Optimal Definition Research Articles

Blood Pressure Responses During Exercise: Physiological Correlates and Clinical Implications.

Abnormal blood pressure (BP) responses to exercise can predict adverse cardiovascular outcomes, but their optimal measurement and definitions are poorly understood. We combined frequently sampled BP during cardiopulmonary exercise testing with vascular stiffness assessment to parse cardiac and vascular components of exercise BP. Cardiopulmonary exercise testing with BP measured every two minutes and resting vascular tonometry were performed in 2858 Framingham Heart Study participants. Linear regression was used to analyze sex-specific exercise BP patterns as a function of arterial stiffness (carotid-femoral pulse wave velocity) and cardiac-peripheral performance (defined by peak O2 pulse). Our sample was balanced by sex (52% women) with mean age 54±9 years and 47% with hypertension. We observed variability in carotid-femoral pulse wave velocity and peak O2 pulse across individuals with clinically defined exercise hypertension (peak systolic BP [SBP] in men ≥210 mm Hg; in women ≥190 mm Hg). Despite similar resting SBP and cardiometabolic profiles, individuals with higher peak O2 pulse displayed higher peak SBP (P≤0.017) alongside higher fitness levels (P<0.001), suggesting that high peak exercise SBP in the context of high peak O2 pulse may in fact be favorable. Although both higher (favorable) O2 pulse and higher (adverse) arterial stiffness were associated with greater peak SBP (P<0.0001 for both), the magnitude of association of carotid-femoral pulse wave velocity with peak SBP was higher in women (sex-carotid-femoral pulse wave velocity interaction P<0.0001). In sex-specific models, exercise SBP measures accounting for workload (eg, SBP during unloaded exercise, SBP at 75 watts, and SBP/workload slope) were directly associated with the adverse features of greater arterial stiffness and lower peak O2 pulse. Higher peak exercise SBP reflects a complex trade-off between arterial stiffness and cardiac-peripheral performance that differs by sex. Studies of BP responses to exercise accounting for vascular and cardiac physiology may illuminate mechanisms of hypertension and clarify clinical interpretation of exercise BP.

Comparison of various strategies to define the optimal target population for liver fibrosis screening: A population‐based cohort study

Liver fibrosis screening is recommended in high-risk populations, but the optimal definition of "high risk" remains to be established. We compared the performance of several risk-stratification strategies in a population-based setting. Data were obtained from the Finnish population-based health examination surveys Health 2000 and FINRISK 2002-2012. The Chronic Liver Disease Risk Score (CLivD) was compared to previously published risk-stratification strategies based on elevated liver enzymes, alcohol use, diabetes, fatty liver index, body mass index, and/or metabolic risk factors for their ability to detect either advanced liver fibrosis or incident severe liver events. Advanced fibrosis was defined as an Enhanced Liver Fibrosis (ELFTM ) score >9.8 in the Health 2000 study (n=6084), and incident liver events were ascertained from registry linkage in the combined FINRISK 2002-2012 and Health 2000 cohort (n=26,957). Depending on the cohort, 53%-60% of the population was considered at risk using the CLivD strategy (low-intermediate-high risk, excluding the minimal-risk category), compared to 30%-32% according to the other risk-stratification strategies. The CLivD captured 85%-91% of cases in the population with advanced liver fibrosis and 90% of incident severe liver events within 10years from baseline. This compares to 33%-44% and 56%-67% captured by the other risk-stratification strategies, respectively. The 10-year cumulative incidence of liver events varied by risk-stratification strategy (1.0%-1.4%). Compared to previously reported traditional risk factor-based strategies, use of the CLivD captured substantially more cases with advanced liver disease in the population and may be superior for targeting further fibrosis screening.

Robust design optimisation under lack-of-knowledge uncertainty

Design optimization is common practice in engineering where the goal is to find the optimal combination of design parameters under prescribed constraints. However, some parameters may be impossible to define in a deterministic sense and may only be known with significant uncertainty. This limitation has led to an alternative definition of design optimality called robustness, where attention is payed to the variation around the optimal performance. Straightforward methods to solve robust optimization problems are usually limited in two ways: (1) the computation burden of the so-called ‘double-loop’ optimization problem hinders application to realistic models, and (2) the formalisms are typically limited to probabilistic descriptions of the uncertainty. This paper presents a formulation of the robust optimization problem under interval uncertainty and proposes a new approach taking advantage of the so-called adaptive Gaussian processes to solve it efficiently. The proposed surrogate approach mitigates the computational burden of the resolution, and a dedicated learning function is proposed to ensure iterative minimization of the surrogate modelling error and convergence towards the robust optimum. The algorithm uses a stopping criterion related to the level of confidence associated with the optimality of the solution. The approach is illustrated on six analytical and engineering benchmark problems.

