An extended ANFIS architecture and its learning properties for type-1 and interval type-2 models

In this paper, an extended ANFIS architecture is proposed. By incorporating an extra layer for the fuzzification process, the extended architecture is able to fit both type-1 and interval type-2 models. The learning properties of the proposed architecture based on the least-squares estimate method are studied on selected type-1 and interval type-2 ANFIS models. We show that the least-squares estimate method in general behaves differently for interval type-2 ANFIS models compared to type-1 ANFIS models, producing larger errors for interval type-2 ANFIS

A Comment on "A direct approach for determining the switch soints in the Karnik-Mendel algorithm"

This letter is a supplement to the previous paper “A Direct Approach for Determining the Switch Points in the Karnik-Mendel Algorithm”. In the previous paper, the enhanced iterative algorithm with stop condition (EIASC) was shown to be the most inefficient in R. Such outcome is apparently different from the results in another paper in which EIASC was illustrated to be the most efficient in Matlab. An investigation has been made into this apparent inconsistency and it can be confirmed that both the results in R and Matlab are valid for the EIASC algorithm. The main reason for such phenomenon is the efficiency difference of loop operations in R and Matlab. It should be noted that the efficiency of an algorithm is closely related to its implementation in practice. In this letter, we update the comparisons of the three algorithms in the previous paper based on optimised implementations under five programming languages (Matlab, R, Python, C and Java). From this, we conclude that results in one programming language cannot be simply extended to all languages

A Comprehensive Study of the Efficiency of Type-Reduction Algorithms

Improving the efficiency of type-reduction algorithms continues to attract research interest. Recently, there have been some new type-reduction approaches claiming that they are more efficient than the well-known algorithms such as the enhanced Karnik-Mendel (EKM) and the enhanced iterative algorithm with stopping condition (EIASC). In a previous paper, we found that the computational efficiency of an algorithm is closely related to the platform, and how it is implemented. In computer science, the dependence on languages is usually avoided by focusing on the complexity of algorithms (using big O notation). In this paper, the main contribution is the proposal of two novel type-reduction algorithms. Also, for the first time, a comprehensive study on both existing and new type-reduction approaches is made based on both algorithm complexity and practical computational time under a variety of programming languages. Based on the results, suggestions are given for the preferred algorithms in different scenarios depending on implementation platform and application context

A Direct Approach for Determining the Switch Points in the Karnik–Mendel Algorithm

The Karnik-Mendel algorithm is used to compute the centroid of interval type-2 fuzzy sets, determining the switch points needed for the lower and upper bounds of the centroid, through an iterative process. It is commonly acknowledged that there is no closed-form solution for determining such switch points. Many enhanced algorithms have been proposed to improve the computational efficiency of the Karnik-Mendel algorithm. However, all of these algorithms are still based on iterative procedures. In this paper, a direct approach based on derivatives for determining the switch points without multiple iterations has been proposed, together with mathematical proof that these switch points are correctly determining the lower and upper bounds of the centroid. Experimental simulations show that the direct approach obtains the same switch points, but is more computationally efficient than any of the existing (iterative) algorithms. Thus, we propose that this algorithm should be used in any application of interval type-2 fuzzy sets in which the centroid is required

TRPV1-expressing primary afferents generate behavioral responses to pruritogens via multiple mechanisms

The mechanisms that generate itch are poorly understood at both the molecular and cellular levels despite its clinical importance. To explore the peripheral neuronal mechanisms underlying itch, we assessed the behavioral responses (scratching) produced by s.c. injection of various pruritogens in PLCβ3- or TRPV1-deficient mice. We provide evidence that at least 3 different molecular pathways contribute to the transduction of itch responses to different pruritogens: 1) histamine requires the function of both PLCβ3 and the TRPV1 channel; 2) serotonin, or a selective agonist, α-methyl-serotonin (α-Me-5-HT), requires the presence of PLCβ3 but not TRPV1, and 3) endothelin-1 (ET-1) does not require either PLCβ3 or TRPV1. To determine whether the activity of these molecules is represented in a particular subpopulation of sensory neurons, we examined the behavioral consequences of selectively eliminating 2 nonoverlapping subsets of nociceptors. The genetic ablation of MrgprD^+ neurons that represent ≈90% of cutaneous nonpeptidergic neurons did not affect the scratching responses to a number of pruritogens. In contrast, chemical ablation of the central branch of TRPV1+ nociceptors led to a significant behavioral deficit for pruritogens, including α-Me-5-HT and ET-1, that is, the TRPV1-expressing nociceptor was required, whether or not TRPV1 itself was essential. Thus, TRPV1 neurons are equipped with multiple signaling mechanisms that respond to different pruritogens. Some of these require TRPV1 function; others use alternate signal transduction pathways

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

Drama, performance and touch in the medieval convent and beyond

In this analysis we explore the sensory performances of the performer, rather than the spectator, in medieval convent drama, particularly the tactile experiences of clothing, props, wigs, and beards worn by female performers presenting male and female characters

Including personal development in palliative care education to address death anxiety

Background: Death anxiety may interfere with health care workers' (HCW) relationship with patients and their families. Aims: Evaluate an intervention to address death anxiety and improve HCW skills dealing with patients/families in palliative and end-of-life care. Design: Quasi-experimental mixed methods approach with a pre-test/post-test design. Participants: 208 HCWs receiving the intervention and working in end-of-life care, in and out of palliative care units, were invited to answer quantitative and qualitative questionnaires. In the end, 150 returned with quantitative answers and of these, 94 with qualitative answers as well. Additionally, out of the 150 participants, 26 were recruited for interview. Results: Pre-and post-test results revealed a significant reduction in levels of death anxiety, an increase in existential wellbeing, and a significant improvement in HCWs' perception of the quality of their helping relationship skills with patients/families. Content analysis provided an understanding of the difficulties experienced by the HCWs and the positive impact of the intervention. Conclusion: An intervention to address death anxiety and help relationship skills can reduce the use of avoidance mechanisms and improve HCW self-perceived psycho-existential support to patients/families

Including personal development in palliative care education to address death anxiety

Background: Death anxiety may interfere with health care workers' (HCW) relationship with patients and their families. Aims: Evaluate an intervention to address death anxiety and improve HCW skills dealing with patients/families in palliative and end-of-life care. Design: Quasi-experimental mixed methods approach with a pre-test/post-test design. Participants: 208 HCWs receiving the intervention and working in end-of-life care, in and out of palliative care units, were invited to answer quantitative and qualitative questionnaires. In the end, 150 returned with quantitative answers and of these, 94 with qualitative answers as well. Additionally, out of the 150 participants, 26 were recruited for interview. Results: Pre-and post-test results revealed a significant reduction in levels of death anxiety, an increase in existential wellbeing, and a significant improvement in HCWs' perception of the quality of their helping relationship skills with patients/families. Content analysis provided an understanding of the difficulties experienced by the HCWs and the positive impact of the intervention. Conclusion: An intervention to address death anxiety and help relationship skills can reduce the use of avoidance mechanisms and improve HCW self-perceived psycho-existential support to patients/families

Morphine and alternative opioids in cancer pain: the EAPC recommendations: Expert Working Group of the Research Network of the European Association for Palliative Care

An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated. © 2001 Cancer Research Campaig