A fuzzy knowledge based system for clinical diagnosis of tropical fever

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.Sıtma ve tifo Sahra-altı Afrika'nın en büyük tropikal ateş enfeksiyonlarıdır. Her ikisi de bölgenin hastalık, ölüm ve ekonomik kayıplarının sebebidir. Tifo ateşi sebebiyle, her 100.000 kişiden 725 tifo vakasına yakalanmakta ve bu hastalardan da 7 adedi ölümle sonuçlandığı tahmin edilmektedir ve Dünya'nın sıtma ölümlerinin %90'ı Sahra-altı Afrika'da meydana gelmektedir. Bu iki hastalığın teşhisinde önemli olan çok sayıda belirti bulunması ve birçoğunun da ortak olması dolayısıyla teşhis zorlaşmaktadır. Bulanık küme teorisine ve insan gibi sonuçlandırma üzerine dayanan bulunak mantık, insani bilimlerde yaygın olarak kullanılmakta ve birçok problemi başarılı bir şekilde çözmektedir. Sınıflandırma ve karar verme görevlerine ihtiyaç duyulan tıbbi teşhis bu cazip uygulamalardan biridir. Belirsizliklerin olduğu teşhis özelliklerindeki karmaşıklıklar bilgisayar sistemlerinde kullanılan doğal dil ile üstesinden gelinmiştir. Bu çalışmada, Sahra-altı Afrika'da sıtma ve tifo ateşinin klinik teşhisi için bilgi tabanlı teşhis sisteminin (TROPFEV) tasarımında bulanık mantık kullanımı anlatılmaktadır. Bilgiler, tıp uzmanları danışmanlığında Uganda Sağlıklı Bakanlığı tarafından hazırlanan UCG-2012'den (Uganda Klinik Klavuzu 2012) çıkarım yapılmıştır. Bu kaynaklardan edinilmiş bilgiler modellenip, bulanık kural tabanlı mantık kullanılarak tanımlanmış ve Matlab 2012a gerçeklenmiştir. Toplanan bilgilere göre, 21 adet teşhis özellikleri, ateş hastalığının durumuna ya da şiddetine göre sistemi oluşturmak için düzenlenmiştir. Kullanıcı, karmaşık-sıtma, karmaşık olmayan-sıtma, karmaşık-tifo, karmaşık olmayan-tifo veya bilinmeyen ateş cevabını sistemden beklemektedir. Test ve performansını değerlendirmek için, TROPFEV sistemin sonuçları ile doktor tarafından yapılan teşhis sonuçlarıyla karşılaştırılmıştır. Uzman teşhisleri ve sistem teşhisleri arasındaki % 86 oranında doğruluk olduğunu görülmüştür. Sonuç olarak, tıbbi teşhis için tecrübesiz hekimlerin teşhislerine daha hızlı ve verimli bir şekilde teşhis koyabilmek için yardımcı olması amacıyla bulanık mantık kullanımına ağırlık verilebilir.. Çünkü bulanık mantık belirtilerdeki kesin olmama sıkıntılarının üstesinden gelebilmek için bulanıklık kümelerini kullanır ve bir sınıflandırmaya ilişkilendirir.Malaria and typhoid fever are major tropical fever infections. Both are responsible for significant morbidity, mortality and economic loss in the region. Typhoid fever is estimated to cause 725 incident cases and 7 deaths per 100,000 people in the year and on the other side 90% of the total world malaria deaths occur in the Sub-Saharan Africa. The two diseases malaria and typhoid fever have several diagnosis features with overlapping signs and symptoms which are a task in medical diagnosis. Fuzzy logic that lies on the fuzzy set theory and similar to human reasoning is widely used for human-related sciences, and successfully solves many problems. Medical diagnosis is one of these attractive applications, which requires classification and decision making tasks. It uses natural language to represent data into computer systems where complications in diagnosis features such as vagueness are perfectly handled. This thesis describes the use of fuzzy logic to design a knowledge based system for clinical diagnosis of malaria and typhoid fever (TROPFEV) in Sub-Saharan Africa. Knowledge was extracted from the documentary of UCG-2012 (Uganda Clinical Guidelines 2012) prepared by the ministry of healthy in Uganda as well as consulting medical experts. The knowledge acquired from these resources is modelled, represented using fuzzy rule based reasoning and implemented in Matlab 2012 a. According to the collected knowledge, 21 diagnosis features have been organised with their situations or severity during fever infections to build the system. The user is expected to get the answer of complicated malaria, uncomplicated malaria, complicated typhoid, uncomplicated typhoid or unknown fever. For testing and evaluating its performance, the results of the TROPFEV system were compared with the results of diagnosis made by a real doctor The difference in results between expert diagnosis and system diagnosis showed that the expert system have similarity with the real experts with 86% accuracy. In conclusion, the use of fuzzy logic in medical diagnosis can be emphasized because it provides an efficient way to assist inexperienced physicians to arrive at the final diagnosis of fever more quickly and efficiently. This is because fuzzy logic applies fuzzy sets to handle vagueness existing in symptoms

