"Brilliant AI Doctor" in Rural China: Tensions and Challenges in AI-Powered CDSS Deployment

Artificial intelligence (AI) technology has been increasingly used in the implementation of advanced Clinical Decision Support Systems (CDSS). Research demonstrated the potential usefulness of AI-powered CDSS (AI-CDSS) in clinical decision making scenarios. However, post-adoption user perception and experience remain understudied, especially in developing countries. Through observations and interviews with 22 clinicians from 6 rural clinics in China, this paper reports the various tensions between the design of an AI-CDSS system ("Brilliant Doctor") and the rural clinical context, such as the misalignment with local context and workflow, the technical limitations and usability barriers, as well as issues related to transparency and trustworthiness of AI-CDSS. Despite these tensions, all participants expressed positive attitudes toward the future of AI-CDSS, especially acting as "a doctor's AI assistant" to realize a Human-AI Collaboration future in clinical settings. Finally we draw on our findings to discuss implications for designing AI-CDSS interventions for rural clinical contexts in developing countries

Human-centered design and evaluation of AI-empowered clinical decision support systems: a systematic review

IntroductionArtificial intelligence (AI) technologies are increasingly applied to empower clinical decision support systems (CDSS), providing patient-specific recommendations to improve clinical work. Equally important to technical advancement is human, social, and contextual factors that impact the successful implementation and user adoption of AI-empowered CDSS (AI-CDSS). With the growing interest in human-centered design and evaluation of such tools, it is critical to synthesize the knowledge and experiences reported in prior work and shed light on future work.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review to gain an in-depth understanding of how AI-empowered CDSS was used, designed, and evaluated, and how clinician users perceived such systems. We performed literature search in five databases for articles published between the years 2011 and 2022. A total of 19874 articles were retrieved and screened, with 20 articles included for in-depth analysis.ResultsThe reviewed studies assessed different aspects of AI-CDSS, including effectiveness (e.g., improved patient evaluation and work efficiency), user needs (e.g., informational and technological needs), user experience (e.g., satisfaction, trust, usability, workload, and understandability), and other dimensions (e.g., the impact of AI-CDSS on workflow and patient-provider relationship). Despite the promising nature of AI-CDSS, our findings highlighted six major challenges of implementing such systems, including technical limitation, workflow misalignment, attitudinal barriers, informational barriers, usability issues, and environmental barriers. These sociotechnical challenges prevent the effective use of AI-based CDSS interventions in clinical settings.DiscussionOur study highlights the paucity of studies examining the user needs, perceptions, and experiences of AI-CDSS. Based on the findings, we discuss design implications and future research directions

The effect of overnight culture after thawing of D3 cleavage-stage embryos on clinical pregnancy outcomes: focus on embryo development to day 4

ObjectiveThis study aims to investigate the impact of day-3 (D3) cleavage-stage embryo thawing with immediate transfer versus thawing and overnight culture before transfer on clinical outcomes. It also examines the relationship between cleavage-stage embryo developmental speed after overnight culture and clinical pregnancy outcomes, as well as factors influencing clinical pregnancy in frozen embryo transfer (FET).MethodsA retrospective analysis was conducted on 1,040 patients who underwent D3 cleavage-stage frozen embryo transfer at Yulin City Maternal and Child Health Hospital between July 2022 and December 2023. Patients were divided into two groups based on embryo culture time after thawing: control (same-day transfer, 2-3 hours) and experimental (overnight culture, 18-20 hours). Clinical pregnancy rates, embryo implantation rates, early miscarriage rates, and multiple pregnancy rates were compared between groups. The experimental group was further subdivided based on the number of cleavage blastomeres increased after culture: A1 (≥4 blastomeres), A2 (1-3 blastomeres), and A3 (no increase). A binary logistic regression analysis identified independent factors affecting clinical pregnancy outcomes in FET.ResultsNo significant differences were found between the control and experimental groups in clinical pregnancy rate (37.2% vs. 40.2%), embryo implantation rate (24.9% vs. 26.4%), early miscarriage rate (13.1% vs. 18.8%), or multiple pregnancy rate (9.2% vs. 10.2%) (P > 0.05). In the experimental group, clinical pregnancy rates for A1, A2, and A3 subgroups were 44.2%, 29.8%, and 25.5%, respectively. Early miscarriage rates were 18.6%, 10.7%, and 38.5%, showing statistically significant differences (P < 0.05). Female age, endometrial thickness, embryo morphology, and the number of cleavage blastomeres were identified as independent factors influencing clinical pregnancy rate.ConclusionThis study indicates that D3 embryos with an increase in the number of blastomeres to more than four or entering the compaction stage after overnight culture have better pregnancy outcomes. Female age and endometrial thickness are important factors influencing clinical pregnancy rates. Optimizing culture conditions and ensuring optimal endometrial thickness may help improve the success rate of frozen-thawed embryo transfer

Origins of N₂ in the Dongtai Depression of the Subei Basin

Identification of N2 origins can help to reduce exploration risks and to improve the understanding of gas generation and accumulation. N2 from the mantle and organic matter in basins cannot be unraveled by using θ15 N ratios alone, due to overlapping θ15 N signatures. In this paper, we comprehensively studied N2, Ar, θ15 N, N2/3He, 3He/4He, θ13 C and their relationships of natural gases in the Dongtai Depression of the Subei Basin. Nitrogen contents of the gases in this depression range from 0.2 to 85.9%. Some samples have the air N2/Ar ratio but others are excess relative to this ratio. θ15N data of all the samples except one constitute two populations in the histogram. All these features reflect at least two origins of N2. One of these populations has θ15N values around 0‰ with N2/3He ratios of 1.0×107 to 9.5×109, whereas the other population has negative θ15N values from −7.3 to −2.2 ‰ with N2/3He of 1.1×107 to 9.4×109. It was obtained that the nitrogen of the former population is mainly atmospheric in origin. For the latter population, a considerable amount of nitrogen from organic matter in sedimentary rocks was identified, which coexist with the nitrogen from the air and mantle. In the Dongtai Depression of the Subei Basin, therefore, atmospheric, organic and mantle origins provided remarkable contributions to the natural gases. </jats:p