Impact assessment of AI-enabled automation on the workplace and employment. The case of Portugal

Artificial intelligence (AI) has the potential to lead to a wave of innovation in organiza-tional design, changes in the workplace and create disruptive effects in the employment sys-tems across the world. Moreover, the future deployment of broad-spectrum algorithms capa-ble of being used in wide areas of application (e.g., industrial robotics, software and data anal-ysis, decision-making) can lead to considerable changes in current work patterns, swiftly render many unemployed across the globe and profoundly destabilize labour relations. The impacts of AI are estimated to lead to a reduction of millions of workplaces. But qualitative research about AI and its governance is scarce. An emergent technology requires a technology assess-ment (TA) approach to understand the implications of AI in firms. Mechanisms of industrial democracy can help to adopt AI by ensuring adequate arrangements for employees and avoid-ing conflicts (mitigating negative effects, promoting reskilling, etc.). In this research work, the probable penetration of AI in the manufacturing sector is identified to study its effects in work organization and employment in Portugal. Is the employ-ment changing alongside recent AI trends in Portugal? What are the expectable changes in work organisation due to AI-enabled automation? Are there signs of work qualification to go with AI systems implementation? Are there visions on the role of humans on the interaction with the features of industry 4.0? Does that imply new forms of human interaction with AI? These are the questions this research work will try to answer. A TA approach using mixed methods was applied to conduct statistical analyses of relevant databases, interviews with ac-ademic, industrial and social actors and exploratory scenarios of AI-based automation systems, on work organization and employment. The manufacturing industry was the chosen sector since it is the sector where most cases of AI-based automation systems are in place. Findings suggest that, until now, it seems AI is still not able to replace most of the human skills and cognitive capacities but can replace humans on simple tasks. In the future, four different possible states may occur, according to the various initial conditions, the com-pany's motivation, their business strategy, the public policies in place and main social actors involved: Re-organisation of work; Substitution of the workforce; People at the centre and Fo-cus on Efficiency. These were the basis for our scenario outcomes.A inteligência artificial (IA) tem o potencial de levar a uma onda de inovação no desenho das organizações, nas mudanças no local de trabalho e em criar efeitos disruptivos nos sistemas de emprego em todo o mundo. Além disso, a futura implementação de algoritmos de amplo espectro, capazes de serem usados em muitas áreas de aplicação (por exemplo, robótica industrial, software e análise de dados, tomada de decisão), pode levar a mudanças consideráveis nos padrões de trabalho atuais, e rapidamente, levar ao desemprego em todo o mundo e à desestabilização profunda das relações laborais. Estima-se que os impactos da IA levem a uma redução de milhões de locais de trabalho. Mas a investigação qualitativa sobre IA é escassa. Uma tecnologia emergente requer uma abordagem de avaliação de tecnologia (AT) para entender as suas implicações. Mecanismos de democracia industrial podem ajudar a adotar a IA, garantindo condições adequadas para os trabalhadores e evitando conflitos (mitigando efeitos negativos, promovendo requalificação, etc.). Neste trabalho de investigação identifica-se a provável penetração da IA no setor da indústria transformadora para estudar os seus efeitos na organização do trabalho e emprego em Portugal. O emprego está a mudar a par das tendências recentes da IA em Portugal? Quais são as mudanças na organização do trabalho devido à automação baseada em IA? Há indícios de qualificação do trabalho para acompanhar a implementação dos sistemas de IA? Existem visões sobre o papel do ser humano na interação com os recursos da indústria 4.0? Isso implica novas formas de interação humana com a IA? Estas são as perguntas que este trabalho de investigação tentará responder. Na abordagem de AT, foram usados métodos mistos para realizar análises estatísticas de bases de dados, entrevistas com atores do ecossistema académico, industrial e social e cenários exploratórios sobre os efeitos da adoção de sistemas de automação baseados em IA, na organização do trabalho e emprego. A indústria transformadora foi escolhida por ser onde existem a maioria de casos de aplicação de sistemas de auto-mação baseados em IA. Os resultados sugerem que, até ao momento, que a IA não tem a capacidade de subs-tituir a maioria das competências e raciocínio humanos, mas apenas tarefas simples. No futuro, poderão ocorrer quatro situações, dependendo das condições iniciais, motivação e estratégia da empresa, das políticas e incentivos públicos existentes e do envolvimento de atores sociais: Reorganização do trabalho; Substituição da mão-de-obra; Pessoas no centro da transformação e foco na Eficiência. Estas foram a base para os nossos cenários de referência

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

PURPOSE: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). METHODS: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. RESULTS: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. CONCLUSION: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.status: publishe

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed

Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis

Purpose: To describe data on epidemiology, microbiology, clinical characteristics and outcome of adult patients admitted in the intensive care unit (ICU) with secondary peritonitis, with special emphasis on antimicrobial therapy and source control. Methods: Post hoc analysis of a multicenter observational study (Abdominal Sepsis Study, AbSeS) including 2621 adult ICU patients with intra-abdominal infection in 306 ICUs from 42 countries. Time-till-source control intervention was calculated as from time of diagnosis and classified into 'emergency' (< 2 h), 'urgent' (2-6 h), and 'delayed' (> 6 h). Relationships were assessed by logistic regression analysis and reported as odds ratios (OR) and 95% confidence interval (CI). Results: The cohort included 1077 cases of microbiologically confirmed secondary peritonitis. Mortality was 29.7%. The rate of appropriate empiric therapy showed no difference between survivors and non-survivors (66.4% vs. 61.3%, p = 0.1). A stepwise increase in mortality was observed with increasing Sequential Organ Failure Assessment (SOFA) scores (19.6% for a value ≤ 4-55.4% for a value > 12, p < 0.001). The highest odds of death were associated with septic shock (OR 3.08 [1.42-7.00]), late-onset hospital-acquired peritonitis (OR 1.71 [1.16-2.52]) and failed source control evidenced by persistent inflammation at day 7 (OR 5.71 [3.99-8.18]). Compared with 'emergency' source control intervention (< 2 h of diagnosis), 'urgent' source control was the only modifiable covariate associated with lower odds of mortality (OR 0.50 [0.34-0.73]). Conclusion: 'Urgent' and successful source control was associated with improved odds of survival. Appropriateness of empirical antimicrobial treatment did not significantly affect survival suggesting that source control is more determinative for outcome

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project

Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection