We have adapted, implemented and trained the Learned Primal Dual algorithm suggested by Adler and Öktem and evaluated its performance in reconstructing projection data from our PET scanner. Learned Primal Dual reconstructions are compared to Maximum Likelihood Expectation Maximisation (MLEM) reconstructions. Different strategies for training are also compared. Whenever the noise level of the data to reconstruct is sufficiently represented in the training set, the Learned Primal Dual algorithm performs well on the recovery of the activity concentrations and on noise reduction as compared to MLEM. The algorithm is also shown to be robust against the appearance of artefacts, even when the images that are to be reconstructed present features were not present in the training set. Once trained, the algorithm reconstructs images in few seconds or less.
Predicting the risk of cardiovascular complications, in particular heart failure hospitalisation (HHF), can improve the management of type 2 diabetes (T2D). Most predictive models proposed so far rely on clinical data not available at the higher Institutional level. Therefore, it is of interest to assess the risk of HHF in people with T2D using administrative claims data only, which are more easily obtainable and could allow public health systems to identify high-risk individuals. In this paper, the administrative claims of > 175,000 patients with T2D were used to develop a new risk score for HHF based on Cox regression. Internal validation on the administrative data cohort yielded satisfactory results in terms of discrimination (max AUROC = 0.792, C-index = 0.786) and calibration (Hosmer–Lemeshow test p value < 0.05). The risk score was then tested on data gathered from two independent centers (one diabetes outpatient clinic and one primary care network) to demonstrate its applicability to different care settings in the medium-long term. Thanks to the large size and broad demographics of the administrative dataset used for training, the proposed model was able to predict HHF without significant performance loss concerning bespoke models developed within each setting using more informative, but harder-to-acquire clinical variables.
Effective dosing of anticoagulants aims to prevent blood clot formation while avoiding hemorrhages. This complex task is challenged by several disturbing factors and drugeffect uncertainties, requesting frequent monitoring and adjustment. Biovariability in drug absorption and action further complicates titration and calls for individualized strategies adapting over time. In this paper, we propose an adaptive closed-loop control algorithm to assist in warfarin therapy management. Methods: The controller was designed and tested in silico using an established pharmacometrics model of warfarin, which accounts for inter-subject variability. The control algorithm is an adaptive Model Predictive Control (a-MPC) that leverages a simplified patient model, whose parameters are updated with a Bayesian strategy. Performance was quantitatively evaluated in simulations performed on a population of virtual subjects against an algorithm reproducing medical guidelines (MG) and an MPC controller available in the literature (l-MPC). Results: The proposed a-MPC significantly (p < 0.05) lowers rising time (2.8 vs. 4.4 and 11.2 days) and time out of range (3.3 vs. 7.2 and 12.9 days) with respect to both MG and l-MPC, respectively. Adaptivity grants a significantly (p < 0.05) lower number of subjects reaching unsafe INR values compared to when this feature is not present (8.9% vs.15% of subjects presenting an overshoot outside the target range and 0.08% vs. 0.28% of subjects reaching dangerous INR values).
Conclusion:The a-MPC algorithm was able to improve warfarin therapy with respect to the benchmark therapies.Significance: This in-silico validation proves the effectiveness of the a-MPC algorithm for anticoagulant administration, paving the way for clinical testing.
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