Nonlinear dynamics of the patient’s response to drug effect during general anesthesia

In today’s healthcare paradigm, optimal sedation during anesthesia plays an important role both in patient welfare and in the socio-economic context. For the closed-loop control of general anesthesia, two drugs have proven to have stable, rapid onset times: propofol and remifentanil. These drugs are related to their effect in the bispectral index, a measure of EEG signal. In this paper wavelet time–frequency analysis is used to extract useful information from the clinical signals, since they are time-varying and mark important changes in patient’s response to drug dose. Model based predictive control algorithms are employed to regulate the depth of sedation by manipulating these two drugs. The results of identification from real data and the simulation of the closed loop control performance suggest that the proposed approach can bring an improvement of 9% in overall robustness and may be suitable for clinical practice.

Visualizing control systems performance: A fractional perspective

This article presents a novel method for visualizing the control systems behavior. The proposed scheme uses the tools of fractional calculus and computes the signals propagating within the system structure as a time/frequency-space wave. Linear and nonlinear closed-loop control systems are analyzed, for both the time and frequency responses, under the action of a reference step input signal. Several nonlinearities, namely, Coulomb friction and backlash, are also tested. The numerical experiments demonstrate the feasibility of the proposed methodology as a visualization tool and motivate its extension for other systems and classes of nonlinearities.

Développement d’un système d’administration de l’anesthésie en boucle fermée

En salle d’opération, les tâches de l’anesthésiste sont nombreuses. Alors que l’utilisation de nouveaux outils technologiques l’informe plus fidèlement sur ce qui se passe pour son patient, ces outils font que ses tâches deviennent plus exigeantes. En vue de diminuer cette charge de travail, nous avons considérer l’administration automatique d’agents anesthésiques en se servant de contrôle en boucle fermée. À cette fin, nous avons développé un système d’administration d’un agent anesthésique (le propofol) visant à maintenir à un niveau optimal la perte de conscience du patient pendant toute la durée d’une chirurgie. Le système comprend un ordinateur, un moniteur d’anesthésie et une pompe de perfusion. L’ordinateur est doté d’un algorithme de contrôle qui, à partir d’un indice (Bispectral IndexTM ou BIS) fournit par le moniteur d’anesthésie détermine le taux d’infusion de l’agent anesthésiant. Au départ, l’anesthésiste choisit une valeur cible pour la variable de contrôle BIS et l’algorithme, basé sur système expert, calcule les doses de perfusion de propofol de sorte que la valeur mesurée de BIS se rapproche le plus possible de la valeur cible établie. Comme interface-utilisateur pour un nouveau moniteur d’anesthésie, quatre sortes d’affichage ont été considérés: purement numérique, purement graphique, un mélange entre graphique et numérique et un affichage graphique intégré (soit bidimensionnel). À partir de 20 scenarios différents où des paramètres normaux et anormaux en anesthésie étaient présentés à des anesthésistes et des résidents, l’étude des temps de réaction, de l’exactitude des réponses et de la convivialité (évaluée par le NASA-TLX) a montré qu’un affichage qui combine des éléments graphiques et numériques était le meilleur choix comme interface du système. Une étude clinique a été réalisée pour comparer le comportement du système d’administration de propofol en boucle fermée comparativement à une anesthésie contrôlée de façon manuelle et conventionnelle où le BIS était aussi utilisé. Suite à l’approbation du comité d’éthique et le consentement de personnes ayant à subir des chirurgies générales et orthopédiques, 40 patients ont été distribués également et aléatoirement soit dans le Groupe contrôle, soit dans le Groupe boucle fermée. Après l’induction manuelle de propofol (1.5 mg/kg), le contrôle en boucle fermée a été déclenché pour maintenir l’anesthésie à une cible de BIS fixée à 45. Dans l’autre groupe, le propofol a été administré à l’aide d’une pompe de perfusion et l’anesthésiste avait aussi à garder manuellement l’indice BIS le plus proche possible de 45. En fonction du BIS mesuré, la performance du contrôle exercé a été définie comme excellente pendant les moments où la valeur du BIS mesurée se situait à ±10% de la valeur cible, bonne si comprise de ±10% à ±20%, faible si comprise de ±20% à ±30% ou inadéquate lorsque >±30%. Dans le Groupe boucle fermée, le système a montré un contrôle excellent durant 55% du temps total de l’intervention, un bon contrôle durant 29% du temps et faible que pendant 9% du temps. Le temps depuis l’arrêt de la perfusion jusqu’à l’extubation est de 9 ± 3.7 min. Dans le Groupe contrôle, un contrôle excellent, bon, et faible a été enregistré durant 33%, 33% et 15% du temps respectivement et les doses ont été changées manuellement par l’anesthésiste en moyenne 9.5±4 fois par h. L’extubation a été accomplie après 11.9 ± 3.3 min de l’arrêt de la perfusion. Dans le Groupe boucle fermée, un contrôle excellent a été obtenu plus longtemps au cours des interventions (P<0.0001) et un contrôle inadéquat moins longtemps (P=0.001) que dans le Groupe contrôle. Le système en boucle fermée d’administration de propofol permet donc de maintenir plus facilement l’anesthésie au voisinage d’une cible choisie que l’administration manuelle.

