Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

2 Algorithms For 3-Layer Channel Routing

A channel router is an important design aid in the design automation of VLSI circuit layout. Many algorithms have been developed based on various wiring models with routing done on two layers. With the recent advances in VLSI process technology, it is possible to have three independent layers for interconnection. In this paper two algorithms are presented for three-layer channel routing. The first assumes a very simple wiring model. This enables the routing problem to be solved optimally in a time of O(n log n). The second algorithm is for a different wiring model and has an upper bound of O(n2) for its execution time. It uses fewer horizontal tracks than the first algorithm. For the second model the channel width is not bounded by the channel density.

Interval Data Classification under Partial Information: A Chance-Constraint Approach

This paper presents a Chance-constraint Programming approach for constructing maximum-margin classifiers which are robust to interval-valued uncertainty in training examples. The methodology ensures that uncertain examples are classified correctly with high probability by employing chance-constraints. The main contribution of the paper is to pose the resultant optimization problem as a Second Order Cone Program by using large deviation inequalities, due to Bernstein. Apart from support and mean of the uncertain examples these Bernstein based relaxations make no further assumptions on the underlying uncertainty. Classifiers built using the proposed approach are less conservative, yield higher margins and hence are expected to generalize better than existing methods. Experimental results on synthetic and real-world datasets show that the proposed classifiers are better equipped to handle interval-valued uncertainty than state-of-the-art.

Offloading content routing cost from routers

The publish/subscribe paradigm has lately received much attention. In publish/subscribe systems, a specialized event-based middleware delivers notifications of events created by producers (publishers) to consumers (subscribers) interested in that particular event. It is considered a good approach for implementing Internet-wide distributed systems as it provides full decoupling of the communicating parties in time, space and synchronization. One flavor of the paradigm is content-based publish/subscribe which allows the subscribers to express their interests very accurately. In order to implement a content-based publish/subscribe middleware in way suitable for Internet scale, its underlying architecture must be organized as a peer-to-peer network of content-based routers that take care of forwarding the event notifications to all interested subscribers. A communication infrastructure that provides such service is called a content-based network. A content-based network is an application-level overlay network. Unfortunately, the expressiveness of the content-based interaction scheme comes with a price - compiling and maintaining the content-based forwarding and routing tables is very expensive when the amount of nodes in the network is large. The routing tables are usually partially-ordered set (poset) -based data structures. In this work, we present an algorithm that aims to improve scalability in content-based networks by reducing the workload of content-based routers by offloading some of their content routing cost to clients. We also provide experimental results of the performance of the algorithm. Additionally, we give an introduction to the publish/subscribe paradigm and content-based networking and discuss alternative ways of improving scalability in content-based networks. ACM Computing Classification System (CCS): C.2.4 [Computer-Communication Networks]: Distributed Systems - Distributed applications

Free-volume dependent pressure sensitivity of Zr-based bulk metallic glass

Instrumented indentation experiments on a Zr-based bulk metallic glass (BMG) in as-cast, shot-peened and structurally relaxed conditions were conducted to examine the dependence of plastic deformation on its structural state. Results show significant differences in hardness, H, with structural relaxation increasing it and shot peening markedly reducing it, and slightly changed morphology of shear bands around the indents. This is in contrast to uniaxial compressive yield strength, sigma(y), which remains invariant with the change in the structural state of the alloys investigated. The plastic constraint factor, C = H/sigma(y), of the relaxed BMG increases compared with that of the as-cast glass, indicating enhanced pressure sensitivity upon annealing. In contrast, C of the shot-peened layer was found to be similar to that observed in crystalline metals, indicating that severe plastic deformation could eliminate pressure sensitivity. Microscopic origins for this result, in terms of shear transformation zones and free volume, are discussed.

Biologically Inspired Cooperative Routing for Wireless Mobile Sensor Networks

Biological systems present remarkable adaptation, reliability, and robustness in various environments, even under hostility. Most of them are controlled by the individuals in a distributed and self-organized way. These biological mechanisms provide useful resources for designing the dynamical and adaptive routing schemes of wireless mobile sensor networks, in which the individual nodes should ideally operate without central control. This paper investigates crucial biologically inspired mechanisms and the associated techniques for resolving routing in wireless sensor networks, including Ant-based and genetic approaches. Furthermore, the principal contributions of this paper are as follows. We present a mathematical theory of the biological computations in the context of sensor networks; we further present a generalized routing framework in sensor networks by diffusing different modes of biological computations using Ant-based and genetic approaches; finally, an overview of several emerging research directions are addressed within the new biologically computational framework.

