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1.
J Adv Res ; 32: 61-71, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34484826

RESUMO

Introduction: As pulmonary dysfunctions are prospective factors for developing cancer, efforts are needed to solve the limitations regarding applications in lung cancer. Fractional order respiratory impedance models can be indicative of lung cancer dynamics and tissue heterogeneity. Objective: The purpose of this study is to investigate how the existence of a tumorous tissue in the lung modifies the parameters of the proposed models. The first use of a prototype forced oscillations technique (FOT) device in a mimicked lung tumor setup is investigated by comparing and interpreting the experimental findings. Methods: The fractional order model parameters are determined for the mechanical properties of the healthy and tumorous lung. Two protocols have been performed for a mimicked lung tumor setup in a laboratory environment. A low frequency evaluation of respiratory impedance model and nonlinearity index were assessed using the forced oscillations technique. Results: The viscoelastic properties of the lung tissue change, results being mirrored in the respiratory impedance assessment via FOT. The results demonstrate significant differences among the mimicked healthy and tumor measurements, (p-values < 0.05) for impedance values and also for heterogeneity index. However, there was no significant difference in lung function before and after immersing the mimicked lung in water or saline solution, denoting no structural changes. Conclusion: Simulation tests comparing the changes in impedance support the research hypothesis. The impedance frequency response is effective in non-invasive identification of respiratory tissue abnormalities in tumorous lung, analyzed with appropriate fractional models.

2.
J Adv Res ; 32: 27-36, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34484823

RESUMO

Introduction: In long-term induced general anesthesia cases such as those uniquely defined by the ongoing Covid-19 pandemic context, the clearance of hypnotic and analgesic drugs from the body follows anomalous diffusion with afferent drug trapping and escape rates in heterogeneous tissues. Evidence exists that drug molecules have a preference to accumulate in slow acting compartments such as muscle and fat mass volumes. Currently used patient dependent pharmacokinetic models do not take into account anomalous diffusion resulted from heterogeneous drug distribution in the body with time varying clearance rates. Objectives: This paper proposes a mathematical framework for drug trapping estimation in PK models for estimating optimal drug infusion rates to maintain long-term anesthesia in Covid-19 patients. We also propose a protocol for measuring and calibrating PK models, along with a methodology to minimize blood sample collection. Methods: We propose a framework enabling calibration of the models during the follow up of Covid-19 patients undergoing anesthesia during their treatment and recovery period in ICU. The proposed model can be easily updated with incoming information from clinical protocols on blood plasma drug concentration profiles. Already available pharmacokinetic and pharmacodynamic models can be then calibrated based on blood plasma concentration measurements. Results: The proposed calibration methodology allow to minimize risk for potential over-dosing as clearance rates are updated based on direct measurements from the patient. Conclusions: The proposed methodology will reduce the adverse effects related to over-dosing, which allow further increase of the success rate during the recovery period.


Assuntos
Anestesia , COVID-19 , Hipnóticos e Sedativos , Modelos Biológicos , SARS-CoV-2 , Idoso , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/farmacocinética , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Pandemias
3.
Sensors (Basel) ; 20(23)2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33256120

RESUMO

The paper aims to revive the interest in bioimpedance analysis for pain studies in communicating and non-communicating (anesthetized) individuals for monitoring purpose. The plea for exploitation of full potential offered by the complex (bio)impedance measurement is emphasized through theoretical and experimental analysis. A non-invasive, low-cost reliable sensor to measure skin impedance is designed with off-the-shelf components. This is a second generation prototype for pain detection, quantification, and modeling, with the objective to be used in fully anesthetized patients undergoing surgery. The 2D and 3D time-frequency, multi-frequency evaluation of impedance data is based on broadly available signal processing tools. Furthermore, fractional-order impedance models are implied to provide an indication of change in tissue dynamics correlated with absence/presence of nociceptor stimulation. The unique features of the proposed sensor enhancements are described and illustrated here based on mechanical and thermal tests and further reinforced with previous studies from our first generation prototype.