Modos ventilatorios avanzados : Ventilación de Soporte Adaptativo (ASV)

El soporte ventilatorio es una de las intervenciones más utilizadas en las unidades de cuidado intensivo. A pesar de su rol «salvador» puede ser un procedimiento riesgoso para el paciente si no es aplicado apropiadamente. Para disminuír los riesgos inherentes a la misma, modos ventilatorios avanzados continúan siendo desarrollados a fin de mejorar los desenlaces clínicos de los pacientes. Estos avances incluyen sistemas de control de asa cerrada, como el ASV, el cual se ajusta automáticamente a los requerimientos del paciente. Es importante el entendimiento de este novedoso modo ventilatorio por el personal médico, incluyendo sus efectos en la mecánica pulmonar. Este artículo discutirá sobre el modo de ventilación de soporte adaptativo haciendo énfasis particular en sus parámetros, ventajas y desventajas sobre la oxigenación y ventilación.

Factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias

El manejo de la obstrucción intestinal por adherencias es un reto para cualquier especialista en Cirugía debido a que existe controversia sobre el alcance del manejo médico y el momento adecuado para llevar el paciente a cirugía para la resolución del cuadro clínico. En el presente trabajo se pretende, identificar los factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias. Metodología: Se realizó un estudio de casos y controles en una relación de 1:1, con una recolección de muestra estadística de 48 pacientes en cada grupo, entre mayo 2012 y mayo 2014 en el Hospital Universitario Mayor Mederi y en Barrios Unidos. Se consideraron casos los pacientes intervenidos quirúrgicamente por obstrucción intestinal por bridas y controles los pacientes manejados con tratamiento médico. Se evaluaron factores como edad, antecedentes personales patológicos y quirúrgicos, tiempo de evolución del cuadro clínico, hallazgos en imágenes y laboratorio entre otros. Resultados: Se recolectaron un total de 158 pacientes, (78 casos, 80 controles). Ambas poblaciones fueron comparables (p=0.13). Los factores asociados a tratamiento quirúrgico estadísticamente significativos fueron género masculino, presencia de fiebre al ingreso, el hallazgo de engrosamiento de la pared intestinal y de obstrucción de asa cerrada en imágenes diagnósticas (p<0,05). Discusión: Los principales factores asociados para que un paciente con obstrucción intestinal por bridas requiera de manejo quirúrgico son consistentes con literatura. Se requiere la socialización de los resultados para disminuir la morbimortalidad de nuestros pacientes.

Architecture for Living Neuronal Network Control of a mobile robot

The intelligent controlling mechanism of a typical mobile robot is usually a computer system. Research is however now ongoing in which biological neural networks are being cultured and trained to act as the brain of an interactive real world robot – thereby either completely replacing or operating in a cooperative fashion with a computer system. Studying such neural systems can give a distinct insight into biological neural structures and therefore such research has immediate medical implications. The principal aims of the present research are to assess the computational and learning capacity of dissociated cultured neuronal networks with a view to advancing network level processing of artificial neural networks. This will be approached by the creation of an artificial hybrid system (animat) involving closed loop control of a mobile robot by a dissociated culture of rat neurons. This paper details the components of the overall animat closed loop system architecture and reports on the evaluation of the results from preliminary real-life and simulated robot experiments.

