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

Conceptual Knowledge Discovery and Data Analysis

. In this paper, we discuss Conceptual Knowledge Discovery in Databases (CKDD) in its connection with Data Analysis. Our approach is based on Formal Concept Analysis, a mathematical theory which has been developed and proven useful during the last 20 years. Formal Concept Analysis has led to a theory of conceptual information systems which has been applied by using the management system TOSCANA in a wide range of domains. In this paper, we use such an application in database marketing to demonstrate how methods and procedures of CKDD can be applied in Data Analysis. In particular, we show the interplay and integration of data mining and data analysis techniques based on Formal Concept Analysis. The main concern of this paper is to explain how the transition from data to knowledge can be supported by a TOSCANA system. To clarify the transition steps we discuss their correspondence to the five levels of knowledge representation established by R. Brachman and to the steps of..

Abox Satisfiability Reduced to Terminological Reasoning in Expressive Description Logics

Description Logics knowledge bases are traditionally divided into a terminological part (Tbox), and an assertional part (Abox). However, most of recent results on practical algorithms are confined to terminological reasoning only. Due to the applications of Description Logics for databases and the so-called &quot;Semantic Web&quot;, there is a growing interest for practical algorithms for Abox reasoning. In this paper we present an algorithm for deciding knowledge base satisfiability based on the idea of separating terminological and assertional reasoning. This modularity allows to build complete Description Logics systems, by reusing available terminological reasoners