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At least 163 records · Page 9Linked to original sources

Optimal continuous positive airway pressure in patients with obstructive sleep apnoea: role of craniofacial structure.

Although nasal continuous positive airway pressure (CPAP) is effective in improving nocturnal obstructive apnoea, daytime sleepiness and well-being in patients with obstructive sleep apnoea syndrome (OSAS), not all patients tolerate this treatment. Since optimal CPAP titration is essential to maintain compliance, it is important to elucidate the factors that help to determine the optimal pressure. However, the determinants of the optimal CPAP level are controversial. The subjects comprised 27 Japanese male patients with OSAS who underwent standard polysomnography (PSG), pulmonary function tests, arterial blood gas analysis, cephalometry and CPAP titration. Twenty normal controls also underwent cephalometric analysis. The apnoea-hypopnoea index (AHI), mean oxygen saturation (mean SaO2) and the lowest SaO2 during sleep were found to be 54.7+/-22.6, 89.0+/-5.6%, and 69.7+/-9.0%, respectively by PSG. The mean optimal CPAP was 9.6+/-1.8 cmH2O. The cephalometric angles (SNA, SNB and NSBa) were similar to those found in the control subjects. but MP-H, and PNS-P were significantly longer than those in the control subjects as shown by cephalometry. The optimal CPAP was correlated with the mean SaO2 (P<0.0001), neck circumference (P<0.05) and three cephalometric variables (NSBa: P<0.01, MP-H: P<0.05, PNS-P: P<0.05). Multiple, step-wise, regression analysis showed that the mean SaO2 and NSBa were independent variables that best predicted the optimal CPAP. These variables accounted for 57.5% of the total variance (R2=0.575, P<0.001). Optimal CPAP was closely correlated with oxygen desaturation during sleep. However, the craniofacial structure had additional effects such as an independent factor in determining the optimal CPAP level.

Adult↗

Which factors determine the optimal pedaling rate in sprint cycling?

INTRODUCTION: Mechanical power output in sprint cycling depends on pedaling rate, with an optimum at around 130 revolutions per minute (rpm). In this study, the question is addressed if this optimal pedaling rate can be understood from a Hill-type description of muscular dynamics. In particular, it is investigated how 1) the power-velocity relationship that follows from Hill's force-velocity relationship and 2) activation dynamics (from the perspective of which the optimal pedaling rate is near-zero) affect the optimal pedaling rate. METHODS: A forward dynamics modeling/simulation approach is adopted in this study. The skeletal model is a 2D linkage of rigid segments; it is actuated by eight Hill-type "muscles." Input of the model is the neural stimulation of the muscles, output is the resulting movement and variables dependent thereupon, such as pedal forces. For a wide range of isokinetic pedaling rates, the neural stimulation is optimized with respect to the average mechanical power output. RESULTS: Correspondence between experimental data and simulation results regarding 1) the (pedaling-rate dependent) muscle phasing, 2) pedal forces, and 3) the power-pedaling rate relationship is good. At the optimal pedaling rate predicted by the model (120 rpm), muscles contract at velocities well below those that maximize their power output. Finally, when a model is considered that lacks activation dynamics, it is found that both the optimal pedaling rate and the maximal power output increase substantially. DISCUSSION: From the results pertaining to the standard model, it is concluded that the optimal pedaling rate is not uniquely specified by the power-velocity relationship of muscle, as suggested in literature. From the results pertaining to the model lacking activation dynamics, it follows that activation dynamics plays a surprisingly large role in determining the optimal pedaling rate. It is concluded that the pedaling rate that maximizes mechanical power output in sprint cycling follows from the interaction between activation dynamics and Hill's power-velocity relationship.

Bicycling↗

Electrical defibrillation optimization: an automated, iterative parallel finite-element approach.

