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Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients

INTENSIVE CARE MEDICINE 2008年第7期34卷 1224-1230页

作者： Pachler, Christoph Plank, Johannes Weinhandl, Heinz Chassin, Ludovic J. Wilinska, Malgorzata E. Kulnik, Roman Kaufmann, Peter Smolle, Karl-Heinz Pilger, Ernst Pieber, Thomas R. Ellmerer, Martin Hovorka, Roman Med Univ Graz Dept Internal Med A-8010 Graz Austria Univ Cambridge Dept Paediat Cambridge England

Objective: Tight glycaemic control (TGC) in critically ill patients improves clinical outcome, but is difficult to establish The primary objective of the present study was to compare glucose control in medical ICU patients applying a computer-based enhanced model predictive control algorithm (eMPC) extended to include time-variant sampling against an implemented glucose management protocol. Design: Open randomised controlled trial. Setting: Nine-bed medical intensive care unit (ICU) in a tertiary teaching hospital. Patients and participants: Fifty mechanically ventilated medical ICU patients. Interventions: Patients were included for a study period of up to 72 h. Patients were randomised to the control group (n = 25), treated by an implemented insulin algorithm, or to the eMPC group (n = 25), using the laptop-based algorithm. Target range for blood glucose (BG) was 4.4-6.1mM. Efficacy was assessed by mean BG, hyperglycaemic index (HGI) and BG sampling interval. Safety was assessed by the number of hypoglycaemic-episodes < 2.2 mM. Each participating nurse filled-in a questionnaire regarding the usability of the algorithm. Measurements and main results: BG and HGI were significantly lower in the eMPC group [BG 5.9mM (5.5-6.3), median (IQR);HGI 0.4 mM (0.2-0.9)] than in control patients [BG 7.4 mM (6.9-8.6), p < 0.001;HGI 1.6mM (1.1-2.4), p < 0.001]. One hypoglycaemic episode was detected in the eMPC group;no such episodes in the control group. Sampling interval was significantly shorter in the eMPC group [eMPC 117 min (+/- 34), mean (+/- SD), vs 174 min (+/- 27);p < 0.001]. Thirty-four nurses filled-in the questionnaire. Thirty answered the question of whether the algorithm could be applied in daily routine in the affirmative. Conclusions: The eMPC algorithm was effective in maintaining tight glycaemic control in severely ill medical ICU patients.

关键词： critically ill insulin resistance tight glycemic control computer algorithm

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No evidence for the use of DIR, D-D fusions, chromosome 15 open reading frames or V_Hreplacement in the peripheral repertoire was found on application of an improved algorithm, JointML, to 6329 human immunoglobulin H rearrangements

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IMMUNOLOGY 2006年第2期119卷 265-277页

作者： Ohm-Laursen, Line Nielsen, Morten Larsen, Stine R. Barington, Torben Odense Univ Hosp Dept Clin Immunol DK-5000 Odense C Denmark Tech Univ Denmark Ctr Biol Sequence Anal BioCentrum DK-2800 Lyngby Denmark

Antibody diversity is created by imprecise joining of the variability (V), diversity (D) and joining (J) gene segments of the heavy and light chain loci. Analysis of rearrangements is complicated by somatic hypermutations and uncertainty concerning the sources of gene segments and the precise way in which they recombine. It has been suggested that D genes with irregular recombination signal sequences (DIR) and chromosome 15 open reading frames (OR15) can replace conventional D genes, that two D genes or inverted D genes may be used and that the repertoire can be further diversified by heavy chain V gene (V-H) replacement. Safe conclusions require large, well-defined sequence samples and algorithms minimizing stochastic assignment of segments. Two computer programs were developed for analysis of heavy chain joints. JOINTHMM is a profile hidden Markow model, while JOINTML is a maximum-likelihood-based method taking the lengths of the joint and the mutational status of the V-H gene into account. The programs were applied to a set of 6329 clonally unrelated rearrangements. A conventional D gene was found in 80% of unmutated sequences and 64% of mutated sequences, while D-gene assignment was kept below 5% in artificial (randomly permutated) rearrangements. No evidence for the use of DIR, OR15, multiple D genes or V-H replacements was found, while inverted D genes were used in less than 1 parts per thousand of the sequences. JOINTML was shown to have a higher predictive performance for D-gene assignment in mutated and unmutated sequences than four other publicly available programs. An online version 1.0 of JOINTML is available at ***/services/VDJsolver.

