Treatment decision-making is complex and involves many factors. A systematic decision-making and optimization technology capable of handling variations and uncertainties of patient characteristics and physician's subjectivity is currently unavailable. We recently developed a novel general-purpose fuzzy discrete event systems theory for optimal decision-making. We now apply it to develop an innovative system for medical treatment, specifically for the first round of highly active antiretroviral therapy of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients involving three historically widely used regimens. The objective is to develop such a system whose regimen choice for any given patient will exactly match expert AIDS physician's selection to produce the (anticipated) optimal treatment outcome. Our regimen selection system consists of a treatment objectives classifier, fuzzy finite state machine models for treatment regimens, and a genetic-algorithm-based optimizer. The optimizer enables the system to either emulate an individual doctor's decision-making or generate a regimen that simultaneously satisfies diverse treatment preferences of multiple physicians to the maximum extent. We used the optimizer to automatically learn the values of 26 parameters of the models. The learning was based on the consensus of AIDS specialists A and B on this project, whose exact agreement was only 35%. The performance of the resulting models was first assessed. We then carried out a retrospective study of the entire system using all the qualifying patients treated in our institution's AIDS Clinical Center in 2001. A total of 35 patients were treated by 13 specialists using the regimens (four and eight patients were treated by specialists A and B, respectively). We compared the actually prescribed regimens with those selected by the system using the same available information. The overall exact agreement was 82.9% (29 out of 35), with the exact agreement with specialists A and B both at 100%. The exact agreement for the remaining 11 physicians not involved in the system training was 73.9% (17 out of 23), an impressive result given the fact that expert opinion can be quite divergent for treatment decisions of such complexity. Our specialists also carefully examined the six mismatched cases and deemed that the system actually chose a more appropriate regimen for four of them. In the other two cases, either would be reasonable choices. Our approach has the capabilities of generalizing, learning, and representing knowledge even in the face of weak consensus, and being readily upgradeable to new medical knowledge. These are practically important features to medical applications in general, and HIV/AIDS treatment in particular, as national HIV/AIDS treatment guidelines are modified several times per year

The U.S. Department of Health and Human Services human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) treatment guidelines are modified several times per year to reflect the rapid evolution of the field (e.g., emergence of new antiretroviral drugs). As such, a treatment- decision support system that is capable of self-learning is highly desirable. Based on the fuzzy discrete event system (FDES) theory that we recently created, we have developed a self-learning HIV/AIDS regimen selection system for the initial round of combination antiretroviral therapy, one of the most complex therapies in medicine. The system consisted of a treatment objectives classifier, fuzzy finite state machine models for treatment regimens, and a genetic-algorithm-based optimizer. Supervised learning was achieved through automatically adjusting the parameters of the models by the optimizer. We focused on the four historically popular regimens with 32 associated treatment objectives involving the four most important clinical variables (potency, adherence, adverse effects, and future drug options). The learning targets for the objectives were produced by two expert AIDS physicians on the project, and their averaged overall agreement rate was 70.6%. The system's learning ability and new regimen suitability prediction capability were tested under various conditions of clinical importance. The prediction accuracy was found between 84.4% and 100%. Finally, we retrospectively evaluated the system using 23 patients treated by 11 experienced nonexpert faculty physicians and 12 patients treated by the two experts at our AIDS Clinical Center in 2001. The overall exact agreement between the 13 physicians' selections and the system's choices was 82.9% with the agreement for the two experts being both 100%. For the seven mismatched cases, the system actually chose more appropriate regimens in four cases and equivalent regimens in another two cases. It made a mistake in one case. These (preliminary) results show that 1) the System outperformed the nonexpert physicians and 2) it performed as well as the expert physicians did. This learning and prediction approach, as well as our original FDESs theory, is general purpose and can be applied to other medical or nonmedical problems.