Clinically Optimal Neuropsychological Tests for Postoperative Cognitive Dysfunction in Heart Valve Surgeries.

Postoperative cognitive dysfunction (POCD) is widely recognized and reported, but the lack of a uniform definition makes it difficult to evaluate its clinical impact. The aim of this study is to establish the optimal neuropsychological tests and definition of POCD relevant to clinical outcomes in heart valve surgeries. Between June 2015 and December 2019, 315 patients undergoing elective heart valve surgeries (age ≥65 years) were enrolled. The Mini-Mental Status Examination, Montreal Cognitive Assessment (MoCA), and the Trail Making Test A and B were performed to evaluate cognitive function. Clinical endpoints were defined as readmission and death. The postoperative readmission and death rate were 17% and 3% (54/315 and 8/315; follow-up 266-1,889 days). By multivariable Cox hazard analysis, Short Physical Performance Battery (adjusted hazard ratio [HR]: 0.84, 95% confidence interval [CI]: 0.49-0.98, P=0.001), MoCA change rate (adjusted HR: 0.64, 95% CI: 0.01-1.22, P=0.024), and intensive care unit stay (adjusted HR: 0.55%, 95% CI: 0.99-1.12, P=0.054) were detected as independent risk factors for combined events. The cutoff value was -12% in the change rate of MoCA. MoCA was the only neuropsychological test that predicted the clinical impact on complex events and has the potential to define POCD.

ANAPLASTİK OLİGODENDROGLİOMADA GÖRÜNTÜLEME YÖNTEMLERİNİN RADYOTERAPİ TEDAVİ VOLÜMÜNÜ BELİRLEMEDEKİ ETKİSİ

Objective: Utility of radiation therapy (RT) has been well established for management of World Health Organization (WHO) grade 3 anaplastic oligodendroglioma. Nevertheless, optimal target definition for radiotherapeutic management of WHO grade 3 anaplastic oligodendroglioma requires elucidation. Within this context, treatment volume determination for WHO grade anaplastic oligodendroglioma based on multimodality imaging is assessed in this original research article. &#x0D; Materials and methods: Treatment volume determination for RT by incorporation of MRI or by CT-simulation images only was comparatively assessed for patients receiving RT for WHO grade 3 anaplastic oligodendroglioma in this original research article.&#x0D; Results: VersaHD (Elekta, UK) Linear Accelerator (LINAC) was used for treatment with 6 MV photons. IGRT techniques were utilized for treatment verification. Ground truth target volume was used as the reference for actual treatment and for comparison purposes, and it was determined after meticulous evaluation on an individual basis. Primary outcome measure of the study was comparative assessment of treatment volume determination by either CT-only imaging and by CT-MR fusion based imaging. This study revealed that the ground truth target volume was identical with treatment volume definition by CT-MR fusion based imaging. &#x0D; Conclusion: This study reveals improved treatment volume determination for WHO grade 3 anaplastic oligodendrogliomas by incorporation of MRI in the treatment planning procedure. Clearly, further studies are warranted to shed light on this issue.

Кибертерроризм как нетипичное проявление (форма) терроризма в современном мире

The article examines the doctrinal aspects of understanding cyber terrorism as an atypical manifestation (form) of traditional terrorism, actualized in the light of the intensive development and widespread dissemination of information and communication technologies (ICT) in the modern world. The conclusion is substantiated that cyber terrorism is a conceptually relevant concept, which is perceived either as a way of committing a terrorist act (truncated understanding), or as any terrorist crimes that are committed through the use of information and communication technologies (broad understanding). Analysis and generalization of scientific positions regarding the development of an optimal definition of cyber terrorism made it possible to define this phenomenon of social reality as the illegal use of information and communication technologies in relation to computer information, computer systems and networks in critical segments of the state and in the private sector, which create the danger of death of people, causing significant property damage or the onset of other socially dangerous consequences, with the aim of whipping up fear and tension, as well as influencing the authorities for political or other, inherent in the ideology of terrorism, motives.

Scheduling Scheme Design of Hotel Service Robot: A Heuristic Algorithm to Provide Personalized Scheme

With the rapid development of machine learning and artificial intelligence, hotel service robots are widely used, but there are many problems to be solved in the scheduling scheme of hotel service robots. In this study, the Pareto optimal definition is used to model the problem, and a nondominated sorting heuristic method including genetic algorithm and differential evolution algorithm is designed to solve this problem. Experimental results show the effectiveness and stability of our algorithm. In addition, compared with the previous methods, the method proposed in this paper can provide a more personalized and reasonable service robot scheduling scheme for hotels. Finally, the hotel can optimize its management and operation and further deepen the degree of hotel intelligence.

Analysis of separate training and validation radical prostatectomy cohorts identifies 0.25 mm diameter as an optimal definition for “large” cribriform prostatic adenocarcinoma

AbstractCribriform growth pattern is well-established as an adverse pathologic feature in prostate cancer. The literature suggests “large” cribriform glands associate with aggressive behavior; however, published studies use varying definitions for “large”. We aimed to identify an outcome-based quantitative cut-off for “large” vs “small” cribriform glands. We conducted an initial training phase using the tissue microarray based Canary retrospective radical prostatectomy cohort. Of 1287 patients analyzed, cribriform growth was observed in 307 (24%). Using Kaplan–Meier estimates of recurrence-free survival curves (RFS) that were stratified by cribriform gland size, we identified 0.25 mm as the optimal cutoff to identify more aggressive disease. In univariable and multivariable Cox proportional hazard analyses, size >0.25 mm was a significant predictor of worse RFS compared to patients with cribriform glands ≤0.25 mm, independent of pre-operative PSA, grade, stage and margin status (p < 0.001). In addition, two different subset analyses of low-intermediate risk cases (cases with Gleason score ≤ 3 + 4 = 7; and cases with Gleason score = 3 + 4 = 7/4 + 3 = 7) likewise demonstrated patients with largest cribriform diameter >0.25 mm had a significantly lower RFS relative to patients with cribriform glands ≤0.25 mm (each subset p = 0.004). Furthermore, there was no significant difference in outcomes between patients with cribriform glands ≤ 0.25 mm and patients without cribriform glands. The >0.25 mm cut-off was validated as statistically significant in a separate 419 patient, completely embedded whole-section radical prostatectomy cohort by biochemical recurrence, metastasis-free survival, and disease specific death, even when cases with admixed Gleason pattern 5 carcinoma were excluded. In summary, our findings support reporting cribriform gland size and identify 0.25 mm as an optimal outcome-based quantitative measure for defining “large” cribriform glands. Moreover, cribriform glands >0.25 mm are associated with potential for metastatic disease independent of Gleason pattern 5 adenocarcinoma.

Flat feet: methods of prevention and treatment

In this paper, the authors investigated methods for the prevention and treatment of flat feet. It was found that the problem under consideration was and remains relevant, despite the scientific progress and great success in the medical industry over the past decades. The growth of diseases is facilitated by the frivolous attitude of people to this pathology, because few people think about the scale of the problem. It has been confirmed that flat feet negatively affects not only the musculoskeletal system, but also other organ systems and the state of the body as a whole. It has also been found that the presence of flat feet can indicate a person's overall health. Today, the problem of providing assistance to adults and children with impaired foot function remains relevant and significant. Three main factors take part in the development of this disease: changes in the general physical condition, a violation in the distribution of physical activity on the musculoskeletal system, and an innate tendency. An analysis of scientific literature has shown that today the rehabilitation system for children with orthopedic pathology provides for the use of various means and methods of kinesiotherapy, where a special place is given to gymnastic and sports-applied exercises aimed at strengthening the muscles that form the arch of the foot. It was revealed that the basis of most of the diagnosed cases of flat feet is a weak tone of the muscular skeleton of the lower leg and foot, as well as excessive load on the legs caused by a long stay in an upright position. The author provided an optimal definition of the concept of flat feet, described its types and forms, named the main causes and symptoms, considered methods of prevention, treatment and correction.