关键词： antibodies computer algorithm gene rearrangements human

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Software-guided versus nurse-directed blood glucose control in critically ill patients: the LOGIC-2 multicenter randomized controlled clinical trial

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CRITICAL CARE 2017年第20170828期21卷 1-10页

作者： Mesotten, Dieter Dubois, Jasperina Van Herpe, Tom van Hooijdonk, Roosmarijn T. Wouters, Ruben Coart, Domien Wouters, Pieter Van Assche, Aime Veraghtert, Guy De Moor, Bart Wauters, Joost Wilmer, Alexander Schultz, Marcus J. Van den Berghe, Greet Katholieke Univ Leuven Univ Hosp Leuven Acad Dept Cellular & Mol Med Clin Div Herestr 49 B-3000 Leuven Belgium Katholieke Univ Leuven Univ Hosp Leuven Acad Dept Cellular & Mol Med Lab Intens Care Med Herestr 49 B-3000 Leuven Belgium Jessa Hosp Dept Anesthesia & Intens Care Salvatorstr 20 B-3500 Hasselt Belgium Katholieke Univ Leuven Res Div SCD iMINDS Future Hlth Dept Dept Elect Engn ESAT Kasteelpk Arenberg 10 B-3001 Heverlee Belgium Acad Med Ctr Dept Intens Care Med Meibergdreef 9 NL-1105 AZ Amsterdam Netherlands Univ Hosp Leuven Med Intens Care Unit Clin Dept Gen Internal Med Herestr 49 B-3000 Leuven Belgium

Background: Blood glucose control in the intensive care unit (ICU) has the potential to save lives. However, maintaining blood glucose concentrations within a chosen target range is difficult in clinical practice and holds risk of potentially harmful hypoglycemia. Clinically validated computer algorithms to guide insulin dosing by nurses have been advocated for better and safer blood glucose control. Methods: We conducted an international, multicenter, randomized controlled trial involving 1550 adult, medical and surgical critically ill patients, requiring blood glucose control. Patients were randomly assigned to algorithm-guided blood glucose control (LOGIC-C, n = 777) or blood glucose control by trained nurses (Nurse-C, n = 773) during ICU stay, according to the local target range (80-110 mg/dL or 90-145 mg/dL). The primary outcome measure was the quality of blood glucose control, assessed by the glycemic penalty index (GPI), a measure that penalizes hypoglycemic and hyperglycemic deviations from the chosen target range. Incidence of severe hypoglycemia (<40 mg/dL) was the main safety outcome measure. New infections in ICU, duration of hospital stay, landmark 90-day mortality and quality of life were clinical safety outcome measures. Results: The median GPI was lower in the LOGIC-C (10.8 IQR 6.2-16.1) than in the Nurse-C group (17.1 IQR 10.6-26.2) (P < 0.001). Mean blood glucose was 111 mg/dL (SD 15) in LOCIC-C versus 119 mg/dL (SD 21) in Nurse-C, whereas the median time-in-target range was 67.0% (IQR 52.1-80.1) in LOGIC-C versus 47.1% (IQR 28.1-65.0) in the Nurse-C group (both P < 0.001). The fraction of patients with severe hypoglycemia did not differ between LOGIC-C (0.9%) and Nurse-C (1.2%) (P = 0.6). The clinical safety outcomes did not differ between groups. The sampling interval was 2.3 h (SD 0.5) in the LOGIC-C group versus 3.0 h (SD 0.8) in the Nurse-C group (P < 0.001). Conclusions: In a randomized controlled trial of a mixed critically ill patient popul

关键词： Blood glucose control computer algorithm Quality of blood glucose control Glycemic penalty index Time-in-target Sepsis Infection

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Validation of an Integrated Software for the Detection of Rapid Eye Movement Sleep Behavior Disorder

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SLEEP 2014年第10期37卷 1663-1671页

作者： Frauscher, Birgit Gabelia, David Biermayr, Marlene Stefani, Ambra Hackner, Heinz Mitterling, Thomas Poewe, Werner Hoegl, Birgit Med Univ Innsbruck Dept Neurol A-6020 Innsbruck Austria

Study Objectives and Design: Rapid eye movement sleep without atonia (RWA) is the polysomnographic hallmark of REM sleep behavior disorder (RBD). To partially overcome the disadvantages of manual RWA scoring, which is time consuming but essential for the accurate diagnosis of RBD, we aimed to validate software specifically developed and integrated with polysomnography for RWA detection against the gold standard of manual RWA quantification. Setting: Academic referral center sleep laboratory. Participants: Polysomnographic recordings of 20 patients with RBD and 60 healthy volunteers were analyzed. Interventions: N/A. Measurements and Results: Motor activity during REM sleep was quantified manually and computer assisted (with and without artifact detection) according to Sleep Innsbruck Barcelona (SINBAR) criteria for the mentalis ("any,"phasic, tonic electromyographic [EMG] activity) and the flexor digitorum superficialis (FDS) muscle (phasic EMG activity). computer-derived indices (with and without artifact correction) for "any,"phasic, tonic mentalis EMG activity, phasic FDS EMG activity, and the SINBAR index ("any" mentalis + phasic FDS) correlated well with the manually derived indices (all Spearman rhos 0.66-0.98). In contrast with computerized scoring alone, computerized scoring plus manual artifact correction (median duration 5.4 min) led to a significant reduction of false positives for "any" mentalis (40%), phasic mentalis (40.6%), and the SINBAR index (41.2%). Quantification of tonic mentalis and phasic FDS EMG activity was not influenced by artifact correction. Conclusion: The computer algorithm used here appears to be a promising tool for REM sleep behavior disorder detection in both research and clinical routine. A short check for plausibility of automatic detection should be a basic prerequisite for this and all other available computer algorithms.

关键词： computer algorithm detection polysomnography REM sleep behavior disorder scoring

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PREDICTION OF PROTEIN-STRUCTURE BY EVALUATION OF SEQUENCE-STRUCTURE FITNESS - ALIGNING SEQUENCES TO CONTACT PROFILES DERIVED FROM 3-DIMENSIONAL STRUCTURES

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JOURNAL OF MOLECULAR BIOLOGY 1993年第3期232卷 805-825页

作者： OUZOUNIS, C SANDER, C SCHARF, M SCHNEIDER, R Protein Design Group EMBL D-6900 Heidelberg Germany

The problem of protein structure prediction is formulated here as that of evaluating how well an amino acid sequence fits a hypothetical structure. The simplest and most complicated approaches, secondary structure prediction and all-atom free energy calculations, can be viewed as sequence-structure fitness problems. Here, an approach of intermediate complexity is described, which involves; (1) description of a protein structure in terms of contact interface vectors, with both intra-protein and protein-solvent contacts counted, (2) derivation of sequence preferences for 2 up to 29 contact interface types, (3) generation of numerous hypothetical model structures by placing the input sequence into a large set of known three-dimensional structures in all possible alignments, (4) evaluation of these models by summing the sequence preferences over all structural positions and (5) choice of predicted three-dimensional structure as that with the best sequence-structure fitness. Evolutionary information is incorporated by using position-dependent core weights derived from multiple sequence alignments. A number of tests of the method are performed: (1) evaluation of cyclic shifts of a sequence in its native structure; (2) alignment of a sequence in its native structure, allowing gaps; (3) alignment search with a sequence or sequence fragment in a database of structures; and (4) alignment search with a structure in a database of sequences. The main results are: (1) a native sequence can very well find its native structure among a large number of alternatives, in correct alignment; (2) substructures, such as (βα) n units, can be detected in spite of very low sequence similarity; (3) remote homologues can be detected, with some dependence on the set of parameters used; (4) contact interface parameters are clearly superior to classical secondary structure parameters; (5) a simple interface description in terms of just two states, protein-protein and protein-water contacts, perfor

关键词： PROTEIN STRUCTURE PREDICTION SEQUENCE-STRUCTURE ALIGNMENT computer algorithm DATABASE EVOLUTIONARY INFORMATION

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Amino acid content of beta strands and alpha helices depends on their flanking secondary structure elements

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BIOSYSTEMS 2018年 168卷 45-54页

