456 research outputs found

    Parallelized Particle and Gaussian Sum Particle Filters for Large Scale Freeway Traffic Systems

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    Large scale traffic systems require techniques able to: 1) deal with high amounts of data and heterogenous data coming from different types of sensors, 2) provide robustness in the presence of sparse sensor data, 3) incorporate different models that can deal with various traffic regimes, 4) cope with multimodal conditional probability density functions for the states. Often centralized architectures face challenges due to high communication demands. This paper develops new estimation techniques able to cope with these problems of large traffic network systems. These are Parallelized Particle Filters (PPFs) and a Parallelized Gaussian Sum Particle Filter (PGSPF) that are suitable for on-line traffic management. We show how complex probability density functions of the high dimensional trafc state can be decomposed into functions with simpler forms and the whole estimation problem solved in an efcient way. The proposed approach is general, with limited interactions which reduces the computational time and provides high estimation accuracy. The efciency of the PPFs and PGSPFs is evaluated in terms of accuracy, complexity and communication demands and compared with the case where all processing is centralized

    2D PANORAMIC RADIOGRAPHY AND 3D CBCT OF MANDIBULAR CORTICAL LOSS IN SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PATIENTS OF HASAN SADIKIN HOSPITAL: A CROSS SECTIONAL STUDY: RADIOGRAFI PANORAMIK 2D DAN CBCT 3D DARI HILANGNYA TULANG KORTIKAL MANDIBULAR DI SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) PADA PASIEN DI RUMAH SAKIT HASAN SADIKIN: STUDI CROSS SECTIONAL

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      Systemic Lupus Erythematosus (SLE) is an autoimmune rheumatic disease that involves extensive inflammation of the bone regions. Studies showed that the long-term medication in SLE patientsaffects the quantity and quality of bones.This should be considered in any treatment administered, including dental treatment. This study was conducted to analyze mandibular cortical bone loss in SLE patients with 2D panoramic radiography and 3D Cone Beam Computerized Tomography (CBCT). The research was a cross-sectional study to measure 31 SLE Indonesian female outpatients in Internal Medicine Installationat Hasan Sadikin Hospital, Bandung in 2014. The mean age is 37.65±10.79 years with 5.23 ± 4.37 mg corticosteroid intake history for 2–20 years. There was a significant correlation in the mandibular cortical loss analyzed by 3D CBCT imaging based on corticosteroid dosage (p=0.026). In conclusion, the level of mandibular cortical bone loss observed by panoramic radiography was moderate while 3D CBCT imaging showed a severe level of loss in this study

    The filtering equations revisited

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    The problem of nonlinear filtering has engendered a surprising number of mathematical techniques for its treatment. A notable example is the change-of--probability-measure method originally introduced by Kallianpur and Striebel to derive the filtering equations and the Bayes-like formula that bears their names. More recent work, however, has generally preferred other methods. In this paper, we reconsider the change-of-measure approach to the derivation of the filtering equations and show that many of the technical conditions present in previous work can be relaxed. The filtering equations are established for general Markov signal processes that can be described by a martingale-problem formulation. Two specific applications are treated

    Voorstel bouwstenen nieuwe weidevogelpakketten agrarisch natuurbeheer in een notendop : wat regelen we in Nederland, wat in Brussel?

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    In opdracht van directie Kennis van het ministerie van LNV is een voorstel ontwikkeld voor bouwstenen voor nieuwe pakketten weidevogelbeheer. De doelstellingen worden per gebiedsplan vastgesteld. De verantwoordelijkheid hiervoor ligt bij provincies en Rijk, die daarvoor desgewenst een gebiedscommissie in het leven kunnen roepen. Het minimum dat altijd (in alle gebiedsplannen) geldt is: 35 bp /100 ha, bestaande uit één of meer van de volgende soorten: Grutto, Tureluur, Watersnip, Kemphaan, Slobeend, Zomertaling, Veldleeuwerik, Wulp, Kluut, Krakeend, Kuifeend, Wintertaling, Graspieper, Gele kwikstaart, Kievit, Scholekster. Per gebied kan deze doelstelling nader worden gefocust op één of meerdere van bovengenoemde soorten en/of naar boven worden bijgestel

    Two different invitation approaches for consecutive rounds of a Delphi survey led to comparable final outcome

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    Objectives: There are two different approaches to involve participants in consecutive rounds of a Delphi survey: (1) invitation to every round independent of response to the previous round ("all-rounds'') and (2) invitation only when responded to the previous round ("respondents-only''). This study aimed to investigate the effect of invitation approach on the response rate and final outcome of a Delphi survey.Study Design and Setting: Both experts (N = 188) and patients (N = 188) took part in a Delphi survey to update the core outcome set (COS) for axial spondyloarthritis. A study with 1:1 allocation to two experimental groups (ie, "all-rounds'' [N = 187] and "respondents-only'' [N = 189]) was built-in.Results: The overall response rate was lower in the "respondents-only group'' (46%) compared to the "all-rounds group'' (61%). All domains that were selected for inclusion in the COS by the "respondents-only group'' were also selected by the "all-rounds group.'' Additionally, the four most important domains were identical between groups after the final round, with only minor differences in the other domains.Conclusion: Inviting panel members who missed a round to a subsequent round will lead to a better representation of opinions of the originally invited panel and reduces the chance of false consensus, while it does not influence the final outcome of the Delphi. (C) 2020 The Authors. Published by Elsevier Inc.Pathophysiology and treatment of rheumatic disease

    Target-Controlled Infusion of Cefepime in Critically Ill Patients:single center experience

