Pathways to democratized healthcare: Envisioning human-centered AI-as-a-service for customized diagnosis and rehabilitation

The ongoing digital revolution in the healthcare sector, emphasized by bodies like the US Food and Drug Administration (FDA), is paving the way for a shift towards person-centric healthcare models. These models consider individual needs, turning patients from passive recipients to active participants. A key factor in this shift is Artificial Intelligence (AI), which has the capacity to revolutionize healthcare delivery due to its ability to personalize it. With the rise of software in healthcare and the proliferation of the Internet of Things (IoT), a surge of digital data is being produced. This data, alongside improvements in AI’s explainability, is facilitating the spread of person-centric healthcare models, aiming at improving health management and patient experience. This paper outlines a human-centered methodology for the development of an AI-as-a-service platform with the goal of broadening access to personalized healthcare. This approach places humans at its core, aiming to augment, not replace, human capabilities and integrate in current processes. The primary research question guiding this study is: “How can Human-Centered AI principles be considered when designing an AI-as-a-service platform that democratizes access to personalized healthcare?” This informed both our research direction and investigation. Our approach involves a design fiction methodology, engaging clinicians from different domains to gather their perspectives on how AI can meet their needs by envisioning potential future scenarios and addressing possible ethical and social challenges. Additionally, we incorporate Meta-Design principles, investigating opportunities for users to modify the AI system based on their experiences. This promotes a platform that evolves with the user and considers many different perspectives

High-Energy Spectra of Active Galactic Nuclei. II. Absorption in Seyfert Galaxies

Absorption by cold material in a large sample of active galaxies has been analyzed in order to study statistically the behavior of absorbed sources. The analysis indicates that on the basis of the column density alone, sources can be divided into low-absorption ([NH/NHGal] ? 50) and high-absorption ([NH/NHGal] ? 50) objects. While the second group consists mostly of narrow emission line galaxies (Seyfert galaxies of type 1.9-2), the first group is less homogenous, being formed by a mixture of broad and narrow emission line objects (Seyfert 1-2 galaxies). A study of the distribution of the column density values by means of bootstrap analysis confirms the reality of this effect. One group consisting of optically selected objects is well explained within the unified theory as nuclei obscured by a molecular torus. The second group made up of X-ray- and IRAS-selected objects is more difficult to define: in these sources the absorption is underestimated owing to difficulties (1) in fitting complex absorption spectra or (2) in measuring NH values in Compton-thick sources or the absorption has a different origin than in the torus. Possible correlations of absorption with X-ray luminosity, axial ratio, and Balmer decrement have also been investigated. Previous suggestions that lower luminosity AGNs tend to be more highly absorbed than those with higher luminosity are not confirmed by the present data; neither is any evidence for a correlation of NH with axial ratio (b/a) found except for a preference of Seyfert 1-1.5 galaxies to be in face-on galaxies. While some sources (Seyfert 1-1.5 galaxies and low-absorption objects) have X-ray absorption compatible with Balmer decrement, high-absorption objects have column densities much higher than predicted from optical observations. These results are in agreement with the unified theory since the torus parameters are expected to be independent of luminosity, its orientation should be random with respect to the host galaxy, and its location should be in between the broad- and narrow-line regions. A study of the NH variability indicates that in a large fraction (70%) of the sources for which the analysis could be done, NH varies on timescales from months to years. In Seyfert 1-1.5 galaxies, the variability is associated with a region in or near the broad-line region and is explained in terms of partial covering and/or warm absorption models. In Seyfert 2 galaxies, the only variability observed is that associated with narrow emission line galaxies. The study of the column density distributions indicates that Seyfert 1-1.5 galaxies are characterized by NH = 18+9?7 ? 1021 atoms cm-2. Seyfert 1.9-2 galaxies have instead NH = 96+54?35 ? 1021 atoms cm-2 and a larger dispersion; if this group is divided into low- and high-absorption objects, NH = 14.5+7.2?5.3 ? 1021 atoms cm-2 and NH = 132.8+80.1?52.6 ? 1021 atoms cm-2, respectively, are obtained. The observed dispersion in each group is consistent with being entirely due to column density variability

