# ADAPT

ADAPT

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/adapt`
HTML: https://magentlab.com/docs/adapt
Markdown: https://magentlab.com/docs/adapt.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Than 2012 ADAPT 2-hour accelerated diagnostic protocol and return whether a caller-assigned TIMI UA/NSTEMI score plus initial ECG and 0-hour/2-hour troponin flags meet the published ADP-negative (low-risk) rule.

## When to use

When an agent already has a caller-assigned Antman 2000 TIMI UA/NSTEMI total (0-7) and caller-assigned flags for new ischemic ECG changes and 0-hour and 2-hour troponin elevation and needs the published Than 2012 ADP-negative result. magent does not assign TIMI items, read an ECG, or assay troponin.

## When not to use

- Not a medical device and not a diagnosis of ACS.
- timi_score is the caller-assigned Antman 2000 TIMI UA/NSTEMI total (0-7). magent does not assign TIMI items.
- new_ischemic_ecg is a caller-assigned flag for new ischemic changes on the initial ECG (not known to be pre-existing). magent does not read an ECG.
- troponin_0_elevated and troponin_2h_elevated are caller-assigned flags for 0-hour and 2-hour (not 3-hour) cTnI at or above the institutional cutoff. magent does not assay troponin.
- This tool is not a discharge order or a stress-test order. Presence of high-risk features does not mandate a test.
- This is the Than 2012 ADAPT protocol (TIMI 0 plus no new ischemic ECG plus both 0h/2h troponins not elevated), not HEART Pathway (Mahler 2015 HEART 0-3 plus 0h/3h) and not TIMI item scoring.

## Formula

```
low_risk iff timi_score == 0 and new_ischemic_ecg is false and troponin_0_elevated is false and troponin_2h_elevated is false; timi_score is the caller-assigned Antman 2000 TIMI UA/NSTEMI total 0-7; ECG and troponin flags are caller-assigned (Than 2012 ADAPT Table 1)
```

## Citation

[2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial](https://doi.org/10.1016/j.jacc.2012.02.035)
Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al.
J Am Coll Cardiol. 2012;59(23):2091-2098
DOI: [10.1016/j.jacc.2012.02.035](https://doi.org/10.1016/j.jacc.2012.02.035)

## Worked example

### TIMI 0, no new ischemic ECG, both troponins not elevated

Given: `new_ischemic_ecg=false, timi_score=0, troponin_0_elevated=false, troponin_2h_elevated=false`

1. timi_score 0 equals 0
2. new_ischemic_ecg is false, troponin_0_elevated is false, and troponin_2h_elevated is false
3. low_risk is true


## Also searched as

- ADAPT protocol
- Than ADAPT
- 2-hour accelerated diagnostic protocol
- ADAPT trial
- ADAPT ADP
- Than 2012 chest pain
- accelerated diagnostic protocol TIMI 0

## Parameters

- `timi_score` (integer, required): Caller-assigned TIMI UA/NSTEMI score integer 0-7 (Antman 2000 components already summed by the caller). magent does not assign TIMI items. Low-risk (ADP-negative) requires 0 when the ECG and both 2-hour serial troponin flags are false.
- `new_ischemic_ecg` (boolean, required): New ischemic changes on the initial ECG (not known to be pre-existing), as assigned by the caller. true or false. true blocks low-risk. magent does not read an ECG.
- `troponin_0_elevated` (boolean, required): 0-hour cTnI at or above the institutional cutoff as assigned by the caller. true or false. true blocks low-risk. magent does not assay troponin.
- `troponin_2h_elevated` (boolean, required): 2-hour (not 3-hour) troponin at or above the institutional cutoff as assigned by the caller. true or false. true blocks low-risk. magent does not assay troponin.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/adapt`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "new_ischemic_ecg": "false",
      "timi_score": "0",
      "troponin_0_elevated": "false",
      "troponin_2h_elevated": "false"
    },
    {
      "new_ischemic_ecg": "false",
      "timi_score": "0",
      "troponin_0_elevated": "false",
      "troponin_2h_elevated": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/adapt

