Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography

OBJECTIVES: This study assessed the incremental prognostic implications of normal and equivocal exercise technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) and sought to determine its incremental prognostic value, impact on patient management and cost implications. BACKGROUND: The prognostic implications of Tc-99m sestamibi SPECT are not well defined, and risk stratification using this test has not been explored. METHODS: We studied 1,702 patients referred for exercise Tc-99m sestamibi SPECT who were followed up for a mean (+/- SD) of 20 +/- 5 months. Patients with previous percutaneous transluminal coronary angioplasty or coronary artery bypass surgery were excluded. The SPECT studies were assessed using semiquantitative visual analysis. Cardiac death and myocardial infarction were considered "hard" events, and coronary angioplasty and bypass surgery > 60 days after testing were considered "soft" events. RESULTS: Of the 1,702 patients studied, 1,131 had normal or equivocal scan results. A total of 10 events occurred in this group (1 cardiac death and 1 myocardial infarction [0.2% hard events]; 4 coronary angioplasty and 4 bypass surgery procedures [0.7% soft events]). The rates of hard events and referral to catheterization after SPECT were similarly low in patients with a low (< 0.15), intermediate (0.15 to 0.85) and high (> 0.85) post-exercise treadmill test (ETT) likelihood of coronary artery disease. With respect to scan type, patients with normal, probably normal or equivocal scan results had similarly low hard event rates. In the 571 patients with abnormal scan results, there were 43 hard events (7.5%) and 42 soft events (7.4%) (p < 0.001 vs. 1,131 patients with normal scan results for both). When the complete spectrum of scan responses was considered, SPECT provided incremental prognostic value in all patient subgroups analyzed. However, the nuclear scan was cost-effective only in patients with interpretable exercise ECG responses and an intermediate to high post-ETT likelihood of coronary artery disease and in those with uninterpretable exercise ECG responses and an intermediate to high pre-ETT likelihood of coronary artery disease. CONCLUSIONS: Normal or equivocal exercise Tc-99m sestamibi study results are associated with a benign prognosis, even in patients with a high likelihood of coronary artery disease. Although incremental prognostic value is added by nuclear testing in all patient subgroups, a testing strategy incorporating nuclear testing proved to be cost-effective only in the groups with an intermediate to high likelihood of coronary artery disease before scanning.     

Picture-Neutrosophic Trusted Safe Semi-Supervised Fuzzy Clustering for Noisy Data

Clustering is a crucial method for deciphering data structure and producing new information. Due to its significance in revealing fundamental connections between the human brain and events, it is essential to utilize clustering for cognitive research. Dealing with noisy data caused by inaccurate synthesis from several sources or misleading data production processes is one of the most intriguing clustering difficulties. Noisy data can lead to incorrect object recognition and inference. This research aims to innovate a novel clustering approach, named Picture-Neutrosophic Trusted Safe Semi-Supervised Fuzzy Clustering (PNTS3FCM), to solve the clustering problem with noisy data using neutral and refusal degrees in the definition of Picture Fuzzy Set (PFS) and Neutrosophic Set (NS). Our contribution is to propose a new optimization model with four essential components: clustering, outlier removal, safe semi-supervised fuzzy clustering and partitioning with labeled and unlabeled data. The effectiveness and flexibility of the proposed technique are estimated and compared with the state-of-art methods, standard Picture fuzzy clustering (FC-PFS) and Confidence-weighted safe semi-supervised clustering (CS3FCM) on benchmark UCI datasets. The experimental results show that our method is better at least 10/15 datasets than the compared methods in terms of clustering quality and computational time.     

Optimization of sodium sulfide treatment of rice straw to increase the enzymatic hydrolysis in bioethanol production

The efficiency of sodium sulfide-assisted alkaline pulping for cellulose preparation from Oryza sativa L. rice straw in Vietnam for enzymatic saccharification was investigated. The response surface methodology was used for the determination of optimal technological parameters of alkaline pulping such as active alkali dosage, temperature and time. The optimal technological parameters were established to be active alkali dosage of 7%, treatment temperature of 100 °C and treatment time of 120 min. At these regimes, a maximal sugar yield of 51.8% (over dry rice straw) was obtained. It meant that the saccharification efficiency up to 97.1% could be achieved by using sodium sulfide-assisted alkaline pretreatment method. Addition of sodium sulfide into alkaline pretreatment resulted in higher sugar yield, higher level of depolymerization of lignin and less loss of cellulose. Moreover, liquid hydrolyzate after enzymatic hydrolysis was analyzed by HPLC to determine the compositions of sugar mixture. The fiber morphology in pretreated biomass solid was also revealed by SEM.     

