The debate on the ethics of AI in health care: a reconstruction and critical review

Healthcare systems across the globe are struggling with increasing costs and worsening outcomes. This presents those responsible for overseeing healthcare with a challenge. Increasingly, policymakers, politicians, clinical entrepreneurs and computer and data scientists argue that a key part of the solution will be ‘Artificial Intelligence’ (AI) – particularly Machine Learning (ML). This argument stems not from the belief that all healthcare needs will soon be taken care of by “robot doctors.” Instead, it is an argument that rests on the classic counterfactual definition of AI as an umbrella term for a range of techniques that can be used to make machines complete tasks in a way that would be considered intelligent were they to be completed by a human. Automation of this nature could offer great opportunities for the improvement of healthcare services and ultimately patients’ health by significantly improving human clinical capabilities in diagnosis, drug discovery, epidemiology, personalised medicine, and operational efficiency. However, if these AI solutions are to be embedded in clinical practice, then at least three issues need to be considered: the technical possibilities and limitations; the ethical, regulatory and legal framework; and the governance framework. In this article, we report on the results of a systematic analysis designed to provide a clear overview of the second of these elements: the ethical, regulatory and legal framework. We find that ethical issues arise at six levels of abstraction (individual, interpersonal, group, institutional, sectoral, and societal) and can be categorised as epistemic, normative, or overarching. We conclude by stressing how important it is that the ethical challenges raised by implementing AI in healthcare settings are tackled proactively rather than reactively and map the key considerations for policymakers to each of the ethical concerns highlighted

Facing Erosion Identification in Railway Lines Using Pixel-wise Deep-based Approaches

Soil erosion is considered one of the most expensive natural hazards with a high impact on several infrastructure assets. Among them, railway lines are one of the most likely constructions for the appearance of erosion and, consequently, one of the most troublesome due to the maintenance costs, risks of derailments, and so on. Therefore, it is fundamental to identify and monitor erosion in railway lines to prevent major consequences. Currently, erosion identification is manually performed by humans using huge image sets, a time-consuming and slow task. Hence, automatic machine learning methods appear as an appealing alternative. A crucial step for automatic erosion identification is to create a good feature representation. Towards such objective, deep learning can learn data-driven features and classifiers. In this paper, we propose a novel deep learning-based framework capable of performing erosion identification in railway lines. Six techniques were evaluated and the best one, Dynamic Dilated ConvNet, was integrated into this framework that was then encapsulated into a new ArcGIS plugin to facilitate its use by non-programmer users. To analyze such techniques, we also propose a new dataset, composed of almost 2,000 high-resolution images

Diabetes Modulates MicroRNAs 29b-3p, 29c-3p, 199a-5p and 532-3p Expression in Muscle: Possible Role in GLUT4 and HK2 Repression

The reduced expression of solute carrier family 2, facilitated glucose transporter member 4 (GLUT4) and hexokinase-2 (HK2) in skeletal muscle participates in insulin resistance of diabetes mellitus (DM). MicroRNAs (miRNAs) have emerged as important modulators of mRNA/protein expression, but their role in DM is unclear. We investigated miRNAs hypothetically involved in GLUT4/HK2 expression in soleus muscle of type 1 diabetes-like rats. In silico analysis revealed 651 miRNAs predicted to regulate solute carrier family 2 member 4 (Slc2a4) mRNA, several of them also predicted to regulate Hk2 mRNA, and 16 miRNAs were selected for quantification. Diabetes reduced Slc2a4/GLUT4 and Hk2/HK2 expression (50–77%), upregulated miR-29b-3p and miR-29c-3p (50–100%), and downregulated miR-93-5p, miR-150-5p, miR-199a-5p, miR-345-3p, and miR-532-3p (~30%) expression. Besides, GLUT4 and HK2 proteins correlated (P < 0.05) negatively with miR-29b-3p and miR-29c-3p and positively with miR-199a-5p and miR-532-3p, suggesting that these miRNAs could be markers of alterations in GLUT4 and HK2 expression. Additionally, diabetes increased the nuclear factor kappa B subunit 1 protein (p50) expression, a repressor of Slc2a4, which was also predicted as a target for miR-199a-5p and miR-532-3p. Correlations were also detected between these miRNAs and blood glucose, 24-h glycosuria and plasma fructosamine, and insulin therapy reversed most of the alterations. In sum, we report that diabetes altered miR-29b-3p, miR-29c-3p, miR-199a-5p and miR-532-3p expression in muscle of male rats, where their predicted targets Slc2a4/GLUT4 and Hk2/HK2 are repressed. These data shed light on these miRNAs as a markers of impaired skeletal muscle glucose disposal, and, consequently, glycemic control in diabetes

ELEMENTS OF WINE PRODUCTION IN THE VALLEY OF SAN FRANCISCO BRAZIL - AND COLCHAGUA – CHILE

A videira ou vinha, pertence à família das Vitaceae, subdivididas nas espécies Parthenocissus quinquefólia e Vitis vinífera, sendo esta última utilizada no cultivo de uvas no mundo. Nos próximos anos o consumo de vinho será maior que sua produção, necessitando que a produção da matéria prima seja otimizada. A tecnologia é a ferramenta preponderante nesse processo, trazendo consigo um manejo eficiente a partir da agricultura de precisão. Com intuito de obter indicadores análogos entre as regiões do Vale do São Francisco no Brasil e Vale do Colchagua no Chile, aprimorando o cultivo. Objetiva-se nesse trabalho, caracterizá-las através da análise de seus elementos agronômicos, topográficos, pedológicos e climáticos. O estudo contou com revisão bibliográfica sobre as duas regiões e coleta de dados agrupados em grupos: 1, 2, 3. Onde se discutiu as carências e vantagens agrícolas existentes nas duas regiões, buscando melhoramento do cultivo. Os fatores estudados culminaram numa análise eficiente e provaram sua importância. A agricultura de precisão coloca à disposição da sociedade seus diversos benefícios de forma sustentável

Platelet-Activating Factor Receptor Plays a Role in Lung Injury and Death Caused by Influenza A in Mice

Influenza A virus causes annual epidemics which affect millions of people worldwide. A recent Influenza pandemic brought new awareness over the health impact of the disease. It is thought that a severe inflammatory response against the virus contributes to disease severity and death. Therefore, modulating the effects of inflammatory mediators may represent a new therapy against Influenza infection. Platelet activating factor (PAF) receptor (PAFR) deficient mice were used to evaluate the role of the gene in a model of experimental infection with Influenza A/WSN/33 H1N1 or a reassortant Influenza A H3N1 subtype. The following parameters were evaluated: lethality, cell recruitment to the airways, lung pathology, viral titers and cytokine levels in lungs. The PAFR antagonist PCA4248 was also used after the onset of flu symptoms. Absence or antagonism of PAFR caused significant protection against flu-associated lethality and lung injury. Protection was correlated with decreased neutrophil recruitment, lung edema, vascular permeability and injury. There was no increase of viral load and greater recruitment of NK1.1+ cells. Antibody responses were similar in WT and PAFR-deficient mice and animals were protected from re-infection. Influenza infection induces the enzyme that synthesizes PAF, lyso-PAF acetyltransferase, an effect linked to activation of TLR7/8. Therefore, it is suggested that PAFR is a disease-associated gene and plays an important role in driving neutrophil influx and lung damage after infection of mice with two subtypes of Influenza A. Further studies should investigate whether targeting PAFR may be useful to reduce lung pathology associated with Influenza A virus infection in humans

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Influenza A Virus as a Predisposing Factor for Cryptococcosis

Influenza A virus (IAV) infects millions of people annually and predisposes to secondary bacterial infections. Inhalation of fungi within the Cryptococcus complex causes pulmonary disease with secondary meningo-encephalitis. Underlying pulmonary disease is a strong risk factor for development of C. gattii cryptococcosis though the effect of concurrent infection with IAV has not been studied. We developed an in vivo model of Influenza A H1N1 and C. gattii co-infection. Co-infection resulted in a major increase in morbidity and mortality, with severe lung damage and a high brain fungal burden when mice were infected in the acute phase of influenza multiplication. Furthermore, IAV alters the host response to C. gattii, leading to recruitment of significantly more neutrophils and macrophages into the lungs. Moreover, IAV induced the production of type 1 interferons (IFN-α4/β) and the levels of IFN-γ were significantly reduced, which can be associated with impairment of the immune response to Cryptococcus during co-infection. Phagocytosis, killing of cryptococci and production of reactive oxygen species (ROS) by IAV-infected macrophages were reduced, independent of previous IFN-γ stimulation, leading to increased proliferation of the fungus within macrophages. In conclusion, IAV infection is a predisposing factor for severe disease and adverse outcomes in mice co-infected with C. gattii

Avaliação e seleção de híbridos de cacaueiro em Rondônia Evaluation and selection of cacao hybrids in Rondônia

Este trabalho teve como objetivo avaliar e selecionar híbridos de cacaueiro, quanto a rendimento e qualidade de sementes, nas condições ecológicas do Município de Ouro Preto do Oeste, Rondônia. A seleção foi feita comparando-se, pelo teste de Duncan, as médias das medidas dos componentes de rendimento avaliados em um ensaio conduzido entre 1986 e 1991. O delineamento experimental usado foi o de blocos completos casualizados. Os melhores desempenhos, quanto aos caracteres avaliados, foram obtidos em cruzamentos que incluíram os clones POUND 7 e BE 10 (número total de frutos coletados), SCA 6 e PA 150 (número total de frutos sadios), PA 150 (peso total de sementes úmidas), IMC 67 e POUND 7 (peso médio de sementes úmidas por fruto). Na análise simultânea dos caracteres, os híbridos SCA 6 x ICS 1, PA 150 x SIC 328 e IMC 67 x BE 8 sobressaíram-se, em relação aos demais.<br>The goal of the present work was to evaluate and to select cacao hybrids with respect to seed yield and quality for ecological conditions of municipality of Ouro Preto do Oeste, Rondônia, Brazil. The selection was done comparing, by means of Duncan test, the yield measurement average in trial conducted from 1986 to 1991. A randomized complete block design was used. The best performance, considering total number of collected fruits, total number of healthy fruits, total weight of humid seeds and mean weight of humid seeds per fruit, were obtained from crosses involving POUND 7 and BE 10, SCA 6 and PA 150, PA 150, IMC 67 and POUND 7 clones, respectively. The hybrids SCA 6 x ICS 1, PA 150 x SIC 328 and IMC 67 x BE 8 were outstanding when compared to the others