the absence of a visual background, eccentric eye positions evoked small axis tilts of slow phases in normal animals. Under the same visual condition, a prominent effect of eye position was found during roll but not during pitch or yaw in animals with low torsional and vertical gains following plugging of the vertical semicircular canals. This result was in accordance with a model incorporating a specific compromise between an optimal VOR and a VOR that perfectly obeys Listing's law. We conclude that the visually assisted VOR of the normal monkey optimally stabilizes foveal as well as peripheral retinal images. The finding of optimal VOR performance challenges a dominant role of plant mechanics and supports the notion of noncommutative operations in the oculomotor control system.

Algorithms↗

Energetically optimal left ventricular pressure for the failing human heart.

BACKGROUND: An energy-starved failing heart would benefit from more effective transfer of the mechanical energy of ventricular contraction to blood propulsion. However, the energetically optimal loading conditions for the failing heart are difficult to establish. In the present study, we analyzed the optimal left ventricular pressure to achieve maximal mechanical efficiency of the failing heart in humans. METHODS AND RESULTS: We determined the relation between left ventricular pressure-volume area and myocardial oxygen consumption per beat (VO2), stoke work, and mechanical efficiency (stroke work/VO2) in 13 patients with different contractile states. We also calculated the optimal end-systolic pressure that would theoretically maximize mechanical efficiency for a given end-diastolic volume and contractility. Left ventricular pressure-volume loops were constructed by plotting the instantaneous left ventricular pressure against the left ventricular volume at baseline and during pressure loading. The contractile properties of the ventricle were defined by the slope of the end-systolic pressure-volume relation. In patients with less compromised ventricular function, the operating end-systolic pressure was close to the optimal pressure, achieving nearly maximal mechanical efficiency. As the heart deteriorated, however, the optimal end-systolic pressure became significantly lower than normal, whereas the actual pressure remained within the normal range. This discrepancy resulted in worsening of ventriculoarterial coupling and decreased mechanical efficiency compared with theoretically maximal efficiency. CONCLUSIONS: Homeostatic mechanisms to maintain arterial blood pressure within the normal range cause the failing heart to deviate from energetically optimal conditions.

Adult↗

Optimal hematocrit for oxygenation of canine intestine.

To determine the direct effects of hematocrit on intestinal oxygen consumption and to determine whether an optimal hematocrit exists for intestinal oxygenation, we perfused isolated canine gut loops at a constant pressure (120 mm Hg) and varied hematocrit from 80% to 10%. As hematocrit fell, blood flow rose while arterial oxygen content fell. The regression of blood flow on hematocrit was linear, whereas the relationship between oxygen uptake and hematocrit was parabolic, showing a maximal oxygen uptake at an hematocrit of 48.7%. To determine whether the optimal hematocrit for intestinal oxygenation could be altered by changes in vasomotor tone, we performed two other series of experiments. Raising perfusion pressure to 180 mm Hg did not significantly alter the optimal hematocrit for oxygen uptake. However, when we increased the oxygen demands of the gut by placing transportable solutes within the intestinal lumen, the optimal hematocrit for oxygen uptake increased markedly. We conclude that the optimal hematocrit for intestinal oxygenation is slightly higher than the normal range, a finding that could possibly be explained by the plasma skimming known to occur in the intestinal mucosa. Our experimental design and method of data analysis could be used to determine the optimal hematocrit in other organs.

Animals↗

Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo.

