USING NEUROFUZZY NETWORKS TO MIMIC ANESTHESIOLOGIST KNOWLEDGE IN DECISION MAKING ON PROPOFOL ADMINISTRATION

2010 ◽  
Vol 22 (06) ◽  
pp. 453-464 ◽  
Author(s):  
Hung-Shan Wu ◽  
Huai-Yuan Hsu ◽  
Chia-Chi Chang ◽  
Tzu-Chien Hsiao
Keyword(s):  
Decision Making ◽  
Bispectral Index ◽  
Anesthetic Drug ◽  
Anesthetic Drugs ◽  
Patient Status ◽  
Patient Will ◽  
Input Variables ◽  
Neurofuzzy Networks ◽  
Self Learning ◽  
Anesthesia Simulator

The purpose of anesthesia is to maintain a steady state for specific clinical operations. In general, one anesthesiologist utilizes anesthetic drugs and anesthetic skills to make sure the depth of anesthesia (DOA) carefully in proper level such that a patient will not perceive pain during surgical procedure. It is complex to be treated as an art to reduce all sensations, whether it is the sense of pain, touch, temperature, or position. In this paper, utilizing the self-learning and the human-like reasoning ability of neurofuzzy networks, we design the virtual anesthesiologist to accommodate the knowledge and the experience of the real anesthesiologist in anesthetic drug administration. The heart rate and bispectral index are used as the input variables and the bispectral index target value (BIStarget) heart is treated as output variable. The anesthesia simulator is adopted to verify the virtual anesthesiologist's ability and to explore the patient status of the simulator. The pilot experiments and extended experiments have been carried out. The result showed that the virtual anesthesiologist was able to support the decision making on the maintenance of the patient DOA at BIStarget 60.

Original Investigations of Anesthetic Practice 

1997 ◽  
Vol 86 (5) ◽  
pp. 1170-1196 ◽  
Author(s):  
Mehernoor F. Watcha ◽  
Paul F. White
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Gas Flow ◽  
Health Care Cost ◽  
Care Quality ◽  
New Drugs ◽  
Recent Analysis ◽  
Clinical Practices ◽  
Anesthetic Drugs ◽  
Acquisition Costs

Anesthesiologists, like all other specialists, need to examine carefully their clinical practices so that excessive costs and waste can be reduced without compromising patient care or safety. While costs of drugs used for anesthesia constitute only a small fraction of total health care cost, they are highly visible costs which are easy for administrators to scrutinize. Although cost savings in an individual case may be small, the total savings may be impressive because of the large volume of cases performed. In a recent analysis of strategies to decrease PACU costs, Dexter and Tinker found that anesthesiologists have "little control over PACU economics via the choice of anesthetic drugs". Greater savings could be achieved by timing the arrival of patients into the PACU to reduce the peak requirement of nursing personnel. Hospital and operating room management would be better served by concentrating on these simple measures to improve efficiency rather than forcing anesthesiologists to base drug usage on acquisition costs. Even in countries that have nationalized health services, salaries make up the largest part of the costs, and the expenses in delaying an operation by 30 min exceeds the costs of a 2 h propofol infusion. It is becoming increasingly apparent that attempts at better scheduling of cases, more efficient processing of patients in the PACU to optimize admission rates, and reduced wastage of anesthetic and surgical supplies lead to greater savings than reducing anesthetic-related drug costs. Nevertheless, it is still important for anesthesiologists to participate in the ongoing effort to reduce medical costs without affecting the quality of patient care. Quality care and fiscally sound decision-making are not necessarily mutually exclusive. Simple, effective cost containment measures that all anesthesiologists can practice include using low fresh gas flow rates with inhalation agents and opening sterile packages and drug ampules only if the contents will be used. The choice of an anesthetic agent for routine use depends not only on its demonstrated efficacy and side effect profile, but also on economic factors. It is important to perform careful pharmacoeconomic evaluations of these newer drugs, including assessing all associated costs and benefits for subsets of patients undergoing different types of surgical procedures. These evaluations should also include input from patients regarding their personal preferences. Excessive emphasis on the acquisition costs of drugs may lead to blanket bans on the use of new drugs because of their higher costs rather than permitting physicians to individualize therapy according to their clinical experience and the perceived needs of a given patient. Institutional and individual variations in clinical practices, their associated costs and outcomes may alter conclusions about acceptability and economic evaluation of a particular drug or technique. The information in this review can be used to provide a rational basis for incorporating cost considerations into the decision-making process regarding the drugs, devices and techniques used in anesthesiology.