From Gustiness to Dustiness—The Impact of Wind Gusts on Particulate Matter Emissions in Field Experiments in La Pampa, Argentina

This study delivers the first empirical data-driven analysis of the impact of turbulence induced gustiness on the fine dust emissions from a measuring field. For quantification of the gust impact, a new measure, the Gust uptake Efficiency (GuE) is introduced. GuE provides a percentage of over- or under-proportional dust uptake due to gust activity during a wind event. For the three analyzed wind events, GuE values of up to 150% could be found, yet they significantly differed per particle size class with a tendency for lower values for smaller particles. In addition, a high-resolution correlation analysis among 31 particle size classes and wind speed was conducted; it revealed strong negative correlation coefficients for very small particles and positive correlations for bigger particles, where 5 μm appears to be an empirical threshold dividing both directions. We conclude with a number of suggestions for further investigations: an optimized field experiment setup, a new particle size ratio (PM1/PM0.5 in addition to PM10/PM2.5), as well as a comprehensive data-driven search for an optimal wind gust definition in terms of soil erosivity.

Association between food insecurity and probable sarcopenia: Data from the 2011–2014 National Health and nutrition examination survey

Aging alters biological processes resulting in body fat redistribution, loss of lean muscle mass, and reduced muscle strength, termed sarcopenia. Nutrition is an important modifiable risk factor in the development of sarcopenia. Food insecurity refers to limited or uncertain access to enough food for an active, healthy life, and is prevalent among older adults. The objective of this study was to examine the relationship between food insecurity and probable sarcopenia in older adults. We examined 3632 adults ≥60 years old from the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). For our analysis food insecurity was identified using the Food Security Survey Module (FSSM). The primary outcome was based on the Sarcopenia Definitions and Outcomes consortium (SDOC) definition. Secondary outcomes were based on three other different grip strength cut-offs as there is debate within the field as to the optimal definition of sarcopenia. Consistent with the revised European consensus on the definition and diagnosis of Sarcopenia (EWGSOP2) recommendations, we used the term probable sarcopenia throughout this text as definitions were based on muscle strength alone and did not include an evaluation of muscle quality. Sensitivity analyses were performed using the standard four category definition of food security. We used logistic regression to examine the association between food insecurity and sarcopenia. Using the Sarcopenia Definitions and Outcomes Consortium definition, 24.7% were classified as having probable sarcopenia (low grip strength); 5.5% had food insecurity and food insecurity was associated with probable sarcopenia (OR 1.51, 95%CI 1.03-2.22). Using three other definitions of probable sarcopenia, food insecurity was significantly associated with probable sarcopenia using the Foundation for the National Institute of Health definition using grip strength alone (OR 1.71, 95%CI 1.08-2.71), but food insecurity was not associated with food insecurity using definitions related to grip strength/BMI (OR 1.16, 95%CI 0.76-1.78) or grip strength/weight (OR 1.14, 95%CI 0.85-1.54). In this nationally representative cohort study, individuals classified as having food insecurity were more likely to have probable sarcopenia (low grip strength) compared to those with full food security. Future studies should examine whether food insecurity interventions may reduce probable sarcopenia and associated adverse outcomes.

PUBLIC PARTICIPATION PROJECT MANAGEMENT

The relevance of the topic is due to the need for improvement and further development of scientific and methodological provision of portfolio management processes within the portfolio management introduction in the field of project management of local (territorial) self-government, including projects of public participation (PP projects). The purpose of the study is to improve and further develop the scientific and methodological provisions of portfolio formation group processes under the conditions of PP projects' implementation, which are considered as the corresponding portfolio components. The study's objectives are as follows: 1) to establish a conceptual research foundation and to identify project management knowledge bases relevant to the research topic;2) to analyze the interrelated scientific and methodological approaches to: structuring categories; defining criteria for evaluation, selection and prioritization; optimization of PP project combinations as those presented in portfolios; 3) to formulate and check, using the database of public projects of Kyiv city, hypotheses relating to the insignificance of differences in the combination of PP projects, separated by thematic direction, which determine the feasibility of presenting projects of thematic areas in the relevant sub-portfolios of the overall PP project portfolio; 4) to propose the model for the formation of the optimal composition of the PP project portfolio recommended for implementation. The methods of the study The method of scientific identification was applied while forming the conceptual basis of the research; the method of comparative analysis was applied in the analysis of scientific and methodological approaches to structuring, definition of criteria (evaluation, selection, prioritization) and optimization of the PP project portfolio; to test the hypothesis of insignificance of differences in the combinations of PP projects, separated by thematic areas, the non-parametric criterion (test) of significance of Kruskal-Wallis was used; while building a model for the formation of the optimal composition of the PP project portfolio, the method of cost-benefit analysis, the time value of money concept, and an integer programming problem were applied.