The fundamental difference between an interval type-2 (IT2) fuzzy controller and a type-1 fuzzy controller is the footprint of uncertainty (FOU) of an IT2 fuzzy set. In this paper, we study how FOUs affect the analytical structure (i.e., the input-output mathematical relationship) of a broad class of IT2 Mamdani and TS controllers. The controllers employ arbitrary fuzzy rules, the KM or EKM type-reducer, the minimum AND operator, and the centroid defuzzifier. The controllers utilize commonly used IT2 fuzzy sets for their input variables and any kind of type-2 fuzzy sets for their output variable. We prove that, with increase of FOUs of the input fuzzy sets, (1) the Mamdani controllers approach constant controllers, and (2) the TS controllers approach piecewise linear controllers. The resemblance to the constant or pricewise linear controllers increases as the FOUs increase. When all the FOUs are at their maximum (to reflect the highest level of uncertainties), the Mamdani and TS controllers become the constant controllers and piecewise linear controllers, respectively. We investigate how change in the resemblance takes place progressively as FOUs increase. We also show that an increase in the resemblance narrows control gain variations for part of the IT2 controllers, which can worsen control performance. These findings implicit controller design – too large FOUs are generally undesirable for the input fuzzy sets because they can make an IT2 controller behave like a constant or piecewise linear controller. Real-time control experiment results are provided to illustrate the theoretical analysis.

Hemorrhagic shock is the leading cause of trauma-related death in the military setting. Definitive surgical treatment of a combat casualty can be delayed and life-saving fluid resuscitation might be necessary in the field. Therefore, improved resuscitation strategies are critically needed for prolonged field and en route care. We developed an automated closed-loop control system capable of titrating fluid infusion to a target endpoint. We used the system to compare the performance of a decision table algorithm (DT) and a fuzzy logic controller (FL) to rescue and maintain the mean arterial pressure (MAP) at a target level during hemorrhages. Fuzzy logic empowered the control algorithm to emulate human expertise. We hypothesized that the FL controller would be more effective and more efficient than the DT algorithm by responding in a more rigid, structured way. Ten conscious sheep were submitted to a hemorrhagic protocol of 25 ml/kg over three separate bleeds. Automated resuscitation with lactated Ringer’s was initiated 30 min after the first hemorrhage started. The endpoint target was MAP. Group differences were assessed by two-tailed t test and alpha of 0.05. Both groups maintained MAP at similar levels throughout the study. However, the DT group required significantly more fluid than the FL group, 1745 ± 552 ml (42 ± 11 ml/kg) versus 978 ± 397 ml (26 ± 11 ml/kg), respectively (p = 0.03). The FL controller was more efficient than the DT algorithm and may provide a means to reduce fluid loading. Effectiveness was not different between the two strategies. Automated closed-loop resuscitation can restore and maintain blood pressure in a multi-hemorrhage model of shock.

As part of the zinc hydrometallurgy plant, the iron removal process is a complex system with four cascaded reactors. Tighter process-index control is difficult to achieve due to the complicated, long, and time-varying removal process. The control performance is also affected by the quality of the ore source and external disturbances. An innovative hybrid control strategy is developed to control the iron removal process indices within narrow ranges with minimum cost of additive regents including oxygen and zinc oxide. This strategy is composed of a steady-state optimal setting model, a model-based optimal controller, an integrated prediction model, a fuzzy-logic-based feedforward compensator, and a model feedback adjustor. The optimal setting model automatically optimizes the set-points of the process indices under different production conditions. To achieve the process requirements with minimal cost, the model-based optimal controller is designed. The integrated prediction model is established to provide a more accurate on-line prediction of the process indices by integrating the mechanism prediction model and an error compensation model based on the least square support vector machine. Based on the predicted process indices, the compensator is developed for the optimal controller. The adjustor provides a parameter adjustment mechanism. Four-week-long industrial experiments in the largest zinc hydrometallurgy plant in China show the control strategy can not only improve the process-indexes control performance, but save 6.55% oxygen and 4.61% zinc oxide consumptions, which translates to 222,858 m3 oxygen and 1,236 t zinc oxide per year.