Technology in Healthcare: How Artificial Intelligence Will Revolutionize the Profession

The topic of artificial intelligence is a hot topic in the U.S. healthcare system and despite some uncertainties, continues to be increasingly integrated into healthcare delivery. Artificial intelligence can be used for different purposes including but not limited to data storage, decision making and image analysis. Critics of artificial intelligence in healthcare are skeptical of its ability to provide security of medical information and afraid that it will eventually replace the need for human healthcare workers. Although the critics skepticisms seem rational, further research of artificial intelligence in healthcare shows that those fears are not based on fact. Artificial intelligence in healthcare has been proven to reduce healthcare expenditures, increase access and improve quality of care and overall health outcomes. It is important for future healthcare providers to increase familiarity with artificial intelligence in order to effectively integrate it into practice to improve the health and well-being of future clients

ePortfolios: Mediating the minefield of inherent risks and tensions

The ePortfolio Project at the Queensland University of Technology (QUT) exemplifies an innovative and flexible harnessing of current portfolio thinking and design that has achieved substantial buy-in across the institution with over 23000 active portfolios. Robust infrastructure support, curriculum integration and training have facilitated widespread take-up, while QUT’s early adoption of ePortfolio technology has enabled the concomitant development of a strong policy and systems approach to deal explicitly with legal and design responsibilities. In the light of that experience, this paper will highlight the risks and tensions inherent in ePortfolio policy, design and implementation. In many ways, both the strengths and weaknesses of ePortfolios lie in their ability to be accessed by a wider, less secure audience – either internally (e.g. other students and staff) or externally (e.g. potential employees and referees). How do we balance the obvious requirement to safeguard students from the potential for institutionally-facilitated cyber-harm and privacy breaches, with this generation’s instinctive personal and professional desires for reflections, private details, information and intellectual property to be available freely and with minimal restriction? How can we promote collaboration and freeform expression in the blog and wiki world but also manage the institutional risk that unauthorised use of student information and work so palpably carries with it? For ePortfolios to flourish and to develop and for students to remain engaged in current reflective processes, holistic guidelines and sensible boundaries are required to help safeguard personal details and journaling without overly restricting students’ emotional, collaborative and creative engagement with the ePortfolio experience. This paper will discuss such issues and suggest possible ways forward

Decoupling social status and status certainty effects on health in macaques: a network approach.

BackgroundAlthough a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual's status), allowing for a more complex examination of how social status impacts health.MethodsBehavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects' general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).ResultsDominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.DiscussionSocial status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one's social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed

Individual acoustic variation in Belding’s ground squirrel alarm chirps

The acoustic structure of calls within call types can vary as function of individual identity, sex, and social group membership and is important in kin and social group recognition. Belding's ground squirrels ͑Spermophilus beldingi͒ produce alarm chirps that function in predator avoidance but little is known about the acoustic variability of these alarm chirps. The purpose of this preliminary study was to analyze the acoustic structure of alarm chirps with respect to individual differences ͑e.g., signature information͒ from eight Belding's ground squirrels from four different lakes in the High Sierra Nevada. Results demonstrate that alarm chirps are individually distinctive, and that acoustic similarity among individuals may correspond to genetic similarity and thus dispersal patterns in this species. These data suggest, on a preliminary basis, that the acoustic structure of calls might be used as a bioacoustic tool for tracking individuals, dispersal, and other population dynamics in Belding's ground squirrels, and perhaps other vocal species

Exploration and confirmation of factors associated with uncomplicated pregnancy in nulliparous women: prospective cohort study