Global flows, local appropriations: facets of secularisation and re-Islamization among contemporary Cape muslims

This is the first ethnographic study of muslims in Cape Town, South Africa at this level in 25 years. It explores processes of secularisation and re-islamization among Cape Muslims in the context of a post-apartheid South Africa in which liberal and secular values have attained considerable purchase in the new political and social elites. Fractured by status, ethnicity and religious orientation, Cape muslims have responded to these changes through an ambiguous accomodation with the new order. This study explores this development through chapters on conversions to Islam among black Africans in Cape Town, Cape women's experiences with polygyny, Cape muslims and HIV/AIDS, the status of Islam in a prison Cape Town in the post-apartheid era and on contestation over rituals among Cape muslims

Religion, gender and civil society: the role of a Muslim Women's Association in the evolution of Nigerian society

This dissertation examines how the Federation of Muslim Women’s Associations in Nigeria (FOMWAN) utilizes effective organizational and networking structures, along with a dynamic religious culture to produce empowering opportunities for women to engage in education, social services, and civic life. Most of the theorizing about civil society has taken Europe and North America as its primary focus, assuming a secular public sphere and leaving open questions about the nature of civil society where those assumptions do not hold. Questions about civil society in nonwestern contexts, in turn, have focused especially on the role of non-governmental organizations (NGOs), and very little of that literature addresses the role of religion. Research elsewhere suggests, however, that religious NGOs may be critical players in the construction of civil society. This dissertation shows how FOMWAN creates trust and fosters agency among Muslim women in Nigeria, enabling them to improve the wellbeing of their communities and create networks across multiple religious and secular lines. To address the role of religious organizations, and FOMWAN specifically, in the construction of civil society, my research uses a triangulated qualitative research design, rooted in grounded theory. I conducted interviews with leaders of FOMWAN and its partners; fostered discussions with members of FOMWAN and some service recipients; conducted a content analysis of records (archival research); and conducted participant observation at FOMWAN events. The qualitative data were analyzed using the technique of grounded theory. Each component of the research sought to uncover how FOMWAN builds trust, agency, opportunities, and participation in decision-making for Muslim women in Nigeria. I find that FOMWAN follows in a line of historic Muslim women’s associations and was created in reaction to Nigeria’s weak and fragile state. I demonstrate the role of the organization’s religious culture and networks in creating a plural civil society. I argue that understanding Nigerian civil society requires understanding that religious ideas and cultures are a powerful force that shape a people’s worldviews and identities and have the potential for influencing human actions. My dissertation thus provides a critical intervention into broader debates about the role of Muslim women’s religious culture in development discourse and in the global South’s public life

Statin Adherence, Utilisation, and Prescribing Patterns. Improving effectiveness of treatment