scholarly journals A Bio-inspired Motivational Decision Making System for Social Robots Based on the Perception of the User

Sensors ◽  
2018 ◽  
Vol 18 (8) ◽  
pp. 2691 ◽  
Author(s):  
Marcos Maroto-Gómez ◽  
Álvaro Castro-González ◽  
José Castillo ◽  
María Malfaz ◽  
Miguel Salichs
Keyword(s):  
Decision Making ◽  
Human Robot Interaction ◽  
Learning Mechanisms ◽  
Biologically Inspired ◽  
Robot Interaction ◽  
Detection Mechanism ◽  
Learned Behaviors ◽  
Decision Making System ◽  
Real Robot ◽  
Self Learning

Nowadays, many robotic applications require robots making their own decisions and adapting to different conditions and users. This work presents a biologically inspired decision making system, based on drives, motivations, wellbeing, and self-learning, that governs the behavior of the robot considering both internal and external circumstances. In this paper we state the biological foundations that drove the design of the system, as well as how it has been implemented in a real robot. Following a homeostatic approach, the ultimate goal of the robot is to keep its wellbeing as high as possible. In order to achieve this goal, our decision making system uses learning mechanisms to assess the best action to execute at any moment. Considering that the proposed system has been implemented in a real social robot, human-robot interaction is of paramount importance and the learned behaviors of the robot are oriented to foster the interactions with the user. The operation of the system is shown in a scenario where the robot Mini plays games with a user. In this context, we have included a robust user detection mechanism tailored for short distance interactions. After the learning phase, the robot has learned how to lead the user to interact with it in a natural way.

scholarly journals Organizing of Independent Cognitive Activity of Teachers in the Context of Didactics and Neuroscience

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Olena Tonne ◽  
◽  
Olena Varetska ◽  
Olena Khaustova ◽  
Victoria Tarasova ◽  
...  
Keyword(s):  
Decision Making ◽  
Professional Training ◽  
Cognitive Activity ◽  
Educational Institutions ◽  
Psychological Mechanisms ◽  
Scientific Substantiation ◽  
Necessary And Sufficient ◽  
External Stimuli ◽  
Self Learning

The article substantiates that in the context of organizing the independent cognitive activity of teachers in the post-Soviet space, the process of improving their qualifications, which takes place on the basis of their free choice of forms of education, programs and educational institutions, is of particular importance. At the heart of this choice, decision-making on independent cognitive activity and emotional-motivational resource are not only external stimuli, but also neurophysiological and psychological mechanisms. The purpose of the study is a scientific substantiation of the necessary and sufficient psychological and pedagogical conditions and models of organization of independent cognitive activity of teachers of secondary schools in the process of competence development. The analysis of the experimental data showed a noticeable difference between samples B3 and B4 at the end of the experiment for each of the defined criteria, as well as for the general indicator of the organizing of independent cognitive activity. The results obtained during the pedagogical experiment proved that the organizing of independent cognitive activity of teachers on the basis of the author's model helped to increase the effectiveness of this activity. During the discussion, it was proved that an important component of a person's professional training for any activity, especially in educational, is the development of neurophysiological and psychological potential for subjective self-determination of self-learning, self-improvement, and in micro-development - for independent choice and decision-making in a situation of cognitive or activity-related uncertainty. Therefore, decision-making is a basic component of any constructive activity.