Subthalamic low beta bursts differ in Parkinson’s disease phenotypes

ObjectiveParkinson’s disease (PD) patients may be categorized into tremor-dominant (TD) and postural-instability and gait disorder (PIGD) motor phenotypes, but the dynamical aspects of subthalamic nucleus local field potentials (STN-LFP) and the neural correlates of this phenotypical classification remain unclear. Methods35 STN-LFP (20 PIGD and 15 TD) were investigated through continuous wavelet transform and machine-learning-based methods. The beta oscillation – the main band associated with motor impairment in PD – dynamics was characterized through beta burst parameters across phenotypes and burst intervals under specific proposed criteria for optimal burst threshold definition. ResultsLow-frequency (13–22 Hz) beta burst probability was the best predictor for PD phenotypes (75% accuracy). PIGD patients presented higher average burst duration (p = 0.018), while TD patients exhibited higher burst probability (p = 0.014). Categorization into shorter and longer than 400 ms bursts led to significant interaction between burst length categories and the phenotypes (p < 0.050) as revealed by mixed-effects models. Long burst durations and short bursts probability positively correlated, respectively, with rigidity-bradykinesia (p = 0.029) and tremor (p = 0.038) scores. ConclusionsSubthalamic low-frequency beta bursts differed between TD and PIGD phenotypes and correlated with motor symptoms. SignificanceThese findings improve the PD phenotypes’ electrophysiological characterization and may define new criteria for adaptive deep brain stimulation.

Device-related thrombus following left atrial appendage occlusion.

Thrombus formation on intracardiac devices remains a subject of importance, with rates in the 2-5% range. Device-related thrombus (DRT) following left atrial appendage occlusion is an area of particular concern considering its association with embolic events. DRT continues to present numerous questions, including the optimal definition, incidence, risk factors, monitoring, therapy, and clinical outcomes - all subjects of ongoing assessment. Herein, we discuss these considerations, building upon the relevant historical context and pathophysiologic insights while discussing the future considerations in this rapidly evolving field.

Logistics 5.0 Implementation Model Based on Decision Support Systems

With the introduction of Society 5.0 for the sustainable future, special caution is given to humans’ role within the general system. Similarly, Industry 5.0 as a concept has been presented, followed by Logistics 5.0 in its theoretical framework. The transition towards the new concept of Logistics 5.0 requires an accurate and optimal strategic plan definition for which, in this paper, an implementation model based on decision support systems will be developed. The output data from this model are the priority of Logistics 5.0 elements (from five groups—green warehousing, green transport, green packaging, infrastructure and organization, and human resources) for the optimal implementation, based on three goals (initial investment, return of investment time, implementation and exploitation complexity) that companies aim to achieve in the future. The model is based on the analytic hierarchy process, and data were collected from an expert group and analyzed with several statistical methods. The result is a model that provides an optimal strategy for the implementation of elements of Logistics 5.0. The implementation priority list of elements is very beneficial for the management of many companies from various types of industries.

K-MEANS CLUSTERING BASED ON OMNIVARIANCE ATTRIBUTE FOR BUILDING DETECTION FROM AIRBORNE LIDAR DATA

Abstract. Building detection is an important process in urban applications. In the last decades, 3D point clouds derived from airborne LiDAR have been widely explored. In this paper, we propose a building detection method based on K-means clustering and the omnivariance attribute derived from eigenvalues. The main contributions lie on the automatic detection without the need for training and optimal neighborhood definition for local attribute estimation. Additionally, one refinement step based on mathematical morphology (MM) operators to minimize the classification errors (commission and omission errors) is proposed. The experiments were conducted in three study areas. In general, the results indicated the potential of proposed method, presenting an average Fscore around 97%.