Reconciling the electron counterstreaming and dropout occurrence rates with the heliospheric flux budget

Counterstreaming electrons (CSEs) are treated as signatures of closed magnetic flux, i.e., loops connected to the Sun at both ends. However, CSEs at 1 AU likely fade as the apex of a closed loop passes beyond some distance R, owing to scattering of the sunward beam along its continually increasing path length. The remaining antisunward beam at 1 AU would then give a false signature of open flux. Subsequent opening of a loop at the Sun by interchange reconnection with an open field line would produce an electron dropout (ED) at 1 AU, as if two open field lines were reconnecting to completely disconnect from the Sun. Thus EDs can be signatures of interchange reconnection as well as the commonly attributed disconnection. We incorporate CSE fadeout into a model that matches time-varying closed flux from interplanetary coronal mass ejections (ICMEs) to the solar cycle variation in heliospheric flux. Using the observed occurrence rate of CSEs at solar maximum, the model estimates R ∼ 8–10 AU. Hence we demonstrate that EDs should be much rarer than CSEs at 1 AU, as EDs can only be detected when the juncture points of reconnected field lines lie sunward of the detector, whereas CSEs continue to be detected in the legs of all loops that have expanded beyond the detector, out to R. We also demonstrate that if closed flux added to the heliosphere by ICMEs is instead balanced by disconnection elsewhere, then ED occurrence at 1 AU would still be rare, contrary to earlier expectations.

Controlling a mobile robot with a biological brain

The intelligent controlling mechanism of a typical mobile robot is usually a computer system. Some recent research is ongoing in which biological neurons are being cultured and trained to act as the brain of an interactive real world robot�thereby either completely replacing, or operating in a cooperative fashion with, a computer system. Studying such hybrid systems can provide distinct insights into the operation of biological neural structures, and therefore, such research has immediate medical implications as well as enormous potential in robotics. The main aim of the research is to assess the computational and learning capacity of dissociated cultured neuronal networks. A hybrid system incorporating closed-loop control of a mobile robot by a dissociated culture of neurons has been created. The system is flexible and allows for closed-loop operation, either with hardware robot or its software simulation. The paper provides an overview of the problem area, gives an idea of the breadth of present ongoing research, establises a new system architecture and, as an example, reports on the results of conducted experiments with real-life robots.

High bandwidth, large workspace haptic interaction: flying phantoms

It is well understood that for haptic interaction: free motion performance and closed-loop constrained motion performance have conflicting requirements. The difficulties for both conditions are compounded when increased workspace is required as most solutions result in a reduction of achievable impedance and bandwidth. A method of chaining devices together to increase workspace without adverse effect on performance is described and analysed. The method is then applied to a prototype, colloquially known as 'The Flying Phantom', and shown to provide high-bandwidth, low impedance interaction over the full range of horizontal movement across the front of a human user.

Architecture for neuronal cell control of a mobile robot

It is usually expected that the intelligent controlling mechanism of a robot is a computer system. Research is however now ongoing in which biological neural networks are being cultured and trained to act as the brain of an interactive real world robot - thereby either completely replacing or operating in a cooperative fashion with a computer system. Studying such neural systems can give a distinct insight into biological neural structures and therefore such research has immediate medical implications. In particular, the use of rodent primary dissociated cultured neuronal networks for the control of mobile `animals' (artificial animals, a contraction of animal and materials) is a novel approach to discovering the computational capabilities of networks of biological neurones. A dissociated culture of this nature requires appropriate embodiment in some form, to enable appropriate development in a controlled environment within which appropriate stimuli may be received via sensory data but ultimate influence over motor actions retained. The principal aims of the present research are to assess the computational and learning capacity of dissociated cultured neuronal networks with a view to advancing network level processing of artificial neural networks. This will be approached by the creation of an artificial hybrid system (animal) involving closed loop control of a mobile robot by a dissociated culture of rat neurons. This 'closed loop' interaction with the environment through both sensing and effecting will enable investigation of its learning capacity This paper details the components of the overall animat closed loop system and reports on the evaluation of the results from the experiments being carried out with regard to robot behaviour.

Adaptation of an commercially available stabilised R/C helicopter to a fully autonomous surveillance UAV

This paper presents the development of an autonomous surveillance UAV that competed in the Ministry of Defence Grand Challenge 2008. In order to focus on higher-level mission control, the UAV is built upon an existing commercially available stabilised R/C helicopter platform. The hardware architecture is developed to allow for non-invasion integration with the existing stabilised platform, and to enable to the distributed processing of closed loop control and mission goals. The resulting control system proved highly successful and was capable of flying within 40knott gusts. The software and safety architectures were key to the success of the research and also hold the potential for use in the development of more complex system comprising of multiple UAVs.

An improved reliability Cuk based solar inverter with sliding mode control

Many photovoltaic inverter designs make use of a buck based switched mode power supply (SMPS) to produce a rectified sinusoidal waveform. This waveform is then unfolded by a low frequency switching structure to produce a fully sinusoidal waveform. The Cuk SMPS could offer advantages over the buck in such applications. Unfortunately the Cuk converter is considered to be difficult to control using classical methods. Correct closed loop design is essential for stable operation of Cuk converters. Due to these stability issues, Cuk converter based designs often require stiff low bandwidth control loops. In order to achieve this stable closed loop performance, traditional designs invariably need large, unreliable electrolytic capacitors. In this paper, an inverter with a sliding mode control approach is presented which enables the designer to make use of the Cuk converters advantages, while ameliorating control difficulties. This control method allows the selection of passive components based predominantly on ripple and reliability specifications while requiring only one state reference signal. This allows much smaller, more reliable non-electrolytic capacitors to be used. A prototype inverter has been constructed and results obtained which demonstrate the design flexibility of the Cuk topology when coupled with sliding mode control.

Cultured neural networks

This article looks at the use of cultured neural networks as the decision-making mechanism of a control system. In this case biological neurons are grown and trained to act as an artificial intelligence engine. Such research has immediate medical implications as well as enormous potential in computing and robotics. An experimental system involving closed-loop control of a mobile robot by a culture of neurons has been successfully created and is described here. This article gives a brief overview of the problem area and ongoing research. Questions are asked as to where this will lead in the future.

Neurofuzzy control using Kalman filtering state feedback with coloured noise for unknown non-linear processes

This paper presents a controller design scheme for a priori unknown non-linear dynamical processes that are identified via an operating point neurofuzzy system from process data. Based on a neurofuzzy design and model construction algorithm (NeuDec) for a non-linear dynamical process, a neurofuzzy state-space model of controllable form is initially constructed. The control scheme based on closed-loop pole assignment is then utilized to ensure the time invariance and linearization of the state equations so that the system stability can be guaranteed under some mild assumptions, even in the presence of modelling error. The proposed approach requires a known state vector for the application of pole assignment state feedback. For this purpose, a generalized Kalman filtering algorithm with coloured noise is developed on the basis of the neurofuzzy state-space model to obtain an optimal state vector estimation. The derived controller is applied in typical output tracking problems by minimizing the tracking error. Simulation examples are included to demonstrate the operation and effectiveness of the new approach.

Feedback dew-point sensor utilising optimally cut plastic optical fibres

A plastic optical fibre reflectance sensor that makes full use of the critical angle of the fibres is implemented to monitor dew formation on a Peltier-cooled reflector surface. The optical configuration permits isolation of optoelectronic components from the sensing head and better light coupling between the reflector and the detecting fibre, giving a better signal of the onset of dew formation on the reflector. Continuous monitoring of the rate of change in reflectance as well as the absolute reflectance signals, the use of a novel polymethyl-methacrylate-coated hydrophobic film reflector on the Peltier element and the application of feedback around the point of dew formation, further reduces the possibility of contamination of the sensor head. Under closed-loop operation, the sensor is capable of cycling around the point of dew formation at a frequency of 2.5 Hz.