scholarly journals Comparison of Anesthesia Depth Monitoring using Conventional and Bispectral Index on Incidence and Severity of Nausea and Vomiting after Urological Surgeries

2018 ◽  
Vol 6 (2) ◽  
pp. 25
Author(s):  
Reihan Shenasi ◽  
Hamzeh Hoseinzadeh ◽  
Hasan Mohammadpor-Anvari ◽  
Davod Aghamohammadi ◽  
Reza Sari-Motlagh
Keyword(s):  
General Anesthesia ◽  
Bispectral Index ◽  
Postoperative Nausea ◽  
Operating Time ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Control Group ◽  
Anesthetic Drugs ◽  
Urological Surgery ◽  
Anesthesia Depth

Bispectral index parameter is used to guide the titration of general anesthesia. This monitoring improves recovery times and hospital discharges, as well as minimizes adverse events. The objective of this study is the comparison of anesthesia depth monitoring by conventional and bispectral index on nausea and vomiting after urological surgery. 180 participants who were scheduled for abdominal urological surgery were studied. Patients before induction of anesthesia were randomize into two groups with and without bispectral index monitoring. Incidence and severity of nausea and vomiting were recorded every 30 minutes for 2 hours and every 6 hours to 24 hours after surgery. The incidence of postoperative nausea and vomiting in Bispectral index group is 14.4% and 8.9% and in control group 28.9% and 23.3%, respectively. The risk of nausea and vomiting after surgery was reduced by 14.5% and 14.4%, respectively in patients monitored with bispectral index.INTRODUCTIONNausea is the conscious perception of medulla stimulation that is associated with vomiting center and create vomiting response (1). General anesthesia with the use of inhalants can cause nausea and vomiting after surgery (Postoperative nausea and vomiting, PONV). The incidence of PONV is reported about 20-30 percent (2). It seems that multiple-factor can cause PONV and few items such as anesthetic drugs, kind of surgery and personal risk factors is effective on PONV. These factors make into two categories that includes factors out of control by anesthesiologists and factors can control by anesthesiologists.1. Factors out of control by anesthesiologists: some of these factors are age, gender, past history of PONV and motion sickness, smoking, kind of surgery, operating time and anesthesia time, anxiety of patients and parents. 2. Factors controlled by anesthesiologists: these factors are associated of anesthesia settings, including premedications, kind of anesthesia, anesthesia drugs during surPublishedby Australian

Challenges of Outcome Prediction for Acute Stroke Treatment Decisions

Stroke ◽  
2021 ◽  
Author(s):  
Mayank Goyal ◽  
Johanna Maria Ospel ◽  
Manon Kappelhof ◽  
Aravind Ganesh
Keyword(s):  
Decision Making ◽  
Acute Stroke ◽  
Acute Treatment ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Clinical Laboratory ◽  
Clinical Perspective ◽  
Stroke Treatment ◽  
Patient Will ◽  
Acute Stroke Treatment

Physicians often base their decisions to offer acute stroke therapies to patients around the question of whether the patient will benefit from treatment. This has led to a plethora of attempts at accurate outcome prediction for acute ischemic stroke treatment, which have evolved in complexity over the years. In theory, physicians could eventually use such models to make a prediction about the treatment outcome for a given patient by plugging in a combination of demographic, clinical, laboratory, and imaging variables. In this article, we highlight the importance of considering the limits and nuances of outcome prediction models and their applicability in the clinical setting. From the clinical perspective of decision-making about acute treatment, we argue that it is important to consider 4 main questions about a given prediction model: (1) what outcome is being predicted, (2) what patients contributed to the model, (3) what variables are in the model (considering their quantifiability, knowability at the time of decision-making, and modifiability), and (4) what is the intended purpose of the model? We discuss relevant aspects of these questions, accompanied by clinically relevant examples. By acknowledging the limits of outcome prediction for acute stroke therapies, we can incorporate them into our decision-making more meaningfully, critically examining their contents, outcomes, and intentions before heeding their predictions. By rigorously identifying and optimizing modifiable variables in such models, we can be empowered rather than paralyzed by them.

