Optimization of treatment strategy used during shockwave lithotripsy to maximize stone fragmentation efficiency.

BACKGROUND AND PURPOSE: Previous studies have demonstrated that treatment strategy plays a critical role in ensuring maximum stone fragmentation during shockwave lithotripsy (SWL). We aimed to develop an optimal treatment strategy in SWL to produce maximum stone fragmentation. MATERIALS AND METHODS: Four treatment strategies were evaluated using an in-vitro experimental setup that mimics stone fragmentation in the renal pelvis. Spherical stone phantoms were exposed to 2100 shocks using the Siemens Modularis (electromagnetic) lithotripter. The treatment strategies included increasing output voltage with 100 shocks at 12.3 kV, 400 shocks at 14.8 kV, and 1600 shocks at 15.8 kV, and decreasing output voltage with 1600 shocks at 15.8 kV, 400 shocks at 14.8 kV, and 100 shocks at 12.3 kV. Both increasing and decreasing voltages models were run at a pulse repetition frequency (PRF) of 1 and 2 Hz. Fragmentation efficiency was determined using a sequential sieving method to isolate fragments less than 2 mm. A fiberoptic probe hydrophone was used to characterize the pressure waveforms at different output voltage and frequency settings. In addition, a high-speed camera was used to assess cavitation activity in the lithotripter field that was produced by different treatment strategies. RESULTS: The increasing output voltage strategy at 1 Hz PRF produced the best stone fragmentation efficiency. This result was significantly better than the decreasing voltage strategy at 1 Hz PFR (85.8% vs 80.8%, P=0.017) and over the same strategy at 2 Hz PRF (85.8% vs 79.59%, P=0.0078). CONCLUSIONS: A pretreatment dose of 100 low-voltage output shockwaves (SWs) at 60 SWs/min before increasing to a higher voltage output produces the best overall stone fragmentation in vitro. These findings could lead to increased fragmentation efficiency in vivo and higher success rates clinically.

Game-Theoretically Allocating Resources to Catch Evaders and Payments to Stabilize Teams

Allocating resources optimally is a nontrivial task, especially when multiple

self-interested agents with conflicting goals are involved. This dissertation

uses techniques from game theory to study two classes of such problems:

allocating resources to catch agents that attempt to evade them, and allocating

payments to agents in a team in order to stabilize it. Besides discussing what

allocations are optimal from various game-theoretic perspectives, we also study

how to efficiently compute them, and if no such algorithms are found, what

computational hardness results can be proved.

The first class of problems is inspired by real-world applications such as the

TOEFL iBT test, course final exams, driver's license tests, and airport security

patrols. We call them test games and security games. This dissertation first

studies test games separately, and then proposes a framework of Catcher-Evader

games (CE games) that generalizes both test games and security games. We show

that the optimal test strategy can be efficiently computed for scored test

games, but it is hard to compute for many binary test games. Optimal Stackelberg

strategies are hard to compute for CE games, but we give an empirically

efficient algorithm for computing their Nash equilibria. We also prove that the

Nash equilibria of a CE game are interchangeable.

The second class of problems involves how to split a reward that is collectively

obtained by a team. For example, how should a startup distribute its shares, and

what salary should an enterprise pay to its employees. Several stability-based

solution concepts in cooperative game theory, such as the core, the least core,

and the nucleolus, are well suited to this purpose when the goal is to avoid

coalitions of agents breaking off. We show that some of these solution concepts

can be justified as the most stable payments under noise. Moreover, by adjusting

the noise models (to be arguably more realistic), we obtain new solution

concepts including the partial nucleolus, the multiplicative least core, and the

multiplicative nucleolus. We then study the computational complexity of those

solution concepts under the constraint of superadditivity. Our result is based

on what we call Small-Issues-Large-Team games and it applies to popular

representation schemes such as MC-nets.

Investigating the Tradespace between Increased Automation and Optimal Manning on Aircraft Carrier Decks

With increasing prevalence and capabilities of autonomous systems as part of complex heterogeneous manned-unmanned environments (HMUEs), an important consideration is the impact of the introduction of automation on the optimal assignment of human personnel. The US Navy has implemented optimal staffing techniques before in the 1990's and 2000's with a "minimal staffing" approach. The results were poor, leading to the degradation of Naval preparedness. Clearly, another approach to determining optimal staffing is necessary. To this end, the goal of this research is to develop human performance models for use in determining optimal manning of HMUEs. The human performance models are developed using an agent-based simulation of the aircraft carrier flight deck, a representative safety-critical HMUE. The Personnel Multi-Agent Safety and Control Simulation (PMASCS) simulates and analyzes the effects of introducing generalized maintenance crew skill sets and accelerated failure repair times on the overall performance and safety of the carrier flight deck. A behavioral model of four operator types (ordnance officers, chocks and chains, fueling officers, plane captains, and maintenance operators) is presented here along with an aircraft failure model. The main focus of this work is on the maintenance operators and aircraft failure modeling, since they have a direct impact on total launch time, a primary metric for carrier deck performance. With PMASCS I explore the effects of two variables on total launch time of 22 aircraft: 1) skill level of maintenance operators and 2) aircraft failure repair times while on the catapult (referred to as Phase 4 repair times). It is found that neither introducing a generic skill set to maintenance crews nor introducing a technology to accelerate Phase 4 aircraft repair times improves the average total launch time of 22 aircraft. An optimal manning level of 3 maintenance crews is found under all conditions, the point at which any additional maintenance crews does not reduce the total launch time. An additional discussion is included about how these results change if the operations are relieved of the bottleneck of installing the holdback bar at launch time.