作者： Khrustalev, Vladislav Victorovich Khrustaleva, Tatyana Aleksandrovna Poboinev, Victor Vitoldovich Belarusian State Med Univ Dept Gen Chem Dzerzinskogo 83 Minsk BELARUS Natl Acad Sci Belarus Inst Physiol Biochem Grp Multidisciplinary Diagnost Lab Acad Skaya 28 Minsk BELARUS

The influence of flanking structures (alpha helices and beta strands in the primary sequence) on amino acid content of the elements of secondary structure has been analyzed in seven sets of nonhomologous proteins. Elevated usage of beta structural amino acid residues and pentapeptides in beta strands between two alpha helices can be explained by the stabilization of secondary structure of those beta strands by natural selection. High usage of alpha helical amino acids and pentapeptides in beta strands situated between two other beta strands is an evidence of the relaxation of natural selection: "passive" beta strands in these fragments of polypeptide chains are frequently formed due to the influence of flanking "active" beta strands. Alpha helices situated between alpha helix and beta strand are enriched by alpha helical pentapeptides and have lower usage of beta structural pentapeptides than those situated between beta strand and alpha helix, their N-termini are more frequently protected from helix to beta transitions by Glu residues. Alpha helices between two beta strands are stabilized by Ala residues and pentapeptides specific to alpha helices. Dipeptide content of the most stable alpha helices and beta strands was used for the creation of the PentaFOLD 2.0 algorithm (http://***) that finds stable fragments of these elements of secondary structure in PDB files. (C) 2018 Elsevier B.V. All rights reserved.

关键词： Protein Secondary structure Propensity scale Stability computer algorithm

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computerized Classification of Neurologic Injury Based on the International Standards for Classification of Spinal Cord Injury

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JOURNAL OF SPINAL CORD MEDICINE 2009年第5期32卷 532-537页

作者： Chafetz, Ross S. Prak, Seyla Mulcahey, M. J. Shriners Hosp Children Philadelphia PA 19140 USA

Background/Objective: To develop and test a computer program to accurately score International Standards for Classification of Spinal Cord Injury (ISCSCI) examinations. Methods: A computer program was written following the algorithm published in the ISCSCI 2003 manual. Two methods were used to test the computer program's accuracy. First, 94 hand-scored examinations representing 25 different patients were entered into the program. Differences between hand-scored examinations and computer-scored examinations were evaluated for accuracy. Second, all case examples from the ISCSCI manual were entered into the computer program to verify its accuracy. Results: Of the 94 hand-scored examinations, the computer detected all incorrectly scored examinations. Furthermore, the computer scoring agreed with every examination's scores that were correctly calculated by hand. Of the hand-scored examinations, 10% of sensory total scores and 4% of motor scores were incorrect. For sensory level and motor level, there were errors in 9% and 26% of hand-scored examinations, respectively;13% of hand-scored examinations had incorrectly assigned ASIA Impairment Scale classification. Conclusion: This study showed that the computer program we developed was effective in correctly scoring ISCSCI examinations and was able to detect errors in hand-scored examinations.

关键词： Spinal cord injuries Children Classification International Standards for Classification of Spinal Cord Injury Validity Reliability computer algorithm Physical examination

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IDENTIFICATION AND ANALYSIS OF DOMAINS IN PROTEINS

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PROTEIN ENGINEERING 1995年第6期8卷 513-525页

作者： ISLAM, SA LUO, JC STERNBERG, MJE IMPERIAL CANC RES FUND BIOMOLEC MODELLING LABLONDON WC2A 3PXENGLAND

An automatic algorithm based on inter-residue contacts is presented to identify domains in proteins. The results of the algorithm are compared to an assignment performed by inspection that was guided by the authors' description in the literature. The authors) and the algorithm's assignments for a chain were considered to agree if the same number of domains were identified and if the assignments were the same for at least 95% of the residues. With this criterion, the algorithm agreed with the authors' assignment for 78% of the 284 non-redundant chains considered, When some of the authors' assignments were re-evaluated based on the results of the algorithm, an agreement of 84% was obtained. The algorithm is therefore a useful tool for data validation in domain assignment. The authors assignments of domains were analysed for structural principles of domains. The number of chains forming one, two, three, four and five domains are 197, 67, 13, 6 and 1 respectively. Most domains in multidomain proteins are formed from continuous segments and adopt the same structural class. Distributions of the number of residues and the ellipticity of domains and chains are presented. The relationship between accessible surface area and molecular weight for domains and chains is examined.

