An intelligent automated robotic assembly system consists of several subsystems capable of providing dynamic interactions with the environment in order to accomplish a task properly. These subsystems ...perform various functions like data gathering, decision making, and task execution. Although a great deal of work has been done on individual subsystems, more attention must be given to the way how these subsystems are integrated so as to achieve the high efficiency of automated production. We propose a cooperative multi-agent model of a shop floor control system architecture of robotic assembly automation and extend this model to all automated production system. Based on this model, we develop a control kernel named TOFAK (task oriented flexible automation kernel) to support users to easily implement any shop floor control system. The by-product is to allow system designers to easily expand an existing system or to integrate several automation systems which are all controlled by TOFAK.
Intratumor heterogeneity is a major clinical problem because tumor cell subtypes display variable sensitivity to therapeutics and may play different roles in progression. We previously characterized ...2 cell populations in human breast tumors with distinct properties: CD44+CD24- cells that have stem cell-like characteristics, and CD44-CD24+ cells that resemble more differentiated breast cancer cells. Here we identified 15 genes required for cell growth or proliferation in CD44+CD24- human breast cancer cells in a large-scale loss-of-function screen and found that inhibition of several of these (IL6, PTGIS, HAS1, CXCL3, and PFKFB3) reduced Stat3 activation. We found that the IL-6/JAK2/Stat3 pathway was preferentially active in CD44+CD24- breast cancer cells compared with other tumor cell types, and inhibition of JAK2 decreased their number and blocked growth of xenografts. Our results highlight the differences between distinct breast cancer cell types and identify targets such as JAK2 and Stat3 that may lead to more specific and effective breast cancer therapies.
Objective: Most automatic cuff blood pressure (BP) measurement devices are based on oscillometry. These devices estimate BP from the envelopes of the cuff pressure oscillations using fixed ratios. ...The values of the fixed ratios represent population averages, so the devices may only be accurate in subjects with normal BP levels. The objective was to develop and demonstrate the validity of a patient-specific oscillometric BP measurement method. Methods: The idea of the developed method was to represent the cuff pressure oscillation envelopes with a physiologic model, and then estimate the patient-specific parameters of the model, which includes BP levels, by optimally fitting it to the envelopes. The method was investigated against gold standard reference BP measurements from 57 patients with widely varying pulse pressures. A portion of the data was used to optimize the patient-specific method and a fixed-ratio method, while the remaining data were used to test these methods and a current office device. Results: The patient-specific method yielded BP root-mean-square-errors ranging from 6.0 to 9.3 mmHg. On an average, these errors were nearly 40% lower than the errors of each existing method. Conclusion: The patient-specific method may improve automatic cuff BP measurement accuracy. Significance: A patient-specific oscillometric BP measurement method was proposed and shown to be more accurate than the conventional method and a current device.
There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes.
The study aimed to assess the impact ...of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes.
Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively.
A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement TAVR, n = 3,889 and surgical AVR SAVR, n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio HR: 0.17; 95% confidence interval CI: 0.05–0.60; p = 0.006).
In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined. (Placement of AoRTic TraNscathetER Valves PARTNERII A; NCT01314313)
Display omitted
Current oscillometric devices for monitoring central blood pressure (BP) maintain the cuff pressure at a constant level to acquire a pulse volume plethysmography (PVP) waveform and calibrate it to ...brachial BP levels estimated with population average methods. A physiologic method was developed to further advance central BP measurement. A patient-specific method was applied to estimate brachial BP levels from a cuff pressure waveform obtained during conventional deflation via a nonlinear arterial compliance model. A physiologically-inspired method was then employed to extract the PVP waveform from the same waveform via ensemble averaging and calibrate it to the brachial BP levels. A method based on a wave reflection model was thereafter employed to define a variable transfer function, which was applied to the calibrated waveform to derive central BP. This method was evaluated against invasive central BP measurements from patients. The method yielded central systolic, diastolic, and pulse pressure bias and precision errors of -0.6 to 2.6 and 6.8 to 9.0 mmHg. The conventional oscillometric method produced similar bias errors but precision errors of 8.2 to 12.5 mmHg (p ≤ 0.01). The new method can derive central BP more reliably than some current non-invasive devices and in the same way as traditional cuff BP.
