Transcatheter aortic valve implantation in patients with pre-existing chronic kidney disease

AbstractBackgroundWe investigated the effect of chronic kidney disease (CKD) on morbidity and mortality following transcatheter aortic valve implantation (TAVI) including patients on haemodialysis, often excluded from randomised trials.Methods and resultsWe performed a retrospective post hoc analysis of all patients undergoing TAVI at our centre between 2008 and 2012. 118 consecutive patients underwent TAVI; 63 were considered as having (CKD) and 55 not having (No-CKD) significant pre-existing CKD, (defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2). Chronic haemodialysis patients (n=4) were excluded from acute kidney injury (AKI) analysis. Following TAVI, in CKD and No-CKD patients respectively, AKI occurred in 23.7% and 14.5% (p=0.455) and renal replacement therapy (RRT) was necessary in 8.5% and 3.6% (relative risk (RR) [95% CI]=2.33 [0.47–11.5], p=0.440); 30-day mortality rates were 6.3% and 1.8% (p=0.370); and 1-year mortality rates were 17.5% and 18.2% (p=0.919). Patients who developed AKI had a significantly increased risk of 30-day (12.5% vs. 1.1%, p=0.029) mortality. We found the presence of diabetes (odds ratio (OR) [95% CI]=4.58 [1.58–13.3], p=0.005) and elevated baseline serum creatinine (OR [95% CI]=1.02 [1.00–1.03], p=0.026) to independently predict AKI to statistical significance by multivariate analysis.ConclusionTAVI is a safe, acceptable treatment for patients with pre-existing CKD, however caution must be exercised, particularly in patients with pre-existing diabetes mellitus and elevated pre-operative serum creatinine levels as this confers a greater risk of AKI development, which is associated with increased short-term post-operative mortality

PicanoE.Stress Echocardiography1997Springer

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Why it Remains Challenging to Assess Artificial Intelligence

Artificial Intelligence (AI) assessment to mitigate risks arising from biased, unreliable, or regulatory non-compliant systems remains an open challenge for researchers, policymakers, and organizations across industries. Due to the scattered nature of research on AI across disciplines, there is a lack of overview on the challenges that need to be overcome to move AI assessment forward. In this study, we synthesize existing research on AI assessment applying a descriptive literature review. Our study reveals seven challenges along three main categories: ethical implications, regulatory gaps, and technical limitations. This study contributes to a better understanding of the challenges in AI assessment so that AI researchers and practitioners can resolve these challenges to move AI assessment forward

Why it Remains Challenging to Assess Artificial Intelligence

Artificial Intelligence (AI) assessment to mitigate risks arising from biased, unreliable, or regulatory non-compliant systems remains an open challenge for researchers, policymakers, and organizations across industries. Due to the scattered nature of research on AI across disciplines, there is a lack of overview on the challenges that need to be overcome to move AI assessment forward. In this study, we synthesize existing research on AI assessment applying a descriptive literature review. Our study reveals seven challenges along three main categories: ethical implications, regulatory gaps, and technical limitations. This study contributes to a better understanding of the challenges in AI assessment so that AI researchers and practitioners can resolve these challenges to move AI assessment forward

Program development of human papillomavirus education program for health officials in the Achham district of Nepal

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections in the world. Cervical cancer, caused almost exclusively by HPV infection, is the most common cancer among women in Nepal, despite being only the fourth most common female cancer globally and the tenth most common female cancer in more developed regions. Nepal intends to address this by initiating a national HPV vaccination program. However, there are low levels of awareness and understanding of HPV, its vaccine, and cervical cancer are present among the general population, medical and nursing students, and likely among local government healthcare officials. Medical professionals are among the most trusted sources for parents when deciding upon vaccination, so capacity building for HPV in the healthcare system is a matter of public health importance. The education program proposed in this paper, to be managed by the Nepal Fertility Care Center, will provide of cervical cancer and HPV training to the healthcare staff in the district of Achham. Through this program, the district healthcare system will be prepared for the increased screenings, vaccinations, and community engagement that will be required for the HPV vaccination campaign. This would facilitate a reduction of rates of HPV and ultimately cervical cancer in the district

Artificial Intelligence as a Service: Trade-Offs Impacting Service Design and Selection

AI as a Service (AIaaS) is a promising path to leverage AI capabilities from the cloud. However, there is no one-size-fits-all service, but heterogenous service options since interdependent AIaaS characteristics require trade-offs. We lack knowledge on these trade-offs and how they result from conflicting characteristics. Therefore, we interviewed 39 AIaaS providers, customers, and consultants to provide rich descriptions of interdependent characteristics and uncover resulting trade-offs and their consequences. This study contributes to a better understanding of the inner functioning and interplay of AIaaS characteristics and discusses how this complex nature of service offerings impacts providers’ design and customers’ selection decisions

Certifications to Safeguard Data Protection Standards? How Superficial Internalization Thwarts the Plan

Motivation The EU General Data Protection Regulation (GDPR) proposes certifications issued by independent and accredited certification bodies to demonstrate compliance with data protection standards in Articles 42 and 43. Beyond demonstrating regulatory compliance, certifications are a valuable means to tackle current challenges in data governance. First, certifications can serve as a global mechanism for decentralized self-regulation [1]. Competitive pressure may motivate companies to adopt data governance and protection standards and undergo corresponding certifications, even if they are not explicitly mandated by governmental regulations [2–4]. Second, certifications can help reduce the asymmetric power distribution between individuals and companies by creating transparency about data processing practices and enabling individuals to make better-informed decisions [5]. Finally, certifications provide organizations with guidance on how to fulfill the requirements imposed by the GDPR and achieve efficient data governance by clarifying the specific requirements an organization needs to fulfill and recommending best practices on how to implement the requirements into the organization’s processes [5]. However, related literature on certifications indicates a severe issue that threatens the effectiveness of certifications as an enforcement mechanism for data governance. Some organizations tend to follow a minimalist approach in implementing the certification. They only meet the minimum requirements and take a short-cut approach to attain the certification [6, 7], which is referred to as superficial internalization. Internalization is defined as the process through which organizations incorporate certification information into their procedures and daily practices [8]. This includes not only the explicit certification information (e.g., proposed data governance best practices) but also tacit information (e.g., attestation results and feedback of the certification body). Despite policymakers demanding rigorous internalization of the certification requirements [9, 10], extant research found that organizations frequently internalize certifications only at a superficial level, undermining their intended effects [6, 11]. As a result, compliance is pretended but not achieved [12]. Such malicious use of the certification mechanism can have detrimental consequences for the societal view on certifications as it downgrades them to a "greenwashing" mechanism used by dubious organizations [12] and is thus particularly concerning for societal relevant areas such as data protection and privacy. Research Objective We strive to examine certifications\u27 potential to contribute to data governance and the safeguarding of data protection standards, as recommended by the EU GDPR. For this purpose, we study potential pitfalls for organizations adopting certifications, illustrate the risks associated with superficial internalization, and provide suggestions for mitigation. Hence, we are seeking to answer the following research question: What are potential pitfalls and which measures for mitigation can be taken in order to leverage data protection certifications to safeguard the requirements of the GDPR? Methods To answer the research question, we conducted a descriptive literature review [13] to synthesize the current state of research on the pitfalls related to superficial internalization. Our database search revealed  800 articles, of which we examined 60 relevant articles to reveal pitfalls hampering organizations\u27 effectiveness in internalizing certifications by using thematic analysis [14]. Results We identified three key pitfalls that pose critical risks for organizations\u27 success in internalizing certifications. First, organizations differ in their motivations to seek certification [15], which impacts their depth of internalization. Research has shown that external pressure exerted by customers or regulators is either not or negatively impacting internalization (e.g., [7, 16]). Hence, relying on external motivation as the sole motive for certification acquisition should be avoided. Instead, this pitfall can be mitigated by empathizing that acquiring a certification should be driven by internal aspirations: approaching the certification as a chance to improve organizational data governance practices is positively impacting internalization (e.g., [17, 18]). Policymakers and developers of certifications should include implementational guidance for organizations to fulfill the certification requirements, and internalizing organizations should perform specific activities to harness internal benefits besides conforming to external pressures. The second pitfall that organizations should avoid is a lack of stakeholder engagement, such as limited executive buy-in and employee involvement [19–22]. Different stakeholder groups inside the organization may have opposing views of the certification, thus hampering internalization [23]. As a mitigation strategy, we argue that organizations need to perform additional internalization activities, such as adequate internal communication, executive sponsorship, and employee participation to avoid this pitfall [22, 24, 25]. The way internalization activities are conveyed across the organizational structure was identified as the third pitfall. Adopting the certification in a purely top-down manner (i.e., using the certification as a blueprint to derive organizational practices and work instructions) neglects the organization\u27s as-is situation and may lead to superficial internalization or even open resistance [6, 21, 22]. At the same time, a bottom-up approach (i.e., drawing mainly from the organization\u27s as-is state and comparing the existing practices to the certification requirements) can lead to a sole mapping of the certification requirements to the as-is situation without achieving organizational change [19, 26]. As mitigation, a mixed (called "discursive") approach should be chosen so that the as-is state is considered and suggestions for improvement based on the certification can be incorporated [19–22]. Conclusion Certifications can only contribute to the safeguarding of data protection standards when risks of superficial internalization are mitigated and pitfalls avoided. 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Interplay of catalytic subsite residues in the positioning of α-d-glucose 1-phosphate in sucrose phosphorylase

AbstractKinetic and molecular docking studies were performed to characterize the binding of α-d-glucose 1-phosphate (αGlc 1-P) at the catalytic subsite of a family GH-13 sucrose phosphorylase (from L. mesenteroides) in wild-type and mutated form. The best-fit binding mode of αGlc 1-P dianion had the phosphate group placed anti relative to the glucosyl moiety (adopting a relaxed 4C1 chair conformation) and was stabilized mainly by hydrogen bonds from residues of the enzyme׳s catalytic triad (Asp196, Glu237 and Asp295) and from Arg137. Additional feature of the αGlc 1-P docking pose was an intramolecular hydrogen bond (2.7Å) between the glucosyl C2-hydroxyl and the phosphate oxygen. An inactive phosphonate analog of αGlc 1-P did not show binding to sucrose phosphorylase in different experimental assays (saturation transfer difference NMR, steady-state reversible inhibition), consistent with evidence from molecular docking study that also suggested a completely different and strongly disfavored binding mode of the analog as compared to αGlc 1-P. Molecular docking results also support kinetic data in showing that mutation of Phe52, a key residue at the catalytic subsite involved in transition state stabilization, had little effect on the ground-state binding of αGlc 1-P by the phosphorylase. However, when combined with a second mutation involving one of the catalytic triad residues, the mutation of Phe52 by Ala caused complete (F52A_D196A; F52A_E237A) or very large (F52A_D295A) disruption of the proposed productive binding mode of αGlc 1-P with consequent effects on the enzyme activity. Effects of positioning of αGlc 1-P for efficient glucosyl transfer from phosphate to the catalytic nucleophile of the enzyme (Asp196) are suggested. High similarity between the αGlc 1-P conformers bound to sucrose phosphorylase (modeled) and the structurally and mechanistically unrelated maltodextrin phosphorylase (experimental) is revealed