Artificial Intelligence and Patient-Centered Decision-Making

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient

Perspectives on the revised Ghent criteria for the diagnosis of Marfan syndrome

Three international nosologies have been proposed for the diagnosis of Marfan syndrome (MFS): the Berlin nosology in 1988; the Ghent nosology in 1996 (Ghent-1); and the revised Ghent nosology in 2010 (Ghent-2). We reviewed the literature and discussed the challenges and concepts of diagnosing MFS in adults. Ghent-1 proposed more stringent clinical criteria, which led to the confirmation of MFS in only 32%-53% of patients formerly diagnosed with MFS according to the Berlin nosology. Conversely, both the Ghent-1 and Ghent-2 nosologies diagnosed MFS, and both yielded similar frequencies of MFS in persons with a causative FBN1 mutation (90% for Ghent-1 versus 92% for Ghent-2) and in persons not having a causative FBN1 mutation (15% versus 13%). Quality criteria for diagnostic methods include objectivity, reliability, and validity. However, the nosology-based diagnosis of MFS lacks a diagnostic reference standard and, hence, quality criteria such as sensitivity, specificity, or accuracy cannot be assessed. Medical utility of diagnosis implies congruency with the historical criteria of MFS, as well as with information about the etiology, pathogenesis, diagnostic triggers, prognostic triggers, and potential complications of MFS. In addition, social and psychological utilities of diagnostic criteria include acceptance by patients, patient organizations, clinicians and scientists, practicability, costs, and the reduction of anxiety. Since the utility of a diagnosis or exclusion of MFS is context-dependent, prioritization of utilities is a strategic decision in the process of nosology development. Screening tests for MFS should be used to identify persons with MFS. To confirm the diagnosis of MFS, Ghent-1 and Ghent-2 perform similarly, but Ghent-2 is easier to use. To maximize the utility of the diagnostic criteria of MFS, a fair and transparent process of nosology development is essential

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Internet addiction: a systematic review of epidemiological research for the last decade

In the last decade, Internet usage has grown tremendously on a global scale. The increasing popularity and frequency of Internet use has led to an increasing number of reports highlighting the potential negative consequences of overuse. Over the last decade, research into Internet addiction has proliferated. This paper reviews the existing 68 epidemiological studies of Internet addiction that (i) contain quantitative empirical data, (ii) have been published after 2000, (iii) include an analysis relating to Internet addiction, (iv) include a minimum of 1000 participants, and (v) provide a full-text article published in English using the database Web of Science. Assessment tools and conceptualisations, prevalence, and associated factors in adolescents and adults are scrutinised. The results reveal the following. First, no gold standard of Internet addiction classification exists as 21 different assessment instruments have been identified. They adopt official criteria for substance use disorders or pathological gambling, no or few criteria relevant for an addiction diagnosis, time spent online, or resulting problems. Second, reported prevalence rates differ as a consequence of different assessment tools and cut-offs, ranging from 0.8% in Italy to 26.7% in Hong Kong. Third, Internet addiction is associated with a number of sociodemographic, Internet use, and psychosocial factors, as well as comorbid symptoms and disorder in adolescents and adults. The results indicate that a number of core symptoms (i.e., compulsive use, negative outcomes and salience) appear relevant for diagnosis, which assimilates Internet addiction and other addictive disorders and also differentiates them, implying a conceptualisation as syndrome with similar etiology and components, but different expressions of addictions. Limitations include the exclusion of studies with smaller sample sizes and studies focusing on specific online behaviours. Conclusively, there is a need for nosological precision so that ultimately those in need can be helped by translating the scientific evidence established in the context of Internet addiction into actual clinical practice

Risk Adjustment Under the Affordable Care Act: A Guide for Federal and State Regulators

Summarizes discussions from a conference about the consequences of the 2010 healthcare reform's risk adjustment provisions, design and implementation challenges, and the merits of various risk adjustment strategies. Recommends diagnostic risk measures

Space biology initiative program definition review. Trade study 2: Prototype utilization in the development of space biology hardware

The objective was to define the factors which space flight hardware developers and planners should consider when determining: (1) the number of hardware units required to support program; (2) design level of the units; and (3) most efficient means of utilization of the units. The analysis considered technology risk, maintainability, reliability, and safety design requirements for achieving the delivery of highest quality flight hardware. Relative cost impacts of the utilization of prototyping were identified. The development of Space Biology Initiative research hardware will involve intertwined hardware/software activities. Experience has shown that software development can be an expensive portion of a system design program. While software prototyping could imply the development of a significantly different end item, an operational system prototype must be considered to be a combination of software and hardware. Hundreds of factors were identified that could be considered in determining the quantity and types of prototypes that should be constructed. In developing the decision models, these factors were combined and reduced by approximately ten-to-one in order to develop a manageable structure based on the major determining factors. The Baseline SBI hardware list of Appendix D was examined and reviewed in detail; however, from the facts available it was impossible to identify the exact types and quantities of prototypes required for each of these items. Although the factors that must be considered could be enumerated for each of these pieces of equipment, the exact status and state of development of the equipment is variable and uncertain at this time

Federated Robust Embedded Systems: Concepts and Challenges

The development within the area of embedded systems (ESs) is moving rapidly, not least due to falling costs of computation and communication equipment. It is believed that increased communication opportunities will lead to the future ESs no longer being parts of isolated products, but rather parts of larger communities or federations of ESs, within which information is exchanged for the benefit of all participants. This vision is asserted by a number of interrelated research topics, such as the internet of things, cyber-physical systems, systems of systems, and multi-agent systems. In this work, the focus is primarily on ESs, with their specific real-time and safety requirements. While the vision of interconnected ESs is quite promising, it also brings great challenges to the development of future systems in an efficient, safe, and reliable way. In this work, a pre-study has been carried out in order to gain a better understanding about common concepts and challenges that naturally arise in federations of ESs. The work was organized around a series of workshops, with contributions from both academic participants and industrial partners with a strong experience in ES development. During the workshops, a portfolio of possible ES federation scenarios was collected, and a number of application examples were discussed more thoroughly on different abstraction levels, starting from screening the nature of interactions on the federation level and proceeding down to the implementation details within each ES. These discussions led to a better understanding of what can be expected in the future federated ESs. In this report, the discussed applications are summarized, together with their characteristics, challenges, and necessary solution elements, providing a ground for the future research within the area of communicating ESs