Oscillometric devices are widely used for automatic cuff blood pressure (BP) measurement. These devices estimate BP from the oscillometric cuff pressure waveform using population average methods. ...Hence, the devices may only be accurate over a limited BP range. The objective was to evaluate a new patient-specific method, which estimates BP by fitting a physiologic model to the same waveform. One-hundred and forty-five cardiac catheterization patients and normal adults were included for study. The oscillometric cuff pressure waveform was obtained with an office device, while reference BP was measured via brachial artery catheterization or auscultation, during baseline and/or nitroglycerin administration. Fifty-seven of the subject records were utilized for refining the patient-specific method, while the remaining 88 subject records were employed for evaluation. The precision errors for all BP levels of the patient-specific method ranged from 6.3 to 7.6 mmHg. These errors were significantly lower than those of the office device (by 29% on average) in subjects with high pulse pressure (>50 mmHg) while being comparable to those of the device in subjects with normal pulse pressure (<;50 mmHg). The bias and precision of the differences in repeated estimates for all BP levels of the patient-specific method ranged from 0.1 to 1.1 and 2.1 to 5.9 mmHg, respectively. These precision differences were significantly lower than those of the office device (by 64% on average). The patient-specific method may afford more accurate automatic cuff BP measurement in patients with large artery stiffening while limiting the number of required cuff inflations/deflations per measurement.
A recent randomized trial reported fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy was noninferior to the intracoronary ultrasound (IVUS)-guided PCI strategy ...with respect to clinical outcomes with fewer revascularizations.
This study sought to investigate the sex differences in treatment and clinical outcomes according to physiology- or imaging-guided PCI strategies.
In this secondary analysis of the FLAVOUR (Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI) trial, the impact of sex on procedural characteristics, PCI rate, and outcomes according to different strategies and treatment types (PCI vs deferral of PCI) was analyzed. The primary outcome was target vessel failure (TVF) at 24 months, defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization.
Of 1,619 patients, 30% were women. Compared with men, women had a smaller minimal lumen area, smaller plaque burden, and higher FFR. They had a lower PCI rate (40.8% vs 47.9%; P = 0.008), which was mainly contributed by FFR guidance. Overall, women showed a lower TVF rate (2.4% vs 4.5%). According to the treatment type, the cumulative incidence of TVF was lower in women than in men among those with the deferral of PCI (1.7% vs 5.2%). However, this trend was not observed in patients who underwent PCI. In both women and men, there were no differences in clinical outcomes between the FFR- and IVUS-guided strategies.
In cases of intermediate stenosis, despite receiving fewer interventions, women had more favorable outcomes than men. The use of FFR led to a lower PCI rate but had a similar prognostic value compared with IVUS in both women and men.
Display omitted
The high instantaneous luminosities expected following the upgrade of the Large Hadron Collider (LHC) to the High-Luminosity LHC (HL-LHC) pose major experimental challenges for the CMS experiment. A ...central component to allow efficient operation under these conditions is the reconstruction of charged particle trajectories and their inclusion in the hardware-based trigger system. There are many challenges involved in achieving this: a large input data rate of about 20–40 Tb/s processing a new batch of input data every 25 ns, each consisting of about 15,000 precise position measurements and rough transverse momentum measurements of particles (“stubs”); performing the pattern recognition on these stubs to find the trajectories; and producing the list of trajectory parameters within 4 μs. This paper describes a proposed solution to this problem, specifically, it presents a novel approach to pattern recognition and charged particle trajectory reconstruction using an all-FPGA solution. The results of an end-to-end demonstrator system, based on Xilinx Virtex-7 FPGAs, that meets timing and performance requirements are presented along with a further improved, optimized version of the algorithm together with its corresponding expected performance.
Most automatic cuff blood pressure (BP) measurement devices are based on oscillometry. These devices compute BP from the envelope of the oscillometric cuff pressure waveform using fixed-ratios. The ...fixed-ratio values are derived from population averages. As a result, the devices are often inaccurate in patients with stiff arteries. Our hypothesis is that oscillometry can be made more accurate in this important patient population by physical modeling of the phenomenon. We studied 126 patients (ages 38-85, 97 males) referred for diagnostic cardiac catheterization at the Taipei Veterans General Hospital under IRB approval. We obtained oscillometric cuff pressure waveforms for analysis using a commercial device (Omron VP1000 or Microlife WatchBP Office) and reference BP waveforms via an invasive catheter in the opposite brachial artery. We recorded these waveforms before and after sublingual nitroglycerin in many of the patients. We divided the data into a training set comprising 57 of the patient records and a testing set consisting of the remaining 69 patient records. We used the training dataset to develop a method to compute BP from the oscillometric cuff pressure waveform based on a physical model. In contrast to existing devices, the model-based method simultaneously determines BP and the arterial stiffness of the patient. In this way, the method is patient-specific rather than population-based. We used the testing dataset to evaluate the new method against the reference BP levels as well as to compare its accuracy to the commercial device. The Table illustrates the resulting BP errors. The model-based method showed, on average, 28% lower precision errors than the commercial device (statistically significant via Pitman-Morgan test with Bonferroni correction for multiple comparisons) and 41% less absolute BP errors exceeding 10 mmHg. In conclusion, the model-based method may afford more accurate automatic cuff BP measurement in patients with stiff arteries.
PDF