Application of continuous positive airway pressure (CPAP) as the standard treatment for sleep apnea/hypopnea syndrome (SAHS) is a moot point. Studies on the effectiveness of this treatment have been challenged because of the lack of a suitable placebo. The recent description of a true placebo (sham CPAP) prompted us to conduct a randomized trial of CPAP or placebo to assess the effectiveness of CPAP in improving SAHS-related symptoms and daytime function in patients with moderate to severe SAHS. Forty-eight patients, stratified in four groups according to severity, were randomly allocated into two treatment groups (optimal and sham CPAP) for a 6-wk period. Of these, 45 completed follow-up (91% males; age: 54 +/- 10 yr; body mass index [BMI]: 32 +/- 6 kg/m(2); apnea-hypopnea index [AHI]: 54 +/- 19 events/h; and Epworth Sleepiness Scale [ESS]: 16 +/- 5). The ESS, a questionnaire on SAHS-related symptoms, Functional Outcomes Sleep Questionnaire (FOSQ), and the Short Form Health Survey (SF-36) were completed at inclusion and after treatment. After 10 d of washout, the placebo group was treated with optimal CPAP and reassessed before and after optimal CPAP. The group receiving optimal CPAP when compared with the group with sham CPAP showed considerably greater improvement in the relief of sleepiness (-9.5 versus -2.3, p < 0.001), other SAHS-related symptoms (-18.5 versus -4.5, p < 0.001), vigilance (+8.5 versus +3.4, p = 0.009), and general productivity (+4.0 versus +0.5, p = 0.04) FOSQ scales. Both groups used a similar number of hours for the optimal and the sham CPAP (4.3 versus 4.5, (p = NS). The patients initially treated with placebo CPAP improved significantly more when optimal CPAP was applied for ESS (-2.3 versus -6.7, p < 0.001) and other sleep apnea syndrome (SAS)-related symptoms (-4.5 versus -11.2, p = 0.02). Our study provides strong evidence of the effectiveness of CPAP treatment in improving symptoms and perceived health status in moderate to severe SAHS.

Activities of Daily Living↗

Optimal statistical design for toxicokinetic studies.

Optimal statistical design strategies are applied to toxicokinetic experiments, for determining proper allocations of subjects and/or spacings of sampling times under a variety of nonlinear concentration-time models. The strategies include: (i) optimal allocations of subjects assuming the placement of time points is fixed, (ii) optimal spacing of design time points while assuming an equal allocation of subjects per time points and (iii) allocations/time-point spacings optimized jointly. Emphasis is placed on the first case, where a variance-minimization method is illustrated for optimizing the allocations when estimating specific toxicokinetic parameters. Appeals to forms of D-optimality are also considered, for cases when no specific toxicokinetic parameter is of specialized interest.

Animals↗

Estimation of the optimal cut off point in a new immunological faecal occult blood test in a corporate colorectal cancer screening programme.

OBJECTIVE: To estimate the optimal cut off point in a new immunological method (OC-Hemodia) for faecal occult blood testing (FOBT). SETTING: A corporate colorectal cancer screening programme in Japan. METHOD - The screening programme targeted colorectal cancer and adenomatous polyps > or = 10 mm, and was conducted on 27 860 participants (age > or = 40 ) during 1991-92. The follow up consisted of diagnostic management by total colonoscopy on positive screened subjects exceeding the manufacturer recommended cut off level of 50 ng/ml faecal haemoglobin, and the identification of false negative cases by health insurance claims. The optimal cut off point was estimated by the positive predictive value, receiver operating characteristic (ROC) curve, and a cost effectiveness analysis. In this study evaluation was carried out only for cancer as the target disease. RESULTS: - At the current cut off level of 50 ng/ml the sensitivity and specificity were 86.5% and 94.9%. When the optimal cut off point was estimated the highest positive predictive value was obtained at 250-350 ng/ml. The ROC curve showed that the sum of sensitivity and specificity is maximised at 50 ng/ml, but evaluation of the ratio, change in sensitivity/change in false positive rate, pointed to higher optimal cut off points, showing marked changes occurring at about 200 ng/ml. The average cost per case was lowest at 250-300 ng/ml. Overall, the optimal cut off point was estimated to be about 200 ng/ml, at which the sensitivity and specificity of the test would be 77.5% and 98.9%, respectively. CONCLUSION: The optimal cut off point of the new immunological method of FOBT was estimated to be about 200 ng/ml, a value which, more than the current cut off value, favours specificity over sensitivity.

Adenoma↗

Optimal selection on two quantitative trait loci with linkage.

A mathematical approach to optimize selection on multiple quantitative trait loci (QTL) and an estimate of residual polygenic effects was applied to selection on two linked or unlinked additive QTL. Strategies to maximize total or cumulative discounted response over ten generations were compared to standard QTL selection on the sum of breeding values for the QTL and an estimated breeding value for polygenes, and to phenotypic selection. Optimal selection resulted in greater response to selection than standard QTL or phenotypic selection. Tight linkage between the QTL (recombination rate 0.05) resulted in a slightly lower response for standard QTL and phenotypic selection but in a greater response for optimal selection. Optimal selection capitalized on linkage by emphasizing selection on favorable haplotypes. When the objective was to maximize total response after ten generations and QTL were unlinked, optimal selection increased QTL frequencies to fixation in a near linear manner. When starting frequencies were equal for the two QTL, equal emphasis was given to each QTL, regardless of the difference in effects of the QTL and regardless of the linkage, but the emphasis given to each of the two QTL was not additive. These results demonstrate the ability of optimal selection to capitalize on information on the complex genetic basis of quantitative traits that is forthcoming.

Animals↗

Optimizing purebred selection for crossbred performance using QTL with different degrees of dominance.

A method was developed to optimize simultaneous selection for a quantitative trait with a known QTL within a male and a female line to maximize crossbred performance from a two-way cross. Strategies to maximize cumulative discounted response in crossbred performance over ten generations were derived by optimizing weights in an index of a QTL and phenotype. Strategies were compared to selection on purebred phenotype. Extra responses were limited for QTL with additive and partial dominance effects, but substantial for QTL with over-dominance, for which optimal QTL selection resulted in differential selection in male and female lines to increase the frequency of heterozygotes and polygenic responses. For over-dominant QTL, maximization of crossbred performance one generation at a time resulted in similar responses as optimization across all generations and simultaneous optimal selection in a male and female line resulted in greater response than optimal selection within a single line without crossbreeding. Results show that strategic use of information on over-dominant QTL can enhance crossbred performance without crossbred testing.

Alleles↗

Optimal fetal growth for the Caucasian singleton and assessment of appropriateness of fetal growth: an analysis of a total population perinatal database.

BACKGROUND: The appropriateness of an individual's intra uterine growth is now considered an important determinant of both short and long term outcomes, yet currently used measures have several shortcomings. This study demonstrates a method of assessing appropriateness of intrauterine growth based on the estimation of each individual's optimal newborn dimensions from routinely available perinatal data. Appropriateness of growth can then be inferred from the ratio of the value of the observed dimension to that of the optimal dimension. METHODS: Fractional polynomial regression models including terms for non-pathological determinants of fetal size (gestational duration, fetal gender and maternal height, age and parity) were used to predict birth weight, birth length and head circumference from a population without any major risk factors for sub-optimal intra-uterine growth. This population was selected from a total population of all singleton, Caucasian births in Western Australia 1998-2002. Births were excluded if the pregnancy was exposed to factors known to influence fetal growth pathologically. The values predicted by these models were treated as the optimal values, given infant gender, gestational age, maternal height, parity, and age. RESULTS: The selected sample (N = 62,746) comprised 60.5% of the total Caucasian singleton birth cohort. Equations are presented that predict optimal birth weight, birth length and head circumference given gestational duration, fetal gender, maternal height, age and parity. The best fitting models explained 40.5% of variance for birth weight, 32.2% for birth length, and 25.2% for head circumference at birth. CONCLUSION: Proportion of optimal birth weight (length or head circumference) provides a method of assessing appropriateness of intrauterine growth that is less dependent on the health of the reference population or the quality of their morphometric data than is percentile position on a birth weight distribution.

Anthropometry↗

Cost-effectiveness of current and optimal treatment for schizophrenia.

BACKGROUND: This paper is part of a project to identify the proportion of the burden of each mental disorder averted by current and optimal interventions, and the cost-effectiveness of both. AIMS: To use epidemiological data on schizophrenia to model the cost-effectiveness of current and optimal treatment. METHOD: Calculate the burden of schizophrenia in the years lived with disability (YLD) component of disability-adjusted life-years lost, the proportion averted by current interventions, the proportion that could be averted by optimal treatment and the cost-effectiveness of both. RESULTS: Current interventions avert some 13% of the burden, whereas 22% could be averted by optimal treatment. Current interventions cost about AUS 200,000 dollars per YLD averted, whereas optimal treatment at a similar cost could increase the number of YLDs averted by two-thirds. Even so, the majority of the burden of schizophrenia remains unavertable. CONCLUSIONS: Optimal treatment is affordable within the present budget and should be implemented.

Aged↗

Dispositional optimism and the mechanisms by which it predicts slower disease progression in HIV: proactive behavior, avoidant coping, and depression.

The issue of whether optimism may prospectively protect against disease progression is one that has generated much interest, with mixed results in the literature. The purpose of this study was to determine whether dispositional optimism predicts slower disease progression in HIV. Two indicators of disease progression, CD4 counts and viral load, were assessed over 2 years in a diverse group (men, women, White, African American, Hispanic) of 177 people with HIV in the midrange of disease at entry to the study. Optimism predicted slower disease progression (less decrease in CD4 and less increase in viral load) controlling for baseline CD4 and viral load, antiretroviral treatment, gender, race, education, and drug use. Those low on optimism (25th percentile) lost CD4 cells at a rate 1.55 times faster than those high on optimism (75th percentile). Optimists had higher proactive behavior, less avoidant coping, and less depression: These variables mediated the linear optimism-disease progression relationship. Thus, optimists may reap health benefits partly through behavioral (proactive behavior), cognitive (avoidant coping), and affective (depression) pathways. Implications, limitations, and interpretations are discussed.

Adaptation, Psychological↗

Monte Carlo study of grid performance in diagnostic radiology: task dependent optimization for screen-film imaging.

An optimization of anti-scatter grid design using Monte Carlo techniques in diagnostic radiology is presented. The criterion for optimization was to find the combinations of the grid parameters (lead strip width, grid ratio and strip density) and tube potential which result in the lowest mean absorbed dose in the patient at fixed image contrast. The optimization was performed in three irradiation geometries, representing different scattering conditions (paediatric examinations, and two adult lumbar spine examinations) and was restricted to grids using fibre materials in covers and interspaces. Grid designs currently available were studied, as were designs which use thinner strips (< 30 microns) and higher grid ratios (> 18). It was found that grids with widely different strip densities (strips cm-1) and grid ratios can have good performance provided that they are used with appropriate strip width and tube potential. With increasing amounts of scatter, the optimal grid requires thicker strips and higher grid ratios. Increasing the strip density and using thinner strips and higher grid ratios are generally required. Grids with low strip density (25 strips cm-1) were found to be less sensitive to alterations in strip width. Optimal grids for paediatric radiology require thinner strips (10-20 microns) than those in currently available grids. Grids on the market are best suited for examinations of the adult body in anteroposterior (AP) view. In the adult lateral view, representing the largest scattering volume, higher grid ratios (> 18) than those in existing grids would be optimal. Examples of good grid designs are given for each examination.

Adult↗

The optimization and inherent limitations of 3D conformal radiotherapy treatment plans of the prostate.

This paper describes the applications of an inverse planning optimization algorithm to the real clinical problem of prostate cancer. The algorithm has been designed to compute optimized beam-weights taking full account of three-dimensional spatial information of dose inside the patient. The algorithm is based on fast simulated annealing, utilizing a cost-function containing both linear and quadratic terms. The linear part of the cost function allows for the implementation of "short-cuts" in the cost-function computation, which reduces the calculation time by a factor of about 30. It has been applied to compute optimized beam-weights for a three-field and a seven-field prostate treatment plan. It is shown for the three-field plan that the optimization algorithm can reproduce, and even slightly improve on, the results of an experienced human planner. For the seven-field plan, the human planner experienced difficulty finding beam-weights that gave an acceptable dose distribution. It is shown that the optimization algorithm can achieve good results in this case. The outcome of the optimization of the seven-field plan prompted an investigation into the best results that could be achieved by an "ideal" conformal radiotherapy technique. The results of this investigation are presented and it is shown that the limiting factor for conformal therapy of the prostate is the size of the overlap volume between the planning target volume (PTV) and the rectum. Finally, the efficiency and accuracy of fast simulated annealing is compared with that of classical simulated annealing. The former was found to be at least 10 times faster for the problem studied.

Algorithms↗

Optimal beam quality selection in digital mammography.

An experimental method of determining the optimal beam quality for digital mammography systems was applied to two systems (Fuji Profect and GE Senographe 2000D). The mean glandular dose (MGD) and contrast-to-noise ratio (CNR) were measured using Perspex breast phantoms simulating breasts from 20 mm to 90 mm thick. For each thickness, four combinations of tube voltage and target/filter were tested. Optimal beam quality was defined as giving a target CNR for the lowest MGD and was similar for the two systems. For breasts with a thickness of 21 mm or 32 mm, a tube voltage of either 25 kV or 28 kV and a Mo/Mo target/filter combination was optimal. For breast thicknesses of 45 mm and greater, the combination that had the highest X-ray energy (34 kV Rh/Rh) was optimal. Optimization using the higher energy beam quality required greater detector dose to compensate for the lower contrast. Thus for a 75 mm thick breast the 34 kV Rh/Rh combination required about a 90% greater detector dose than 28 kV Mo/Mo to achieve the same CNR because of the 25% reduction in contrast. Nonetheless, the MGD was reduced by 32% by choosing the higher energy spectra and achieving the same CNR. Current automatic exposure control (AEC) designs that aim for a fixed detector dose are not optimal and greater use of higher energy spectra should be accompanied by higher detector doses at all breast thicknesses which are average or above. This may result in slightly higher doses, but better image quality for these breasts.

