Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

Agent-based simulation for renewable energy incentive design

In this thesis, we propose a novel approach to model the diffusion of residential PV systems. For this purpose, we use an agent-based model where agents are the families living in the area of interest. The case study is the Emilia-Romagna Regional Energy plan, which aims to increase the produc- tion of electricity from renewable energy. So, we study the microdata from the Survey on Household Income and Wealth (SHIW) provided by Bank of Italy in order to obtain the characteristics of families living in Emilia-Romagna. These data have allowed us to artificial generate families and reproduce the socio-economic aspects of the region. The families generated by means of a software are placed on the virtual world by associating them with the buildings. These buildings are acquired by analysing the vector data of regional buildings made available by the region. Each year, the model determines the level of diffusion by simulating the installed capacity. The adoption behaviour is influenced by social interactions, household’s economic situation, the environmental benefits arising from the adoption and the payback period of the investment.

Self-reference Scrubber for TMR Systems Based on Xilinx Virtex FPGAs

SRAM-based FPGAs are sensitive to radiation effects. Soft errors can appear and accumulate, potentially defeating mitigation strategies deployed at the Application Layer. Therefore, Configuration Memory scrubbing is required to improve radiation tolerance of such FPGAs in space applications. Virtex FPGAs allow runtime scrubbing by means of dynamic partial reconfiguration. Even with scrubbing, intra-FPGA TMR systems are subjected to common-mode errors affecting more than one design domain. This is solved in inter-FPGA TMR systems at the expense of a higher cost, power and mass. In this context, a self-reference scrubber for device-level TMR system based on Xilinx Virtex FPGAs is presented. This scrubber allows for a fast SEU/MBU detection and correction by peer frame comparison without needing to access a golden configuration memory

Dynamic rupture in a 3-D particle-based simulation of a rough planar fault

An appreciation of the physical mechanisms which cause observed seismicity complexity is fundamental to the understanding of the temporal behaviour of faults and single slip events. Numerical simulation of fault slip can provide insights into fault processes by allowing exploration of parameter spaces which influence microscopic and macroscopic physics of processes which may lead towards an answer to those questions. Particle-based models such as the Lattice Solid Model have been used previously for the simulation of stick-slip dynamics of faults, although mainly in two dimensions. Recent increases in the power of computers and the ability to use the power of parallel computer systems have made it possible to extend particle-based fault simulations to three dimensions. In this paper a particle-based numerical model of a rough planar fault embedded between two elastic blocks in three dimensions is presented. A very simple friction law without any rate dependency and no spatial heterogeneity in the intrinsic coefficient of friction is used in the model. To simulate earthquake dynamics the model is sheared in a direction parallel to the fault plane with a constant velocity at the driving edges. Spontaneous slip occurs on the fault when the shear stress is large enough to overcome the frictional forces on the fault. Slip events with a wide range of event sizes are observed. Investigation of the temporal evolution and spatial distribution of slip during each event shows a high degree of variability between the events. In some of the larger events highly complex slip patterns are observed.

Agent-based simulation of lock-in dynamics in a duopoly

Lock-in is observed in real world markets of experience goods; experience goods are goods whose characteristics are difficult to determine in advance, but ascertained upon consumption. We create an agent-based simulation of consumers choosing between two experience goods available in a virtual market. We model consumers in a grid representing the spatial network of the consumers. Utilising simple assumptions, including identical distributions of product experience and consumers having a degree of follower tendency, we explore the dynamics of the model through simulations. We conduct simulations to create a lock-in before testing several hypotheses upon how to break an existing lock-in; these include the effect of advertising and free give-away. Our experiments show that the key to successfully breaking a lock-in required the creation of regions in a consumer population. Regions arise due to the degree of local conformity between agents within the regions, which spread throughout the population when a mildly superior competitor was available. These regions may be likened to a niche in a market, which gains in popularity to transition into the mainstream.

Modelling e-business processes:a component-based simulation approach

With new and emerging e-business technologies to transform business processes, it is important to understand how those technologies will affect the performance of a business. Will the overall business process be cheaper, faster and more accurate or will a sub-optimal change have been implemented? The use of simulation to model the behaviour of business processes is well established, and it has been applied to e-business processes to understand their performance in terms of measures such as lead-time, cost and responsiveness. This paper introduces the concept of simulation components that enable simulation models of e-business processes to be built quickly from generic e-business templates. The paper demonstrates how these components were devised, as well as the results from their application through case studies.

