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PubMed2004

Multi-loop decentralized PID control based on covariance control criteria: an LMI approach.

PID control is well known and widely applied in industry and many design algorithms are readily available in the literature. However, systematic design of multi-loop or decentralized PID control for multivariable processes to meet certain objectives simultaneously is still a challenging task. Designing multi-loop PID controllers such that the process variables satisfy the generalized covariance constraints is studied in this paper. A convergent computational algorithm is proposed to calculate the multi-loop PID controller for a process with stable disturbances. This algorithm is then extended to a process with random-walk disturbances. The feasibility of the proposed algorithm is verified by applying it to several simulation examples.

Journal Article↗
PubMed1993

The pathophysiology of contractile activity in the chronic decentralized feline bladder.

Autonomous wave activity occurs in the decentralized bladder and may contribute to upper tract damage and incontinence. In order to clarify the poorly understood pathophysiology and neuropharmacology of autonomous waves, cats were prepared with L7-S3 ventrodorsal rhizotomy alone or with L7-S3 ventral rhizotomy with and without total sympathectomy. The incidence of autonomous waves was < 15% 12 weeks after ventral or ventrodorsal rhizotomy, but acute sympathectomy at 13 weeks increased the incidence to 58% in these groups. With chronic sympathectomy the incidence was 100%. This suggests that the waves arise locally via a mechanism which is independent of L7-S3 dorsal roots, due to lack of a suppressive sympathetic pathway. Autonomous waves were inhibited by atropine after acute sympathectomy and by prazosin after chronic sympathectomy, but increased inhibition occurred after both drugs in either case. Adrenergic neuron depletion with 6-hydroxydopamine enhanced wave activity, which was incompletely inhibited by subsequent atropine. This implies that the peripheral reflex pathway has facilitatory alpha 1-adrenergic, muscarinic and also noncholinergic nonadrenergic elements. Clinically, sensory or sympathetic damage caused incontinence, but sympathectomy also caused high pressure waves, which may cause upper tract damage and treatment resistant incontinence in patients.

Adrenergic Fibers↗
PubMed1997

Peripheral afferent stimulation of decentralized sympathetic neurons activates lipolysis in spinal cord-injured subjects.

Spinal cord-injured (SCI) subjects exhibit a normal lipolytic rate despite the failure of centrally mediated sympathoexcitatory stimuli to activate lipolysis. Peripheral afferent stimulation below the lesion level induces an exaggerated autonomic reaction in SCI with lesion levels above T5, ie, so-called autonomic dysreflexia. The metabolic effects of induced dysreflexia were investigated in five SCI subjects (age, 35 +/- 8 years; duration of paresis, 15 +/- 7.5 years [mean +/- SD]; lesion level, T3 to T4, n = 2, C7, n = 3) following bladder stimulation. Subcutaneous glycerol concentrations were measured by microdialysis above and below the lesion level. Diurnal plasma noradrenaline (NA) and adrenaline levels were continuously monitored in seven SCI subjects (lesion level T3 to T4, n = 2; C4 to C7, n = 5). Bladder stimulation resulted in an increased mean arterial pressure ([MAP] 81 +/- 8 to 114 +/- 11 mm Hg, P < .05), a decreased heart rate (70 +/- 3 to 54 +/- 4 beats/min, P < .05), and an increased plasma NA (0.70 +/- 0.49 v 3.27 +/- 1.56 nmol/L, P < .05). Interstitial glycerol was increased in the decentralized region (89 +/- 12 to 135 +/- 21 mumol/L, P < .05), whereas no reaction was found in the centrally innervated region. Plasma concentrations of glycerol and insulin increased. Diurnal monitoring showed periods of increased plasma NA sufficient to induce lipolysis (> 1.4 nmol/L) during 20% of the registration period. The data suggest that peripheral afferent stimulation below the lesion level increases NA release and activates lipolysis and that frequent episodes of activation are found in SCI subjects with tetraplegia or high paraplegia.

Adult↗
PubMed1988

Quality assurance in a rehabilitation facility: a decentralized approach.

Quality assurance (QA) in rehabilitation facilities and units must be tailored to rehabilitation activities, that is, those activities that enable patients to manage conditions and disabilities caused by their injuries or illnesses. Good Samaritan Medical and Rehabilitation Center in Zanesville, Ohio, has developed a system for QA in which managers of departments and services are responsible for QA in their own areas, thereby enabling them to monitor and evaluate the important aspects of care provided by their department or service. This article outlines the steps by which appropriate QA activities are determined and implemented in a rehabilitation facility using this decentralized approach.

Combined Modality Therapy↗
PubMed1990

Rapid determination of intraocular lens tilt and decentration through the undilated pupil.

The apparent optical axis of an implanted intraocular lens (IOL) can be located by alignment of the examiner's hand light with the third and fourth Purkinje images from the front and back surfaces of the IOL. Tilt of the IOL can be estimated (or measured with an arc perimeter) by the angle between the apparent optical axis and the patient's line of sight (actual tilt approximately 0.85 x apparent tilt). Decentration of the IOL is easily detected, equal to the distance of the IOL optical axis from the center of the pupil. This simple technique can be used through the natural pupil with posterior chamber IOLs, providing the optical axis of the malpositioned IOL still passes through the pupil.

Humans↗
PubMed1997

Health technology assessment: decentralized and fragmented in the US compared to other countries.

This paper presents the results of the first comprehensive international survey to catalogue health technology assessment (HTA) activities. By 1995, there were formal HTA programs in 24 countries established mostly in the late 1980s and early 1990s. European countries generally have one or two federal or provincial HTA programs each, Canada has an extensive network of federal and regional organizations coordinated by a central body and the US has 53 HTA organizations, the vast majority of which are in the private sector. While the commitment of the US government to HTA has been erratic, the private sector has been witness to an expansion of HTA activities by insurance companies, hospitals, medical/device manufacturers, consulting firms and health professional societies. In contrast to other developed countries, the current state of technology assessment in the US is decentralized, fragmented and duplicative. We conclude by discussing the importance of a US HTA agency at the national level.

Canada↗
PubMedDate not supplied

[Evaluation of health system decentralization and reform of the Social Security system in Colombia].

The aim of this study is to present the results of the reforms in the health sector that have taken place in Colombia since 1990. These reforms replaced the previous national health system and the so-called Bismarkian social security system. The new system has three basic characteristics: a) the public subsidies are decentralized in the municipalities and territorial departments; b) the public hospitals have been converted into state social enterprises, which has led them towards a management model, and c) the health and social security system monopoly has been abolished and a system of health subsidies has been created for the poorest citizens. This article systematically collects secondary information extracted from the most important studies evaluating the health sector reforms in Colombia. The present author participated in some of these studies. The reforms have increased financial resources, which, has led to an increase in public system staff and their salaries. The availability of hospitals' budgetary resources has increased and the social security system has become wider, including 20% of the poorest population who have benefited from subsidies on demand. Ease of access and equity in the health system have significantly improved. However, indicators of public health have fallen and health professionals are critical of a system based on mediation, which increases transaction costs.

Colombia↗
PubMedDate not supplied

[Primary care: decentralization and efficiency].

OBJECTIVE: The purpose of this study was to evaluate whether the productive behavior of health centers in autonomous communities with competence in health is more efficient than that among centers belonging to Spanish public health system (INSALUD). METHODS: The technical efficiency of 66 health centers in Alava, Navarre and La Rioja was analyzed. Centers in autonomous communities that in 1997 had been granted complete authority from the central government to manage their healthcare services were compared with centers whose administration, in the same year, was still in the hands of INSALUD. The method used to measure and quantify the efficiency of these centers was data envelopment analysis. RESULTS: Nonparametric contrast of the health centers' mean efficiency rates revealed no significant differences in the (in)efficiency of centers from La Rioja, Navarre and Alava. CONCLUSIONS: The results obtained from the model of efficiency measurement used did not indicate that decentralization improves the productive efficiency of primary care centers.

Efficiency, Organizational↗
PubMedDate not supplied

[Decentralization: part of the health system problem or the solution?].

The greatest change experienced by the Spanish health system in the last two decades has probably been the devolution of power to the autonomous communities composing the Spanish state. This may generate tensions in the status quo and poses questions of whether decentralization of the health system is compatible with a cohesive national health system and whether this devolution of power is part of the problem of the health system or part of its solution. Generalized devolution occurring as rapidly as that produced in Spain (negotiated in slightly less than 6 months, with minimal financial agreements, without explicit legal frameworks in the areas of coordination and development of basic norms, and with a new agreement of general financing of the autonomous communities which possibly contains lacunae, etc.) presents an uncertain panorama. The possible misuse of the wide powers recently transferred to the autonomous communities could easily be used by those who would like to see a restoration of pre-democratic centralism to sow fear of the collapse of the health service as the cornerstone of the welfare state among the general public. The present article briefly addresses these questions.

Delivery of Health Care↗
PubMed2002

SWAp dynamics in a decentralized context: experiences from Uganda.

This paper examines the role of the Ministry of Health (MoH) in Uganda in the process of developing a Sector-Wide Approach (SWAp) within the health sector. Power dynamics are integral to any understanding of development assistance, and SWAps bring with them new opportunities for the deployment of influence. The SWAp process has changed the interaction between the donors and the Government, and the perspective of this interaction has shifted from various technical areas to the entire health sector. It is argued that although the decentralization of the public sector has transferred considerable responsibilities and duties from the central level to the districts, significant power, defined as a social construct, has been generated by the MoH in the very process of developing SWAps. The MoH has been able to exercise significant influence on defining the content and boundaries of the SWAp process, as well as the direction it is taking. This development has largely followed blueprints drawn by donors. Through the institutional framework associated with SWAps, the MoH has redefined the interaction between the central level and the districts as well as between the MoH and the donors. While the SWAp process is now moving from the planning to the implementation phase in Uganda, we see a number of new, changing, ambiguous and contradictory strategies emerging.

Financing, Organized↗
PubMed1988

Posterior capsular opacification and intraocular lens decentration. Part II: Experimental findings on a prototype circular intraocular lens design.

In a prospective randomized study, 25 New Zealand white rabbit eyes were implanted with four intraocular lens (IOL) designs. These included a one-piece modified J-loop IOL, a three-piece modified J-loop IOL, a rigid disc IOL, and an experimental compressible disc (CD) IOL. The CD IOL revealed the lowest mean posterior capsular opacification (PCO) of all IOLs tested (P less than .01). With all lenses tested, a positive correlation between PCO and decentration was found (R = 0.55, P less than .05). These results suggest that because of its design features (i.e., one-piece construction, biconvex optic, posterior angulation of the fixation element), the CD lens produces a mechanical barrier against lens epithelial cell migration and reduces the incidence of PCO.

Animals↗
PubMed1989

Measurement of postoperative intraocular lens tilting and decentration using Scheimpflug images.

A three-dimensional, in vivo method for determining the position of implanted intraocular lenses (IOLs) using an image-processing technique has been developed. Two images of the anterior segment of the eye with an implanted IOL were photographed with a Scheimpflug camera at slit-lamp angles of 90 degrees and 180 degrees. After geometrical correction, the contours of the original images were enhanced using binarization and curve-fitting techniques. These images afforded calculation of the angle of tilt of the IOL optic axis relative to a standard reference line which connected the center of anterior corneal surface curvature with the geometrical center of the pupil. The extent and direction of IOL decentration could also be shown. The IOL image in the posterior chamber was expressed as a wire-frame figure. This method provides several kinds of biometry in pseudophakic eyes.

Anterior Eye Segment↗
PubMed1998

The neural network approach to a parallel decentralized network routing.

With the progress of high-speed optical transmission and packet switching, a large capacity packet-based multi-media communication network is expected to spread rapidly. One of the key issues in these networks is the network routing that chooses the route to the destination for packet transmission in the network. In most previous work, the whole network is mapped to a large size-Hopfield-type neural network. Hence, the network routing by this method is not beyond the centralized control. In this paper, a parallel decentralized Network Routing method is presented. The model comprises an interconnection of groups of an intraconnected network, which is fully connected, and resides at each node of the communication network. Since the dynamics of each neuron in the whole system follows a unique state equation, we can see easily how the update of a neuron maps to real world network routing problems. Most important, becauase of the dynamics of the neurons with such a high speed of convergence, the model has the ability to achieve a sub-optimum routing solution in a real-time application. Finally, simulation results validate the proposed method.

Journal Article↗
PubMed1990

Decentration of the posterior chamber lens implant: the effect of optic size on the incidence of visual aberrations.

Intraocular lens implant components such as dialling holes can cause disabling symptoms when decentration of the implant places these components in the pupil. In order to investigate the importance of optic size in this context, we studied two groups of consecutive patients who had undergone cataract surgery: one group had received an implant with a 6 mm diameter optic, and the other an implant with a 7 mm diameter optic. We found that there was a significantly higher incidence of implant components such as dialling holes in the pupil in the 6 mm group when compared to the 7 mm group. The incidence of symptoms such as monocular diplopia and glare was marginally but not significantly higher in the 6 mm group. To minimise the risks of symptoms related to dialling holes in the pupil we recommend an implant design that has a large optical clear zone of at least 6 mm.

Aged↗
PubMed1997

The relationship between pupil diameter and decentration in myopia.

Since optical zone centration is of such importance in refractive surgery, we have studied, with a computer-aided videopupillograph, the problem of identifying it in myopes. The findings of pupil centre shift as a function of pupil diameter and degree of myopia are reported in two groups of myopes (low and medium) and a control group. Results indicate that the amount and direction of decentration vary according to pupil diameter and degree of myopia. No generally valid instructions can be laid down and each case must be treated on its merits.

Adolescent↗
PubMed2001

A uniform regimen enables decentralized care of diabetic pregnancies.

AIMS: A nationwide recommendation to standardize the care of diabetic pregnancies in different hospitals was given in Finland in 1993. The Medical Birth Register (MBR) was used to investigate whether these recommendations have been accepted and how they have affected the outcome of newborns. METHODS: Data on 1442 singleton pregnancies complicated by insulin-treated diabetes in 1991-1995 were obtained from the MBR. RESULTS: The incidence of insulin treatment during pregnancy was 4.5 per 1000 births. Sixty-six per cent (n = 954) of all women had Type 1 diabetes. During the study period, the number of deliveries managed in tertiary centres decreased from 59% to 47% (95% confidence interval [CI] 39-58%) and care was more often carried out on an out-patient basis. The perinatal mortality rate (>or= 28 weeks of gestation) declined from 19.3 to 8.2/1000, being 12.6/1000 in the whole diabetic population and 5.5/1000 in the general population (95% CI 3.4-8.8/1000). The risk was especially increased in insulin-treated gestational diabetic (GDM) pregnancies (14.3/1000). The proportion of macrosomic newborns (31.7%) in diabetic women was significantly higher than among the general population (3.2%) (95% CI 27.0-33.9%). CONCLUSIONS: The decentralization and change-over to a mainly out-patient basis of management does not appear to have increased the number of cases of adverse outcome of diabetic pregnancy when patients have been selected to the appropriate level of care. The risks in insulin-treated GDM pregnancies were almost similar to Type 1 diabetes. To succeed, there must be a standardized care programme, continuous education and motivated personnel.

Birth Weight↗
PubMed1997

Reliability of delayed INR determination: implications for decentralized anticoagulant care with off-site blood sampling.

In order to develop decentralized anticoagulant care by off-site blood sampling and transport of samples to a centralized laboratory for International Normalized Ratio (INR) determination we have performed a direct comparative study of INR stability. Analysis was performed daily for 5 d using nine thromboplastins. The overall mean difference of INR after 3d was only 0.05 INR units for samples with a therapeutic INR. After 5 d there was a mean difference of 0.11 INR units with 'non-Manchester' reagents and 0.44 INR units with 'Manchester' reagents. With over-anticoagulated samples mean differences of 0.55-0.72 INR units were observed after 3 d and 1.16-2.46 INR units after 5 d. Although there was some variation in stability of results with different thromboplastins, the difference over time with each thromboplastin was much less than the difference between thromboplastins. In conclusion, there is no clinically significant change in INR when analysis is delayed for up to 3 d. Off-site blood sampling can accommodate a large increase in patient workload without a major revenue increase in primary care and with continued total quality management and central expert advice.

Blood Coagulation Disorders↗