**5. Procedures for data collection and analysis**

The process of insertion of the research team on the islands first involved systematic access to the spaces shared by the family. During the approach of the places frequented by the residents, such as the school, residents' association, and houses themselves, we took care to become part of the population day-by-day by sharing time and activities.

After familiarization with the families, we were able to access their homes with the help of local boaters because of a lack of an address system similar to the ones used in cities given that igarapés are constituted by rivers that intersect, which can cause confusion for those who do not live in the region. After mapping the participants' houses, we began visiting the houses. The observations, talks, and activities were reported in a field diary immediately after the visits.

A statement of consent warranted the rights of the participants, and the ethical committee of the Federal University of Pará approved the study (CAEE – 0<IP_ADDRESS>-09).

The inventories were applied with the parents on previously scheduled days. During the interviews, we asked questions, and the participants were free to respond. The responses were recorded and transcribed. The tabulation of responses into categories of activities was based on discussions and agreement of two of the three researchers who collected the data. In case of discordance, we consulted the project mentors.


**5.1 Biochemical parameter**

The severity is linked to recurrence risk in ATD-treated GD patients. Partly the biochemical parameters help to determine the seriousness of GD. The parametric increase of serum T3, which is affected by increased intrathyroid type 1 deiodinase activity, is significant in untreated GD. Independent GD factors influenced free thyroxine-to-free triiodothyronine ratio (FT3 andFT4) is predictive for the ATD treatment outcome for patients with GD. Hyperthyroidism symptoms observed after the treatment with beta-blockers. Patients with a higher T3/FT3 or FT3/ T4 serum ratio have been found to be more at recurrence, requiring a longer and more additional dose in the treatment. The risk of relapsed treatment is increased for patients with a higher serum T3 and FT3/FT4 ratio. When a patient has a high T3/T4 ratio, therapy should be continued for at least one year after the ATD has been removed. Serum thyroid-stimulating hormone (TSH) should be measured. However, as it is known, the thyroid hormone has a negative feed-back influence on the TSH. Thus, prior research has established that drug discontinuation is associated with elevated levels of TSH. These findings suggest that treatment with a prolonged ATD may be indicated for GD patients who do not normalize their thyroid-stimulating hormone levels quickly.

## **5.2 Immune parameters**

The GD is the result of hyper-activation by TRAb of the TSH receptor in follicular thyroid cells. In approximately 95% of newly diagnosed GD patients, TRAb is positive and higher TRAb levels are indicative of serious immune disorder. Recent times have demonstrated TRAb as a helpful and qualitative prognostic indicator for ATD therapy. At the time of GD diagnosis, patients with high TRAb levels had a considerably higher recurrence risk, while TRAb patients were often more likely to get long-term recovery. Switching from positive to negative TRAb in GD patients involves a reduced immune disorder after ATD therapy. In the prognosis of GD patients, TRAb levels were also observed at ATD withdrawal. Recurrence risk was noted to be increased in TRAb-positive GD during the time of drug discontinuation. New assays can be used to distinguish the stimulating (stimulating) and blocking (disturbing) effects of medications on antigen responses. Thyroid stimulating antibodies (TSAb) antibodies are found to be predominant in GD patients. Recently, the value of TRAb for patients on GD treatments for recurrence risk with prediction has been shown to be greater than that of GD, particularly TSAb. GD patients with thyroiditis from Hashimoto appear to be remission after Hashimoto's thyroiditis due to advanced harm. The prevalence of peroxidase/ peroxidase antibodies is highest in people with Hashimoto's thyroiditis. Few studies have analyzed whether the existence of Thyroid peroxidase antibodies (TPOAb) and Thyroglobulin antibodies (TgAb) autoantibodies is linked to the risk of a subsequent relapse in those with GD. People with GD may also show low TPOAb and TgAb levels, and in such cases, the clinical and laboratory findings are not completely consistent with the diagnosis of Hashimoto's disease.

#### **5.3 Goiter size**

A major clinical manifestation found in GD patients is the large goiter. Previous studies show a large predictor of increased risk of recurrence in GD patients after the removal of ATD, goiter size. Findings from 5 years of trail follow-up have shown that the rate of remission for normal or mild-goiter patients is higher than for largegoiter patients. GD patients with significantly lower goiter sizes tend to have higher rates of remission after ATD treatment. Enlarged goiter size at the time of GD diagnosis and drug withdrawal is associated with a higher recurrence risk of GD.

#### **5.4 Graves' orbitopathy**

At the time of diagnosis of GD, Graves' orbitopathy is observed in 35% of patients. Sometimes, the presence of the Graves orbitopathy indicated that the immune system gets worsen. Previous studies show that the risk of GD recurrence after withdrawal of ATD in patients with Graves' orbitopathy is higher [38]. An Eckstein et al. study even found that GD patients with severe Graves' orbitopathy only received a 7% remission rate. Although the recurrence rate is higher, the ATD treatment remains a preferred therapeutic option for GD patients with orbitopathy of Graves because Graves's orbitopathy improves as well as a steady eutyroid status achieved and reduces inflammatory markers of the TRAb. Recent studies have demonstrated that the continuous low dose of ATD has helped to improve GD disease in Graves orbitopathy patients.

#### **5.5 Genetic factors**

Genetic factors plays a key role in the pathogenesis of GD and increase the risk of recurrence to the development of GD. Several studies supports both cytotoxic T-lymphocyte-associated factor 4 (CTLA4) rs231775 and rs231779 polymorphisms were strongly associated with recurrence of GD even after ATD withdrawal in Asians, while there is no association in Caucasians for developing GD. In Caucasian patients with GD, the recurrence risk after ATD withdrawal was observed with the polymorphisms of HLA DQA2, HLA DRB1∗03, and HLA DQB1∗02. The HLA region majorly contains immune response genes and tHLA polymorphisms might also influence the outcome of GD patients by regulating the immune system.

#### **5.6 Environmental factors**

GD starts with some environmental factors in the predisposed genetic association in individuals. Stress is one of the important environmental considerations, and a majority of the studies have supported the association between stress and recurrence in GD patients after ATD therapy. The overall stress score for large life events was significantly higher in the recurrence group in a prospective study that examined the recurrence risk of GD in patients than in the remission. Another trial showed that the recurrence group was more stressful than the remission patients, and that the total number of stressful events is linked to the number of the recurrence. Psychosocial stress is an important part of a stressful event. It is worth mentioning. Previous trials showed that the risk of GD recurrence is higher than that of GD patients without such a disease for patients with psychiatric disorders as depression and hypochondriasis. Therefore, reducing stress is an essential way of improving the prognosis of ATD-treated GD patients. Another ecological factor is iodine intake.

The synthesis of the thyroid hormone is based on Iodine. Increased content of iodine in thyrocytes has promoted degradation of ATD and reduced uptake of ATD. The supplementation of iodine increased the GD recurrence rate. After ATD withdrawal hyperthyroidism in euthyroid GD patients arose when pharmaceutical doses of iodine were taken. Epidemiologic studies have shown, however, that in iodine-adequate countries, recurrence rates in GD patients do not exceed those in iodine-deficient areas following ATD withdrawal.


*2.2. Analysis*

We produced a before (*n* = 100 ED patients) and after (N = 100 UCC patients) design, i.e., prior and after the UCC being established. Focus was on dimensions concerning the outcome of treatment at the ED in comparison to the UCC. Aspects studied were LOS, TTP, use of medical services (radiology, laboratory analysis), revisits, hospitalisations, mortality and cost. Descriptive statistics included central tendency and dispersion. LOS was defined as the time spent from admission to discharge from the UCC or the ED or admission to a ward. TTP was defined as the time spent from admission to seeing a physician. Paired-sample calculations of LOS, TTP and laboratory analysis showed a statistical di fference of means. However, the results of normality measured by the Kolmogorov Smirnov test did indicate LOS, TTP and laboratory analysis to be significantly skewed (LOS sig. 0.00, TTP sig. 0.00, and laboratory analysis sig. 0.00). The samples could consequently not be regarded as normally distributed due to outliers. A complementary non-parametric test was therefore conducted using a Wilcoxon signed-rank test.