Statins are one of the most widely studied and evidence-based medications. Randomised controlled trials have provided convincing evidence on the benefits of statin therapy in preventing cardiovascular events. Despite proven benefits, low costs, and few adverse effects, everyday effectiveness of statins is limited, since adherence to statin therapy is poor. This thesis was conducted as four pharmacoepidemiological studies using register data on statin users in real clinical care. The main purpose of the study was to evaluate prescribing patterns and to discover the lifestyle factors predicting statin nonadherence and discontinuation. This knowledge is essential in order to help physicians to motivate the adherence of their patients to treatment. In Finland, from 1998 to 2004, the number of statin initiators nearly doubled. The discovered channelling of atorvastatin and simvastatin may have affected the treatment outcomes at the public health level. It is possible that money spent on statins in Finland in 1998‒2004 could have been used in a more cost-effective way. In 2015, the percentage of patients receiving reimbursement for statins was 12% of the total population. Thus, it is a major public health and economic challenge to improve statin effectiveness and allocate therapy correctly. Among the participants with cardiovascular comorbidities, risky alcohol use or clustering of lifestyle risks were predictors of nonadherence. In addition, the prevalence of nonadherence to statins increased after retirement among both men and women. This increase in post-retirement nonadherence was highest among those receiving statins for secondary prevention. Discontinuation of statin therapy was predicted by high patient co-payment, and in women, by risky alcohol use. Recognising the predictors of nonadherence to statins is important because nonadherence is associated with an increased risk of adverse cardiovascular outcomes and higher healthcare costs. In conclusion, optimal outcomes in medical therapy require both efficacious medications and adherence to those treatments. When prescribing statins to eligible patients, the physician’s clinical expertise in recognising patients at risk of statin discontinuation and nonadherence, as well as their ability to increase adherence, may have a great effect on public health.Statiinihoitoon sitoutuminen, lääkekäyttö ja -määräykset. Hoidon vaikuttavuutta parantamassa. Kattavasti tutkittu ja näyttöön perustuva statiinilääkitys on oleellinen osa sydän- ja verisuonitautien ehkäisyä ja hoitoa. Satunnaistetuissa, kontrolloiduissa hoitotutkimuksissa osoitetusta tehosta, matalasta kustannuksesta ja vähäisistä haittavaikutuksista huolimatta statiinien vaikuttavuus arkielämässä jää odotettua heikommaksi, mikäli hoitoon sitoudutaan huonosti. Tämä väitöskirja koostuu neljästä lääke-epidemiologisesta tutkimuksesta, joissa arkielämän statiinikäyttöä tutkittiin rekisteritiedon avulla. Tutkimuksen tavoitteena oli sekä selvittää statiinien käyttöä ja lääkemääräyskäytäntöjä että tunnistaa hoitoon sitoutumiseen vaikuttavia tekijöitä, jotta käytännön lääkärit voisivat lääkehoidon toteutumisen seurannassa paremmin ylläpitää potilaan hoitomotivaatiota. Statiinilääkityksen aloittajien määrä lähes kaksinkertaistui Suomessa vuodesta 1998 vuoteen 2004. Tässä tutkimuksessa havaittu atorva- ja simvastatiinin kanavoituminen viittaa siihen, että statiineihin sijoitettu raha olisi mahdollisesti voitu Suomessa vuosina 1998–2004 käyttää kustannustehokkaammin. Vuonna 2015 statiineista sai sairausvakuutuskorvausta lähes joka kahdeksas suomalainen, minkä vuoksi statiinihoidon oikea kohdentaminen ja vaikuttavuuden parantaminen ovat merkittäviä sekä kansanterveyden että -talouden kannalta. Tämä tutkimus osoittaa, että haitallinen alkoholin käyttö ja elämäntapariskien kasautuminen ennustivat huonoa statiinihoitoon sitoutumista niillä tutkittavilla, joilla oli aiemmin diagnosoitu sydän- ja verisuonitauti tai diabetes. Myös eläköityminen lisäsi huonosti statiinihoitoon sitoutuneiden osuutta sekä miesten että naisten joukossa. Vaikutus tuli selvimmin esiin sekundaaripreventiopotilailla. Statiinihoidon aloittaneista 12 % lopetti lääkityksen ensimmäisen vuoden aikana. Hoidon ennenaikaista lopettamista ennusti korkeampi potilaan maksama osuus lääkekustannuksesta, naisilla myös haitallinen alkoholin käyttö. Edellä mainittujen tekijöiden tunnistaminen on tärkeää, sillä huonon hoitoon sitoutumisen tai hoidon ennenaikaisen lopettamisen tiedetään lisäävän haitallisia valtimosairaustapahtumia ja terveydenhuollon kokonaiskustannuksia. Järkevän ja ihanteellisesti vaikuttavan lääkehoidon edellytyksenä on sopivan käyttöaiheen ja sopivan lääkkeen valinnan lisäksi se, että potilas ymmärtää lääkityksensä merkityksen ja sitoutuu hoitoon. Lääkehoidon lopettamiseen tai hoitoon sitoutumattomuuteen liittyvien riskien tunnistaminen voi merkittävästi edistää kansanterveyttä.Siirretty Doriast