User-defined semantics for the design of IoT systems enabling smart interactive experiences

© The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Automation in computing systems has always been considered a valuable solution to unburden the user. Internet of Things (IoT) technology best suits automation in different domains, such as home automation, retail, industry, and transportation, to name but a few. While these domains are strongly characterized by implicit user interaction, more recently, automation has been adopted also for the provision of interactive and immersive experiences that actively involve the users. IoT technology thus becomes the key for Smart Interactive Experiences (SIEs), i.e., immersive automated experiences created by orchestrating different devices to enable smart environments to fluidly react to the final users’ behavior. There are domains, e.g., cultural heritage, where these systems and the SIEs can support and provide several benefits. However, experts of such domains, while intrigued by the opportunity to induce SIEs, are facing tough challenges in their everyday work activities when they are required to automate and orchestrate IoT devices without the necessary coding skills. This paper presents a design approach that tries to overcome these difficulties thanks to the adoption of ontologies for defining Event-Condition-Action rules. More specifically, the approach enables domain experts to identify and specify properties of IoT devices through a user-defined semantics that, being closer to the domain experts’ background, facilitates them in automating the IoT devices behavior. We also present a study comparing three different interaction paradigms conceived to support the specification of user-defined semantics through a “transparent” use of ontologies. Based on the results of this study, we work out some lessons learned on how the proposed paradigms help domain experts express their semantics, which in turn facilitates the creation of interactive applications enabling SIEs.Peer reviewedFinal Published versio

Photorealistic True-Dimensional Visualization of Remote Panoramic Views for VR Headsets

© 2023 IEEE. This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/Virtual Reality headsets have evolved to include unprecedented display quality. Meantime, they have become light-weight, wireless and low-cost, which has opened to new applications and a much wider audience. Photo-based omnidirectional imaging has also developed, becoming directly exploitable for VR, with their combination proven suitable for: remote visits and realistic scene reconstruction, operator’s training and control panels, surveillance and e-tourism. There is however a limited amount of scientific work assessing VR experience and user’s performance in photo-based environment representations. This paper focuses on assessing the effect of photographic realism in VR when observing real places through a VR headset, for two different pixel-densities of the display, environment types and familiarity levels. Our comparison relies on the observation of static three-dimensional and omnidirectional photorealistic views of environments. The aim is to gain an insight about how photographic texture can affect perceived realness, sense of presence and provoked emotions, as well as perception of image-lighting and actual space dimension (true-dimension). Two user studies are conducted based on subjective rating and measurements given by users to a number of display and human factors. The display pixel-density affected the perceived image-lighting and prevailed over better lighting specs. The environment illumination and distance to objects generally played a stronger role than display. The environment affected the perceived image-lighting, spatial presence, depth impression and specific emotions. Distances to a set of objects were generally accurately estimated. Place familiarity enhanced perceived realism and presence. They confirmed some previous studies, but also introduced new elements.Peer reviewe

Decoding the Complexity of Systemic Inflammation Predictors in Locally Advanced Cervical Cancer, with Hemoglobin as the Hidden Key (the ESTHER Study)

