The ménage à trois of healthcare: the actors in after-AI era under patient consent

Introduction: Artificial intelligence has become an increasingly powerful technological instrument in recent years, revolutionizing many sectors, including public health. Its use in this field will inevitably change clinical practice, the patient-caregiver relationship and the concept of the diagnosis and treatment pathway, affecting the balance between the patient’s right to self-determination and health, and thus leading to an evolution of the concept of informed consent. The aim was to characterize the guidelines for the use of artificial intelligence, its areas of application and the relevant legislation, to propose guiding principles for the design of optimal informed consent for its use. Materials and methods: A classic review by keywords on the main search engines was conducted. An analysis of the guidelines and regulations issued by scientific authorities and legal bodies on the use of artificial intelligence in public health was carried out. Results: The current areas of application of this technology were highlighted, divided into sectors, its impact on them, as well as a summary of current guidelines and legislation. Discussion: The ethical implications of artificial intelligence in the health care system were assessed, particularly regarding the therapeutic alliance between doctor and patient, and the balance between the right to self-determination and health. Finally, given the evolution of informed consent in relation to the use of this new technology, seven guiding principles were proposed to guarantee the right to the most informed consent or dissent

The Increasing Centrality of Robotic Technology in the Context of Nursing Care: Bioethical Implications Analyzed through a Scoping Review Approach

At the dawn of the fourth industrial revolution, the healthcare industry is experiencing a momentous shift in the direction of increasingly pervasive technologization of care. If, up until the 2000s, imagining healthcare provided by robots was a purely futuristic fantasy, today, such a scenario is in fact a concrete reality, especially in some countries, such as Japan, where nursing care is largely delivered by assistive and social robots in both public and private healthcare settings, as well as in home care. This revolution in the context of care, already underway in many countries and destined to take place soon on a global scale, raises obvious ethical issues, related primarily to the progressive dehumanization of healthcare, a process which, moreover, has undergone an important acceleration following the outbreak of the COVID-19 pandemic, which has made it necessary to devise new systems to deliver healthcare services while minimizing interhuman contact. According to leading industry experts, nurses will be the primary users of healthcare robots in the short term. The aim of this study is to provide a general overview, through a scoping review approach, of the most relevant ethical issues that have emerged in the nursing care field in relation to the increasingly decisive role that service robots play in the provision of care. Specifically, through the adoption of the population-concept-context framework, we formulated this broad question: what are the most relevant ethical issues directly impacting clinical practice that arise in nursing care delivered by assistive and social robots? We conducted the review according to the five-step methodology outlined by Arksey and O’Malley. The first two steps, formulating the main research question and carrying out the literature search, were performed based on the population-context-concept (PCC) framework suggested by the Joanna Briggs Institute. Starting from an initial quota of 2,328 scientific papers, we performed an initial screening through a computer system by eliminating duplicated and non-English language articles. The next step consisted of selection based on a reading of the titles and abstracts, adopting four precise exclusion criteria: articles related to a nonnursing environment, articles dealing with bioethical aspects in a marginal way, articles related to technological devices other than robots, and articles that did not treat the dynamics of human-robot relationships in depth. Of the 2,328 titles and abstracts screened, we included 14. The results of the 14 papers revealed the existence of nonnegligible difficulties in the integration of robotic systems within nursing, leading to a lively search for new theoretical ethical frameworks, in which robots can find a place; concurrent with this exploration are the frantic attempts to identify the best ethical design system applicable to robots who work alongside nurses in hospital wards. In the final part of the paper, we also proposed considerations about the Italian nursing context and the legal implications of nursing care provided by robots in light of the Italian legislative panorama. Regarding future perspectives, this paper offers insights regarding robot engagement strategies within nursing

Characterization of anti-proliferative and anti-oxidant effects of nano-sized vesicles from Brassica oleracea L. (Broccoli)

In this in vitro study, we test our hypothesis that Broccoli-derived vesicles (BDVs), combining the anti-oxidant properties of their components and the advantages of their structure, can influence the metabolic activity of different cancer cell lines. BDVs were isolated from homogenized fresh broccoli (Brassica oleracea L.) using a sucrose gradient ultracentrifugation method and were characterized in terms of physical properties, such as particle size, morphology, and surface charge by transmission electron microscopy (TEM) and laser doppler electrophoresis (LDE). Glucosinolates content was assessed by RPLC–ESI–MS analysis. Three different human cancer cell lines (colorectal adenocarcinoma Caco-2, lung adenocarcinoma NCI-H441 and neuroblastoma SHSY5Y) were evaluated for metabolic activity by the MTT assay, uptake by fluorescence and confocal microscopy, and anti-oxidant activity by a fluorimetric assay detecting intracellular reactive oxygen species (ROS). Three bands were obtained with average size measured by TEM based size distribution analysis of 52 nm (Band 1), 70 nm (Band 2), and 82 nm (Band 3). Glucobrassicin, glucoraphanin and neoglucobrassicin were found mostly concentrated in Band 1. BDVs affected the metabolic activity of different cancer cell lines in a dose dependent manner compared with untreated cells. Overall, Band 2 and 3 were more toxic than Band 1 irrespective of the cell lines. BDVs were taken up by cells in a dose- and time-dependent manner. Pre-incubation of cells with BDVs resulted in a significant decrease in ROS production in Caco-2 and NCI-H441 stimulated with hydrogen peroxide and SHSY5Y treated with 6-hydroxydopamine, with all three Bands. Our findings open to the possibility to find a novel “green” approach for cancer treatment, focused on using vesicles from broccoli, although a more in-depth characterization of bioactive molecules is warranted