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/adapt",
  "items": [
    {
      "components": [
        {
          "value": 0,
          "factor": "timi_score_eq_0",
          "met": true
        },
        {
          "value": false,
          "factor": "no_new_ischemic_ecg",
          "met": true
        },
        {
          "value": false,
          "factor": "trop0_not_elevated",
          "met": true
        },
        {
          "value": false,
          "factor": "trop2h_not_elevated",
          "met": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al.",
        "doi": "10.1016/j.jacc.2012.02.035",
        "id": "than-2012",
        "pmid": "22578923",
        "source": "J Am Coll Cardiol. 2012;59(23):2091-2098",
        "title": "2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial"
      },
      "formula": "adapt",
      "formula_expression": "low_risk iff timi_score == 0 and new_ischemic_ecg is false and troponin_0_elevated is false and troponin_2h_elevated is false; timi_score is the caller-assigned Antman 2000 TIMI UA/NSTEMI total 0-7; ECG and troponin flags are caller-assigned (Than 2012 ADAPT Table 1)",
      "low_risk": true,
      "new_ischemic_ecg": false,
      "timi_score": 0,
      "troponin_0_elevated": false,
      "troponin_2h_elevated": false
    },
    {
      "components": [
        {
          "value": 0,
          "factor": "timi_score_eq_0",
          "met": true
        },
        {
          "value": false,
          "factor": "no_new_ischemic_ecg",
          "met": true
        },
        {
          "value": false,
          "factor": "trop0_not_elevated",
          "met": true
        },
        {
          "value": false,
          "factor": "trop2h_not_elevated",
          "met": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al.",
        "doi": "10.1016/j.jacc.2012.02.035",
        "id": "than-2012",
        "pmid": "22578923",
        "source": "J Am Coll Cardiol. 2012;59(23):2091-2098",
        "title": "2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial"
      },
      "formula": "adapt",
      "formula_expression": "low_risk iff timi_score == 0 and new_ischemic_ecg is false and troponin_0_elevated is false and troponin_2h_elevated is false; timi_score is the caller-assigned Antman 2000 TIMI UA/NSTEMI total 0-7; ECG and troponin flags are caller-assigned (Than 2012 ADAPT Table 1)",
      "low_risk": true,
      "new_ischemic_ecg": false,
      "timi_score": 0,
      "troponin_0_elevated": false,
      "troponin_2h_elevated": false
    }
  ]
}
```

## Response fields

- `formula` (string): adapt
- `formula_expression` (string): Than 2012 ADAPT 2-hour accelerated diagnostic protocol
- `timi_score` (integer): Echo of the caller-assigned TIMI UA/NSTEMI total 0-7
- `new_ischemic_ecg` (boolean): Echo of the caller-assigned new ischemic ECG flag
- `troponin_0_elevated` (boolean): Echo of the caller-assigned 0-hour institutional-cutoff flag
- `troponin_2h_elevated` (boolean): Echo of the caller-assigned 2-hour institutional-cutoff flag
- `low_risk` (boolean): true only when timi_score is 0, new_ischemic_ecg is false, and both 0-hour and 2-hour troponin flags are false. Not a discharge order or diagnosis.
- `components` (array): Rows for timi_score_eq_0, no_new_ischemic_ecg, trop0_not_elevated, and trop2h_not_elevated with factor, met, and value
- `citation` (object): Than 2012 J Am Coll Cardiol citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 0,
      "factor": "timi_score_eq_0",
      "met": true
    },
    {
      "value": false,
      "factor": "no_new_ischemic_ecg",
      "met": true
    },
    {
      "value": false,
      "factor": "trop0_not_elevated",
      "met": true
    },
    {
      "value": false,
      "factor": "trop2h_not_elevated",
      "met": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al.",
    "doi": "10.1016/j.jacc.2012.02.035",
    "id": "than-2012",
    "pmid": "22578923",
    "source": "J Am Coll Cardiol. 2012;59(23):2091-2098",
    "title": "2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial"
  },
  "formula": "adapt",
  "formula_expression": "low_risk iff timi_score == 0 and new_ischemic_ecg is false and troponin_0_elevated is false and troponin_2h_elevated is false; timi_score is the caller-assigned Antman 2000 TIMI UA/NSTEMI total 0-7; ECG and troponin flags are caller-assigned (Than 2012 ADAPT Table 1)",
  "low_risk": true,
  "new_ischemic_ecg": false,
  "timi_score": 0,
  "troponin_0_elevated": false,
  "troponin_2h_elevated": false
}
```

## Errors

- HTTP 400 `invalid_timi_score`: timi_score must be an integer from 0 to 7 (caller-assigned Antman 2000 TIMI UA/NSTEMI total as used in Than 2012 ADAPT). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [HEART Pathway](https://magentlab.com/docs/heart-pathway) — Apply the Mahler 2015 HEART Pathway and return whether a caller-assigned HEART score plus 0-hour and 3-hour troponin flags meet the published early-discharge rule.
- [TIMI UA/NSTEMI](https://magentlab.com/docs/timi-ua-nstemi) — Compute the TIMI risk score for unstable angina / NSTEMI from age and six caller-assigned flags.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.