High-Throughput Flexible Constraint Length Viterbi Decoders on De Bruijn, Shuffle-Exchange and Butterfly Connected Architectures

Flexible constraint length channel decoders are required for software defined radios. This paper presents a novel scalable scheme for realizing flexible constraint length Viterbi decoders on a de Bruijn interconnection network. Architectures for flexible decoders using the flattened butterfly and shuffle-exchange networks are also described. It is shown that these networks provide favourable substrates for realizing flexible convolutional decoders. Synthesis results for the three networks are provided and a comparison is performed. An architecture based on a 2D-mesh, which is a topology having a nominally lesser silicon area requirement, is also considered as a fourth point for comparison. It is found that of all the networks considered, the de Bruijn network offers the best tradeoff in terms of area versus throughput.

A new constraint programming approach for optimising a coal rail system

Because of the bottlenecking operations in a complex coal rail system, millions of dollars are costed by mining companies. To handle this issue, this paper investigates a real-world coal rail system and aims to optimise the coal railing operations under constraints of limited resources (e.g., limited number of locomotives and wagons). In the literature, most studies considered the train scheduling problem on a single-track railway network to be strongly NP-hard and thus developed metaheuristics as the main solution methods. In this paper, a new mathematical programming model is formulated and coded by optimization programming language based on a constraint programming (CP) approach. A new depth-first-search technique is developed and embedded inside the CP model to obtain the optimised coal railing timetable efficiently. Computational experiments demonstrate that high-quality solutions are obtainable in industry-scale applications. To provide insightful decisions, sensitivity analysis is conducted in terms of different scenarios and specific criteria. Keywords Train scheduling · Rail transportation · Coal mining · Constraint programming

Inventory Routing - A Strategic Management Accounting Perspective

This dissertation develops a strategic management accounting perspective of inventory routing. The thesis studies the drivers of cost efficiency gains by identifying the role of the underlying cost structure, demand, information sharing, forecasting accuracy, service levels, vehicle fleet, planning horizon and other strategic factors as well as the interaction effects among these factors with respect to performance outcomes. The task is to enhance the knowledge of the strategic situations that favor the implementation of inventory routing systems, understanding cause-and-effect relationships, linkages and gaining a holistic view of the value proposition of inventory routing. The thesis applies an exploratory case study design, which is based on normative quantitative empirical research using optimization, simulation and factor analysis. Data and results are drawn from a real world application to cash supply chains. The first research paper shows that performance gains require a common cost component and cannot be explained by simple linear or affine cost structures. Inventory management and distribution decisions become separable in the absence of a set-dependent cost structure, and neither economies of scope nor coordination problems are present in this case. The second research paper analyzes whether information sharing improves the overall forecasting accuracy. Analysis suggests that the potential for information sharing is limited to coordination of replenishments and that central information do not yield more accurate forecasts based on joint forecasting. The third research paper develops a novel formulation of the stochastic inventory routing model that accounts for minimal service levels and forecasting accuracy. The developed model allows studying the interaction of minimal service levels and forecasting accuracy with the underlying cost structure in inventory routing. Interestingly, results show that the factors minimal service level and forecasting accuracy are not statistically significant, and subsequently not relevant for the strategic decision problem to introduce inventory routing, or in other words, to effectively internalize inventory management and distribution decisions at the supplier. Consequently the main contribution of this thesis is the result that cost benefits of inventory routing are derived from the joint decision model that accounts for the underlying set-dependent cost structure rather than the level of information sharing. This result suggests that the value of information sharing of demand and inventory data is likely to be overstated in prior literature. In other words, cost benefits of inventory routing are primarily determined by the cost structure (i.e. level of fixed costs and transportation costs) rather than the level of information sharing, joint forecasting, forecasting accuracy or service levels.

Influence of crack tip constraint on void growth in ductile FCC single crystals

Effect of constraint (stress triaxiality) on void growth near a notch tip in a FCC single crystal is investigated. Finite element simulations within the modified boundary layer framework are conducted using crystal plasticity constitutive equations and neglecting elastic anisotropy. Displacement boundary conditions based on model, elastic, two term K-T field are applied on the outer boundary of a large circular domain. A pre-nucleated void is considered ahead of a stationary notch tip. The interaction between the notch tip and the void is studied under different constraints (T-stress levels) and crystal orientations. It is found that negative T-stress retards the mechanisms of ductile fracture. However, the extent of retardation depends on the crystal orientation. Further, it is found that there exists a particular orientation which delays the ductile fracture processes and hence can potentially improve ductility. This optimal orientation depends on the constraint level. (C) 2010 Published by Elsevier B.V.