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients

A new limit on the CP violating decay KS -> 3pi0 with the KLOE experiment

We have carried out a new direct search for the CP violating decay KS -> 3pi0 with 1.7 fb^-1 of e+e- collisions collected by the KLOE detector at the phi-factory DAFNE. We have searched for this decay in a sample of about 5.9 x 10^8 KS KL events tagging the KS by means of the KL interaction in the calorimeter and requiring six prompt photons. With respect to our previous search, the analysis has been improved by increasing of a factor four the tagged sample and by a more effective background rejection of fake KS tags and spurious clusters. We find no candidates in data and simulated background samples, while we expect 0.12 standard model events. Normalizing to the number of KS -> 2pi0 events in the same sample, we set the upper limit on BR(KS -> 3pi0 < 2.6 x 10^-8 at 90% C.L., five times lower than the previous limit. We also set the upper limit on the eta_000 parameter, |eta_000 | < 0.0088 at 90% C.L., improving by a factor two the latest direct measurement.Comment: Accepted for publication in Physics Letters B (15 pages, 13 figures

Search for dark Higgsstrahlung in e+ e- -> mu+ mu- and missing energy events with the KLOE experiment

We searched for evidence of a Higgsstrahlung process in a secluded sector, leading to a final state with a dark photon U and a dark Higgs boson h', with the KLOE detector at DAFNE. We investigated the case of h' lighter than U, with U decaying into a muon pair and h' producing a missing energy signature. We found no evidence of the process and set upper limits to its parameters in the range 2m_mu<m_U<1000 MeV, m_h'<m_U.Comment: 16 pages, 7 figures, submitted to Physics Letters

Limit on the production of a new vector boson in e+e−→Uγ\mathrm{e^+ e^-}\rightarrow {\rm U}\gamma, U→π+π−\rightarrow \pi^+\pi^- with the KLOE experiment

The recent interest in a light gauge boson in the framework of an extra U(1) symmetry motivates searches in the mass range below 1 GeV. We present a search for such a particle, the dark photon, in ${\rm e^+ e^-}\rightarrow {\rm U}\gamma$, U$\rightarrow \pi^+\pi^-$ based on 28 million $\mathrm{e^+ e^-} \rightarrow \pi^+ \pi^-\gamma$ events collected at DA$\Phi$NE by the KLOE experiment. The $\pi^+ \pi^-$ production by initial-state radiation compensates for a loss of sensitivity of previous KLOE ${\rm U} \rightarrow \mathrm{e^+ e^-}$, $\mu^+\mu^-$ searches due to the small branching ratios in the $\rho-\omega$ resonance region. We found no evidence for a signal and set a limit at 90\% CL on the mixing strength between the photon and the dark photon, $\varepsilon^2$, in the U mass range between $527$ and $987$~MeV. Above 700 MeV this new limit is more stringent than previous ones.Comment: 6 pages, 9 figures, 1 table, submitted to Phys. Lett.

Measurement of the ϕ→π0e+e−\phi \to \pi^0 e^+e^- transition form factor with the KLOE detector

A measurement of the vector to pseudoscalar conversion decay $\phi \to \pi^0 e^+e^-$ with the KLOE experiment is presented. A sample of $\sim 9500$ signal events was selected from a data set of 1.7 fb$^{-1}$ of $e^+e^-$ collisions at $\sqrt{s} \sim m_{\phi}$ collected at the DA$\Phi$NE $e^+e^-$ collider. These events were used to obtain the first measurement of the transition form factor $| F_{\phi \pi^0}(q^2) |$ and a new measurement of the branching ratio of the decay: $\rm{BR}\,(\phi \to \pi^0 e^+e^-) = (\,1.35 \pm 0.05^{\,\,+0.05}_{\,\,-0.10}\,) \times 10 ^{-5}$. The result improves significantly on previous measurements and is in agreement with theoretical predictions.Comment: 13 pages, 4 figures; matches published versio

Precision measurement of σ(e+e−→π+π−γ)/σ(e+e−→μ+μ−γ)\sigma(e^+e^-\rightarrow\pi^+\pi^-\gamma)/\sigma(e^+e^-\rightarrow \mu^+\mu^-\gamma) and determination of the π+π−\pi^+\pi^- contribution to the muon anomaly with the KLOE detector

We have measured the ratio $\sigma(e^+e^-\rightarrow\pi^+\pi^-\gamma)/\sigma(e^+e^-\rightarrow \mu^+\mu^-\gamma)$, with the KLOE detector at DA$\Phi$NE for a total integrated luminosity of $\sim$ 240 pb$^{-1}$. From this ratio we obtain the cross section $\sigma(e^+e^-\rightarrow\pi^+\pi^-)$. From the cross section we determine the pion form factor $|F_\pi|^2$ and the two-pion contribution to the muon anomaly $a_\mu$ for $0.592<M_{\pi\pi}<0.975$ GeV, $\Delta^{\pi\pi} a_\mu$= $({\rm 385.1\pm1.1_{stat}\pm2.7_{sys+theo}})\times10^{-10}$. This result confirms the current discrepancy between the Standard Model calculation and the experimental measurement of the muon anomaly.Comment: 18 pages, 8 figures, minor text corrections, one table added, version to appear on Physics Letters