Artificial Intelligence and Patient-Centered Decision-Making

Advanced AI systems are rapidly making their way into medical research and practice, and, arguably, it is only a matter of time before they will surpass human practitioners in terms of accuracy, reliability, and knowledge. If this is true, practitioners will have a prima facie epistemic and professional obligation to align their medical verdicts with those of advanced AI systems. However, in light of their complexity, these AI systems will often function as black boxes: the details of their contents, calculations, and procedures cannot be meaningfully understood by human practitioners. When AI systems reach this level of complexity, we can also speak of black-box medicine. In this paper, we want to argue that black-box medicine conflicts with core ideals of patient-centered medicine. In particular, we claim, black-box medicine is not conducive for supporting informed decision-making based on shared information, shared deliberation, and shared mind between practitioner and patient

Modeling Gully Erosion Susceptibility to Evaluate Human Impact on a Local Landscape System in Tigray, Ethiopia

In recent years, modeling gully erosion susceptibility has become an increasingly popular approach for assessing the impact of different land degradation factors. However, different forms of human influence have so far not been identified in order to form an independent model. We investigate the spatial relation between gully erosion and distance to settlements and footpaths, as typical areas of human interaction, with the natural environment in rural African areas. Gullies are common features in the Ethiopian Highlands, where they often hinder agricultural productivity. Within a catchment in the north Ethiopian Highlands, 16 environmental and human-related variables are mapped and categorized. The resulting susceptibility to gully erosion is predicted by applying the Random Forest (RF) machine learning algorithm. Human-related and environmental factors are used to generate independent susceptibility models and form an additional inclusive model. The resulting models are compared and evaluated by applying a change detection technique. All models predict the locations of most gullies, while 28% of gully locations are exclusively predicted using human-related factors

Mange bekker små gjør et stort åhh..: hvilke sammenhenger er det mellom arbeidsmiljø og muskel- og skjelettlidelser i sykehjem?

Gjennom tall vi har fått fra NAV Arbeidslivssenter i Sør Trøndelag, har vi fått konstatert at det er relativt høyt sykefravær ved sykehjemmene i Trondheim kommune. Vi vet også at dette sykefraværet har vært gjennomsnittlig relativt høyt de siste fem årene og vi vet at nesten 40 % av sykefraværet ved sykehjemmene i Trondheim kommune skyldes muskel – og skjelettlidelser hos de syke. Formålet med denne studien er å se på om det finnes sammenhenger mellom muskel – og skjelettlidelser og arbeidsmiljøfaktorer som løfte –og forflytningshjelpemidler/verneutstyr, stress og press på jobb, ansattes kunnskaper om forflytning, - og om det er sammenheng mellom ledelse og utvikling av muskel – og skjelettlidelser? Det er også et mål for oss å finne frem til tiltak som kan bidra til at sykefraværet på sikt går ned, men vi vil også se på om vi kan finne noen årsaker til det høye fraværet – er det noe ved enhetene som gir symptomene

Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest : The PRINCESS Randomized Clinical Trial

© 2019 American Medical Association. All rights reserved.Importance: Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). Objective: To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. Design, Setting, and Participants: The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Interventions: Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. Main Outcomes and Measures: The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Results: Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P < .001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, -2.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P = .25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, -3.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P = .44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups. Conclusions and Relevance: Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. Trial Registration: ClinicalTrials.gov Identifier: NCT01400373.Peer reviewedFinal Accepted Versio

The Benefits and Harms of Transmitting Into Space

Deliberate and unintentional radio transmissions from Earth propagate into space. These transmissions could be detected by extraterrestrial watchers over interstellar distances. Here, we analyze the harms and benefits of deliberate and unintentional transmissions relevant to Earth and humanity. Comparing the magnitude of deliberate radio broadcasts intended for messaging to extraterrestrial intelligence (METI) with the background radio spectrum of Earth, we find that METI attempts to date have much lower detectability than emissions from current radio communication technologies on Earth. METI broadcasts are usually transient and several orders of magnitude less powerful than other terrestrial sources such as astronomical and military radars, which provide the strongest detectable signals. The benefits of radio communication on Earth likely outweigh the potential harms of detection by extraterrestrial watchers; however, the uncertainty regarding the outcome of contact with extraterrestrial beings creates difficulty in assessing whether or not to engage in long-term and large-scale METI.Comment: Published in Space Polic

Localization of Events in Space-Time

The present paper deals with the quantum coordinates of an event in space-time, individuated by a quantum object. It is known that these observables cannot be described by self-adjoint operators or by the corresponding spectral projection-valued measure. We describe them by means of a positive-operator-valued (POV) measure in the Minkowski space-time, satisfying a suitable covariance condition with respect to the Poincare' group. This POV measure determines the probability that a measurement of the coordinates of the event gives results belonging to a given set in space-time. We show that this measure must vanish on the vacuum and the one-particle states, which cannot define any event. We give a general expression for the Poincare' covariant POV measures. We define the baricentric events, which lie on the world-line of the centre-of-mass, and we find a simple expression for the average values of their coordinates. Finally, we discuss the conditions which permit the determination of the coordinates with an arbitrary accuracy.Comment: 31 pages, latex, no figure

Events in a Non-Commutative Space-Time

We treat the events determined by a quantum physical state in a noncommutative space-time, generalizing the analogous treatment in the usual Minkowski space-time based on positive-operator-valued measures (POVMs). We consider in detail the model proposed by Snyder in 1947 and calculate the POVMs defined on the real line that describe the measurement of a single coordinate. The approximate joint measurement of all the four space-time coordinates is described in terms of a generalized Wigner function (GWF). We derive lower bounds for the dispersion of the coordinate observables and discuss the covariance of the model under the Poincare' group. The unusual transformation law of the coordinates under space-time translations is interpreted as a failure of the absolute character of the concept of space-time coincidence. The model shows that a minimal length is compatible with Lorents covariance.Comment: 13 pages, revtex. Introductory part shortened and some arguments made more clea