Behavioral and biological correlates of medicine use in type 2 diabetic patients attended by Brazilian public healthcare system

A relação entre atividade física e consumo de medicamentos não é clara. Assim, o objetivo do estudo foi investigar a relação entre nível de atividade física e uso de medicamentosem diabéticos tipo 2 atendidos pelo Sistema Único de Saúde. A amostra foi composta por 121 diabéticos do tipo 2 de ambos os sexos atendidos pelos sistema público de saúde. Gordura corporal (antropometria e bioimpedância elétrica), atividade física (Questionário de Baecke) e uso de medicamentos (15 dias prévios a avaliação) foram avaliados. Houve relação entre uso de medicamentos e sexo (r = 0.18; p = 0.045), índice de massa corporal (r = 0.22; p = 0.012), circunferência de cintura (r = 0.19; p = 0.029), percentual de gordura (r = 0.21; p = 0.016), idade (r = 0.23; p = 0.009) e atividade física (r = -0.22; p = 0.012). A regressão linear incluiu no modelo apenas idade (β = 0.718; p = 0.057), IMC BMI (β = 0.057; p = 0.022) e atividade física (β = -0.176; p = 0.044) no modelo multivariado. Conclui-se que a prática de atividade física diminui uso de medicamentos independente da idade e obesidade.

Mapping lightning processes using fuzzy inference system

This paper describes a novel approach for mapping lightning processes using fuzzy logic. The core regarding lightning process is to identify and to model those uncertain information on mathematical principles. In fact, the lightning process involves several nonlinear features that our current mathematical tools would not be able to model. The estimation process has been carried out using a fuzzy system based on Sugeno's architecture. Simulation results confirm that proposed approach can be efficiently used in these types of problem.

Fuzzy logic to predict thermal damages of ground parts

One of the critical problems in implementing an intelligent grinding process is the automatic detection of workpiece surface burn. This work uses fuzzy logic as a tool to classify and predict burn levels in the grinding process. Based on acoustic emission signals, cutting power, and the mean-value deviance (MVD), linguistic rules were established for the various burn situations (slight, intermediate, severe) by applying fuzzy logic using the Matlab Toolbox. Three practical fuzzy system models were developed. The first model with two inputs resulted only in a simple analysis process. The second and third models have an additional MVD statistic input, associating information and precision. These two models differ from each other in terms of the rule base developed. The three developed models presented valid responses, proving effective, accurate, reliable and easy to use for the determination of ground workpiece burn. In this analysis, fuzzy logic translates the operator's human experience associated with powerful computational methods.

Development of a water quality index using a fuzzy logic: A case study for the sorocaba river

Due to growing urbanization and industrialization, the environment is suffering from pollution of rivers, degradation of soils and deteriorated air quality. Quality indices appear to be useful to evaluate the conditions of these media. The aim of this study was the development of a water quality index using a fuzzy inference system, since such an approach has proved advantageous in addressing problems that are subjective by nature or for which the data are uncertain. The methodology employed was based on this inference system, and considered the nine water quality parameters employed by CETESB (Companhia de Tecnologia de Saneamento Ambiental, São Paulo, Brazil) to evaluate water quality. After assessment of the data using the index, a comparison was made with the WQI (Water Quality Index), which is used for the monitoring of various water bodies, including in the study region. The results obtained using the index developed on the basis of fuzzy inference were found to be more useful than those derived from the method currently used by CETESB, since losses and/or omissions concerning individual parameters were minimized. © 2010 IEEE.

Metodologia baseada em sistema fuzzy intervalar do tipo-2 para detecção e identificação de faltas de incipientes em motores de indução

Desde a incorporação da automação no processo produtivo, a busca por sistemas mais eficientes, objetivando o aumento da produtividade e da qualidade dos produtos e serviços, direcionou os estudos para o planejamento de estratégias que permitissem o monitoramento de sistemas com o intuito principal de torna-los mais autônomos e robustos. Por esse motivo, as pesquisas envolvendo o diagnóstico de faltas em sistemas industriais tornaram-se mais intensivas, visto a necessidade da incorporação de técnicas para monitoramente detalhado de sistemas. Tais técnicas permitem a verificação de perturbações, falta ou mesmo falhas. Em vista disso, essa trabalho investiga técnicas de detecção e diagnostico de faltas e sua aplicação em motores de indução trifásicos, delimitando o seu estudo em duas situações: sistemas livre de faltas, e sobre atuação da falta incipiente do tipo curto-circuitoparcial nas espiras do enrolamento do estator. Para a detecção de faltas, utilizou-se analise paramétrica dos parâmetros de um modelo de tempo discreto, de primeira ordem, na estrutura autoregressivo com entradas exógenas (ARX). Os parâmetros do modelo ARX, que trazem informação sobre a dinâmica dominante do sistema, são obtidos recursivamente pela técnica dos mínimos quadrados recursivos (MQR). Para avaliação da falta, foi desenvolvido um sistema de inferência fuzzy (SIF) intervala do tipo-2, cuja mancha de incerteza ou footprint of uncertainty (FOU), características de sistema fuzzy tipo-2, é ideal como forma de representar ruídos inerentes a sistemas reais e erros numéricos provenientes do processo de estimação paramétrica. Os parâmetros do modelo ARX são entradas para o SIF. Algoritmos genéricos (AG’s) foram utilizados para otimização dos SIF intervalares tipo-2, objetivando reduzir o erro de diagnóstico da falta identificada na saída desses sistemas. Os resultados obtidos em teste de simulação computacional demonstram a efetividade da metodologia proposta.

Projeto de um Multiplicador Divisor Anal´ogico em tecnologia CMOS para uso em controlador fuzzy tipo-2 intervalar

The main objective of the presented study is the design of a analog multiplier-divider as integrant part of the type-reducer circuit of type-2 fuzzy controller chip. The proposed circuit is a multiplier/divider which operates in current mode, in the CMOS technology with a supply voltage of 1.8 V.The circuit simulation was performed in PSPICE software with simulation model provided by AMS (Austria Mikro Systems International) in CMOS technology 0.35μm

Expert system to detect incipient fauts in rotating machines using fuzzy logic and virtual instrumentation

This paper refers to the design of an expert system that captures a waveform through the use of an accelerometer, processes the signal and converts it to the frequency domain using a Fast Fourier Transformer to then, using artificial intelligence techniques, specifically Fuzzy Reasoning, it determines if there is any failure present in the underlying mode of the equipment, such as imbalance, misalignment or bearing defects.

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.

Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes

To assess whether blockade of the renin-angiotensin system (RAS), a recognized strategy to prevent the progression of diabetic nephropathy, affects renal tissue oxygenation in type 2 diabetes mellitus (T2DM) patients.

Economic efficiency analysis of different strategies to control post-weaning multi-systemic wasting syndrome and porcine circovirus type 2 subclinical infection in 3-weekly batch system farms.

The study assessed the economic efficiency of different strategies for the control of post-weaning multi-systemic wasting syndrome (PMWS) and porcine circovirus type 2 subclinical infection (PCV2SI), which have a major economic impact on the pig farming industry worldwide. The control strategies investigated consisted on the combination of up to 5 different control measures. The control measures considered were: (1) PCV2 vaccination of piglets (vac); (2) ensuring age adjusted diet for growers (diets); (3) reduction of stocking density (stock); (4) improvement of biosecurity measures (bios); and (5) total depopulation and repopulation of the farm for the elimination of other major pathogens (DPRP). A model was developed to simulate 5 years production of a pig farm with a 3-weekly batch system and with 100 sows. A PMWS/PCV2SI disease and economic model, based on PMWS severity scores, was linked to the production model in order to assess disease losses. This PMWS severity scores depends on the combination post-weaning mortality, PMWS morbidity in younger pigs and proportion of PCV2 infected pigs observed on farms. The economic analysis investigated eleven different farm scenarios, depending on the number of risk factors present before the intervention. For each strategy, an investment appraisal assessed the extra costs and benefits of reducing a given PMWS severity score to the average score of a slightly affected farm. The net present value obtained for each strategy was then multiplied by the corresponding probability of success to obtain an expected value. A stochastic simulation was performed to account for uncertainty and variability. For moderately affected farms PCV2 vaccination alone was the most cost-efficient strategy, but for highly affected farms it was either PCV2 vaccination alone or in combination with biosecurity measures, with the marginal profitability between 'vac' and 'vac+bios' being small. Other strategies such as 'diets', 'vac+diets' and 'bios+diets' were frequently identified as the second or third best strategy. The mean expected values of the best strategy for a moderately and a highly affected farm were £14,739 and £57,648 after 5 years, respectively. This is the first study to compare economic efficiency of control strategies for PMWS and PCV2SI. The results demonstrate the economic value of PCV2 vaccination, and highlight that on highly affected farms biosecurity measures are required to achieve optimal profitability. The model developed has potential as a farm-level decision support tool for the control of this economically important syndrome.

Ascorbic acid effects on the immune system and type -1 /type -2 cytokine balance in humans

Vitamin C (ascorbic acid--AA) can have a substantial impact on human health by reducing the incidence and/or severity of coryza. Studies also suggest it has immunomodulatory functions in humans. Immune function is controlled by cytokines, such as type-1 cytokines (IFNγ) that promote antiviral immunity and type-2 cytokines (IL-4, IL-10) that promote humoral immunity. Knowing the mechanisms responsible for both antiviral immunity and type-1/type-2 cytokine balance, we sought to identify AA-induced alterations of human peripheral blood mononuclear cells (PBMC) in vivo and in vitro . We hypothesized that AA modulates the immune system, altering both number and function of PBMC. We first described the effect of 14 days of oral (1 gram) AA in healthy subjects. AA increased circulating natural killer (NK) cells, CD25+ and HLA-DR+ T cells, and PMA/ionomycin-stimulated intracellular IFNγ. We subsequently developed models for in vitro use. We determined that AA was toxic in vitro to T cells when used at doses found intracellularly but doses found in plasma from individuals taking 1gm/day AA were nontoxic. The model that most fully reproduced our in vivo intracellular cytokine findings used dehydroascorbic acid and buffers to deliver AA intracellularly. This model generated the largest increase in IFNγ at physiologic plasma concentrations. Previous studies demonstrate that chronic psychological stress is associated with a type-2 cytokine response. We hypothesized that vitamin C could prevent the type-2 cytokine shift associated with stress. In a study of medical students taking 1 g AA or placebo, a significant increase in IFNγ was seen intracellularly in CD4+ and CD8+ cells and in tetanus-stimulated cultures in the AA group only. We also observed increases in IFNγ/IL-4 and IFNγ/IL-10 ratios with AA supplementation, indicating a type-1 shift. Furthermore, we noted increased numbers of NK cells and activated T cells in the peripheral blood in the AA treated group only. Lastly, we investigated the role of the CD40L/CD40 and CD28/B7 costimulatory pathway in these cytokine alterations. AA did not have any effect on either pathway studied. Thus costimulatory pathways are not contributing to AA induced modulation of the type-1/type-2 immune balance. ^

A Stress-Detection System Based on Physiological Signals and Fuzzy Logic

A stress-detection system is proposed based on physiological signals. Concretely, galvanic skin response (GSR) and heart rate (HR) are proposed to provide information on the state of mind of an individual, due to their nonintrusiveness and noninvasiveness. Furthermore, specific psychological experiments were designed to induce properly stress on individuals in order to acquire a database for training, validating, and testing the proposed system. Such system is based on fuzzy logic, and it described the behavior of an individual under stressing stimuli in terms of HR and GSR. The stress-detection accuracy obtained is 99.5% by acquiring HR and GSR during a period of 10 s, and what is more, rates over 90% of success are achieved by decreasing that acquisition period to 3-5 s. Finally, this paper comes up with a proposal that an accurate stress detection only requires two physiological signals, namely, HR and GSR, and the fact that the proposed stress-detection system is suitable for real-time applications.

Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

AIM: To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic approach. METHODS: In the simulation performed in the current study, the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery (VICTUS, TECHNOLAS Perfect Vision GmbH, Bausch & Lomb, Munich, Germany) during a period of 5y were considered. A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y period. Furthermore, a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery (G). RESULTS: According to the sensitivity analysis, the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $500. In contrast, the fuzzy logic analysis confirmed that the patient had to pay more per surgery, between $661.8 and $667.4 per surgery, without considering the cost of the intraocular lens (IOL). CONCLUSION: A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis, especially in those centers with large volumes of patients. The cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

Type-2 TOPSIS:a group decision problem when ideal values are not extreme endpoints

In the traditional TOPSIS, the ideal solutions are assumed to be located at the endpoints of the data interval. However, not all performance attributes possess ideal values at the endpoints. We termed performance attributes that have ideal values at extreme points as Type-1 attributes. Type-2 attributes however possess ideal values somewhere within the data interval instead of being at the extreme end points. This provides a preference ranking problem when all attributes are computed and assumed to be of the Type-1 nature. To overcome this issue, we propose a new Fuzzy DEA method for computing the ideal values and distance function of Type-2 attributes in a TOPSIS methodology. Our method allows Type-1 and Type-2 attributes to be included in an evaluation system without compromising the ranking quality. The efficacy of the proposed model is illustrated with a vendor evaluation case for a high-tech investment decision making exercise. A comparison analysis with the traditional TOPSIS is also presented. © 2012 Springer Science+Business Media B.V.