Objective: To identify factors at 15 and 20 weeks’ gestation associated with a subsequent uncomplicated pregnancy. Design: Prospective international multicentre observational cohort study. Setting: Auckland, New Zealand and Adelaide, Australia (exploration and local replication dataset) and Manchester, Leeds, and London, United Kingdom, and Cork, Republic of Ireland (external confirmation dataset). Participants: 5628 healthy nulliparous women with a singleton pregnancy. Main outcome measure: Uncomplicated pregnancy, defined as a normotensive pregnancy delivered at >37 weeks’ gestation, resulting in a liveborn baby not small for gestational age, and the absence of any other significant pregnancy complications. In a stepwise logistic regression the comparison group was women with a complicated pregnancy. Results: Of the 5628 women, 3452 (61.3%) had an uncomplicated pregnancy. Factors that reduced the likelihood of an uncomplicated pregnancy included increased body mass index (relative risk 0.74, 95% confidence intervals 0.65 to 0.84), misuse of drugs in the first trimester (0.90, 0.84 to 0.97), mean diastolic blood pressure (for each 5 mm Hg increase 0.92, 0.91 to 0.94), and mean systolic blood pressure (for each 5 mm Hg increase 0.95, 0.94 to 0.96). Beneficial factors were prepregnancy fruit intake at least three times daily (1.09, 1.01 to 1.18) and being in paid employment (per eight hours’ increase 1.02, 1.01 to 1.04). Detrimental factors not amenable to alteration were a history of hypertension while using oral contraception, socioeconomic index, family history of any hypertensive complications in pregnancy, vaginal bleeding during pregnancy, and increasing uterine artery resistance index. Smoking in pregnancy was noted to be a detrimental factor in the initial two datasets but did not remain in the final model. Conclusions: This study identified factors associated with normal pregnancy through adoption of a novel hypothesis generating approach, which has shifted the emphasis away from adverse outcomes towards uncomplicated pregnancies. Although confirmation in other cohorts is necessary, this study implies that individually targeted lifestyle interventions (normalising maternal weight, increasing prepregnancy fruit intake, reducing blood pressure, stopping misuse of drugs) may increase the likelihood of normal pregnancy outcomes.Lucy C Chappell, Paul T Seed, Jenny Myers, Rennae S Taylor, Louise C Kenny, Gustaaf A Dekker, James J Walker, Lesley M E McCowan, Robyn A North, Lucilla Posto

Tetra­kis(N,N-diethyl­carbamato)titanium(IV)

The mononuclear title compound, [Ti(C5H10NO2)4], is a rare example of an eight-coordinate TiIV compound in which all donor atoms are O atoms. The coordination geometry around TiIV is pseudo-dodeca­hedral and the O—C—O angles of the carbamate ligands are slightly compressed [range 115.3 (2)–116.7 (2)°], apparently on account of the high coordination number. One ethyl group is disordered over two positions; the site occupancy factors are 0.64 and 0.36

Conceptualising Higher Education and the Public Good in Ghana, Kenya, Nigeria, and South Africa

Higher education has been the object of policy attention in sub-Saharan Africa in recent years. It has been seen as key to unlocking the potential of the youth bulge, responding to the demands of a growing middle class and to transforming commodities-based economies into knowledge societies (World Bank 2009; Cloete, Maassen & Bailey 2015; Chuks, 2017). Yet despite significant expansions of enrolment – including widening participation by women, major barriers to access exist, reflecting inequalities based on class, gender, geographical location, ethnicity, religion, language and disability (AAI 2015; Morley & Lugg 2009; Morley & Croft, 2011). There are quality challenges in relation to teaching and learning, research, and governance. While some comment on a ’renaissance in African higher education’ (Higgs, 2016), and others on the effects and framings of colonial epistemicides (Nyamnjoh, 2012) key questions abound about relevance and power relations highlighting the need to decolonise the curriculum, structure, organisation and cultures of universities. The student protests in South Africa from 2015 highlighted problems of access and funding, but these are not isolated events. They expose an unresolved colonial legacy in these higher education systems. These processes raise questions not only of the public good relevance of higher education - beyond the obvious advantages conferred on those who manage to go to these institutions – but also of how higher education and its relationship with society may be conceptualised given these contexts (Lebeau and Milla, 2008; Mamdani, 2017). An overarching question is who is defining the public good and how? While many of the above issues are global e.g. universities throughout Latin America, Australasia, Asia and Europe are involved in similar debates and protests, this paper explores the relationship between higher education and the public good in the sub- Saharan African context through a consideration of some connections and disconnections. There appear to be two distinct ways in which higher education and the public good have been conceptualised are discussed. Firstly, higher education can be portrayed as instrumental in shaping a version of the public good where its qualifications, knowledge production, innovation, development of the professional classes, and expertise are perceived to lead to particular manifestations of public good, delineated as economic, social, political or cultural (McMahon 2009; Stiglitz 1999). The key arguments that underpin this conceptual framing speak to different levels of the public good, whether individual and community levels or the provision of ‘global public goods’ (Marginson 2007; 2013; Menashy 2009). However, a contrasting set of arguments portray the relationship between higher education and the public good as an intrinsic one, where the intellectual, physical and cultural experiences enabled through higher education express and enact the public good e.g. prejudice reduction, democratisation, critical thinking, active citizenship (Singh 2001; Calhoun 2006; Leibowitz, 2013; Marginson, 2011; Locatelli, 2017). Important here are considerations of the historical conjuncture that shapes experiences of higher education at a particular time and what these may mean. In considering the connections and disjunctures between these two formulations and the way writings on higher education in contemporary Africa have engaged with this debate, the paper makes an argument for discussing the importance of processes that link instrumental and intrinsic visions of higher education and the public good. The analysis of these from a rigorous review of literature leads to a delineation of some different views of time, space and evaluation. The paper argues that these contestations need to be read contextually. Higher education in sub-Saharan Africa has moved through phases, from the establishment of flagship national universities in the post-independence period for state bureaucracy formation (Teferra, 2017), to the emergence of developmental universities with a commitment to indigenising knowledge and benefiting marginalised populations, through more recent tendencies towards the marketisation of public institutions and the significant growth of the private sector (Assié-Lumumba & CODESRIA 2006; ADEA & AAU 2004; Coleman 1986; Mamdani, 2007; McCowan 2016). Appreciating these contextual factors in shaping the role and functioning of higher education and thus its relationship to the public good is a central theme in our analysis. We suggest that mainstream conceptualisations of higher education and the public good are underpinned by particular understandings of the nature and form of higher education and how knowledge is acquired, developed and disseminated – orientations that may be very far from the reality of highly unequal, socially stratified, and politically complex societies within which higher education is deeply embedded. Thus a reconceptualisation of the public is required by these contexts and some challenge to conceptualisations of the private, given the strong obligations of individuals to extended families, and the sharing of the benefits of higher education amongst their communities of origin. The paper concludes with a consideration of what may be important in conceptualising higher education and the public good in the African context and the value of such thinking for broader debates on the role of higher education

