Depth of anesthesia control using internal model control techniques

The major difficulty in the design of closed-loop control during anaesthesia is the inherent patient variability due to differences in demographic and drug tolerance. These discrepancies are translated into the pharmacokinetics (PK), and pharmacodynamics (PD). These uncertainties may affect the stability of the closed loop control system. This paper aims at developing predictive controllers using Internal Model Control technique. This study develops patient dose-response models and to provide an adequate drug administration regimen for the anaesthesia to avoid under or over dosing of the patients. The controllers are designed to compensate for patients inherent drug response variability, to achieve the best output disturbance rejection, and to maintain optimal set point response. The results are evaluated compared with traditional PID controller and the performance is confirmed in our simulation

Robust internal model control for depth of anaesthesia

This paper investigates the depth of anaesthesia control problem during a surgery, where paralytic, analgesic and hypnotic are regulated by means of monitored administration of specific drugs. A robust internal model controller (RIMC) based on the Bispectral Index (BIS) is proposed. The controller compares the measured BIS with its input reference to provide the expected propofol concentration, and then the controller manipulates the anaesthetic propofol concentration entering the anaesthetic system to achieve the desired BIS value. This study develops patient dose-response models and provides an adequate drug administration regimen to avoid under or over dosing of patients. Numerical simulations illustrate that the RIMC performed better than the traditional PID controller. The robust performance of the two controllers is evaluated for a wide range of patient models by varying in patient parameters. The other relative performance is also compared for different BIS step settings

Optimal Sizing of Battery Storage Systems for Industrial Applications when Uncertainties Exist

in fact, we think that the sizing procedure must properly take into account the unavoidable uncertainties introduced by the cost of electricity and the load demands of industrial facilities. Three approaches provided by Decision Theory were applied, and they were based on: (1) the minimization of expected cos

Effects of reduced-risk nicotine-delivery products on smoking prevalence and cigarette sales: an observational study

BACKGROUND: It is not currently clear what impact alternative nicotine-delivery products (electronic cigarettes, heated tobacco products and snus) have on smoking rates and cigarette sales. OBJECTIVE: To assess whether access to these products promotes smoking in the population. DESIGN AND DATA SOURCES: We examined associations of alternative nicotine product use and sales with smoking rates and cigarette sales overall, and in different age and socioeconomic groups, and compared smoking prevalence over time in countries with contrasting regulations of these products. For electronic cigarettes, we examined data from countries with historically similar smoking trajectories but differing current electronic cigarette regulations (United Kingdom and United States of America vs. Australia, where sales of nicotine-containing electronic cigarettes are banned); for heated tobacco, we used data from countries with state tobacco monopolies, where cigarette and heated tobacco sales data are available (Japan, South Korea), and for snus we used data from Sweden. ANALYSIS METHODS: We pre-specified dynamic time series analyses to explore associations between use and sales of alternative nicotine-delivery products and smoking prevalence and cigarette sales, and time series analyses to compare trends of smoking prevalence in countries with different nicotine product policies. RESULTS: Because of data and analysis limitations (see below), results are only tentative and need to be interpreted with caution. Only a few findings reached statistical significance and for most results the Bayes factor indicated inconclusive evidence. We did not find an association between rates of smoking and rates of the use of alternative nicotine products. The increase in heated tobacco product sales in Japan was accompanied by a decrease in cigarette sales. The decline in smoking prevalence seems to have been slower in Australia than in the United Kingdom overall, and slower than in both the United Kingdom and the United States of America among young people and also in lower socioeconomic groups. The decline in cigarette sales has also accelerated faster in the United Kingdom than in Australia. LIMITATIONS: Most of the available data had insufficient data points for robust time series analyses. The assumption of our statistical approach that causal interactions are more likely to be detected when longer-term changes are screened out may not apply for short time series and in product interaction scenarios, where short-term fluctuations can be caused by, for example, fluctuations in prosperity or product supplies. In addition, due to dual use, prevalence figures for smoking and alternative product use overlap. The ecological study design limits the causal inferences that can be made. Longer time periods are needed for any effects of exclusive use of the new products on smoking prevalence to emerge. CONCLUSIONS: We detected some indications that alternative nicotine products are competing with cigarettes rather than promoting smoking and that regulations that allow their sales are associated with a reduction rather than an increase of smoking, but the findings are inconclusive because of insufficient data points and issues with the assumptions of the pre-specified statistical analyses. FUTURE WORK: As further prevalence and sales data emerge the analyses will become more informative. Accessing sales figures in particular is the current research priority. STUDY REGISTRATION: The project is registered on Open Science Framework https://osf.io/bd3ah. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR129968) and will be published in full in Public Health Research; Vol. 11, No. 7. See the NIHR Journals Library website for further project information

Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12- and folic acid supplement use, and biomarkers (serum B12 [B12], plasma total-homocysteine [tHcy], plasma-methylmalonic acid [MMA], and serum-folate). Vegans (n=115) and vegetarians (n=90) completed a 24-hour dietary recall and a food-frequency questionnaire and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status were adequate in both vegans and vegetarians according to the cB12 indicator, however 4% had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357pmol/L, 9.0µmol/L, 0.18µmol/L, 1.30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25.8nmol/L, vegetarians: 21.6nmol/L, p=0.027). Serum B12 concentration <221pmol/L, was found in 14% of all participants. Vegetarians revealed the highest proportion of participants below the RDI of 2 µg/day including supplements (40 vs. 18%, p<0.001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (<10 nmol/L) was uncommon overall (<2.5%). The combined indicator cB12 suggested that none of the participants was B12 depleted, however low serum B12 concentration was found in 14% of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians.publishedVersionPaid open acces

Comparative phase imaging of live cells by digital holographic microscopy and transport of intensity equation methods

We describe a microscopic setup implementing phase imaging by digital holographic microscopy (DHM) and transport of intensity equation (TIE) methods, which allows the results of both measurements to be quantitatively compared for either live cell or static samples. Digital holographic microscopy is a well-established method that provides robust phase reconstructions, but requires a sophisticated interferometric imaging system. TIE, on the other hand, is directly compatible with bright-field microscopy, but is more susceptible to noise artifacts. We present results comparing DHM and TIE on a custom-built microscope system that allows both techniques to be used on the same cells in rapid succession, thus permitting the comparison of the accuracy of both methods

Temperature effects on incidence of surgery for acute type A aortic dissection in the Nordics

Peer reviewe

Impact of national holidays and weekends on incidence of acute type A aortic dissection repair

Publisher Copyright: © 2022, The Author(s).Previous studies have demonstrated that environmental and temporal factors may affect the incidence of acute type A aortic dissection (ATAAD). Here, we aimed to investigate the hypothesis that national holidays and weekends influence the incidence of surgery for ATAAD. For the period 1st of January 2005 until 31st of December 2019, we investigated a hypothesised effect of (country-specific) national holidays and weekends on the frequency of 2995 surgical repairs for ATAAD at 10 Nordic cities included in the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) collaboration. Compared to other days, the number of ATAAD repairs were 29% (RR 0.71; 95% CI 0.54–0.94) lower on national holidays and 26% (RR 0.74; 95% CI 0.68–0.82) lower on weekends. As day of week patterns of symptom duration were assessed and the primary analyses were adjusted for period of year, our findings suggest that the reduced surgical incidence on national holidays and weekends does not seem to correspond to seasonal effects or surgery being delayed and performed on regular working days.Peer reviewe

Once after a full moon : acute type A aortic dissection and lunar phases

Publisher Copyright: © 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.OBJECTIVES: Acute type A aortic dissection (ATAAD) is a rare but severe condition, routinely treated with emergent cardiac surgery. Many surgeons have the notion that patients with ATAAD tend to come in clusters, but no studies have examined these observations. This investigation was undertaken to study the potential association between the lunar cycle and the incidence of ATAAD. METHODS: We collected information on 2995 patients who underwent ATAAD surgery at centres from the Nordic Consortium for Acute Type A Aortic Dissection collaboration. We cross-referenced the time of surgery with lunar phase using a case-crossover design with 2 different definitions of full moon (>99% illumination and the 7-day full moon period). RESULTS: The period when the moon was illuminated the most (99% definition) did not show any significant increase in incidence for ATAAD surgery. However, when the full moon period was compared with all other moon phases, it yielded a relative risk of 1.08 [95% confidence interval (CI) 1.00-1.17, P = 0.057] and, compared to waxing moon, only the relative risk was 1.11 (95% CI 1.01-1.23, P = 0.027). The peak incidence came 4-6 days after the moon was fully illuminated. CONCLUSIONS: This study found an overrepresentation of surgery for ATAAD during the full moon phase. The explanation for this is not known, but we speculate that sleep deprivation during full moon leads to a temporary increase in blood pressure, which in turn could trigger rupture of the aortic wall. While this finding is interesting, it needs to be corroborated and the clinical implications are debateable.Peer reviewe