To date, optimization of electrode systems for electrical defibrillation has been limited to hand-selected electrode configurations. In this paper we present an automated approach which combines detailed, three-dimensional (3-D) finite-element torso models with optimization techniques to provide a flexible analysis and design tool for electrical defibrillation optimization. Specifically, a parallel direct search (PDS) optimization technique is used with a representative objective function to find an electrode configuration which corresponds to the satisfaction of a postulated defibrillation criterion with a minimum amount of power and a low possibility of myocardium damage. For adequate representation of the thoracic inhomogeneities, 3-D finite-element torso models are used in the objective function computations. The CPU-intensive finite-element calculations required for the objective function evaluation have been implemented on a message-passing parallel computer in order to complete the optimization calculations in a timely manner. To illustrate the optimization procedure, it has been applied to a representative electrode configuration for transmyocardial defibrillation, namely the subcutaneous patch-right ventricular catheter (SP-RVC) system. Sensitivity of the optimal solutions to various tissue conductivities has been studied. Results for the optimization of defibrillation systems are presented which demonstrate the feasibility of the approach.

Algorithms↗

Optimization of wide-band linear arrays.

An optimization method is proposed for linear arrays to be used in ultrasound systems under wide-band operation. A fast algorithm, the threshold accepting, has been utilized to determine the element positions and weight coefficients of a linear array that generates a desired beam pattern. To reduce the computational burden in the optimization procedure, an efficient numerical routine for the beam pattern evaluation has been implemented. We address the optimization problem of both dense and sparse wide-band arrays. In the first case, the goal is to minimize the side-lobe energy by varying the element weights; we compare the optimized beam pattern with that obtained with classical shading functions, showing that better results can be achieved with a wide-band optimization. We also consider the optimization of the layout (positions and weights) of a sparse linear array to achieve a desired beam pattern with a fixed or minimum number of array elements. The comparison of the proposed method with a narrow-band optimization algorithm is presented, showing that better performances (about -7 dB further reduction of the side-lobe level) can be achieved with a wide-band sparse array optimization. Further numerical simulations are given, showing that the proposed method yields better results than wide-band sparse random arrays and periodic arrays with the same aperture width.

Journal Article↗

A dose-volume histogram based optimization algorithm for ultrasound guided prostate implants.

The task of treatment planning for prostate implants is to find an optimal seed configuration, comprising the target coverage and dosimetric consideration of critical structures such as the rectum and urethra. An efficient method to accomplish this is to use an inverse planning technique that derives the optimized solution from a prescribed treatment goal. The goal can be specified in the voxel domain as the desired doses to the voxels of the target and critical structures, or in the dose volume representation as the desired dose volume histograms (DVHs) of the target and critical structures. The DVH based optimization has been successfully used in plan optimization for intensity-modulated radiation therapy (IMRT) but little attention has been paid to its application in prostate implants. Clinically, it has long been known that some normal structure tolerances are more accurately assessed by volumetric information. Dose-volume histograms are also widely used for plan evaluation. When working in the DVH domain for optimization one has more control over the final DVHs. We have constructed an objective function sensitive to the DVHs of the target and critical structures. The objective function is minimized using an iterative algorithm, starting from a randomly selected initial seed configuration. At each iteration step, a trial position is given to a randomly selected source and the trial position is accepted if the objective function is decreased. To avoid being trapped in a less optimal local minimum, the optimization process is repeated. The final plan is selected from a pool of optimized plans obtained from a series of randomized initial seed configurations.

Algorithms↗

Optimized dynamic rotation with wedges.

