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

Algorithm for Adapting Cases Represented in a Tractable Description Logic

Case-based reasoning (CBR) based on description logics (DLs) has gained a lot of attention lately. Adaptation is a basic task in the CBR inference that can be modeled as the knowledge base revision problem and solved in propositional logic. However, in DLs, it is still a challenge problem since existing revision operators only work well for strictly restricted DLs of the \emph{DL-Lite} family, and it is difficult to design a revision algorithm which is syntax-independent and fine-grained. In this paper, we present a new method for adaptation based on the DL $\mathcal{EL_{\bot}}$. Following the idea of adaptation as revision, we firstly extend the logical basis for describing cases from propositional logic to the DL $\mathcal{EL_{\bot}}$, and present a formalism for adaptation based on $\mathcal{EL_{\bot}}$. Then we present an adaptation algorithm for this formalism and demonstrate that our algorithm is syntax-independent and fine-grained. Our work provides a logical basis for adaptation in CBR systems where cases and domain knowledge are described by the tractable DL $\mathcal{EL_{\bot}}$.Comment: 21 pages. ICCBR 201

Knowledge representation on the web

Exploiting the full potential of the World Wide Web will require semantic as well as syntactic interoperability. This can best be achieved by providing a further representation and inference layer that builds on existing and proposed web standards. The OIL language extends the RDF schema standard to provide just such a layer. It combines the most attractive features of frame based languages with the expressive power, formal rigour and reasoning services of a very expressive description logic.

Automated Synthesis of Tableau Calculi

This paper presents a method for synthesising sound and complete tableau calculi. Given a specification of the formal semantics of a logic, the method generates a set of tableau inference rules that can then be used to reason within the logic. The method guarantees that the generated rules form a calculus which is sound and constructively complete. If the logic can be shown to admit finite filtration with respect to a well-defined first-order semantics then adding a general blocking mechanism provides a terminating tableau calculus. The process of generating tableau rules can be completely automated and produces, together with the blocking mechanism, an automated procedure for generating tableau decision procedures. For illustration we show the workability of the approach for a description logic with transitive roles and propositional intuitionistic logic.Comment: 32 page

Unified management of multi-model data : (Vision paper)

Peer reviewe

Confluence up to Garbage

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Ambient-aware continuous care through semantic context dissemination

Background: The ultimate ambient-intelligent care room contains numerous sensors and devices to monitor the patient, sense and adjust the environment and support the staff. This sensor-based approach results in a large amount of data, which can be processed by current and future applications, e. g., task management and alerting systems. Today, nurses are responsible for coordinating all these applications and supplied information, which reduces the added value and slows down the adoption rate. The aim of the presented research is the design of a pervasive and scalable framework that is able to optimize continuous care processes by intelligently reasoning on the large amount of heterogeneous care data. Methods: The developed Ontology-based Care Platform (OCarePlatform) consists of modular components that perform a specific reasoning task. Consequently, they can easily be replicated and distributed. Complex reasoning is achieved by combining the results of different components. To ensure that the components only receive information, which is of interest to them at that time, they are able to dynamically generate and register filter rules with a Semantic Communication Bus (SCB). This SCB semantically filters all the heterogeneous care data according to the registered rules by using a continuous care ontology. The SCB can be distributed and a cache can be employed to ensure scalability. Results: A prototype implementation is presented consisting of a new-generation nurse call system supported by a localization and a home automation component. The amount of data that is filtered and the performance of the SCB are evaluated by testing the prototype in a living lab. The delay introduced by processing the filter rules is negligible when 10 or fewer rules are registered. Conclusions: The OCarePlatform allows disseminating relevant care data for the different applications and additionally supports composing complex applications from a set of smaller independent components. This way, the platform significantly reduces the amount of information that needs to be processed by the nurses. The delay resulting from processing the filter rules is linear in the amount of rules. Distributed deployment of the SCB and using a cache allows further improvement of these performance results

Knowledge representation for culturally competent personal robots: requirements, design principles, implementation, and assessment

Culture, intended as the set of beliefs, values, ideas, language, norms and customs which compose a person’s life, is an essential element to know by any robot for personal assistance. Culture, intended as that person’s background, can be an invaluable source of information to drive and speed up the process of discovering and adapting to the person’s habits, preferences and needs. This article discusses the requirements posed by cultural competence on the knowledge management system of a robot. We propose a framework for cultural knowledge representation that relies on (i) a three layer ontology for storing concepts of relevance, culture specific information and statistics, person-specific information and preferences; (ii) an algorithm for the acquisition of person-specific knowledge, which uses culture specific knowledge to drive the search; (iii) a Bayesian Network for speeding up the adaptation to the person by propagating the effects of acquiring one specific information onto interconnected concepts. We have conducted a preliminary evaluation of the framework involving 159 Italian and German volunteers and considering 122 among habits, attitudes and social norms

Infectious Disease Ontology

Technological developments have resulted in tremendous increases in the volume and diversity of the data and information that must be processed in the course of biomedical and clinical research and practice. Researchers are at the same time under ever greater pressure to share data and to take steps to ensure that data resources are interoperable. The use of ontologies to annotate data has proven successful in supporting these goals and in providing new possibilities for the automated processing of data and information. In this chapter, we describe different types of vocabulary resources and emphasize those features of formal ontologies that make them most useful for computational applications. We describe current uses of ontologies and discuss future goals for ontology-based computing, focusing on its use in the field of infectious diseases. We review the largest and most widely used vocabulary resources relevant to the study of infectious diseases and conclude with a description of the Infectious Disease Ontology (IDO) suite of interoperable ontology modules that together cover the entire infectious disease domain

Ranking Services Using Fuzzy HEX Programs

Abstract. The need to reason with knowledge expressed in both Logic Program-ming (LP) and Description Logics (DLs) paradigms on the Semantic Web lead to several integrating formalisms, e.g., Description Logic programs (dl-programs) allow a logic program to retrieve results from and feed results to a DL knowledge base. Two functional extensions of dl-programs are HEX programs and fuzzy dl-programs. The former abstract away from DLs, allowing for general exter-nal queries, the latter deal with the uncertain, vague, and inconsistent nature of knowledge on the Web by means of fuzzy logic mechanisms. In this paper, we generalize both HEX programs and fuzzy dl-programs to fuzzy HEX programs: a LP-based paradigm, supporting both fuzziness as well as reasoning with exter-nal sources. We define basic syntax and semantics and analyze the framework semantically, e.g., by investigating the complexity. Additionally, we provide a translation from fuzzy HEX programs to HEX programs, enabling an implementa-tion via the dlvhex reasoner. Finally, we illustrate the use of fuzzy HEX programs for ranking services by using them to model non-functional properties of services and user preferences.