关键词： computer algorithm DATABASE FOLDING UNITS PROTEIN STRUCTURE

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Toward an algorithmic Control Theory

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JOURNAL OF GUIDANCE CONTROL AND DYNAMICS 2017年第2期40卷 194-196页

作者： Tsiotras, Panagiotis Mesbahi, Mehran Georgia Inst Technol Daniel Guggenheim Sch Aerosp Engn Atlanta GA 30332 USA Univ Washington William M Boeing Dept Aeronaut & Astronaut Seattle WA 98195 USA

The February 2017 Special Issue of Journal of Guidance, Control and Dynamics discusses papers that reflect some of the current trends in control community that best represent novel intersections of aerospace guidance and control and computation. the paper by AcAÇikmesAÇe and colleagues and the paper by Scharf and colleagues aim to explore the adoption of convex optimization and custom solvers based on interior point algorithms for powered descent guidance. In the same vein, the paper by Nicotra and colleagues examines the adoption of convex optimization for fast reference governors. Real-time nonlinear optimal control provides the backbone of the contributions by Lu and colleagues, Adurthi and colleagues, Sagliano and colleagues, Ferranti and Keviczky, De La Torre and colleagues, Zidek and Kolmanovsky, and finally by Liu and colleagues. All these papers examine topics ranging from entry guidance, onboard trajectory generation, predictive flight control, trajectory optimization for autonomous suspended load operations, computational optimal control with disturbance, and guidance for constrained impact. Approximate dynamic programming in the context of nonlinear adaptive control is discussed in the paper by Zhou and colleagues, whereas MPC-based approaches with embedded convex optimization solvers are the subject of the contributions by Lee and Mesbahi, Lee and colleagues, and Petersen and colleagues, with applications in constrained landing, underactuated spacecraft, and constrained attitude control with reaction wheels, respectively. The extension of MPC in the context of model predictive path integral control is explored in the paper byWilliams and colleagues, which also examines parallel implementations. Finally, a semi-analytic approach is examined in the paper by Gerlach and Doman for ballistic airdrops.

关键词： Nonlinear Adaptive Control Feedback Control Convex Optimization Powered Descent Guidance computer algorithm Trajectory Optimization Information Processing Computational Fluid Dynamics Unmanned Aerial Vehicle Numerical algorithms

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AN ANALYTICAL METHOD OF PREDICTING LEE-KESLER-PLOCKER EQUATION-OF-STATE BINARY INTERACTION COEFFICIENTS

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INTERNATIONAL JOURNAL OF THERMOPHYSICS 1995年第6期16卷 1393-1411页

作者： LABINOV, SD SAND, JR OAK RIDGE NATL LAB DIV ENERGYOAK RIDGETN 37831 THERMODYNAM CTR KIEVUKRAINE

An analytical method is proposed for finding numerical values of binary interaction coefficients for the Lee-Kesler-Plocker (LKP) equation of state. The method is based on solving simultaneous equations from Plocker's mixing rules for pseudocritical parameters of a mixture and the Lee-Kesler equation for the saturation line. For mixtures of hydrocarbons containing from two to nine carbon atoms, the divergence between calculated and experimentally based interaction coefficients (ICs) is no more than +/-0.4%. The method is extended to mixtures of polar substances. For polar mixtures, an effective molar composition concept is introduced which takes into account the impact of dipole moments on the process of molecular associations. Formulas for finding the effective molar composition of mixtures containing polar and/or nonpolar constituents and the binary interaction coefficient (kappa(ij)) based on this effective composition and pure component properties are shown. Calculated kappa(ij) values for 12 binary mixtures of polar substances differ by 0.4% or less from corresponding kappa(ij) values obtained by processing experimental data on saturated pressure (P-s) and saturated temperature (T-s) lines for these same mixtures. A simplified alternative kappa(ij) approximation method with an error (2-5%) is also given for mixtures of polar substances.

关键词： computer algorithm BINARY INTERACTION COEFFICIENT EQUATION OF STATE MIXTURE NONPOLAR AND POLAR SUBSTANCES THERMODYNAMIC PROPERTIES REDUCED PROPERTIES

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