Inclusivity in TAS research:An example of EDI as RRI

Responsible research and innovation (RRI) aims to achieve the goal of making research activities responsible and ethical. To those ends, it is vital for researchers to actively engage with equality, diversity and inclusion (EDI) which, if not attended to, may detrimentally affect both potential research participants and the research itself. Our paper offers an account of our ongoing discussions surrounding the importance of EDI when designing our research, how we employed EDI to intentionally make our recruitment process more inclusive, and our ongoing planning to make all our research activities as inclusive, diverse, and accessible as possible. There is no one-size-fits-all approach for adopting EDI principles in RRI, however, we posit that their consideration is essential for research communities who wish their work to represent the perspectives of those who will be affected by future novel technologies

Chapter Is coercion ever beneficent?

Early intervention in mental health seeks to improve the wellbeing of as many people as possible, by intervening at an early stage in the onset of illness, or by taking preventative action in ‘at risk’ populations. The paradigm is rhetorically powerful, and it is easy to talk in terms of it helping to deliver rights to health and realise social justice. However, in spite – or perhaps because – of the apparently unarguable desirability of such goals, it is harder to discuss rights to dissent. In this respect the risk of coercion is an issue that should be discussed, especially because of the stigmatizing effect that the labelling associated with early intervention may have in mental health contexts. Here we explore this issue, with a particular focus on its practical and ethical implications in relation to UK policy for treating Attention Deficit Hyperactivity Disorder and mild Conduct Disorder in young people

Ethical dimensions of translational developmental neuroscience research in autism

Background Since the 1990s, increasing research has been devoted to the identification of biomarkers for autism to help attain more objective diagnosis; enable early prediction of prognosis; and guide individualized intervention options. Early studies focused on the identification of genetic variants associated with autism, but more recently, research has expanded to investigate neurodevelopmental markers. While ethicists have extensively discussed issues around advances in autism genomics, much less ethical scrutiny has focused on research on early neurodevelopment and on the interventions being developed as a result. Objectives We summarize the current state of the science on the identification of early markers for autism and its potential clinical applications, before providing an overview of the ethical issues arising from increasing understanding of children's neurodevelopment in very early life. Results Advances in the understanding of brain and behavioral trajectories preceding later autism diagnosis raise ethical concerns around three themes: (a) New models for understanding autism; (b) Risks and benefits of early identification and intervention; and (c) Communication of early concerns to families. These ethical issues should be further investigated in research conducted in partnership with autistic people and their families. Conclusions This paper highlights the need for ethical scrutiny of early neurodevelopmental research in autism. Scrutiny requires expertise and methods from the basic sciences and bioethics, as well as constructive collaborations among autistic people, their parents, and autism researchers to anticipate early interventions that serve the community's interests and accommodate the varied experiences and preferences of people on the spectrum and their families.</p

Touch Imprinting Cytology may be useful in the intraoperative evaluation of the sentinel lymph node in melanoma

The aim of the study was to assess whether the reliability of Touch Imprinting Cytology (TIC) of Sentinel lymph node biopsy (SLNB) in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made. Previous experiences have shown that the limit of TIC in extemporaneous diagnosis was represented by the minimal deposits of the tumor. Many current data seem to show that in this situation radical lymphadenectomy is no longer necessary, so we wondered if TIC could regain importance in the intraoperative management of these patients

AERoS: Assurance of Emergent Behaviour in Autonomous Robotic Swarms

The behaviours of a swarm are not explicitly engineered. Instead, they are an emergent consequence of the interactions of individual agents with each other and their environment. This emergent functionality poses a challenge to safety assurance. The main contribution of this paper is a process for the safety assurance of emergent behaviour in autonomous robotic swarms called AERoS, following the guidance on the Assurance of Machine Learning for use in Autonomous Systems (AMLAS). We explore our proposed process using a case study centred on a robot swarm operating a public cloakroom.Comment: 12 pages, 11 figure

Soft Gripping: Specifying for Trustworthiness

Soft robotics is an emerging technology in which engineers create flexible devices for use in a variety of applications. In order to advance the wide adoption of soft robots, ensuring their trustworthiness is essential; if soft robots are not trusted, they will not be used to their full potential. In order to demonstrate trustworthiness, a specification needs to be formulated to define what is trustworthy. However, even for soft robotic grippers, which is one of the most mature areas in soft robotics, the soft robotics community has so far given very little attention to formulating specifications. In this work, we discuss the importance of developing specifications during development of soft robotic systems, and present an extensive example specification for a soft gripper for pick-and-place tasks for grocery items. The proposed specification covers both functional and non-functional requirements, such as reliability, safety, adaptability, predictability, ethics, and regulations. We also highlight the need to promote verifiability as a first-class objective in the design of a soft gripper.Comment: Updated the Standards subsection of paper. 9 pages, 2 figures, 1 table, 34 reference

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay &gt;6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P &lt; 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Chapter 15 La medicina predittiva e il dibattito etico sui test genetici

The "genetic revolution" that characterized the beginning of the third millennium and the most recent “genomic revolution” have made me wait more and more of human existence have become the object of scientific and technological control. This has created great expectations regarding the diagnostic potential and therapeutics in this field; however, to the increased ability to control there is an increasing number of situations that pose serious dilemmas moral standards for researchers, doctors and patients. In the following reflections we will focus our attention on the issues bioethics related to the management of the diagnostic potential expressed by genetic tests. The first part will be dedicated to a brief overview of the state of the art genetic testing from a scientific point of view; the second part will deal with the ethical debate around their uses. The goal we set ourselves, integrating our competences, respectively biological and bioethical ones, is to allow you to acquire an overview of the main guidelines that confront each other in the current bioethical debate, in order to elaborate in our pluralistic context of an adequate ethical-regulatory framework.La “rivoluzione genetica” che ha caratterizzato l’inizio del terzo millennio e la più recente “rivoluzione genomica”1 hanno fatto sì che sempre più aspetti dell’esistenza umana siano diventati oggetto di controllo scientifico e tecnologico. Ciò ha creato grandi aspettative in merito alle potenzialità diagnostiche e terapeutiche in questo campo; tuttavia, alle aumentate capacità di controllo si accompagna un numero crescente di situazioni che pongono seri dilemmi morali per ricercatori, medici e pazienti. Nelle riflessioni che seguono concentreremo la nostra attenzione sulle questioni bioetiche legate alla gestione delle potenzialità diagnostiche espresse dai test genetici. La prima parte sarà dedicata a una breve panoramica sullo stato dell’arte dei test genetici dal punto di vista scientifico; la seconda parte si occuperà del dibattito etico intorno ai loro impieghi. L’obiettivo che ci proponiamo, integrando le nostre competenze, rispettivamente quella biologica e quella bioetica, è di permettere di acquisire una visione d’insieme sui principali orientamenti che si confrontano nell’attuale dibattito bioetico, in ordine all’elaborazione nel nostro contesto pluralistico di un adeguato quadro etico-normativo