Type-2 fuzzy sets applied to multivariable self-organizing fuzzy logic controllers for regulating anesthesia

In this paper, novel interval and general type-2 self-organizing fuzzy logic controllers (SOFLCs) are proposed for the automatic control of anesthesia during surgical procedures. The type-2 SOFLC is a hierarchical adaptive fuzzy controller able to generate and modify its rule-base in response to the controller's performance. The type-2 SOFLC uses type-2 fuzzy sets derived from real surgical data capturing patient variability in monitored physiological parameters during anesthetic sedation, which are used to define the footprint of uncertainty (FOU) of the type-2 fuzzy sets. Experimental simulations were carried out to evaluate the performance of the type-2 SOFLCs in their ability to control anesthetic delivery rates for maintaining desired physiological set points for anesthesia (muscle relaxation and blood pressure) under signal and patient noise. Results show that the type-2 SOFLCs can perform well and outperform previous type-1 SOFLC and comparative approaches for anesthesia control producing lower performance errors while using better defined rules in regulating anesthesia set points while handling the control uncertainties. The results are further supported by statistical analysis which also show that zSlices general type-2 SOFLCs are able to outperform interval type-2 SOFLC in terms of their steady state performance

An Adaptive Monitoring Scheme for Automatic Control of Anaesthesia in dynamic surgical environments based on Bispectral Index and Blood Pressure.

During surgical procedures, bispectral index (BIS) is a well-known measure used to determine the patient's depth of anesthesia (DOA). However, BIS readings can be subject to interference from many factors during surgery, and other parameters such as blood pressure (BP) and heart rate (HR) can provide more stable indicators. However, anesthesiologist still consider BIS as a primary measure to determine if the patient is correctly anaesthetized while relaying on the other physiological parameters to monitor and ensure the patient's status is maintained. The automatic control of administering anesthesia using intelligent control systems has been the subject of recent research in order to alleviate the burden on the anesthetist to manually adjust drug dosage in response physiological changes for sustaining DOA. A system proposed for the automatic control of anesthesia based on type-2 Self Organizing Fuzzy Logic Controllers (T2-SOFLCs) has been shown to be effective in the control of DOA under simulated scenarios while contending with uncertainties due to signal noise and dynamic changes in pharmacodynamics (PD) and pharmacokinetic (PK) effects of the drug on the body. This study considers both BIS and BP as part of an adaptive automatic control scheme, which can adjust to the monitoring of either parameter in response to changes in the availability and reliability of BIS signals during surgery. The simulation of different control schemes using BIS data obtained during real surgical procedures to emulate noise and interference factors have been conducted. The use of either or both combined parameters for controlling the delivery Propofol to maintain safe target set points for DOA are evaluated. The results show that combing BIS and BP based on the proposed adaptive control scheme can ensure the target set points and the correct amount of drug in the body is maintained even with the intermittent loss of BIS signal that could otherwise disrupt an automated control system

Performance Analysis of Extracted Rule-Base Multivariable Type-2 Self-Organizing Fuzzy Logic Controller Applied to Anesthesia

We compare type-1 and type-2 self-organizing fuzzy logic controller (SOFLC) using expert initialized and pretrained extracted rule-bases applied to automatic control of anaesthesia during surgery. We perform experimental simulations using a nonfixed patient model and signal noise to account for environmental and patient drug interaction uncertainties. The simulations evaluate the performance of the SOFLCs in their ability to control anesthetic delivery rates for maintaining desired physiological set points for muscle relaxation and blood pressure during a multistage surgical procedure. The performances of the SOFLCs are evaluated by measuring the steady state errors and control stabilities which indicate the accuracy and precision of control task. Two sets of comparisons based on using expert derived and extracted rule-bases are implemented as Wilcoxon signed-rank tests. Results indicate that type-2 SOFLCs outperform type-1 SOFLC while handling the various sources of uncertainties. SOFLCs using the extracted rules are also shown to outperform those using expert derived rules in terms of improved control stability

Robust fractional order PI control for cardiac output stabilisation

Drug regulatory paradigms are dependent on the hemodynamic system as it serves to distribute and clear the drug in/from the body. While focusing on the objective of the drug paradigm at hand, it is important to maintain stable hemodynamic variables. In this work, a biomedical application requiring robust control properties has been used to illustrate the potential of an autotuning method, referred to as the fractional order robust autotuner. The method is an extension of a previously presented autotuning principle and produces controllers which are robust to system gain variations. The feature of automatic tuning of controller parameters can be of great use for data-driven adaptation during intra-patient variability conditions. Fractional order PI/PD controllers are generalizations of the well-known PI/PD controllers that exhibit an extra parameter usually used to enhance the robustness of the closed loop system. (C) 2019, IFAC (International Federation of Automatic Control) Hosting by Elsevier Ltd. All rights reserved

A computationally efficient Hill curve adaptation strategy during continuous monitoring of dose-effect relation in anaesthesia

This paper discusses a possibility to simplify the number of parameters in the Hill curve by exploiting special mathematical functions. This simplification is relevant when adaptation is required for personalized model-based medicine during continuous monitoring of dose-response values. A mathematical framework of the involved physiology and modelling by means of distributed parameter progressions has been employed. Convergence to a unique dynamic response is achieved, allowing simplifying assumptions with guaranteed solution. Discussion on its use and comparison with other adaptation mechanism is provided

Advanced multiparametric optimization and control studies for anaesthesia

Anaesthesia is a reversible pharmacological state of the patient where hypnosis, analgesia and muscle relaxation are guaranteed and maintained throughout the surgery. Analgesics block the sensation of pain; hypnotics produce unconsciousness, while muscle relaxants prevent unwanted movement of muscle tone. Controlling the depth of anaesthesia is a very challenging task, as one has to deal with nonlinearity, inter- and intra-patient variability, multivariable characteristics, variable time delays, dynamics dependent on the hypnotic agent, model analysis variability, agent and stability issues. The modelling and automatic control of anaesthesia is believed to (i) benefit the safety of the patient undergoing surgery as side-effects may be reduced by optimizing the drug infusion rates, and (ii) support anaesthetists during critical situations by automating the drug delivery systems. In this work we have developed several advanced explicit/multi-parametric model predictive (mp-MPC) control strategies for the control of depth of anaesthesia. State estimation techniques are developed and used simultaneously with mp-MPC strategies to estimate the state of each individual patient, in an attempt to overcome the challenges of inter- and intra- patient variability, and deal with possible unmeasurable noisy outputs. Strategies to deal with the nonlinearity have been also developed including local linearization, exact linearization as well as a piece-wise linearization of the Hill curve leading to a hybrid formulation of the patient model and thereby the development of multiparametric hybrid model predictive control methodology. To deal with the inter- and intra- patient variability, as well as the noise on the process output, several robust techniques and a multiparametric moving horizon estimation technique have been design and implemented. All the studies described in the thesis are performed on clinical data for a set of 12 patients who underwent general anaesthesia.Open Acces

Intelligent Decision Support Systems in Ventilation Management

Introduction: Intensive Care Unit (ICU) medical personnel, in an ongoing process termed ventilation management, utilize patient physiology and pathology data to define ventilator apparatus settings. Aims: The aim of the research is to develop and evaluate in comparison hybrid ventilation advisor systems, that could support ventilation management process, specific to lung pathology for patients ventilated in control mode. Methodology: A questionnaire was designed and circulated to Intensivists. Patient data, as defined by the questionnaire analysis, were collected and categorized into three lung pathologies. Three ICU doctors evaluated correlation analysis of the recorded data. Evaluation results were used for identifying models basic architecture. Two custom software toolboxes were developed for developing hybrid systems; namely the EVolution Of Fuzzy INference Engines (EVOFINE) and the FUzzy Neural (FUN) toolbox. Eight hybrid systems developed with EVOFINE, FUN, ANFIS and ANN techniques were evaluated against applied clinical decisions and patient scenarios. Results: Seventeen (17) models were designed for each of the eight (8) modeling techniques. The modelled process consisted of twelve physiology variables and six ventilator settings. The number of models’ inputs ranged from single to six based on correlation and evaluation findings. Evaluation against clinical recommendations has shown that ANNs performed better; mean average error as percentage for four of the applied techniques was 0.16%, 1.29% & 0.62 for ANN empirical, 0.05%, 2.23% & 2.30% for ANFIS, 0.93%, 2.33% & 1.89% for EVOFINE and 0.73%, 2.63% & 6.56 for FUN NM, in Normal, COPD and ALI-ARDS categories respectively. Additionally evaluation against clinical disagreement SD has shown that 70.6% of the NN empirical models were performing in 90% of their suggestions within clinical SD, while the percentages were 53%, 53% and 59% for the EVOFINE, ANFIS and NN Normalized models respectively. The EVOFINE and ANFIS produced Fuzzy Systems whose architecture is transparent for the user. Visual observation of ANFIS architectures revealed possibly hazardous advices. Evaluation against clinical disagreement has shown that the NN empirical was not producing hazardous advices, while EVOFINE, ANFIS and NN Normalized were shown to produce potentially hazardous advice in 17.6%, 23% and 5.8% of the developed models

Data analysis and modeling for engineering and medical applications

Master'sMASTER OF ENGINEERIN

Changing Professionals: Professionals’ Role in the Institutional Dynamics of German Health Care

With an empirical focus on the health care sector, this dissertation addresses the questions on when, how and why professionals influence institutional change and stability. Specifically, this dissertation focuses on the institutional work efforts of different groups of health care professionals, namely physicians and nurses, within German health care. Given the significant regulatory dynamics that German health care experienced during the last decades, this setting provides a particularly favorable background for the study on when, why, and how professionals seek to create, maintain and disrupt institutions. Elaborating on how professionals interact with the different contexts in which they are embedded, this thesis aims to provide a holistic picture of professionals’ engagement in institutional dynamics. In particular, this thesis contributes to the growing literature on the micro-processes of professionals’ institutional work within the diverse contexts in which these actors operate

Risk Management for the Future

A large part of academic literature, business literature as well as practices in real life are resting on the assumption that uncertainty and risk does not exist. We all know that this is not true, yet, a whole variety of methods, tools and practices are not attuned to the fact that the future is uncertain and that risks are all around us. However, despite risk management entering the agenda some decades ago, it has introduced risks on its own as illustrated by the financial crisis. Here is a book that goes beyond risk management as it is today and tries to discuss what needs to be improved further. The book also offers some cases