Insulin Glargine in the Intensive Care Unit: A Model-Based Clinical Trial Design

Online 4 Oct 2012Introduction: Current succesful AGC (Accurate Glycemic Control) protocols require extra clinical effort and are impractical in less acute wards where patients are still susceptible to stress-induced hyperglycemia. Long-acting insulin Glargine has the potential to be used in a low effort controller. However, potential variability in efficacy and length of action, prevent direct in-hospital use in an AGC framework for less acute wards. Method: Clinically validated virtual trials based on data from stable ICU patients from the SPRINT cohort who would be transferred to such an approach are used to develop a 24-hour AGC protocol robust to different Glargine potencies (1.0x, 1.5x and 2.0x regular insulin) and initial dose sizes (dose = total insulin over prior 12, 18 and 24 hours). Glycemic control in this period is provided only by varying nutritional inputs. Performance is assessed as %BG in the 4.0-8.0mmol/L band and safety by %BG<4.0mmol/L. Results: The final protocol consisted of Glargine bolus size equal to insulin over the previous 18 hours. Compared to SPRINT there was a 6.9% - 9.5% absolute decrease in mild hypoglycemia (%BG<4.0mmol/L) and up to a 6.2% increase in %BG between 4.0 and 8.0mmol/L. When the efficacy is known (1.5x assumed) there were reductions of: 27% BG measurements, 59% insulin boluses, 67% nutrition changes, and 6.3% absolute in mild hypoglycemia. Conclusion: A robust 24-48 clinical trial has been designed to safely investigate the efficacy and kinetics of Glargine as a first step towards developing a Glargine-based protocol for less acute wards. Ensuring robustness to variability in Glargine efficacy significantly affects the performance and safety that can be obtained

Online dispute resolution: an artificial intelligence perspective

Litigation in court is still the main dispute resolution mode. However, given the amount and characteristics of the new disputes, mostly arising out of electronic contracting, courts are becoming slower and outdated. Online Dispute Resolution (ODR) recently emerged as a set of tools and techniques, supported by technology, aimed at facilitating conflict resolution. In this paper we present a critical evaluation on the use of Artificial Intelligence (AI) based techniques in ODR. In order to fulfill this goal, we analyze a set of commercial providers (in this case twenty four) and some research projects (in this circumstance six). Supported by the results so far achieved, a new approach to deal with the problem of ODR is proposed, in which we take on some of the problems identified in the current state of the art in linking ODR and AI.The work described in this paper is included in TIARAC - Telematics and Artificial Intelligence in Alternative Conflict Resolution Project (PTDC/JUR/71354/2006), which is a research project supported by FCT (Science & Technology Foundation), Portugal. The work of Davide Carneiro is also supported by a doctoral grant by FCT (SFRH/BD/64890/2009).Acknowledgments. The work described in this paper is included in TIARAC - Telematics and Artificial Intelligence in Alternative Conflict Resolution Project (PTDC/JUR/71354/2006), which is a research project supported by FCT (Science & Technology Foundation), Portugal. The work of Davide Carneiro is also supported by a doctoral grant by FCT (SFRH/BD/64890/2009)

Denotative and Connotative Semantics in Hypermedia: Proposal for a Semiotic-Aware Architecture

In this article we claim that the linguistic-centered view within hypermedia systems needs refinement through a semiotic-based approach before real interoperation between media can be achieved. We discuss the problems of visual signification for images and video in dynamic systems, in which users can access visual material in a non-linear fashion. We describe how semiotics can help overcome such problems, by allowing descriptions of the material on both denotative and connotative levels. Finally we propose an architecture for a dynamic semiotic-aware hypermedia system

At the coalface and the cutting edge: general practitioners’ accounts of the rewards of engaging with HIV medicine

The interviews we conducted with GPs suggest that an engagement with HIV medicine enables clinicians to develop strong and long-term relationships with and expertise about the care needs of people living with HIV ‘at the coalface’, while also feeling connected with a broader network of medical practitioners and other professionals concerned with and contributing to the ever-changing world of science: ‘the cutting edge’. The general practice HIV prescriber is being modelled here as the interface between these two worlds, offering a rewarding opportunity for general practitioners to feel intimately connected to both community needs and scientific change