The reliability mathematical model of load-sharing parallel systems based on fatigue cumulative damage

Conventional reliability models for parallel systems are not applicable for the analysis of parallel systems with load transfer and sharing. In this short communication, firstly, the dependent failures of parallel systems are analyzed, and the reliability model of load-sharing parallel system is presented based on Miner cumulative damage theory and the full probability formula. Secondly, the parallel system reliability is calculated by Monte Carlo simulation when the component life follows the Weibull distribution. The research result shows that the proposed reliability mathematical model could analyze and evaluate the reliability of parallel systems in the presence of load transfer.

Some parameters that affect CDMA capacity analysis. Results using GIS based simulation

In previous papers we describe a model for capacity analysis in CDMA systems using DC-Cell, a GIS based planning tool developed at Universidad Politecnica de Valencia, and MATLAB. We show some initial results of that model, and now, we are exploring different parameters like cell size, proximity between cells, number of cells in the system and “clustering” CDMA in order to improve the planning process for third generation systems. In this paper we show the results for variations of some of these parameters, specifically the cell size and number of cells. In CDMA systems is quite common to suppose only one carrier frequency for capacity estimation, and it is intuitive to think that for more base stations, mean more users. However the multiple access interference problem in CDMA systems could establish a limit for that supposition in a similar way that occurs in FDMA and TDMA systems.

Human Behavious Modelling for Discrete Event and Agent Based Simulation: A Case Study

This study is about the comparison of simulation techniques between Discrete Event Simulation (DES) and Agent Based Simulation (ABS). DES is one of the best-known types of simulation techniques in Operational Research. Recently, there has been an emergence of another technique, namely ABS. One of the qualities of ABS is that it helps to gain a better understanding of complex systems that involve the interaction of people with their environment as it allows to model concepts like autonomy and pro-activeness which are important attributes to consider. Although there is a lot of literature relating to DES and ABS, we have found none that focuses on exploring the capability of both in tackling the human behaviour issues which relates to queuing time and customer satisfaction in the retail sector. Therefore, the objective of this study is to identify empirically the differences between these simulation techniques by stimulating the potential economic benefits of introducing new policies in a department store. To apply the new strategy, the behaviour of consumers in a retail store will be modelled using the DES and ABS approach and the results will be compared. We aim to understand which simulation technique is better suited to human behaviour modelling by investigating the capability of both techniques in predicting the best solution for an organisation in using management practices. Our main concern is to maximise customer satisfaction, for example by minimising their waiting times for the different services provided.

Collaborative Web-Based Simulation Platform for Construction Project Planning

Part 13: Virtual Reality and Simulation

Prediction of adjacent vertebral fracture risk associated with vertebroplasty : a computer-based simulation study

Vertebrplasty involved injecting cement into a fractured vertebra to provide stabilisation. There is clinical evidence to suggest however that vertebroplasty may be assocated with a higher risk of adjacent vertebral fracture; which may be due to the change in material properties of the post-procedure vertebra modifying the transmission of mechanical stresses to adjacent vertebrae.

Collaborative Filtering Recommender Systems based on Popular Tags

The social tags in web 2.0 are becoming another important information source to profile users' interests and preferences for making personalized recommendations. However, the uncontrolled vocabulary causes a lot of problems to profile users accurately, such as ambiguity, synonyms, misspelling, low information sharing etc. To solve these problems, this paper proposes to use popular tags to represent the actual topics of tags, the content of items, and also the topic interests of users. A novel user profiling approach is proposed in this paper that first identifies popular tags, then represents users’ original tags using the popular tags, finally generates users’ topic interests based on the popular tags. A collaborative filtering based recommender system has been developed that builds the user profile using the proposed approach. The user profile generated using the proposed approach can represent user interests more accurately and the information sharing among users in the profile is also increased. Consequently the neighborhood of a user, which plays a crucial role in collaborative filtering based recommenders, can be much more accurately determined. The experimental results based on real world data obtained from Amazon.com show that the proposed approach outperforms other approaches.