scholarly journals Neural Networks in Credit Risk Classification of Companies in the Construction Sector

2018 ◽  
Vol 2 (2) ◽  
pp. 63-77 ◽  
Author(s):  
Aleksandra Wójcicka
Keyword(s):  
Neural Networks ◽  
Decision Making ◽  
Credit Risk ◽  
Financial Institutions ◽  
Real World ◽  
Decision Making Process ◽  
Construction Sector ◽  
Real World Data ◽  
Input Variables

The financial sector (banks, financial institutions, etc.) is the sector most exposed to financial and credit risk, as one of the basic objectives of banks' activity (as a specific enterprise) is granting credit and loans. Because credit risk is one of the problems constantly faced by banks, identification of potential good and bad customers is an extremely important task. This paper investigates the use of different structures of neural networks to support the preliminary credit risk decision-making process. The results are compared among the models and juxtaposed with real-world data. Moreover, different sets and subsets of entry data are analyzed to find the best input variables (financial ratios).

scholarly journals A MODIFIED MCDM ALGORITHM WITH CUMULATIVE ENTROPY WEIGHTS FOR SELECTING THE WINNER OF THE TENDER

2019 ◽  
pp. 46-51
Author(s):  
A. O. Matin ◽  
F. Misagh
Keyword(s):  
Decision Making ◽  
Evaluation Criteria ◽  
Specific Weight ◽  
Multi Criteria Decision Making ◽  
Efficient Management ◽  
Research Findings ◽  
Utility Rate ◽  
Input Variables ◽  
Decision Making Model ◽  
Cumulative Entropy

The aim of this research is to evaluate the proposed bids using impartial and entropy weights in a multi-criteria decision-making model. We use matrix data for hypothetical bidding involving nine criteria, with the presence of four domestic and two foreign contractors. Then, using cumulative entropy function, we estimate the entropy weights and use it in a multi-criteria decision-making model. The criteria of experience and knowledge in the field, good history and satisfaction in previous projects, financial and support capabilities, localization of the contractor, having the experience at the site of the project, availability and readiness of equipment and machines, the adequacy of technical staff, the work quality system, the efficient management and appropriate management system, creativity and innovation in similar tasks are the input variables of the decision model. After analyzing them, the proposals are prioritized through a multi-criteria decision-making model. The research findings include Shannon entropy and cumulative entropy-based weights for evaluation criteria and after applying the specific weight for the proposed quotation, the utility rate of each contractor is calculated. The results showed that the use of modified multi-dimensional decision-making method is more advantageous than traditional methods of evaluating bidding proposals in selecting the winner of a tender, and also using cumulative entropy weights in comparison with Shannon's leads to a more realistic choice of contractors.

scholarly journals Application of fuzzy logic at the Port of Cotonou (Benin / West Africa) in analysis of port logistics viability

2021 ◽  
Vol 9 (2) ◽  
pp. 209-225
Author(s):  
Alphonse Hounsounou ◽  
Prof. Dr. Hito Braga de Moraes ◽  
Prof. Dr. Maamar El Robrini
Keyword(s):  
Decision Making ◽  
Fuzzy Logic ◽  
West Africa ◽  
Membership Functions ◽  
Medium Term ◽  
Matlab Toolbox ◽  
Access Channel ◽  
Port Logistics ◽  
Input Variables