A generalized layerwise higher-order shear deformation theory for laminated composite and sandwich plates based on isogeometric analysis

This paper presents a generalized layerwise higher-order shear deformation theory for laminated composite and sandwich plates. We exploit a higher-order shear deformation theory in each layer such that the continuity of the displacement and transverse shear stresses at the layer interfaces is ensured. Thanks for enforcing the continuity of the displacement and transverse shear stresses at an inner-laminar layer, the minimum number of variables is retained from the present theory in comparison with other layerwise theories. The method requires only five variables, the same as what obtained from the first- and higher-order shear deformation theories. In comparison with the shear deformation theories based on the equivalent single layer, the present theory is capable of producing a higher accuracy for inner-laminar layer shear stresses. The free boundary conditions of transverse shear stresses at the top and bottom surfaces of the plate are fulfilled without any shear correction factors. The discrete system equations are derived from the Galerkin weak form, and the solution is obtained by isogeometric analysis (IGA). The discrete form requires the C¹ continuity of the transverse displacement, and hence NURBS basis functions in IGA naturally ensure this condition. The laminated composite and sandwich plates with various geometries, aspect ratios, stiffness ratios and boundary conditions are studied. The obtained results are compared with the 3D elasticity solution, the analytical as well as numerical solutions based on various plate theories.     

Prefrontal cortical projections to the hypothalamus in macaque monkeys

The organization of projections from the macaque orbital and medial prefrontal cortex (OMPFC) to the hypothalamus and related regions of the diencephalon and midbrain was studied with retrograde and anterograde tracing techniques. Almost all of the prefrontal cortical projections to the hypothalamus arise from areas within the "medial prefrontal network," as defined previously by Carmichael and Price ([1996] J. Comp. Neurol. 371:179-207). Outside of the OMPFC, only a few neurons in the temporal pole, anterior cingulate and insular cortex project to the hypothalamus. Axons from the OMPFC also innervate the basal forebrain, zona incerta, and ventral midbrain. Within the medial prefrontal network, different regions project to distinct parts of the hypothalamus. The medial wall areas 25 and 32 send the heaviest projections to the hypothalamus; axons from these areas are especially concentrated in the anterior hypothalamic area and the ventromedial hypothalamic nucleus. Orbital areas 13a, 12o, and Iai, which are related to the medial prefrontal network, selectively innervate the lateral hypothalamic area, especially its posterior part. The cellular regions of the paraventricular, supraoptic, suprachiasmatic, arcuate, and mammillary nuclei are conspicuously devoid of cortical axons, but many axons abut the borders of these nuclei and may contact dendrites that extend from them. Areas within the orbital prefrontal network on the posterior orbital surface and agranular insula send only weak projections to the posterior lateral hypothalamic area. The rostral orbital surface does not contribute to the cortico-hypothalamic projection.     

Distributed model predictive control of dynamically decoupled systems with coupled cost

This paper considers the distributed model predictive control (DMPC) of systems with interacting subsystems having decoupled dynamics and constraints but coupled costs. An easily-verifiable constraint is introduced to ensure asymptotic stability of the overall system in the absence of disturbance. The constraint introduced has a parameter which allows for the performance of the DMPC system to approach that controlled by a centralized model predictive controller. When the subsystems are linear and additive disturbance is present, the added constraint ensures the state of each subsystem converges to its respective minimal disturbance invariant set. The approach is demonstrated via several numerical examples.     

A novel AR-based robot programming and path planning methodology

This paper discusses the benefits of applying Augmented Reality (AR) to facilitate intuitive robot programming, and presents a novel methodology for planning collision-free paths for an n degree-of-freedom (DOF) manipulator in an unknown environment. The targeted applications are where the end-effector is constrained to move along a visible 3D path/curve, which position is unknown, at a particular orientation with respect to the path, such as arc welding and laser cutting. The methodology is interactive as the human is involved in obtaining the 3D data points of the desired curve to be followed through performing a number of demonstrations, defining the free space relevant to the task, and planning the orientations of the end-effector along the curve. A Piecewise Linear Parameterization (PLP) algorithm is used to parameterize the data points using an interactively generated piecewise linear approximation of the desired curve. A curve learning method based on Bayesian neural networks and reparameterization is used to learn and generate 3D parametric curves from the parameterized data points. Finally, the orientation of the end-effector along the learnt curve is planned with the aid of AR. Two case studies are presented and discussed.     

A comparative study of two techniques for improving power‐handling capability of CMOS T/R switches

This article proposes an asymmetric topology for transmit/receive (T/R) switches and more importantly presents a comparative study of both LC‐tuned and resistive body‐floating techniques for improving the power‐handling capability of the T/R switches in the same 0.18‐μm triple‐well CMOS. It is shown from simulations and measurements that the switches adopting either technique achieve comparable performances. For instance, the switch employing the LC‐tuned body‐floating technique exhibits insertion loss of 1.5 dB, isolation of 23.5 dB, and power‐handling capability of 22.5 dBm at 5.2 GHz, whereas the switch using the resistive body‐floating technique exhibits insertion loss of 1.3 dB, isolation of 24 dB, and power‐handling capability of 22.2 dBm, respectively. Therefore, one can conclude that the asymmetric topology with the resistive body‐floating technique is more suitable for designing T/R switches for wireless local area network applications as it consumes smaller silicon area. © 2010 Wiley Periodicals, Inc. Int J RF and Microwave CAE, 2010.