Optimal intensity of oral anticoagulant therapy after myocardial infarction

AbstractObjectives.This study attempted to determine the optimal intensity of anticoagulant therapy in patients after myocardial infarction.Background.Treatment with oral anticoagulant therapy entails a delicate balance between over- (risk of bleeding) and under-anticoagulant (risk of thromboemboli). The optimal intensity required to prevent the occurrence of either event (bleeding or thromboembolic) is not known.Methods.A method was used to determine the optimal intensity of anticoagulant therapy by calculating incidence rates for either event associated with a specific international normalized ratio. The numerator included events occurring at given international normalized ratios, and the denominator comprised the total observation time.Results.The study population included 3,404 myocardial infarction patients enrolled in the ASPECT (anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis) trial. Total treatment was 6,918 patient-years. Major bleeding occurred in 57 patients (0.8/100 patient-years), and thromboembolic complications in 397 (5.7/100 patient-years). The incidence of the combined outcome (bleeding or thromboembolic complications) with international normalized ratio < 2 was 8.0/100 patient-years (283 events in 3,559 patient-years), with international normalized ratios between 2 and 3, 3.9/100 patient-years (33 events in 838 patient-years); 3.2/100 patient-years (57 events in 1,775 patient-years) for international normalized ratios between 3 and 4; 6.6/100 patient-years (37 events in 564 patient-years) for international normalized ratios between 4 and 5; and 7.7/100 patient-years (14 events in 182 patient-years) for international normalized ratios >5. After adjustment for achieved international normalized ratio levels, significant predictors were higher levels of systolic blood pressure and age.Conclusions.If equal weight is given to hemorrhagic and thromboembolic complications, these results suggest that the optimal intensity of long-term anticoagulant therapy for myocardial infarction patients lies between 2.0 and 4.0 international normalized ratio, with a trend to suggest an optimal intensity of 3.0 to 4.0

Antitrombotische behandeling na een acute ischemische hartziekte: acetylsalicylzuur en (of) orale anticoagulantia? ASPECT-II, een nieuw onderzoek

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Do you get it? User-evaluated explainable BDI agents

In this paper we focus on explaining to humans the behavior of autonomous agents, i.e., explainable agents. Explainable agents are useful for many reasons including scenario-based training (e.g. disaster training), tutor and pedagogical systems, agent development and debugging, gaming, and interactive storytelling. As the aim is to generate for humans plausible and insightful explanations, user evaluation of different explanations is essential. In this paper we test the hypothesis that different explanation types are needed to explain different types of actions. We present three different, generically applicable, algorithms that automatically generate different types of explanations for actions of BDI-based agents. Quantitative analysis of a user experiment (n=30), in which users rated the usefulness and naturalness of each explanation type for different agent actions, supports our hypothesis. In addition, we present feedback from the users about how they would explain the actions themselves. Finally, we hypothesize guidelines relevant for the development of explainable BDI agents. © 2010 Springer-Verlag Berlin Heidelberg

Validity of a virtual negotiation training

In this paper we present a rigorously setup VR negotiation training, including an intelligent virtual agent able to express emotion and to give explanations of its behavior. We discuss the measures we took to ensure the validity of the VR training. We also present a small scale experiment showing convergent validity of the VR training. © 2011 Springer-Verlag

Dose-dependent efficacy of miglitol, an alfa-glucosidase inhibitor, in type 2 diabetic patients: results of a 24-week double-blind placebo-controlled study.

AIMS: A double-blind randomised study was performed to compare the dose-effect and dose-tolerability relationships between the alpha-glucosidase inhibitor miglitol in doses of 25 mg, 50 mg, 100 mg and 200 mg all t.i.d. vs placebo t.i.d. in patients with Type 2 diabetes mellitus on diet only. METHODS: After a 6-week placebo run-in period 468 patients with a fasting blood glucose > or = 7 mmol/l as well as a HbA1c between 6.1% and 10.4% were randomised for a 24-week treatment period. RESULTS: The results of 465 patients were valid for safety analysis and of 384 patients for the efficacy analysis. In the placebo group the HbA1c level increased by 0.40+/-1.46% as compared with baseline. The decrease in the mean HbA1c values (corrected for differences in baseline values) was significant and dose-dependent for all miglitol groups compared with placebo, being -0.46% (95% CI: -0.91%, -0.01%) in the 25 mg group, -0.45% (95% CI: -0.90%, -0.003%) in the 50 mg group, -0.84% (95% CI: -1.31%, -0.37%) in the 100 mg group and -1.26% (95% CI: -1.76%, -0.76%) in the 200 mg group. Blood glucose levels following a standardised breakfast tolerance test were significantly and dose-dependently lower for all the miglitol doses at 12 and 24 wk of treatment compared to baseline: in comparison with baseline maximum blood glucose increased by 4% with placebo and decreased by 7%, 14%, 24% and 33% with miglitol 25 mg, 50 mg, 100 mg and 200 mg t.i.d. respectively. The same pattern was seen with postprandial maximal serum insulin levels which decreased by 8% under placebo and by 17%, 26%, 25% and 35% with the 25 mg to 200 mg doses of miglitol. The adverse events reported were mainly of gastrointestinal nature, mostly being flatulence, diarrhoea and abdominal pain and the incidence increased with increasing dose. Although the side effects were not serious, they were troublesome, leading to a considerable drop-out rate increasing with dose. CONCLUSIONS: The alpha-glucosidase inhibitor miglitol in Type 2 diabetic patients on diet alone decreases both HbA1c levels and postprandial glucose and insulin levels in a dose-dependent manner. Gastrointestinal side effects also showed dose-dependency. Combination of efficacy and safety results leads to the conclusion that the optimal dose of miglitol will be in the range of 50 to 100 mg t.i.d

Integrating Agent Models and Dynamical Systems

Abstract. Agent-based modelling approaches are usually based on logical languages, whereas in many areas dynamical system models based on differential equations are used. This paper shows how to model complex agent systems, integrating quantitative, numerical and qualitative, logical aspects, and how to combine logical and mathematical analysis methods.