Suboptimal Midcourse Guidance of Interceptors for High-Speed Targets with Alignment Angle Constraint

Using the recently developed computationally efficient model predictive static programming and a closely related model predictive spread control concept, two nonlinear suboptimal midcourse guidance laws are presented in this paper for interceptors engaging against incoming high-speed ballistic missiles. The guidance laws are primarily based on nonlinear optimal control theory, and hence imbed effective trajectory optimization concepts into the guidance laws. Apart from being energy efficient by minimizing the control usage throughout the trajectory (minimum control usage leads to minimum turning, and hence leads to minimum induced drag), both of these laws enforce desired alignment constraints in both elevation and azimuth in a hard-constraint sense. This good alignment during midcourse is expected to enhance the effectiveness of the terminal guidance substantially. Both point mass as well as six-degree-of-freedom simulation results (with a realistic inner-loop autopilot based on dynamic inversion) are presented in this paper, which clearly shows the effectiveness of the proposed guidance laws. It has also been observed that, even with different perturbations of missile parameters, the performance of guidance is satisfactory. A comparison study, with the vector explicit guidance scheme proposed earlier in the literature, also shows that the newly proposed model-predictive-static-programming-based and model-predictive-spread-control-based guidance schemes lead to lesser lateral acceleration demand and lesser velocity loss during engagement.

Profile-Based Load Scheduling in Wireless Energy Harvesting Sensors for Data Rate Maximization

In this paper, power management algorithms for energy harvesting sensors (EHS) that operate purely based on energy harvested from the environment are proposed. To maintain energy neutrality, EHS nodes schedule their utilization of the harvested power so as to save/draw energy into/from an inefficient battery during peak/low energy harvesting periods, respectively. Under this constraint, one of the key system design goals is to transmit as much data as possible given the energy harvesting profile. For implementational simplicity, it is assumed that the EHS transmits at a constant data rate with power control, when the channel is sufficiently good. By converting the data rate maximization problem into a convex optimization problem, the optimal load scheduling (power management) algorithm that maximizes the average data rate subject to energy neutrality is derived. Also, the energy storage requirements on the battery for implementing the proposed algorithm are calculated. Further, robust schemes that account for the insufficiency of battery storage capacity, or errors in the prediction of the harvested power are proposed. The superior performance of the proposed algorithms over conventional scheduling schemes are demonstrated through computations using numerical data from solar energy harvesting databases.

A System-C based Micro architectural Exploration Framework for Latency, Power and Performance Trade-offs of On-Chip Interconnection

We describe a System-C based framework we are developing, to explore the impact of various architectural and microarchitectural level parameters of the on-chip interconnection network elements on its power and performance. The framework enables one to choose from a variety of architectural options like topology, routing policy, etc., as well as allows experimentation with various microarchitectural options for the individual links like length, wire width, pitch, pipelining, supply voltage and frequency. The framework also supports a flexible traffic generation and communication model. We provide preliminary results of using this framework to study the power, latency and throughput of a 4x4 multi-core processing array using mesh, torus and folded torus, for two different communication patterns of dense and sparse linear algebra. The traffic consists of both Request-Response messages (mimicing cache accesses)and One-Way messages. We find that the average latency can be reduced by increasing the pipeline depth, as it enables higher link frequencies. We also find that there exists an optimum degree of pipelining which minimizes energy-delay product.

Unified Vdd Vth Optimization Based DVFM Controller for a Logic Block

In this paper analytical expressions for optimal Vdd and Vth to minimize energy for a given speed constraint are derived. These expressions are based on the EKV model for transistors and are valid in both strong inversion and sub threshold regions. The effect of gate leakage on the optimal Vdd and Vth is analyzed. A new gradient based algorithm for controlling Vdd and Vth based on delay and power monitoring results is proposed. A Vdd-Vth controller which uses the algorithm to dynamically control the supply and threshold voltage of a representative logic block (sum of absolute difference computation of an MPEG decoder) is designed. Simulation results using 65 nm predictive technology models are given.

Impact of Energy Expenditure Rate Constraints on the performance of Multihop Wireless Mesh Networks

In this article we study the problem of joint congestion control, routing and MAC layer scheduling in multi-hop wireless mesh network, where the nodes in the network are subjected to maximum energy expenditure rates. We model link contention in the wireless network using the contention graph and we model energy expenditure rate constraint of nodes using the energy expenditure rate matrix. We formulate the problem as an aggregate utility maximization problem and apply duality theory in order to decompose the problem into two sub-problems namely, network layer routing and congestion control problem and MAC layer scheduling problem. The source adjusts its rate based on the cost of the least cost path to the destination where the cost of the path includes not only the prices of the links in it but also the prices associated with the nodes on the path. The MAC layer scheduling of the links is carried out based on the prices of the links. We study the e�ects of energy expenditure rate constraints of the nodes on the optimal throughput of the network.