Assuntos
Dor Aguda , Processamento de Sinais Assistido por Computador , Dor Aguda/diagnóstico , Impedância Elétrica , Humanos
4.
J Adv Res ; 25: 191-203, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32922986

RESUMO

The present study provides a generalization of event-based control to the field of fractional calculus, combining the benefits brought by the two approaches into an industrial-suitable control strategy. During recent years, control applications based on fractional order differintegral operators have gained more popularity due to their proven superior performance when compared to classical, integer order, control strategies. However, the current industrial setting is not yet prepared to fully adapt to complex fractional order control implementations that require hefty computational resources; needing highly-efficient methods with minimum control effort. The solution to this particular problem lies in combining benefits of event-based control such as resource optimization and bandwidth allocation with the superior performance of fractional order control. Theoretical and implementation aspects are developed in order to provide a generalization of event-based control into the fractional calculus field. Different numerical examples validate the proposed methodology, providing a useful tool, especially for industrial applications where the event-based control is most needed. Several event-based fractional order implementation possibilities are explored, the final result being an event-based fractional order control methodology.

5.
J Clin Med ; 9(6)2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32545464

RESUMO

This paper introduces a mathematical compartmental formulation of dose-effect synergy modelling for multiple therapies in non small cell lung cancer (NSCLC): antiangiogenic, immuno- and radiotherapy. The model formulates the dose-effect relationship in a unified context, with tumor proliferating rates and necrotic tissue volume progression as a function of therapy management profiles. The model accounts for inter- and intra-response variability by using surface model response terms. Slow acting peripheral compartments such as fat and muscle for drug distribution are not modelled. This minimal pharmacokinetic-pharmacodynamic (PKPD) model is evaluated with reported data in mice from literature. A systematic analysis is performed by varying only radiotherapy profiles, while antiangiogenesis and immunotherapy are fixed to their initial profiles. Three radiotherapy protocols are selected from literature: (1) a single dose 5 Gy once weekly; (2) a dose of 5 Gy × 3 days followed by a 2 Gy × 3 days after two weeks and (3) a dose of 5 Gy + 2 × 0.075 Gy followed after two weeks by a 2 Gy + 2 × 0.075 Gy dose. A reduction of 28% in tumor end-volume after 30 days was observed in Protocol 2 when compared to Protocol 1. No changes in end-volume were observed between Protocol 2 and Protocol 3, this in agreement with other literature studies. Additional analysis on drug interaction suggested that higher synergy among drugs affects up to three-fold the tumor volume (increased synergy leads to significantly lower growth ratio and lower total tumor volume). Similarly, changes in patient response indicated that increased drug resistance leads to lower reduction rates of tumor volumes, with end-volume increased up to 25-30%. In conclusion, the proposed minimal PKPD model has physiological value and can be used to study therapy management protocols and is an aiding tool in the clinical decision making process. Although developed with data from mice studies, the model is scalable to NSCLC patients.

6.
J Clin Med ; 9(3)2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32143327

RESUMO

Although the measurement of dielectric properties of the skin is a long-known tool for assessing the changes caused by nociception, the frequency modulated response has not been considered yet. However, for a rigorous characterization of the biological tissue during noxious stimulation, the bioimpedance needs to be analyzed over time as well as over frequency. The 3-dimensional analysis of nociception, including bioimpedance, time, and frequency changes, is provided by ANSPEC-PRO device. The objective of this observational trial is the validation of the new pain monitor, named as ANSPEC-PRO. After ethics committee approval and informed consent, 26 patients were monitored during the postoperative recovery period: 13 patients with the in-house developed prototype ANSPEC-PRO and 13 with the commercial device MEDSTORM. At every 7 min, the pain intensity was measured using the index of Anspec-pro or Medstorm and the 0-10 numeric rating scale (NRS), pre-surgery for 14 min and post-anesthesia for 140 min. Non-significant differences were reported for specificity-sensitivity analysis between ANSPEC-PRO (AUC = 0.49) and MEDSTORM (AUC = 0.52) measured indexes. A statistically significant positive linear relationship was observed between Anspec-pro index and NRS (r2 = 0.15, p < 0.01). Hence, we have obtained a validation of the prototype Anspec-pro which performs equally well as the commercial device under similar conditions.

7.
Front Physiol ; 10: 1390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31803060

RESUMO

This paper introduces the use of low frequencies forced oscillation technique (FOT) in the presence of breathing signal. The hypothesis tested is to evaluate the sensitivity of FOT to various degrees of obstruction in COPD patients. The measurements were performed in the frequency range 0-2 Hz. The use of FOT to evaluate respiratory impedance has been broadly recognized and its complementary use next to standardized method as spirometry and body plethysmography has been well-documented. Typical use of FOT uses frequencies between 4-32 Hz and above. However, interesting information at frequencies below 4 Hz is related to viscoelastic properties of parenchyma. Structural changes in COPD affect viscoelastic properties and we propose to investigate the use of FOT at low frequencies with a fourth generation fan-based FOT device. The generator non-linearity introduced by the device is separated from the linear approximation of the impedance before evaluating the results on patients. Three groups of COPD obstruction, GOLD II, III, and IV are evaluated. We found significant differences in mechanical parameters (tissue damping, tissue elasticity, hysteresivity) and increased degrees of non-linear dynamic contributions in the impedance data with increasing degree of obstruction (p < 0.01). The results obtained suggest that the non-linear index correlates better with degrees of heterogeneity linked to COPD GOLD stages, than the currently used hysteresivity index. The protocol and method may prove useful to improve current diagnosis percentages for various COPD phenotypes.

8.
Heliyon ; 5(7): e02154, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31388585

RESUMO

Many processes in industry are highly-coupled Multiple-Input Multiple-Output (MIMO) systems. In this paper, a methodology, based on the Kissing Circle (KC) tuning method, is proposed to tune a fractional-order PI controller for these types of systems. The KC method relies on frequency domain specifications and emphasizes improving robustness. The method does not require a model, a single sine test suffices to obtain the controller parameters. Hence, the method can be categorized as an auto-tuner. For comparison, an integer-order PI is tuned with the same requirements. To evaluate and analyze the performance of both controllers an experimental test bench is used, i.e. a landscape office lighting system. A direct low-order discretization method is used to implement the controller in a real process. Both controllers are subjected to simulation experiments to test the performance in time and frequency domain and they are subjected to process variations to evaluate their robustness. The fractional controller manages to control a process that is susceptible to 85% variation in time constant mismatch as opposed to 79% for the integer-order controller. An Integer Absolute Error evaluation of experimental results show that the fractional-order PI controller and integer-order PI controller have similar control performance, as expected from the frequency domain analysis. As model uncertainty can add up in MIMO systems, improved robustness is crucial and with this methodology the control performance does not deteriorate. Moreover, a decrease in power consumption of 6% is observed.

9.
ISA Trans ; 84: 178-186, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30342816

RESUMO

This paper presents a new tuning method for fractional-order (FO)PID controllers to simplify current tuning and make FOPID controllers more convenient for industry, i.e. facilitate transition from state-of-art to state-of-use. The number of tuning parameters is reduced from five to three based on popular specification settings for PID controllers without the need for reduced process models which introduce modeling errors. A test batch of 133 simulated processes and two real-life processes are used to test the presented method. A comparative study between the new method and the established CRONE controller, quantifies the performance. The conclusion states that the new method gives fractional controllers with similar performances as the current methods but with a significantly decreased tuning complexity making FOPID controllers more acceptable to industry.

10.
IEEE Trans Biomed Eng ; 66(3): 718-726, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30010543

RESUMO

OBJECTIVE: This paper introduces a primer in the health care practice, namely a mathematical model and methodology for detecting and analysing nociceptor stimulation followed by related tissue memory effects. METHODS: Noninvasive nociceptor stimulus protocol and prototype device for measuring bioimpedance is provided. Various time instants, sensor location, and stimulus train have been analysed. RESULTS: The method and model indicate that nociceptor stimulation perceived as pain in awake healthy volunteers is noninvasively detected. The existence of a memory effect is proven from data. Sensor location had minimal effect on detection level, while day-to-day variability was observed without being significant. CONCLUSION: Following the experimental study, the model enables a comprehensive management of chronic pain patients, and possibly other analgesia, or pain related regulatory loops. SIGNIFICANCE: A device and methodology for noninvasive for detecting nociception stimulation have been developed. The proposed method and models have been validated on healthy volunteers.


Assuntos
Impedância Elétrica , Nociceptividade/fisiologia , Dor , Processamento de Sinais Assistido por Computador , Vigília/fisiologia , Adulto , Analgesia , Dor Crônica , Feminino , Mãos/fisiologia , Humanos , Masculino , Dor/diagnóstico , Dor/fisiopatologia
11.
ISA Trans ; 74: 229-238, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29395129

RESUMO

Fractional order systems become increasingly popular due to their versatility in modelling and control applications across various disciplines. However, the bottleneck in deploying these tools in practice is related to their implementation on real-life systems. Numerical approximations are employed but their complexity no longer match the attractive simplicity of the original fractional order systems. This paper proposes a low-order, computationally stable and efficient method for direct approximation of general order (fractional order) systems in the form of discrete-time rational transfer functions, e.g. processes, controllers. A fair comparison to other direct discretization methods is presented, demonstrating its added value with respect to the state of art.

12.
Comput Methods Programs Biomed ; 144: 21-35, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28495004

RESUMO

BACKGROUND AND OBJECTIVE: This paper addresses the use of proportional-integral-derivative controllers for regulating the depth of hypnosis in anesthesia by using propofol administration and the bispectral index as a controlled variable. In fact, introducing an automatic control system might provide significant benefits for the patient in reducing the risk for under- and over-dosing. METHODS: In this study, the controller parameters are obtained through genetic algorithms by solving a min-max optimization problem. A set of 12 patient models representative of a large population variance is used to test controller robustness. The worst-case performance in the considered population is minimized considering two different scenarios: the induction case and the maintenance case. RESULTS: Our results indicate that including a gain scheduling strategy enables optimal performance for induction and maintenance phases, separately. Using a single tuning to address both tasks may results in a loss of performance up to 102% in the induction phase and up to 31% in the maintenance phase. Further on, it is shown that a suitably designed low-pass filter on the controller output can handle the trade-off between the performance and the noise effect in the control variable. CONCLUSIONS: Optimally tuned PID controllers provide a fast induction time with an acceptable overshoot and a satisfactory disturbance rejection performance during maintenance. These features make them a very good tool for comparison when other control algorithms are developed.


Assuntos
Anestesia/métodos , Hipnose Anestésica , Hipnóticos e Sedativos/administração & dosagem , Propofol/administração & dosagem , Algoritmos , Humanos , Modelos Teóricos
13.
PLoS One ; 12(5): e0177969, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28542377

RESUMO

This paper proposes a mathematical framework for understanding how the structural changes in the COPD lung reflect in model parameters. The core of the analysis is a correlation between the heterogeneity in the lung as COPD degree changes (GOLD II, III and IV) and the nonlinearity index evaluated using the forced oscillation technique. A low frequency evaluation of respiratory impedance models and nonlinearity degree is performed since changes in tissue mechanics are related to viscoelastic properties. Simulation analysis of our model indicates a good correlation to expected changes in heterogeneity and nonlinear effects. A total of 43 COPD diagnosed patients are evaluated, distributed as GOLD II (18), GOLD III (15) and GOLD IV (10). Experimental data supports the claims and indicate that the proposed model and index for nonlinearity is well-suited to capture COPD structural changes.


Assuntos
Pulmão/patologia , Doença Pulmonar Obstrutiva Crônica/patologia , Idoso , Impedância Elétrica , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Modelos Teóricos , Índice de Gravidade de Doença
14.
ISA Trans ; 62: 268-75, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26903289

RESUMO

Fractional order PID controllers benefit from an increasing amount of interest from the research community due to their proven advantages. The classical tuning approach for these controllers is based on specifying a certain gain crossover frequency, a phase margin and a robustness to gain variations. To tune the fractional order controllers, the modulus, phase and phase slope of the process at the imposed gain crossover frequency are required. Usually these values are obtained from a mathematical model of the process, e.g. a transfer function. In the absence of such model, an auto-tuning method that is able to estimate these values is a valuable alternative. Auto-tuning methods are among the least discussed design methods for fractional order PID controllers. This paper proposes a novel approach for the auto-tuning of fractional order controllers. The method is based on a simple experiment that is able to determine the modulus, phase and phase slope of the process required in the computation of the controller parameters. The proposed design technique is simple and efficient in ensuring the robustness of the closed loop system. Several simulation examples are presented, including the control of processes exhibiting integer and fractional order dynamics.

15.
IEEE Trans Biomed Eng ; 62(3): 832-41, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25373077

RESUMO

This paper describes strategies toward model-based automation of intravenous anaesthesia employing advanced control techniques. In particular, based on a detailed compartmental mathematical model featuring pharmacokinetic and pharmacodynamics information, two alternative model predictive control strategies are presented: a model predictive control strategy, based on online optimization, the extended predictive self-adaptive control and a multiparametric control strategy based on offline optimization, the multiparametric model predictive control. The multiparametric features to account for the effect of nonlinearity and the impact of estimation are also described. The control strategies are tested on a set of 12 virtually generated patient models for the regulation of the depth of anaesthesia by means of the bispectral index (BIS) using Propofol as the administrated anaesthetic. The simulations show fast response, suitability of dose, and robustness to induce and maintain the desired BIS setpoint.


Assuntos
Anestesia Intravenosa/métodos , Anestésicos Intravenosos , Modelos Biológicos , Propofol , Adulto , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Anestésicos Intravenosos/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Propofol/farmacocinética , Propofol/farmacologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-25570723

RESUMO

The forced oscillation technique (FOT) is a non-invasive method to measure the respiratory impedance Z, defined as the complex ratio of transrespiratory pressure P to the airflow at the airway opening Q as a function of frequency. FOT determines Z by superimposing small amplitude pressure oscillations on the normal breathing and measuring the resulting air flow. In this work a new approach for the analysis of the respiratory impedance Z at low frequencies (0.1-5 Hz) during spontaneous breathing is presented. When the respiratory impedance is measured in frequency ranges that overlap with the frequency of spontaneous breathing (0.1-1 Hz), the measured air flow will contain both the breathing of the patient and the response of the respiratory impedance to the pressure oscillations. A nonlinear estimator is developed which is able to separate the breathing signal from the respiratory response in order to obtain the respiratory impedance. The estimated results are used to obtain accurate estimates of airway and tissue components of a constant phase model.


Assuntos
Fisiologia/métodos , Respiração , Algoritmos , Simulação por Computador , Impedância Elétrica , Humanos , Pulmão/fisiologia
17.
J Clin Monit Comput ; 28(6): 537-46, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24271330

RESUMO

In this paper is presented a brief state of art regarding the multivariable formulation for controlling the depth of anaesthesia by means of two intravenously administrated drugs, i.e. propofol and remifentanil. In a feasibility study of determining a suitable variable to quantify analgesia levels in patients undergoing cardiac surgery, the bispectral index and an electromyogram-based surrogate variable are proposed as the controlled variables. The study is carried on in the context of implementing a multivariable predictive control algorithm. The simulation results show that such a paradigm is feasible, although it does not guarantee perfect knowledge of the analgesia level-in other words, the variable is not validated against typical evaluations of the pain levels (e.g. clinical scores).


Assuntos
Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacocinética , Monitoramento de Medicamentos/métodos , Quimioterapia Assistida por Computador/métodos , Eletroencefalografia/efeitos dos fármacos , Eletromiografia/efeitos dos fármacos , Modelos Biológicos , Anestésicos Intravenosos/sangue , Simulação por Computador , Monitores de Consciência , Retroalimentação Fisiológica/fisiologia , Humanos , Análise Multivariada
18.
IEEE Trans Biomed Circuits Syst ; 7(6): 882-92, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24473552

RESUMO

In this work, a re-visited model of the respiratory system is proposed. Identification of a recurrent electrical ladder network model of the lungs, which incorporates their specific morphology and anatomical structure, is performed on 31 healthy subjects. The data for identification has been gathered using the forced oscillation lung function test, which delivers a non-parametric model of the impedance. On the measured frequency response, the ladder network parameters have been identified and a fractional order has been calculated from the recurrent ratios of the respiratory mechanics (resistance and compliance). The paper includes also a comparison of our recurrent parameter model with another parametric model for high frequency range. The results suggest that the two models can equally well characterize the respiratory impedance over a long range of frequencies. Additionally, we have shown that the fractional order resulting from the recurrent properties of resistance and compliance in the ladder network model is independent of frequency and is not biased by the nose clip wore by the patients during measurements. An illustrative example shows that our re-visited model is sensitive to changes in respiratory mechanics and the fractional order value is a reliable parameter to capture these changes.


Assuntos
Testes de Função Respiratória/métodos , Mecânica Respiratória/fisiologia , Resistência das Vias Respiratórias/fisiologia , Algoritmos , Desenho de Equipamento , Humanos , Testes de Função Respiratória/instrumentação
19.
Comput Methods Programs Biomed ; 104(3): e189-200, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21477881

RESUMO

This paper presents the application of multidimensional scaling (MDS) analysis to data emerging from noninvasive lung function tests, namely the input respiratory impedance. The aim is to obtain a geometrical mapping of the diseases in a 3D space representation, allowing analysis of (dis)similarities between subjects within the same pathology groups, as well as between the various groups. The adult patient groups investigated were healthy, diagnosed chronic obstructive pulmonary disease (COPD) and diagnosed kyphoscoliosis, respectively. The children patient groups were healthy, asthma and cystic fibrosis. The results suggest that MDS can be successfully employed for mapping purposes of restrictive (kyphoscoliosis) and obstructive (COPD) pathologies. Hence, MDS tools can be further examined to define clear limits between pools of patients for clinical classification, and used as a training aid for medical traineeship.


Assuntos
Respiração , Adulto , Asma/fisiopatologia , Criança , Fibrose Cística/fisiopatologia , Humanos , Cifose/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Valores de Referência , Testes de Função Respiratória
20.
Comput Methods Programs Biomed ; 104(3): e178-88, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21458877

RESUMO

The paper discusses the application of a direct adaptive controller to a pressure controlled artificial ventilation problem. In pressure controlled ventilators, the manipulated variable is the maximum flow applied to the patient during the active phase (inspiration), and the regulated variable is the peak pressure at end-inspiration. This simulation case study focuses on patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD), which require artificial/mechanical ventilation. An adaptive PID controller ensures peak pressures below critical values, by manipulating the flow delivered by the ventilator. The simulation study is performed on fractional-order models of the respiratory impedance identified from lung function data obtained from 21 COPD patients. Additional simulation studies show the robustness of the controller in presence of varying model parameters from the respiratory impedance of the patient. Possibilities to implement the control strategy as an online adaptive algorithm are also explored. The results show that the design of the control is suitable for this kind of application and provides useful insight on realistic scenarios.


Assuntos
Simulação por Computador , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Respiração Artificial , Humanos , Modelos Teóricos , Pressão , Respiração
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