**Luis Amengual-Peñafiel 1,\*, Manuel Brañes-Aroca 2, Francisco Marchesani-Carrasco 3, María Costanza Jara-Sepúlveda 3, Leopoldo Parada-Pozas 4 and Ricardo Cartes-Velásquez 5,6**

Received: 10 December 2018; Accepted: 22 January 2019; Published: 25 January 2019

**Abstract:** The permanent interaction between bone tissue and the immune system shows us the complex biology of the tissue in which we insert oral implants. At the same time, new knowledge in relation to the interaction of materials and the host, reveals to us the true nature of osseointegration. So, to achieve clinical success or perhaps most importantly, to understand why we sometimes fail, the study of oral implantology should consider the following advice equally important: a correct clinical protocol, the study of the immunomodulatory capacity of the device and the osteoimmunobiology of the host. Although osseointegration may seem adequate from the clinical point of view, a deeper vision shows us that a Foreign Body Equilibrium could be susceptible to environmental conditions. This is why maintaining this cellular balance should become our therapeutic target and, more specifically, the understanding of the main cell involved, the macrophage. The advent of new information, the development of new implant surfaces and the introduction of new therapeutic proposals such as therapeutic mechanotransduction, will allow us to maintain a healthy host-implant relationship long-term.

**Keywords:** oral implants; osseointegration; marginal bone loss; immunomodulation; mechanotransduction


*Edited by Fausto Pedro García Márquez*

*and Benjamin Lev*

The Engineering Management book synthesises the engineering principles with business practice, i.e. the book provides an interface between the main disciplines of engineering/technology and the organizational, administrative, and planning abilities of management. It is complementary to other sub-disciplines such as economics, finance, marketing, decision and risk analysis, etc. This book is intended for engineers, economics and researchers who are developing new advances in engineering management, or who employ the engineering management discipline as part of their work. The authors of this volume describe their pioneering work in the area or provide material for case studies successfully applying the engineering management discipline in real life cases.

ISBN 978-953-51-1037-8

Engineering Management

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**5. BLDC Motor Control Based on PID**

PID consists of a set of conditions that could be applied to give a closed-loop control system precise regulation. In a closed-loop control process, the controlling device receives continuous real-time measurements of the process being controlled to ensure it reaches the desired range. The computed value, also known as the "process variable", is made by the controlling device to resemble the indented value, also known as the "set point". To complete the desired work effectively, the PID control algorithm is adapted. The most important of these is proportionate control, which measures the error value and creates proportionate changes to lower the error in the control variable. Proportional control is mostly used in many control systems. The PID controller continuously evaluates the difference between the process variable and the set point and makes the necessary corrections. Derivative control monitors the process variable's rate of change and modifies the output variable to take unexpected changes into account.

Each of the three control functions is directed by a user-defined parameter. These characteristics may differ from one control system to another, and as a result, they must be modified for the best control precision. Finding the values of these parameters is known as PID tuning. Although many people think of PID tuning as "black magic", it is always known as a precise mathematical process.

There are numerous ways to accomplish PID tuning, and any of the methods can be used to tune any system. While some PID controlling methods require more devices than others, they typically produce more accurate output with low effort. The fundamental objective of the PID controller is to execute algorithm-based tuning constants. The control engineer delivers the current plant process value and the operator's intended operating value (set point). In most situations, the controller will conduct to bring the process value as close to the set point as is practical. To perform a simple process control loop, PID algorithms will be implemented by the control engineer.


**2.1 Sildenafil citrate administration**

The rats in the treatment groups (A, B, & C) received respectively, 0.25mg/kg, 0.70mg/kg and 1.43mg/kg body weight of Sildenafil citrate base dissolved in distilled water daily for 6 weeks, through orogastric feeding tube, while that of the control group D, received equal volume of distilled water daily during the period of the experiment. The rats were sacrificed by cervical dislocation on day forty-three of the experiment. The liver and kidneys of the animals in each group were dissected out and quickly fixed in 10% formal saline for general histological studies.