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In recent years there has been an explosion of interest in Artificial Intelligence (AI) both in health care and academic philosophy. This has been due mainly to the rise of effective machine learning and deep learning algorithms, together with increases in data collection and processing power, which have made rapid progress in many areas. However, use of this technology has brought with it philosophical issues and practical problems, in particular, epistemic and ethical. In this paper the authors, with backgrounds in philosophy, maternity care practice and clinical research, draw upon and extend a recent framework for shared decision-making (SDM) that identified a duty of care to the client's knowledge as a necessary condition for SDM. This duty entails the responsibility to acknowledge and overcome epistemic defeaters. This framework is applied to the use of AI in maternity care, in particular, the use of machine learning and deep learning technology to attempt to enhance electronic fetal monitoring (EFM). In doing so, various sub-kinds of epistemic defeater, namely, transparent, opaque, underdetermined, and inherited defeaters are taxonomized and discussed. The authors argue that, although effective current or future AI-enhanced EFM may impose an epistemic obligation on the part of clinicians to rely on such systems' predictions or diagnoses as input to SDM, such obligations may be overridden by inherited defeaters, caused by a form of algorithmic bias. The existence of inherited defeaters implies that the duty of care to the client's knowledge extends to any situation in which a clinician (or anyone else) is involved in producing training data for a system that will be used in SDM. Any future AI must be capable of assessing women individually, taking into account a wide range of factors including women's preferences, to provide a holistic range of evidence for clinical decision-making.
Computed tomography perfusion (CTP) imaging could be useful in guiding reperfusion therapy or patient selection in acute ischemic stroke (AIS) patients. Eribulin mouse The aim of the current study was to determine the efficacy of the CTP-guided reperfusion therapy in AIS by performing a systematic review and meta-analysis.
Medline/PubMed, Embase, and the Cochrane library were searched using the terms "CT perfusion", "acute stroke" and "reperfusion therapy". The following studies were included (a) studies reporting original data; (b) patients aged 18years or above; (c) patients diagnosed with anterior circulation AIS; and (d) studies with good methodological design.
Twenty-two studies were finally included in the metanalysis with a total of 5, 687 patients. CTP-guided reperfusion therapy was associated with increased odds of good functional outcome without significant difference in safety profile.
CTP-guided reperfusion therapy improved functional outcomes in AIS, with increased benefits to patients treated with endovascular thrombectomy.
CTP-guided reperfusion therapy improved functional outcomes in AIS, with increased benefits to patients treated with endovascular thrombectomy.
Simultaneous alcohol and marijuana (SAM) use is reported by roughly 30% of young adult drinkers. Among SAM users, SAM use days have more negative substance-related consequences than single-substance days. Little information is available about contextual factors contributing to the likelihood of SAM use on a particular day. This study compared days on which individuals reported SAM use relative to days on which they reported alcohol but not marijuana use in terms of physical location, engagement in risky activities and social context of use.
Participants were 148 young adults (57% female) reporting past-month SAM use and past two-week binge drinking. Participants completed up to 14 daily surveys assessing substance use behaviour and socio-environmental characteristics of use.
For those <21 years, only using at home was associated with greater odds of SAM use. For those 21+, using at a friend's house and outdoors were associated with increased odds of use; using at a bar/club was associated with lower odds. Using alone was associated with lower odds of use for those 21+. Engagement in risky activities (pre-gaming and drinking games) was not associated with SAM use.
SAM days are linked with use in private settings and social situations. Despite experiencing more harms on SAM days, SAM use is not more likely than alcohol use alone to occur in certain environments and situations traditionally found to be linked with increased risk. Findings may provide key insight for developing context-informed interventions focused on SAM use.
SAM days are linked with use in private settings and social situations. Despite experiencing more harms on SAM days, SAM use is not more likely than alcohol use alone to occur in certain environments and situations traditionally found to be linked with increased risk. Findings may provide key insight for developing context-informed interventions focused on SAM use.Cancer is one of the leading causes of annual deaths worldwide, accounting for nearly 10 million deaths each year. Metastasis, the process by which cancer spreads across the patient's body, is the main cause of death in cancer patients. Because the rising trend observed in statistics of new cancer cases and cancer-related deaths does not allow for an optimistic viewpoint on the future-in relation to this terrible disease-the scientific community has sought methods to enable early detection of cancer and prevent the apparition of metastatic tumors. One such method is known as liquid biopsy, wherein a sample is taken from a bodily fluid and analyzed for the presence of CTCs or other cancer biomarkers (e.g., growth factors). With this objective, interest is growing by year in electrokinetically-driven microfluidics applied for the concentration, capture, filtration, transportation, and characterization of CTCs. Electrokinetic techniques-electrophoresis, dielectrophoresis, electrorotation, and electrothermal and EOF-have great potential for miniaturization and integration with electronic instrumentation for the development of point-of-care devices, which can become a tool for early cancer diagnostics and for the design of personalized therapeutics. In this contribution, we review the state of the art of electrokinetically-driven microfluidics for cancer cells manipulation.
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