New diagnostıc perspectives in the management of pediatrıc beta-lactam allergy.

Since overdiagnosis of beta-lactam (BL) allergy is common in the pediatric population, delabeling is a critical part of antimicrobial stewardship. Undesirable consequences of inaccurate BL allergy labeling can be handled by incorporating traditional delabeling or newer risk-based strategies into antibiotic stewardship programs. Conventional assessment of BL allergy relies upon a stepwise algorithm including a clinical history with skin testing followed by drug provocation tests (DPTs). However, a growing number of studies highlighted the suboptimal diagnostic value of skin testing in children. Recently, there has been a paradigm shift in the practice of BL allergy assessment due to recent challenging data which emphasize the safety and accuracy of direct DPTs in children with a suspicion of non-immediate mild cutaneous reactions such as maculopapular eruption, delayed urticaria, and possibly also for benign immediate reactions such as urticaria/angioedema. Identifying low-risk BL allergy patients, in whom skin tests can be skipped and proceeding directly to DPTs could be safe, has become a hot topic in recent years. New risk stratification and predictive modeling studies that have the potential to better predict BL allergy risk status have recently been introduced into the field of drug allergy, particularly in adults. However, in contrast to adults, risk assessment studies in children are rare, and optimal risk definitions are controversial. In the coming years, promising potential methods to elucidate the predictors of BL allergy in children will require multidimensional approaches that may include predictive analytics, artificial intelligence techniques, and point-of-care clinical decision tools.

A Method for Obtaining a DEM with Curved Abscissa from MLS Data for Linear Infrastructure Survey Design

The sudden deterioration of the condition of linear infrastructure networks makes road management a complex task. Knowledge of the surface condition of the pavement is a requirement in order to estimate the causes of instabilities, select the appropriate action and identify all those sections that require urgent intervention. The mobile laser scanning (MLS) technique allows for a fast and safe diagnosis, thus making it possible to plan an early intervention program quickly and cost-effectively. This paper describes a methodology implemented with a twofold purpose: (i) the optimal definition, during the design phase, of the input parameters of the MLS survey (velocity of the vehicle and acquisition rate), defined through the study of the relationship between these parameters and the density of the scanned points and, therefore, with the resolution that allows the analysis of a certain type of pavement distress; (ii) the creation of a Digital Elevation Model with a curved abscissa (DEMc), specific for the analysis of road pavements. The field surveys made and the procedure developed allowed the velocity of the MLS to be associated with the resolution of the DEMc, and thus its capability to highlight distresses at different levels of severity. The creation of the road model is semiautomatic; the height value of each single node of the grid is estimated through spatial interpolation algorithms. Starting from experimental data, a few charts were created that relate the density of the point cloud to the variation of the acquisition rate, together with the minimum resolution. Depending on the type of distress analyzed, it is possible to infer the values to be respected of the parameters. In this way, it should be possible to draw up a few guidelines about MLS surveys addressing linear infrastructures focused on the optimization of the survey design, so as to identify strategies that can maximize benefits with the same available budget.

Radiologic Approach for Skin US.

Radiologic Approach for Skin US.

Microgrid Operation Optimization Using Hybrid System Modeling and Switched Model Predictive Control

Optimization of economic aspects of microgrid operation in both grid-connected and islanded mode leads to contradictive definitions of optimality for both modes. There is no general agreement on how to cope with this duality. To address this issue, as well as modern energy market requirements and a better renewable energy utilization necessity in the case of large facilities, a comprehensive control solution utilizing the appropriate model is needed. In response, the authors propose a hybrid microgrid model covering fundamental features and designed to work in conjunction with two switched receding horizon control laws. A relevant controller is chosen according to the current microgrid operation mode and its cost function tailored to specific demands of the islanded or grid-connected operation. Performed research led to a new switched hybrid model predictive control approach focused on microgrid economic optimization. This approach utilizes an appropriate hybrid microgrid model also contributed by the authors. The introduced solution turned out to be effective in overall energy cost reduction in the case of large commercial facilities, regardless of grid-connection and renewable generation scenarios. Furthermore, it also provides satisfactory renewable energy and storage capabilities utilization in changing grid connection conditions.