Breast↗

Optimization of peak power of doubly Q-switched lasers with both an acousto-optic modulator and a Cr4+-doped saturable absorber.

A doubly Q-switched laser can obtain a shorter pulse with a stable repetition rate and high pulse peak power, which has been experimentally proved. By taking into account the Gaussian spatial distributions of the intracavity photon density and the initial population-inversion density as well as the influence of the acousto-optic (AO) Q switch, we introduce the coupled rate equations for a doubly Q-switched laser with both an AO modulator and a Cr(4+)-doped saturable absorber. These coupled rate equations are solved numerically. The key parameters of an optimally coupled doubly Q-switched laser are determined based on maximizing the peak power, which include the optimal normalized coupling parameter, the optimal normalized saturable absorber parameters, and the normalized parameters of the AO Q switch. The optimal normalized peak power, the corresponding normalized energy, and the normalized pulse width are also given, and a group of general curves are generated for the first time to our knowledge. The curves can give us a good understanding of the dependence of the optimal key parameters on the parameters of the gain medium, the saturable absorber, the AO Q switch, the resonator, and the spatial distributions of the intracavity photon density. The optimal calculations for a diode-pumped Nd(3+):YVO(4) laser with both an AO modulator and a Cr(4+):YAG saturable absorber are presented to demonstrate the use of the curves and the related formulas.

Journal Article↗

Optimization of secondary metabolite production using singular approximation and minimum principle.

Optimal control profiles as calculated with two control algorithms, singular approximation and minimum principle, are compared in this article. Switching points were determined using the singular approximation by mathematical calculation. The optimal growth rate was calculated using minimum principle. With an increased number of switching points, the calculated optimal control profiles approached the theoretical optimal control profile as calculated using the minimum principle. With three switching times, the product concentration approached 96% of the theoretical optimal control profile. From these results, optimal control can be achieved with more than a three-switching-point approximation.

Bioreactors↗

Determination of optimal time lapse for recall of patients in an incremental dental care program.

The study was designed to determine the optimal recall interval for persons, ages 5 to 19 years, in the Indian Health Service dental care program and to determine the optimal number of persons to whom maintenance care could be provided at various recall intervals. Analyses used to determine the optimal number of persons and the optimal recall period are described. As expected, the number of services required increased as the maintenance interval increased. The maximum number of persons can be treated on a recall period of 25 to 27 months, but during this time persons 5 to 9 years old had significant increases in the number of services required. Therefore, the optimal recall interval for persons in this age group is to 10 to 12 months. The optimal recall interval for persons 10 to 14 years old is 25 to 27 months, and for persons 15 to 19 years old, 22 to 24 months.

Adolescent↗

Optimization of mouse embryo culture media using simplex methods.

Culture media were developed for pronuclear-stage mouse embryos using simplex optimization, which has the benefit of being able to optimize several components simultaneously. Initially, several different media were generated. All media contained the same components, yet each medium was characterized by having a different component at a high concentration. The simplex procedure identified 4 components (NaCl, pyruvate, KH2PO4 and glucose) which at high concentrations were detrimental to embryo development, compared to the other components tested. For example, all embryos cultured in a medium with high NaCl blocked at the 2-cell stage. The optimization method then adjusted each medium by lowering the concentration of the component or removing it entirely, which resulted in a significant increase in development. In an experiment comparing 8 media generated from the simplex optimization, along with 7 other media, removal of KH2PO4 resulted in the largest increase in development; 88% of embryos were greater than or equal to 4 cells on Day 3 after hCG, and 53% developed into blastocysts by Day 5. Another experiment compared 4 of the best media generated from the simplex optimization. In 3 out of the 4 media, 90% or more of the embryos were greater than or equal to 4 cells on Day 3. In 3 of the media, approximately 60% or more of the embryos developed into blastocysts. The simplex optimization procedure is an efficient method for developing culture media and determining requirements for development in vitro.

Animals↗