Safer Prescribing:A Trial of Education, Informatics, and Financial Incentives

BACKGROUND High-risk prescribing and preventable drug-related complications are common in primary care. We evaluated whether the rates of high-risk prescribing by primary care clinicians and the related clinical outcomes would be reduced by a complex intervention. METHODS In this cluster-randomized, stepped-wedge trial conducted in Tayside, Scotland, we randomly assigned participating primary care practices to various start dates for a 48-week intervention comprising professional education, informatics to facilitate review, and financial incentives for practices to review patients’ charts to assess appropriateness. The primary outcome was patient-level exposure to any of nine measures of high-risk prescribing of nonsteroidal antiinflammatory drugs (NSAIDs) or selected antiplatelet agents (e.g., NSAID prescription in a patient with chronic kidney disease or coprescription of an NSAID and an oral anticoagulant without gastroprotection). Prespecified secondary outcomes included the incidence of related hospital admissions. Analyses were performed according to the intention-to-treat principle, with the use of mixed-effect models to account for clustering in the data. RESULTS A total of 34 practices underwent randomization, 33 of which completed the study. Data were analyzed for 33,334 patients at risk at one or more points in the preintervention period and for 33,060 at risk at one or more points in the intervention period. Targeted high-risk prescribing was significantly reduced, from a rate of 3.7% (1102 of 29,537 patients at risk) immediately before the intervention to 2.2% (674 of 30,187) at the end of the intervention (adjusted odds ratio, 0.63; 95% confidence interval [CI], 0.57 to 0.68; P<0.001). The rate of hospital admissions for gastrointestinal ulcer or bleeding was significantly reduced from the preintervention period to the intervention period (from 55.7 to 37.0 admissions per 10,000 person-years; rate ratio, 0.66; 95% CI, 0.51 to 0.86; P = 0.002), as was the rate of admissions for heart failure (from 707.7 to 513.5 admissions per 10,000 person-years; rate ratio, 0.73; 95% CI, 0.56 to 0.95; P = 0.02), but admissions for acute kidney injury were not (101.9 and 86.0 admissions per 10,000 person-years, respectively; rate ratio, 0.84; 95% CI, 0.68 to 1.09; P = 0.19). CONCLUSIONS A complex intervention combining professional education, informatics, and financial incentives reduced the rate of high-risk prescribing of antiplatelet medications and NSAIDs and may have improved clinical outcomes