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PubMed2004

A feasibility study of the childhood depression medication algorithm: the Texas Children's Medication Algorithm Project (CMAP).

OBJECTIVE: To evaluate the feasibility and impact on clinical response and function associated with the use of an algorithm-driven disease management program (ALGO) for children and adolescents treated for depression with or without attention-deficit/hyperactivity disorder (ADHD) in community mental health centers. METHOD: Interventions included (1). medication algorithms, (2). clinical and technical support for the physician, (3). uniform chart documentation of outcomes, and (4). a patient/family psychoeducation program. Children eligible for entry into the study were referred to the child psychiatrist for initiation or change in medicine. Outcomes of treatment with the ALGO for up to 4 months are presented. Measures of change included clinical symptoms, functioning, and global improvement (Clinical Global Impression Scale). A historical chart cohort from the same clinics was used as a quasi-control. RESULTS: Thirty-nine individuals (depression = 24; comorbid depression with ADHD = 15) were enrolled for treatment with ALGO. One hundred fourteen children were in the control cohort (74 depressed, 40 comorbid). For the ALGO groups, Children's Depression Rating Scale-Revised depression severity scores decreased from 48.2 to 32.5 and Child Adolescent Functioning Assessment Scale function scores improved from 70.3 to 40.9 (all p < or =.0005). Clinical Global Impression Scale severity scores decreased from 5.7 to 3.7 in ALGO compared to only 5.8 to 4.8 in the control (p <.003). CONCLUSIONS: There was clear improvement in clinical symptoms, functioning, and global response with ALGO treatment. The magnitude of the improvement was greater in children and adolescents treated with the ALGO program compared with a historical cohort. These data support the need for controlled studies in larger populations examining the effects of algorithm-driven disease management programs on the clinical outcomes of children with mental illness.

Adolescent↗
PubMed1991

An algorithm for matching anonymous hospital discharge records used in occupational disease surveillance: anonymous record matching algorithm.

The expense of collecting primary data, coupled with limited authority to mandate reporting, requires alternative methods of implementing an occupational disease registry in Illinois. One alternative data source for surveillance of some occupational diseases is hospital discharge records. Because these records lack personal identifiers, it has been impossible historically to match records belonging to the same individual and obtain reliable case estimates. To circumvent this difficulty, an algorithm has been developed to match anonymous hospital discharge records collected from all Illinois hospitals. The algorithm was based on the assumption that specific combinations of occupational disease code, sex, zip code, and date of birth would identify an individual to whom multiple hospitalizations belong. Matching with the algorithm reduced the 1986 case estimates from 597 to 499 for all cases of coal workers' pneumoconiosis, asbestosis, and silicosis.

Algorithms↗
PubMed2002

HLAMatchmaker: a molecularly based algorithm for histocompatibility determination. I. Description of the algorithm.

This report describes an algorithm for identifying acceptable HLA antigens for highly alloimmunized patients without the need for extensive serum screening. This algorithm is based on the concept that immunogenic epitopes are represented by amino acid triplets on exposed parts of protein sequences of human leukocyte antigen chains (HLA-A, HLA-B, and HLA-C) accessible to alloantibodies. A computer program (HLAMatchmaker) has been developed to determine class I HLA compatibility at the molecular level. It makes intralocus and interlocus comparisons of polymorphic triplets in sequence positions to determine the spectrum of non-shared triplets on donor HLA antigens. In most cases is it possible to identify certain mismatched HLA antigens that share all their polymorphic triplets with the patient's HLA antigens and could therefore, be considered fully compatible. HLAMatchmaker permits also the identification of additional mismatches that are acceptable as determined from the triplet information on HLA-typed panel cells that do not react with patient's serum.HLAMatchmaker provides an assessment of donor-recipient HLA compatibility at the structural level and this algorithm is different from conventional methods based on the mere counting of numbers of mismatched HLA antigens or CREGs. This donor selection strategy is suitable especially for allosensitized patients in need of a compatible transplant or platelet transfusion.

Algorithms↗
PubMed2001

Texas Medication Algorithm Project: development and feasibility testing of a treatment algorithm for patients with bipolar disorder.

BACKGROUND: Use of treatment guidelines for treatment of major psychiatric illnesses has increased in recent years. The Texas Medication Algorithm Project (TMAP) was developed to study the feasibility and process of developing and implementing guidelines for bipolar disorder, major depressive disorder, and schizophrenia in the public mental health system of Texas. This article describes the consensus process used to develop the first set of TMAP algorithms for the Bipolar Disorder Module (Phase 1) and the trial testing the feasibility of their implementation in inpatient and outpatient psychiatric settings across Texas (Phase 2). METHOD: The feasibility trial answered core questions regarding implementation of treatment guidelines for bipolar disorder. A total of 69 patients were treated with the original algorithms for bipolar disorder developed in Phase 1 of TMAP. RESULTS: Results support that physicians accepted the guidelines, followed recommendations to see patients at certain intervals, and utilized sequenced treatment steps differentially over the course of treatment. While improvements in clinical symptoms (24-item Brief Psychiatric Rating Scale) were observed over the course of enrollment in the trial, these conclusions are limited by the fact that physician volunteers were utilized for both treatment and ratings. and there was no control group. CONCLUSION: Results from Phases 1 and 2 indicate that it is possible to develop and implement a treatment guideline for patients with a history of mania in public mental health clinics in Texas. TMAP Phase 3, a recently completed larger and controlled trial assessing the clinical and economic impact of treatment guidelines and patient and family education in the public mental health system of Texas, improves upon this methodology.

Adolescent↗
PubMed1998

[Evaluation of the Swedish interactive thresholding algorithm, a new thresholding algorithm, of the Humphrey Field Analyzer in glaucoma patients].

The Swedish interactive thresholding algorithm (SITA) is a new thresholding algorithm that aims to obtain the visual fields of the same quality in a shorter examination time than the conventional up-and-down method. We investigated the correlation between the threshold values obtained by SITA and the conventional thresholding algorithm in 30 glaucoma patients. The results of two types of SITA, i.e., SITA accurate and SITA fast, showed a significant correlation with those of the conventional method (r = 0.855, p < 0.0001 and r = 0.833, p < 0.0001, respectively). There was no statistical relation between the mean deviation (MD) of the conventional method and the difference between MD values of the conventional method, and SITA accurate and SITA fast. The examination time of SITA accurate and SITA fast was 50% and 31% shorter, respectively, than that of the conventional method. The difference in threshold of each test point in the conventional and SITA methods was minor except in one with a deep relative defect. These results indicate that SITA can be useful for detecting glaucomatous visual field defects in a shorter time.

Algorithms↗
PubMed2004

Algorithm-assisted elucidation of disulfide structure: application of the negative signature mass algorithm to mass-mapping the disulfide structure of the 12-cysteine transforming growth factor beta type II receptor extracellular domain.

The power of an algorithm-driven method for interpreting disulfide mass-mapping data is demonstrated in the context of determining the disulfide structure of the extracellular domain of the transforming growth factor beta type II receptor, a 14-kDa cystinyl protein containing 12 cysteines in the form of six disulfide bonds. The disulfide mass-mapping methodology is based on partial reduction and cyanylation-induced cleavage of the cystinyl protein. Because the multiplicity of possible disulfide structures that must be considered grows rapidly with the number of cysteines, as does the difficulty in physically isolating each of the partially reduced and cyanylated isoforms of the analyte, manual data interpretation for disulfide mapping a cystinyl protein containing more than eight cysteines becomes unmanageable. Recently, we introduced the concept of a "negative signature mass algorithm" (NSMA) to determine the disulfide structure of a cystinyl protein by processing an input of its amino acid sequence and mass spectral data from analysis of its associated cyanylation-induced cleavage products. Here, we present experimental results to validate the NSMA concept. A key advantage of the NSMA, in addition to convenience and automation, is its capacity to interpret mass spectra from mixtures of cyanylation-induced cleavage fragments without separating the partially reduced isoforms of the cystinyl protein and without knowledge of the extent of partial reduction.

Algorithms↗
PubMed2002

HLAMatchmaker: a molecularly based algorithm for histocompatibility determination. II. Verification of the algorithm and determination of the relative immunogenicity of amino acid triplet-defined epitopes.

HLAMatchmaker is a computer algorithm that assesses human leukocyte antigen (HLA) compatibility at the structural level by intralocus and interlocus comparisons of polymorphic amino acid triplets in antibody-accessible sequences of HLA class I molecules. This program permits the identification of mismatched HLA antigens that share all of their polymorphic triplets with the patient's HLA antigens and, therefore, could be considered fully compatible. The validity of this algorithm has been verified by analyzing the antibody specificity patterns of 127 well-characterized sera (panel reactive antibody [PRA] > 80%) that had been screened by direct complement-dependent and/or anti-human globulin augmented lymphocytotoxicity testing with large HLA-typed cell panels. A 2 x 2 table-based Chi-square analysis program was applied to determine positive and negative correlations between serum reactivity and the presence HLA triplets assigned from the HLA types in the cell panel. The results indicate that high PRA patients do not produce antibodies to shared triplets on mismatched HLA antigens. Moreover, this serum analysis has permitted the identification of triplets with different degrees of immunogenicity as indicated by the frequencies of positive and negative correlations of serum reactivity with the HLA-typed cell panel. Mismatching for triplets with low immunogenicity provides further opportunities for identifying donors with acceptable HLA mismatches for highly sensitized patients.

Algorithms↗
PubMed2001

Feature subset selection by genetic algorithms and estimation of distribution algorithms. A case study in the survival of cirrhotic patients treated with TIPS.

The transjugular intrahepatic portosystemic shunt (TIPS) is an interventional treatment for cirrhotic patients with portal hypertension. In the light of our medical staff's experience, the consequences of TIPS are not homogeneous for all the patients and a subgroup dies in the first 6 months after TIPS placement. Actually, there is no risk indicator to identify this subgroup of patients before treatment. An investigation for predicting the survival of cirrhotic patients treated with TIPS is carried out using a clinical database with 107 cases and 77 attributes. Four supervised machine learning classifiers are applied to discriminate between both subgroups of patients. The application of several feature subset selection (FSS) techniques has significantly improved the predictive accuracy of these classifiers and considerably reduced the amount of attributes in the classification models. Among FSS techniques, FSS-TREE, a new randomized algorithm inspired on the new EDA (estimation of distribution algorithm) paradigm has obtained the best average accuracy results for each classifier.

Algorithms↗
PubMed1998

Texas Medication Algorithm Project: definitions, rationale, and methods to develop medication algorithms.

BACKGROUND: The Texas Medication Algorithm Project (TMAP), a public-academic collaborative effort, is a 3-phase project to develop, implement, and evaluate medication treatment algorithms for public sector patients with schizophrenia, major depressive disorders, or bipolar disorders. DISCUSSION: This paper, the first in a series describing the activities of the TMAP, focuses on the various definitions and reasons why guidelines have gained popularity. Also discussed are their strengths, the limitations of the various methods used to develop them, and potential barriers to their implementation.

Algorithms↗
PubMed1996

Re-evaluating genetic algorithm performance under coordinate rotation of benchmark functions. A survey of some theoretical and practical aspects of genetic algorithms.

In recent years, genetic algorithms (GAs) have become increasingly robust and easy to use. Current knowledge and many successful experiments suggest that the application of GAs is not limited to easy-to-optimize unimodal functions. Several results and GA theory give the impression that GAs easily escape from millions of local optima and reliably converge to a single global optimum. The theoretical analysis presented in this paper shows that most of the widely-used test functions have n independent parameters and that, when optimizing such functions, many GAs scale with an O(n ln n) complexity. Furthermore, it is shown that the current design of GAs and its parameter settings are optimal with respect to independent parameters. Both analysis and results show that a rotation of the coordinate system causes a severe performance loss to GAs that use a small mutation rate. In case of a rotation, the GA's complexity can increase up to O(nn) = O(exp(n ln n)). Future work should find new GA designs that solve this performance loss. As long as these problems have not been solved, the application of GAs will be limited to the optimization of easy-to-optimize functions.

Algorithms↗
PubMed2006

Comparison of a rule-based algorithm with a phenotype-based algorithm for the interpretation of HIV genotypes in guiding salvage regimens in HIV-infected patients by a randomized clinical trial: the mutations and salvage study.

BACKGROUND: There is still considerable uncertainty as to the best algorithm for interpreting human immunodeficiency virus (HIV) genotyping results. METHODS: A total of 318 subjects with HIV RNA levels of >1000 copies/mL were enrolled in 41 centers throughout Italy from 2001 through 2003, stratified on the basis of their drug history, randomized (1:1) to 2 arms to have their treatments modified on the basis of the results of HIV genotyping (as interpreted by virtual phenotype analysis or with use of a rule-based interpretation system), and followed up for 48 weeks. At least 1 nucleoside reverse-transcriptase inhibitor and 1 protease inhibitor had to be included in any new regimen; nonnucleoside reverse-transcriptase inhibitor-naive patients were also prescribed a nonnucleoside reverse-transcriptase inhibitor. Only drugs licensed in Italy were allowed. The primary end point was a decrease in HIV RNA level to <400 copies/mL by week 12 according to on-treatment analysis. RESULTS: The mean (+/- standard deviation) values at baseline were as follows: HIV RNA level, 4.1+/-0.74 log(10) copies/mL; CD4(+) T lymphocyte count, 410+/-262 cells/microL; reverse-transcriptase mutations, 4.8+/-2.9; and protease mutations, 2.8+/-2.5. There were 133 patients (41.8%) who were nonnucleoside reverse-transcriptase inhibitor naive and protease inhibitor experienced, 63 patients (19.8%) who were nonnucleoside reverse-transcriptase inhibitor experienced and protease inhibitor naive, and 122 patients (38.4%) who were 3-class experienced. A total of 192 patients completed 12 weeks of the treatment regimen assigned at baseline; at 12 weeks, 66.3% of patients in the virtual phenotype arm and 71.3% of patients in the rule-based interpretation arm had HIV RNA levels of <400 copies/mL (P = .46). No statistically significant difference between arms was observed by intention-to-treat analysis. CONCLUSION: Both the virtual phenotype and rule-based interpretation methods of HIV genotyping can guide the selection of effective antiretroviral drugs for a salvage regimen.

Adult↗
PubMed2006

Chemical genetic algorithms--evolutionary optimization of binary-to-real-value translation in genetic algorithms.

A chemical genetic algorithm (CGA) in which several types of molecules (information units) react with each other in a cell is proposed. Not only the information in DNA, but also smaller molecules responsible for the transcription and translation of DNA into amino acids, are adaptively changed during evolution, which optimizes the fundamental mapping from binary substrings in DNA ( genotype) to real values for a parameter set (phenotype). Through the struggle between cells containing a DNA unit and small molecular units, the codes (DNA) and the interpreter (the small molecular units) coevolve, and a specific output function, from which a cell's fitness is evaluated, is optimized. To demonstrate the effectiveness of the CGA, it is applied to a set of variable-separable and variable-inseparable problems, and it is shown that the CGA can robustly solve a wide range of optimization problems regardless of their fitness characteristics. To ascertain the optimization of the genotype-to-phenotype mapping by the CGA, we also conduct analytical experiments for some problems while observing the basin size of a global optimum solution in the binary genotype space. The results show that the CGA effectively augments the basin size, makes it easier for evolution to find a path to the global optimum solution, and enhances the GA's evolvability during evolution.

Algorithms↗
PubMed2001

Algorithmic complexity. A new approach of non-linear algorithms for the analysis of atrial signals from multipolar basket catheter.

Symbolic dynamics as a non linear method and computation of the normalized algorithmic complexity (C alpha) was applied to basket-catheter mapping of atrial fibrillation (AF) in the right human atrium. The resulting different degrees of organisation of AF have been compared to conventional classification of Wells. Short time temporal and spatial distribution of the C alpha during AF and effects of propafenone on this distribution have been investigated in 30 patients. C alpha was calculated for a moving window. Generated C alpha was analyzed within 10 minutes before and after administration of propafenone. The inter-regional C alpha distribution was statistically analyzed. Inter-regional C alpha differences were found in all patients (p < 0.001). The right atrium could be divided in high- and low complexity areas according to individual patterns. A significant C alpha increase in cranio-caudal direction was confirmed inter-individually (p < 0.01). The administration of propafenone enlarged the areas of low complexity.

Algorithms↗
PubMed2002

Mass and thermal diffusivity algorithms: reduced algorithms for mass and thermal diffusivity determinations.

Mass and thermal diffusivity measurements conducted on Earth are prone to contamination by uncontrollable convective contributions to the overall transport. Previous studies of mass and thermal diffusivities conducted on spacecraft have demonstration the gain in precision, and lower absolute values, resulting from the reduced convective transport possible in a low-gravity environment. We have developed and extensively tested real-time techniques for diffusivity measurements, where several measurements may be obtained on a single sample. This is particularly advantageous for low gravity research were there is limited experiment time. The mass diffusivity methodology uses a cylindrical sample geometry. A radiotracer, initially located at one end of the host is used as the diffusant. The sample is positioned in a concentric isothermal radiation shield with collimation bores located at defined positions along its axis. The intensity of the radiation emitted through the collimators is measured versus time with solid-state detectors and associated energy discrimination electronics. For the mathematical algorithm that we use, only a single pair of collimation bores and detectors are necessary for single temperature measurements. However, by employing a second, offset, pair of collimation holes and radiation detectors, diffusivities can be determined at several temperatures per sample. For thermal diffusivity measurements a disk geometry is used. A heat pulse is applied in the center of the sample and the temperature response of the sample is measured at several locations. Thus, several values of the diffusivity are measured versus time. The exact analytic solution to a heat pulse in the disk geometry leads to a unique heated area and measurement locations. Knowledge of the starting time and duration of he heating pulse is not used in the data evaluation. Thus, this methodology represents an experimentally simpler and more robust scheme.

Journal Article↗
PubMed1997

Proposal of a computerized algorithm for continuous wave CO2 laser on-line control during orthopaedic surgery. Phase II: simplified algorithm version (LCA-s) and helmet-mounted data access device solution.

This paper is the continuation of the Phase I report published in 1992 by Canestri. It contains recent findings on how to speed-up the process of sublimated volume forecasting for a TEM11* CO2 laserbeam in CW mode following an original model proposed by the author--called LCA--here presented in a simplified version (LCA-s) on PMMA (polymethylmethacrilate) samples. Other interesting parameters, such as the time required to create the minimal injury vb along with its physical interpretations, are reported and explained. TEM11*, TEM01* and TEM00 beams profiles are also compared and discussed for LCA-s. The results of both Phase I and Phase II of this investigation can be integrated in one single solution package for the end-user, combining fast decisions making and operational features. The final part of this paper describes the 'helmet-mounted' data recall visor methodology which allows the surgeon to access to a data base for information retrieval during the course of an operation without interrupting the surgical case itself. This particularly interesting application allows the surgeon to consult a centrally-located data base which contains important information regarding similar clinical cases, choice of laserbeam profiles and focal lengths, simulation of beam behaviours, performances and other data. The on-line and direct access to the data base supports him in all those borderline situations in the O.R. in which the laser device type and configuration/calibration play a device role in the success of the operation. Also, the helmet-mounted display frees surgeon's hands in order to allow him to continue the operation while consulting the data base on-line, thus speeding up decision processes regarding changes of laser set-up, general calibration optimization and remote clinical consultancy.

Algorithms↗