The Autonomous Port of Cotonou (PAC) located in West Africa has an access channel 15m deep, 11 berths, and an internal draft of 15m (maximum), and is connected with a road to serve continental countries such as Burkina-Faso, Chad , Mali, Niger and Nigeria. The PAC presents low productivity (average of 10,000,000 tons / year, 24.40% of the movement from the port of Lagos / Nigeria) in West Africa. This article aims to evaluate the application of fuzzy logic in the Autonomous Port of Cotonou (Benin) in the analysis of logistic viability. The methodology followed the fuzzy logic that is a support method for logistic decision-making, based on fuzzy rules (SBRF). It was used characteristic of Mamdani Matlab Toolbox with three membership functions (triangular, trapezoidal and Gaussian) to model the quality variables of infrastructures and services, equipment productivity, seeking a long-term way out of logistic viability. The result of logistic viability was medium term, equivalent to 13 years / 25 years; as far as the outcome of the future PAC is concerned. The logistic viability of the PAC depends on its input variables. The projection of this application was long term, at least 19 years / 25 years when the infrastructures are of good quality and the equipment is more modern and consistent with the current realities to satisfy the expectations of the customers.  

Decision Making by Emergency Room Physicians and Residents

2011 ◽  
pp. 131-148
Author(s):  
Michael J. Hine ◽  
Ken J. Farion ◽  
Wojtek Michalowski ◽  
Szymon Wilk
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Decision Support ◽  
Physical Examination ◽  
Tacit Knowledge ◽  
Expert Knowledge ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Clinical Decisions ◽  
Input Variables

Clinical Decision Support Systems (CDSS) are typically constructed from expert knowledge and are often reliant on inputs that are difficult to obtain and on tacit knowledge that only experienced clinicians possess. Research described in this article uses empirical results from a clinical trial of a CDSS with a decision model based on expert knowledge to show that there are differences in how clinician groups of the same specialty, but different level of expertise, elicit necessary CDSS input variables and use said variables in their clinical decisions. This article reports that novice clinicians have difficulty eliciting CDSS input variables that require physical examination, yet they still use these incorrectly elicited variables in making their clinical decisions. Implications for the design of CDSS are discussed.

Clinico-biochemical study on different pre-anesthetic drugs combined with propofol for neutering dogs

2019 ◽  
Author(s):  
Sadaf Aslam ◽  
Raheela Akhtar ◽  
M. Arif Khan ◽  
Saima Masood ◽  
Uzma Fareed ◽  
...  
Keyword(s):  
Body Weight ◽  
Biochemical Study ◽  
Randomized Study ◽  
Rapid Onset ◽  
Total Leukocyte Count ◽  
Anesthetic Drug ◽  
Anesthetic Drugs ◽  
Long Duration ◽  
Group A ◽  
Group B

The objective of present study was to select the best pre-anesthetic to be used in combination with propofol for neutering dogs. A prospective randomized study was conducted on 18 clinical cases of mongrel dogs admitted for neutering were subjected in to three groups (n=6). In group A (xylazine @ 2.2 mg/kg), group B (diazepam@ 0.25 mg/kg) and group C (medetomidine @ 40 µg/kg body weight), were injected intramuscular as preanesthetics. After 3-5 minutes of pre-anesthetic, the propofol injection @ 6 mg/kg of body weight was administered intravenous as anesthetic drug in all three groups. Analgesia was tested by the presence or absence of following reflexes - tail pricking, toes pinch, pedal reflex and patellar reflex. Rapid onset (9.13 ± 1.41 minutes) and long duration (59.67± 5.50 minutes) of analgesia was observed in group C compared other groups (onset 13.661±1.72 A, 20.16 ± 1.75 B minutes) and duration of analgesia (48.56 ± 4.61 A and 40.66± 5.46 B minutes). CBC, ALT, AST, ALP and blood urea nitrogen values were non-significantly (P e” 0.5) same within and between all three groups. There was significant (P d” 0.5) increase in ALT, AST, ALP, BUN and serum creatinine in group B at 24 hours interval. The results of our study showed that there was non significant decrease (P e” 0.5) in Hb and total erythrocytes count while non-significant increase (P e” 0.5) in total leukocyte count was noted in all three groups. The results showed that Medetomidine HCl in combination with propofol produce, rapid onset, and long duration of analgesia, with rapid and smooth recovery and no effects on haematological parameters of dogs.

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