Modelling the UK burden of cardiovascular disease to 2020

This new research report demonstrates the scale of the burden of cardiovascular disease (CVD) - shown to be large, costly, and increasing. Whilst mortality from CVD has fallen, an increasing population over the next decade will create further demands on services as the actual numbers of people living with CVD climb higher.<br /

A home for all? : exploring discourses that inform the construction of belonging in contemporary South Africa

Includes abstract.Includes bibliographical references.This thesis is concerned with the construction of belonging in contemporary South Africa and how it is reproduced, challenged and negotiated within the social action of language. This is explored by investigating the situated meanings individuals assign to events, places, institutions and people in relation to their experiences of belonging and exclusion. Poststructuralism, phenomenology and social constructionism shape the theoretical framework of this study. Multi-disciplinary discourse analysis and critical discourse analysis are used to explore how the construct- ion of belonging [is] reflected and produced in everyday language. The texts analyzed in this study are the product of five focus group discussions with 23 residents of Cape Town. The texts are read for how individuals’ lived experiences, memories and imaginations inform the process of constructing belonging

On Africana/Islamica existential thought: Don Mattera and the question of transcendence

Although a figure of many interests, Don Mattera remains one of the least studied figures in South African scholarship. This study combines two primary concerns. The first revolves around an imperative for a comprehensive study of Don Mattera. Linked to the first concern is the second, which is the challenge to find a method and a theoretical approach to read Mattera. In addition to being a poet of note, writer and journalist, Mattera is also known as a resilient activist and one of the critical voices in the Black Consciousness Movement of South Africa. Yet, the little that is written on him is either limited to his role in youth gangs, even though he eschewed the life of gangsterism as far back as the mid-1950s, or studied within the context of black South African writing in English. Hence, he is relegated to what is termed 'literature of protest’. There is to date hardly any substantive writing on Mattera and his attachment to Islam despite the fact that he encountered Islam in the 1970s and considers his conversion (to Islam) one of the most significant milestones in his life. The interest expressed in Don Mattera in this study, therefore, is not limited to Mattera the poet and writer only; it also looks at Mattera as a black Muslim subject. The decision to read Mattera in this extended sense presented a theoretical challenge and informed the second concern and problem addressed in this study. Given Mattera’s complexity and range of interests, the question of which method and theoretical approach is ideal for a comprehensive reading of him remained a challenge. In the end, after considering several disciplinary and methodological options, black/Africana existential thought and philosophy as a method and theoretical anchor was selected. This is because black/Africana existential thought and philosophy understood as 'an intertextually embedded discursive practice’ facilitates a comprehensive reading and study on Don Mattera. Informed by a critical engagement with the data of this study, which consists of Mattera’s poetry, fiction and public discourse where Mattera is read alongside Malcolm X, the perceived proclivity of black/Africana existential thought (and philosophy) to privilege a hermeneutic of struggle proved inadequate. The hypothesis presented in this study is that inasmuch as Mattera has been read through the lenses of struggle and protest, such a reading, and by inference, hermeneutic, fosters epistemic closure. For not only does it fail to earnestly consider categories such as Islam as a critical discursive concern within black/Africana existential thought and philosophy, it also, entrenches fossilised notions of black subjectivity and sense of self and being. As a reversal to the hermeneutic of struggle, this dissertation posits an alternative reading in a hermeneutic of transcendence. A hermeneutic of transcendence is attentive to Mattera’s complex sense of self, identity and subjectivity that extends beyond his literary output. Transcendence as used in this study connotes a double meaning that captures both the Sartrean sense of intersubjective transcendence, as well as Levinasian sense of transcendence as a gesture towards the beyond and metaphysical. I argue that a hermeneutic of transcendence provides a better reading of Don Mattera than the hermeneutic of struggle and protest

Community reintegration and satisfaction of survivors of stroke receiving physiotherapy services in the community health centres within the Johannesburg area

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Physiotherapy (dissertation) Johannesburg, 2016Background and aim of the study The prevalence of stroke is high in South Africa. The average length of stay in hospital for stroke survivors in a tertiary hospital in Johannesburg is twelve days. Despite the benefits of early discharge from hospital for stroke survivors, early discharge from hospitals may lead to inadequate physiotherapy intervention for functional independence. This lack of independence would therefore lead to increased dependence on caregivers and lower levels of perceived and real community integration for survivors of stroke. When patients return to their homes, they require high levels of care. This care is often provided by family members or designated caregivers. These caregivers undergo high levels of strain that often lead to exhaustion and isolation. Patients at community health centres receive physiotherapy services on an outpatient basis and home visits are done when necessary. Literature on levels of community reintegration among stroke survivors within health centres in the Johannesburg area and their satisfaction with the physiotherapy services received is lacking. The aim of this study was to determine levels of community reintegration and satisfaction levels with physiotherapy of survivors of stroke in community healthcare centres in the Johannesburg area as well as to determine if there were any relationships between community reintegration and caregiver strain, quality of life and patient satisfaction with physiotherapy. Method and procedures This was a quantitative, cross-sectional study with questionnaires administered to stroke survivors and their caregivers at the community health centres in the Johannesburg area. Community reintegration was measured using the Maleka Stroke Community Reintegration Measure (M-SCRIM) and represented as frequencies and percentages as well as means and standard deviations. Caregiver strain was measured using the Caregiver Strain Index (CSI) and represented as frequencies and percentages. Quality of life was measured using the Stroke- Specific Quality of Life measure (SSQOL) represented as frequencies and percentages and satisfaction with physiotherapy services was measured using the Physical Therapy Patient Satisfaction Questionnaire (PTPSQ) and represented as medians and interquartile ranges. Correlations between M-SCRIM and CSI, M-SCRIM and SSQOL and M-SCRIM and PTPSQ were determined using Spearman’s rank correlation coefficient. Results This study was conducted on 108 participants and 45 caregivers. The average age of the participants was 54 years (SD=12.73). Eighty five of the participants (78%) had achieved some form of community reintegration according to the M-SCRIM. Participants’ lowest scores on the PTPSQ were for accuracy of bills, availability of parking and cost of physiotherapy. All the other questions scored a median of 100%. The mean score for SSQOL was 157 out of 245 (64%) with the highest score recorded at 235 out of 245 (96%) and the lowest score measured was 54 out of 245. Participants had some problems with each of the SSQOL domains. Forty five of the participants had caregivers. Twenty five (55%) of the 45 caregivers were strained according to the CSI. A positive correlation was found between the M-SCRIM and PTPSQ (r = 0.27, p <0.0001) and the M-SCRIM and SSQOL (r = 0.51, p < 0.0001). A negative correlation was found between the M-SCRIM and CSI (r = -0.37, p < 0.0001). Conclusion Eighty five per cent of the stroke survivors in this study had some form of community reintegration and were generally satisfied with physiotherapy services. Their quality of life SSQOL was relatively low with the participants experiencing problems in every SSQOL domain. The majority of the caregivers were strained and survivors of stroke with higher community reintegration had less caregiver strain.MT201