Dynamic rotation is a computer-controlled therapy technique utilizing an automated multileaf collimator in which the radiation beam shape changes dynamically as the treatment machine rotates about the patient so that at each instant the beam shape matches the projected shape of the target volume. In simple dynamic rotation, the dose rate remains constant during rotation. For optimized dynamic rotation, the dose rate is varied as a function of gantry angle. Optimum dose rate at each gantry angle is computed by linear programming. Wedges can be included in the optimized dynamic rotation therapy by using additional rotations. Simple and optimized dynamic rotation treatment plans, with and without wedges, for a pancreatic tumor have been compared using optimization cost function values, normal tissue complication probabilities, and positive difference statistic values. For planning purposes, a continuous rotation is approximated by static beams at a number of gantry angles equally spaced about the patient. In theory, the quality of optimized treatment planning solutions should improve as the number of static beams increases. The addition of wedges should further improve dose distributions. For the case studied, no significant improvements were seen for more than 36 beam angles. Open and wedged optimized dynamic rotations were better than simple dynamic rotation, but wedged optimized dynamic rotation showed no definitive improvement over open beam optimized dynamic rotation.

Humans↗

Matching between feline left ventricle and arterial load: optimal external power or efficiency.

We tested the hypothesis that the feline left ventricle normally works at optimal external power as opposed to optimal efficiency by (re)analyzing data from five isolated, blood-perfused cat hearts and 39 open-thorax cats. In the isolated hearts, we measured pump function, external steady power, myocardial oxygen consumption, and efficiency. Optimal external power and optimal efficiency were found at different left ventricular outputs (6.94 +/- 0.33 and 8.35 +/- 0.37 ml/s, respectively; P less than 0.001). In the in situ cat hearts the working point was found at an output of 4.72 +/- 0.32 ml/s, whereas optimal external power was found at 4.84 +/- 0.26 ml/s. These values were not significantly different. Assuming that the point of optimal efficiency was located at the same fraction of the maximal unloaded left ventricular output (Fmax) as in the isolated hearts, i.e., 0.7, we found the point of optimal efficiency for the in situ heart at a flow of 5.83 +/- 0.32 ml/s, which was significantly different (P less than 0.001) from the flow in the working point. Our data therefore indicate that the left ventricle in the open-thorax cat is matched to the arterial load such that its external power output rather than efficiency is optimized.

Algorithms↗

Signal-averaged electrocardiogram. Improved identification of patients with ventricular tachycardia using a 28-lead optimal array.

BACKGROUND: Although the signal-averaged ECG (SAECG) is currently the best noninvasive test to identify patients with ventricular tachycardia (VT) following myocardial infarction (MI), it is still a relatively insensitive test. Body surface mapping has improved the sensitivity of ECG in detecting various cardiac diseases. This study applied body surface mapping to the SAECG in the form of a clinically practical, 28-lead optimal array and compared its sensitivity and specificity with those of an orthogonal array. METHODS AND RESULTS: Two hundred twenty-three patients with previous MI (82 with inducible VT) underwent SAECG using 28 surface electrodes from which were obtained a three-lead orthogonal array and a 28-lead optimal array (optimal). From the orthogonal array, two QRS durations (QRSd) were obtained using the combined vector magnitude method (CVM) and the earliest onset to latest offset of the three individually filtered leads (individual). From the optimal array, 28 QRSd were obtained, each defined as the duration from the earliest onset of any of the 28 leads to the offset of each individually filtered lead. QRSd > 120 msec in > or = 3 leads was considered abnormal. For CVM and individual, QRSd of > 120 msec were considered abnormal. While the specificity of each method was comparable (84%, 86%, and 84% for CVM, individual, and optimal, respectively), the sensitivity of optimal (70%) was significantly greater than the sensitivity of CVM (54%) (p = 0.001) or individual (59%) (p = 0.004). The magnitude of improvement in sensitivity, 16% and 15%, respectively, was equal for anterior (n = 120) and inferior (n = 103) infarctions. CONCLUSIONS: Body surface mapping using the 28-lead optimal array significantly improved the sensitivity of the SAECG without loss of specificity. The increased sensitivity was of equal magnitude for inferior and anterior infarctions. The superiority and practicality of the 28-lead optimal array make it worth pursuing as an option for further refinement in SAECG:

Aged↗

Evaluation of nonlinear optimization for scheduling of follow-up cystoscopies to detect recurrent bladder cancer. The Bladder Cancer follow-up Group.

Standard recommendations for patients who have had superficial bladder cancer are inspection by cystoscopy quarterly for a year or two after tumor removal, then half-yearly and yearly. The authors assessed the potential for improvement in scheduling cystoscopies according to probabilistic optimization techniques. Eight hypothetical practices were created, based on retrospective analysis of 918 bladder-cancer-patient charts. Standard and alternative recommendations for the interval to next cystoscopy were compared. The alternatives were derived from patient-specific predictions of future tumor risks (based on the patient's prior recurrence rate and tumor stage and grade) and a nonlinear optimization approach to allocation of the same number of cystoscopies as were available for standard follow-up. The optimization proposed longer intervals between visits for low-risk patients and shorter intervals for high-risk patients. Overall, optimization reduced expected tumor detection delays by 30%, from 12.6 to 8.7 weeks. When optimization intervals were shorter than standard, cancer was found more often at subsequent cystoscopies (34% vs 27%, p less than 0.05), suggesting that the optimization was a better predictor of cancer recurrence. If reduction in tumor-detection delay is the goal of follow-up for recurrent cancers, then urologists can improve monitoring by using probabilistic optimization methods for scheduling cystoscopies. Further understanding of the accuracy of predictive models for bladder-cancer recurrence rates is desirable. Subsequently, the optimization method developed here may be tested prospectively.

Aftercare↗

Optimal wave-front reconstruction strategies for multiconjugate adaptive optics.

We propose an optimal approach for the phase reconstruction in a large field of view (FOV) for multiconjugate adaptive optics. This optimal approach is based on a minimum-mean-square-error estimator that minimizes the mean residual phase variance in the FOV of interest. It accounts for the C2n profile in order to optimally estimate the correction wave front to be applied to each deformable mirror (DM). This optimal approach also accounts for the fact that the number of DMs will always be smaller than the number of turbulent layers, since the C2n profile is a continuous function of the altitude h. Links between this optimal approach and a tomographic reconstruction of the turbulence volume are established. In particular, it is shown that the optimal approach consists of a full tomographic reconstruction of the turbulence volume followed by a projection onto the DMs accounting for the considered FOV of interest. The case where the turbulent layers are assumed to match the mirror positions [model-approximation (MA) approach], which might be a crude approximation, is also considered for comparison. This MA approach will rely on the notion of equivalent turbulent layers. A comparison between the optimal and MA approaches is proposed. It is shown that the optimal approach provides very good performance even with a small number of DMs (typically, one or two). For instance, good Strehl ratios (greater than 20%) are obtained for a 4-m telescope on a 150-arc sec x 150-arc sec FOV by using only three guide stars and two DMs.

Journal Article↗

Geometric optimization of a tissue pattern for semilunar valve reconstruction.

BACKGROUND AND AIM OF THE STUDY: A novel geometric trefoil pattern has been suggested for semilunar valve reconstruction. Optimization of the geometry must rely on an appreciation of normal anatomy and knowledge of the mechanical properties of the tissue used for the reconstruction. METHODS: Computer-assisted design (CAD) was used to create an optimized leaflet geometry based on published dimensions for normal human aortic valves. The optimized leaflet geometry was subjected to finite element analysis (FEA) to study stress distribution with pressure loading of the leaflet. In vitro function of the optimized trefoil tissue pattern is being studied by static testing initially, with physiological saline. RESULTS: An optimized leaflet geometry has been developed by CAD, and further refined by FEA. Static testing of the optimized trefoil tissue pattern shows near-normal anatomy, with no prolapse or pin wheeling, and full valve competence to 90 mmHg pressure. CONCLUSIONS: An initial optimized geometry has been developed for a two-dimensional tissue pattern that can be used to reconstruct diseased semilunar heart valves with human pericardium. Optimization studies are based on the mechanical properties of the tissue, CAD to mimic normal anatomy, FEA to study stress distribution, and static load testing to confirm function.

Animals↗

Optimizing replacement decisions for Finnish dairy herds.

The purposes of the study were to determine how "an optimal herd" would be structured with respect to its calving pattern, average herdlife and calving interval, and to evaluate how sensitive the optimal solution was to changes in input prices, which reflected the situation in Finland in 1998. The study used Finnish input values in an optimization model developed for dairy cow insemination and replacement decisions. The objective of the optimization model was to maximize the expected net present value from present and replacement cows over a given decision horizon. In the optimal solution, the average net revenues per cow were highest in December and lowest in July, due to seasonal milk pricing. Based on the expected net present value of a replacement heifer over the decision horizon, calving in September was optimal. In the optimal solution, an average calving interval was 363 days and average herdlife after first calving was 48.2 months (i.e., approximately 4 complete lactations). However, there was a marked seasonal variation in the length of a calving interval (it being longest in spring and early summer) that can be explained by the goal of having more cows calving in the fall. This, in turn, was due to seasonal milk pricing and higher production in the fall. In the optimal solution, total replacement percentage was 26, with the highest frequency of voluntary culling occurring at the end of the year. Seasonal patterns in calving and replacement frequencies by calendar month and variation in calving interval length or herdlife did not change meaningfully (< 1%-2% change in the output variables) with changes in calf, carcass or feed prices. When the price of a replacement heifer decreased, average herdlife was shorter and replacement percentage increased. When the price increased, the effect was the opposite.

Animal Feed↗

Genetic algorithms-based design and optimization of statistical quality-control procedures.

In general, one cannot use algebraic or enumerative methods to optimize a quality-control (QC) procedure for detecting the total allowable analytical error with a stated probability with the minimum probability for false rejection. Genetic algorithms (GAs) offer an alternative, as they do not require knowledge of the objective function to be optimized and can search through large parameter spaces quickly. To explore the application of GAs in statistical QC, I developed two interactive computer programs based on the deterministic crowding genetic algorithm. Given an analytical process, the program "Optimize" optimizes a user-defined QC procedure, whereas the program "Design" designs a novel optimized QC procedure. The programs search through the parameter space and find the optimal or near-optimal solution. The possible solutions of the optimization problem are evaluated with computer simulation.

Algorithms↗

[The role of the atrium and optimal values of AV intervals in sequentially paced patients].

In 1995, 2249 dual chamber pacemakers were implanted in the Czech Republic. These pacemakers make it possible to set an optimal AV delay between the atrial and ventricular impulse. Although the optimization of the AV interval has its well defined physiologic advantages, it does not seem to be necessary in otherwise healthy individuals with a good atrial and ventricular function. In these patients the default value, usually about 170 ms, is acceptable. However, AV interval optimization--i.e. finding the interval at which the atrial contribution to ventricular filling is maximal--should be done in all patients with left ventricular dysfunction, indicated for pacing because of bradyarrhthmia. In this subset of patients, even a small improvement in ventricular filling is believed to be clinically useful. Moreover, it has been documented, that in some types of ventricular dysfunction the so-called "primary optimization" (i.e. optimization of the AV interval in patients, in whom the pacemaker is not indicated for bradyarrhthmia but for ventricular dysfunction that might be improved by AV interval optimization) may be clinically useful. It is the case in patients with hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy with presystolic regurgitation and AV interval prolongation, and perhaps even in some patients with impairment of ventricular systolic function and substantial prolongation of the AV interval. Despite all that, optimization of the AV interval is not routinely performed because even the best available optimization procedures (stroke volume measurements at different AV intervals by aortic Doppler echography) is observer dependent, time-consuming and costly.

Arrhythmias, Cardiac↗

Optimism, coping and long-term recovery from coronary artery surgery in women.

Optimism, coping strategies, and psychological and functional outcomes were measured in 55 women undergoing coronary artery surgery. Data were collected in-hospital and at 1, 6, and 12 months after surgery. Optimism was related to positive moods and life satisfaction, and inversely related to negative moods. Few relationships were found between optimism and functional ability. Cognitive coping strategies accounted for a mediating effect between optimism and negative mood. Optimists were more likely to accept their situation, and less likely to use escapism. In turn, these coping strategies were inversely related to negative mood and mediated the relationship between optimism and this outcome. Optimism was not related to problem-focused coping strategies; this, these coping strategies cannot explain the relationship between optimism and outcomes.

Adaptation, Psychological↗

Optimal cryogen spray cooling parameters for pulsed laser treatment of port wine stains.

BACKGROUND AND OBJECTIVE: In dermatologic laser therapy, cryogen spray cooling (CSC) is a means to protect the epidermis while leaving dermal structures susceptible to thermal damage. The purpose of this study was to determine optimal spurt duration, tau(s), and optimal delay, tau(d), between the cryogen spurt and laser pulse when using CSC in treatment of port wine stain birthmarks. STUDY DESIGN/MATERIALS AND METHODS: A finite difference method is used to compute temperature distributions in human skin in response to CSC. Optimal tau(s) and tau(d) are determined by maximizing the temperature difference between a modeled basal layer and an imaginary target chromophore. RESULTS: The model predicts an optimal tau(s) of 170-300 msec and approximately 400 msec for shallow (150 microm) and deeper (400 microm) targets, respectively. Spraying for longer than the optimal tau(s) does not critically impair cooling selectivity. For a spurt duration of 100 msec, optimal delays are 5-10 msec and 25-70 msec for a shallow and deep basal layer, respectively. CONCLUSION: In the absence of knowledge about the lesion anatomy, using a tau(s) of 100-200 msec and no delay is a good compromise. A delay is justified only when basal layer and target chromophore are relatively deep and the optimal spurt duration cannot be applied, e.g., to avoid frostbite.

Cryotherapy↗

Framework for online optimization of recombinant protein expression in high-cell-density Escherichia coli cultures using GFP-fusion monitoring.

A framework for the online optimization of protein induction using green fluorescent protein (GFP)-monitoring technology was developed for high-cell-density cultivation of Escherichia coli. A simple and unstructured mathematical model was developed that described well the dynamics of cloned chloramphenicol acetyltransferase (CAT) production in E. coli JM105 was developed. A sequential quadratic programming (SQP) optimization algorithm was used to estimate model parameter values and to solve optimal open-loop control problems for piecewise control of inducer feed rates that maximize productivity. The optimal inducer feeding profile for an arabinose induction system was different from that of an isopropyl-beta-D-thiogalactopyranoside (IPTG) induction system. Also, model-based online parameter estimation and online optimization algorithms were developed to determine optimal inducer feeding rates for eventual use of a feedback signal from a GFP fluorescence probe (direct product monitoring with 95-minute time delay). Because the numerical algorithms required minimal processing time, the potential for product-based and model-based online optimal control methodology can be realized.

Algorithms↗

Application of modified Rosenbrock's method for optimization of nutrient media used in microorganism culturing.

The Rosenbrock's procedure has been modified for optimization of nutrient medium composition and has been found to be less tedious than the Box-Wilson method, especially for larger numbers of optimized parameters. Its merits are particularly obvious with multiparameter optimization where the gradient method, so far the only one employed in microbiology from a variety of optimization methods (e.g., refs, 9 and 10), becomes impractical because of the excessive number of experiments required. The method suggested is also more stable during optimization than the gradient methods which are very sensitive to the selection of steps in the direction of the gradient and may thus easily shoot out of the optimized region. It is also anticipated that other direct search methods, particularly simplex design, may be easily adapted for optimization of medium composition. It is obvious that direct search methods may find an application in process improvement in antibiotic and related industries.

Culture Media↗