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    Attainment of appropriate pharmacokinetic-pharmacodynamic (PK-PD) targets for antimicrobial treatment is challenging in critically ill patients, particularly for cefepime, which exhibits a relative narrow therapeutic-toxic window compared to other beta-lactam antibiotics. Target-controlled infusion (TCI) systems, which deliver drugs to achieve specific target drug concentrations, have successfully been implemented for improved dosing of sedatives and analgesics in anesthesia. We conducted a clinical trial in an intensive care unit (ICU) to investigate the performance of TCI for adequate target attainment of cefepime. Twenty-one patients treated with cefepime according to the standard of care were included. Cefepime was administered through continuous infusion using TCI for a median duration of 4.5 days. TCI was based on a previously developed population PK model incorporating the estimated creatinine clearance based on the Cockcroft-Gault formula as the input variable to calculate cefepime clearance. A cefepime blood concentration of 16 mg/liter was targeted. To evaluate the measured versus predicted plasma concentrations, blood samples were taken (median of 10 samples per patient), and total cefepime concentrations were measured using ultraperformance liquid chromatography-tandem mass spectrometry. The performance of the TCI system was evaluated using Varvel criteria. Half (50.3%) of the measured cefepime concentrations were within +/- 30% around the target value of 16 mg liter(-1). The wobble was 11.4%, the median performance error (MdPE) was 21.1%, the median absolute performance error (MdAPE) was 32.0%, and the divergence was -3.72% h(-1). Based on these results, we conclude that TCI is useful for dose optimization of cefepime in ICU patients

    Cost-Effectiveness and Cost-Utility of Early Levodopa in Parkinson's Disease

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    Background: In the Levodopa in EArly Parkinson's disease (LEAP) study, 445 patients were randomized to levodopa/carbidopa 100/25 mg three times per day for 80 weeks (early-start) or placebo for 40 weeks followed by levodopa/carbidopa 100/25 mg three times per day for 40 weeks (delayed-start).Objective: This paper reports the results of the economic evaluation performed alongside the LEAP-study.Methods: Early-start treatment was evaluated versus delayed-start treatment, in which the cost-effectiveness analysis (CEA) and the cost-utility analysis (CUA) were performed from the societal perspective, including health care costs among providers, non-reimbursable out-of-pocket expenses of patients, employer costs of sick leave, and lowered productivity while at work. The outcome measure for the CEA was the extra cost per unit decrease on the Unified Parkinson's Disease Rating Scale 80 weeks after baseline. The outcome measure for the CUA was the extra costs per additional quality adjusted life year (QALY) during follow-up.Results: 212 patients in the early-start and 219 patients in the delayed-start group reported use of health care resources. With savings of D 59 per patient (BCa 95% CI: -829, 788) in the early-start compared to the delayed-start group, societal costs were balanced. The early-start group showed a mean of 1.30 QALYs (BCa 95% CI: 1.26, 1.33) versus 1.30 QALYs (BCa 95% CI: 1.27, 1.33) for the delayed-start group. Because of this negligible difference, incremental cost-effectiveness and cost-utility ratios were not calculated.Conclusion: From an economic point of view, this study suggests that early treatment with levodopa is not more expensive than delayed treatment with levodopa.Neurological Motor Disorder

    Randomized Delayed-Start Trial of Levodopa in Parkinson's Disease

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    BACKGROUND Levodopa is the main treatment for symptoms of Parkinson's disease. Determining whether levodopa also has a disease-modifying effect could provide guidance as to when in the course of the disease the treatment with this drug should be initiated. METHODS In a multicenter, double-blind, placebo-controlled, delayed-start trial, we randomly assigned patients with early Parkinson's disease to receive levodopa (100 mg three times per day) in combination with carbidopa (25 mg three times per day) for 80 weeks (early-start group) or placebo for 40 weeks followed by levodopa in combination with carbidopa for 40 weeks (delayed-start group). The primary outcome was the between-group difference in the mean change from baseline to week 80 in the total score on the Unified Parkinson's Disease Rating Scale (UPDRS; scores range from 0 to 176, with higher scores signifying more severe disease). Secondary analyses included the progression of symptoms, as measured by the UPDRS score, between weeks 4 and 40 and the noninferiority of early initiation of treatment to delayed initiation between weeks 44 and 80, with a noninferiority margin of 0.055 points per week. RESULTS A total of 445 patients were randomly assigned: 222 to the early-start group and 223 to the delayed-start group. The mean (+/- SD) UPDRS score at baseline was 28.1 +/- 11.4 points in the early-start group and 29.3 +/- 12.1 points in the delayed-start group. The change in UPDRS score from baseline to week 80 was -1.0 +/- 13.1 points and -2.0 +/- 13.0 points, respectively (difference, 1.0 point; 95% confidence interval [CI], -1.5 to 3.5; P = 0.44); this finding of no significant between-group difference at week 80 implies that levodopa had no disease-modifying effect. Between weeks 4 and 40, the rate of progression of symptoms, as measured in UPDRS points per week, was 0.04 +/- 0.23 in the early-start group and 0.06 +/- 0.34 in the delayed-start group (difference, -0.02; 95% CI, -0.07 to 0.03). The corresponding rates between weeks 44 and 80 were 0.10 +/- 0.25 and 0.03 +/- 0.28 (difference, 0.07; two-sided 90% CI, 0.03 to 0.10); the difference in the rate of progression between weeks 44 and 80 did not meet the criterion for noninferiority of early receipt of levodopa to delayed receipt. The rates of dyskinesia and levodopa-related fluctuations in motor response did not differ significantly between the two groups. CONCLUSIONS Among patients with early Parkinson's disease who were evaluated over the course of 80 weeks, treatment with levodopa in combination with carbidopa had no disease-modifying effect
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