Simple Summary We explored whether specific factors, like inflammation indicators in the blood, could help predict treatment outcomes for locally advanced cervical cancer (LACC). LACC is generally treated with a combination of chemotherapy and radiation. We wanted to see if these factors could help physicians personalize treatments for better results. Our study involved looking at various aspects, including inflammation indices in the blood and various clinical treatment details, in LACC patients. While some factors, such as age and hemoglobin levels, seemed to predict outcomes, there was no clear connection between inflammation indicators in the blood and results. These findings challenge previous ideas and highlight the importance of considering multiple factors to predict the prognoses of LACC patients.Abstract Locally advanced cervical cancer (LACC) is treated with concurrent chemoradiation (CRT). Predictive models could improve the outcome through treatment personalization. Several factors influence prognosis in LACC, but the role of systemic inflammation indices (IIs) is unclear. This study aims to assess the correlation between IIs and prognosis in a large patient cohort considering several clinical data. We retrospectively analyzed pretreatment IIs (NLR, PLR, MLR, SII, LLR, COP-NLR, APRI, ALRI, SIRI, and ANRI) in 173 LACC patients. Patient, tumor, and treatment characteristics were also considered. Univariate and multivariate Cox's regressions were conducted to assess associations between IIs and clinical factors with local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Univariate analysis showed significant correlations between age, HB levels, tumor stage, FIGO stage, and CRT dose with survival outcomes. Specific pretreatment IIs (NLR, PLR, APRI, ANRI, and COP-NLR) demonstrated associations only with LC. The multivariate analysis confirmed Hb levels, CRT dose, and age as significant predictors of OS, while no II was correlated with any clinical outcome. The study findings contradict some prior research on IIs in LACC, emphasizing the need for comprehensive assessments of potential confounding variables

The T.O.S.CA. Project: Research, Education and Care

Despite recent and exponential improvements in diagnostic- therapeutic pathways, an existing “GAP” has been revealed between the “real world care” and the “optimal care” of patients with chronic heart failure (CHF). We present the T.O.S.CA. Project (Trattamento Ormonale dello Scompenso CArdiaco), an Italian multicenter initiative involving different health care professionals and services aiming to explore the CHF “metabolic pathophysiological model” and to improve the quality of care of HF patients through research and continuing medical education

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis

BackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson’s comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.ResultsA total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox’s regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).ConclusionsThe unexpected results of this analysis could be explained by a “response shift bias” concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens

Risk for cancer development in familial Mediterranean fever and associated predisposing factors: an ambidirectional cohort study from the international AIDA Network registries

Objective: Inflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF. Methods: The risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still's disease patients and Behçet's disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression. Results: 580 FMF patients and 102 fibromyalgia subjects, 1012 Behçet's disease patients and 497 Still's disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, p=0.10) in FMF compared to Still's disease and 0.60 (95% CI. 0.29-1.28, p=0.18) in FMF compared to Behçet's disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (β1 = 0.039, 95% CI. 0.001-0.071, p=0.02), the age at the diagnosis (β1 = 0.048, 95% CI. 0.039-0.085, p=0.006), the age at the enrolment (β1 = 0.05, 95% CI. 0.007-0.068, p=0.01), the number of attacks per year (β1 = 0.011, 95% CI. 0.001- 0.019, p=0.008), the use of biotechnological agents (β1 = 1.77, 95% CI. 0.43-3.19, p=0.009), the use of anti-IL-1 agents (β1 = 2.089, 95% CI. 0.7-3.5, p=0.002). Conclusions: The risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease

Risk for cancer development in familial Mediterranean fever and associated predisposing factors: an ambidirectional cohort study from the international AIDA Network registries

Objective: Inflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF. Methods: The risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still's disease patients and Beh & ccedil;et's disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression. Results: 580 FMF patients and 102 fibromyalgia subjects, 1012 Beh & ccedil;et's disease patients and 497 Still's disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, p=0.10) in FMF compared to Still's disease and 0.60 (95% CI. 0.29-1.28, p=0.18) in FMF compared to Beh & ccedil;et's disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (beta 1 = 0.039, 95% CI. 0.001-0.071, p=0.02), the age at the diagnosis (beta 1 = 0.048, 95% CI. 0.039-0.085, p=0.006), the age at the enrolment (beta 1 = 0.05, 95% CI. 0.007-0.068, p=0.01), the number of attacks per year (beta 1 = 0.011, 95% CI. 0.001- 0.019, p=0.008), the use of biotechnological agents (beta 1 = 1.77, 95% CI. 0.43-3.19, p=0.009), the use of anti-IL-1 agents (beta 1 = 2.089, 95% CI. 0.7-3.5, p=0.002).Conclusions: The risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease