Πέμπτη 22 Οκτωβρίου 2020

Artificial Intelligence in Medical Imaging . Its Perspective on the Service of Humanity.

The term Artificial Intelligence (AI) is used when a machine imitates gnostic functions like for instance learning, and problem solving. Specifically, AI refers to a spectrum of informatics that aims to the growth of smart systems that perform tasks usually demanding human intelligence. The AI systems have characteristics that are related to human behavior; they think like humans and think and function logically.

Among the greatest milestones of AI until now is that IBM’s Deep Blue beated Gary Kasparof at chess. ‘I was deceived’ was the reaction of Kasparof after the chess game when he realized he had lost from a machine. There was a move on the part of Deep Blue that decided not to take the pawn offered by Kasparof and he characterized it ‘human’ with specific character and creativity. It was the point back in 1997 that machines started thinking as humans. Later on, this chess player said: ‘I lost from ana alarm clock’ meaning that with today’s computing capability, the Deep Blue machine seems outdated therefore the current level of AI is very much more modern and strong.

WeE have machine learning and deep learning. Machine learning describes some sub-level of AI that involves all computer approaches that allow computers to learn from a total of data without having been programmed to do so, yet they perform based on the use f paradigm. Deep learning is a part of machine learning with multi-leveled representation; these levels are processing raw data in order to carry out filing works or tracing.

There are a lot of studies dealing with the problem of prognosis, diagnosis or therapy of diseases with the aid of machines. An example was given where the clinical information, the display as well as the characteristics of the therapy were used for the development of logistics regression models (LR) and Random Forest (RF) for the prognosis of patients that react to the therapy or not.
There is of a very strong evidence of a very strong that AI can have in some medical cases like interventional radiology. There can be prognosis of the therapeutic result, improvement I selection of patients, improvement of interventional procedures (new systems etc) and training along with the development of educational tools particularly in simulation.

One very important challenge we face in AI is the education of the software (education of the algorithm) and this is based on the big data we have from relative medical tests. This procedure requires supervision and the quality of data is very important too. Samples used should be representative ofrepresentative of all characteristics required i.e. men, women, age etc. Finally, in case of a finding that is particularly rare, the training of the algorithm becomes very difficult.

To whom the data belong (namely the findings, the test results etc)? An example was given of a monkey that stole a camera from a photographer to take a selfie which finally was uploaded to Wikipedia. The photographer sued Wikipedia to remove it, but Wikipedia refuses to delete it saying that the monkey owns it.

Who has the responsibility for the diagnosis? The radiologist? The Hospital? He who developed the algorithm? The AI company involved? These issues require regulations and some others that can be added tot the list are: transparency of results, explainability required when decision making is involved, patients feeling uncomfortable for AI diagnosis to be applied etc.

Intelligent Pervasive Health Management.

From telemedicine to telecare; following the principles of pervasive and ubiquitous computing we have decentralization, diversification, connectivity, simplicity. Efficinet processing of information (ambient intelligence) is filtering the unnecessary idea. Context awareness means to know the situation. State of the art technologies to be employed are internet of things (IoT) and advanced sensors.

What it means to give to the people a personal health navigator? A user-friendly tool helping people find and interact with their nearest doctor, pharmacy or hospital. A tool to give them accessible and trustworthy health information wherever they are. A tool that offers a quick and secure access to their personal data if they need it. A tool that can detect and support the treatment of a disease – but also encourage healthy habits and prevent conditions before they occur.
There are sensors that can monitor the health of an individual, they do some processing and then they send the information to the cloud so that the care givers can assess the situation and act accordingly.

There is a cloud based platform i.e. a homecare system for assisted independent living: health monitoring, communication and social networking, and emergency response. There are also vital signs measurements & physical activity tracking, 24/7 helpdesk service and four sub-systems: the mobile application, web-based application, helpdesk application and cloud back-end platform.
In terms of hardware a smart phone or tablet can be used; service provision is through the mobile app and there is also devices inter-connection and video-conferencing; wifreless medical sensors and wearables for vital signs and activity monitoring of SpO2, pulse rate, blood pressure, glucose levels and of weight, physical activity, body temperature, daily step count and sleep.

A pilot study was presented having as target group the idiopathic pulmonary fibrosis and had taken place back in 2016. There were noticed progressive worsening of dyspnea and pulmonary function, progressive fibrosis of the lungs, acute respiratory decline. The etiology was unknown and the mean age was 67-69 years. The attending doctor set the measuring schedule and respective thresholds for each patient, had access to each patient’s PHR. He was able to receive weekly reports and notification for threshold violations and also could use weekly doctor-patient communication via video-conferencing. The results of the project were astonishing, better than expected; all patients had been consistently adherent to their measurements schedule and medication regimen. Average compliance to measurement schedule schedule was more than 98% and the sense of safety was very vivid. There was no significant technical issues or problems with the system’s usability, approximately 70% of the participants were able to use the system and communication features were appreciated by relatives of patients who live alone.

In terms of challenges, personalization was mentioned, along with intelligence (reinvent edge computing in order to have the right edge devices that can perform analytics locally), and the need to respect privacy (GDPR etc.)

Digital Medicine, the Medicine in the Future.

By Digital Mmedicine we mean the use of digital information, data and communication technologies in order to collect, share and analyze health information and for the purpose of improving patients health and health care delivery. When referring to digital medicine or eHealth, we mean informatics in departments, informatics in countries or states, registries and the use of Big Data, as well as telemedicine, mHealth and pHealth (personalized data).

In the case of cardiovascular diseases, remote device management is of crucial importance. There are home monitoring devices of various kinds that can be connected to a service center so a physician or a nurse can gain access on information gathered.
In order to detect arrhythmias, the classic way is to push on the artery of the hand; another way is the electro-cardiogram and today we have a number of other modern ways – modern tools to detect arrhythmias of the heart: among them are wearables, mart tattoos, dermallu implanted sensors and subcutaneous implants. Lately, smart phones were added in the picture using the method of photoplethysmography and the same goes for bands and watches designed for this purpose. Another tools that was approved by the NHS was the Alivecor system, the findings of which can be transmitted to the physician immediately via email.

Telemonitoring in cases of heart failure is very important and very useful; it makes use of specific architecture (phone/web based) to connect patients to their nurse, GP or hospital. There can be monitoring (daily or weekly) of vital signs such a s weight, pressure, pulse and symptoms (breath-lessness, fatigue, oedema) as well as close monitoring of fluid status and therapy, monitoring of brady and tachy-arhythmias. Finally, it can advise by telephone on diuretic dosage, diet, training and behavior.

In the case of arterial hypertension, the digital medicine can be equally useful; there are many devices that measure the blood pressure, send measurement directly to the physicians. Of course, there are currently more than 1000 clinical tests registered aiming to confirm the accuracy of all these measurements coming from application of new technology in this field.

Applications of the above can be found also in exercise, meaning wearable devices used in sports medicine – using more or less the same technology, in sleep disorders etc.
Precision medicine is of crucial importance. Now we tend to give the same medicine to all patients. But in the case of precision medicine we can personalize the treatment according to the very characteristics of the patient. Through this procedure we can use various types of data like genomics, transcriptomics, proteomics and clinical. We can also separate among various groups of patients which are going to have positive effect or negative effect depending on the case at hand.

The major problem in medicine is the so called medication adherence, particularly in case of patients that take many pills. To this end there are now smart pills – microchipped medication tablets that track patient adherence with a smartphone app and can also detect information about the body’s response to the medicine.

Undoubtedly overall, digital medicine is the medicine of the future.

Individual Responsibility or Health Protocols in the Management of a Pandemic.

The global coronavirus pandemic not only showed the deficiencies, failures and ommissions of the various states in the field of health infrastructure but also showed the deficit of education at the level of the people. The arrogance of the leaders in many states led many of them to a myopic assessment of the spread of the virus and to an underestimation of its deadly danger. But they did not realize in time the seriousness of the impending threat.
The management of the recent Covid-19 pandemic is reviewing several aspects of the health sciences such as medicine and hygiene. Within a compressed period of time huge changes are tsking shape in the everyday life of modern man but also in the thinking of the health scientists.

The science of Hygiene seeks a stable wide scope of measures to be effective. Firstly individual responsibility is promoted as the basic line of prevention. Phenomena of arbitrariness such as overcrowding seem to ignore. Secondly, strict health protocols are appeared which come to enforce rules. The question is which of the two is the more effective? It all starts from our examination of how man acts as a responsible unit; the eponymous and responsible individuality, with its self-respect, self-awareness and self-criticism is accountable to its morals: ‘
“‘I implement measures because I understand and accept their usefulness”’. On the contrary, people as a mass, without individual objections and differences without quality requirements and strict evaluation judgments, act with the levelling logic as a ‘limited liability company’ and unlimited responsibility.

Individual responsibility is not the responsibility that is legally delimited. It is not the law required or imposed from above but mainly the inspired from within. It is not therefore a product of coercion but a consequence of moral self-control. It does not come only from the legal culture but mainly spring from the culture of our moral priorities. In ancient Greek history, the first case of personal responsibility was found in the person of Antigone, who chose to bury the dead body of her brother Polynices despite the ban of King Kreon – a superior form of personal responsibility who obeyed her conscience and the morals of the time.

There was a need to integrate new health data into daily practice during the pandemic. Thus health protocols were created which indicated the correct practice based on science. They changed daily habits and created new behaviors that caused discomfort and controversy.
It is important to understand that the responsibility of each person for his choices and actions, the individual responsibility does not conflict with the collective or social responsibility nor with the responsibility of the State and the institutions toward the citizen. It is a transfer of responsibility to one. On the contrary individual responsibility ensures individual freedom and makes us moral persons.

In conclusion it was said that the world community will be severely injured by the pandemic but if she does not capitalize on this dramatic experience does not lead to redefining goals and priorities and re-evaluating values, then the lesson will not be worth the lesson. Therefore the next day in parallel with the upgrade of infrastructure and health services there should be an equally courageous investment in the field of education. This education will delimit the new value purpose and will strengthen the self-respect.

Health and Safety in the time of Covid 19 Pandemic.

Every 10 years we observe new viruses like SARS and MERS. What makes Covid SARS more dangerous is that it contaminatecontaminates easily even without symptoms. There are studies to examine the similarity of the Spanish flu and with other viruses or pandemic situations. Today we have better medicine but we do not have special treatment or vaccine (yet), therefore the only weapon we have as we speak is the face mask along with the social distancing. People are more educated today, news travel fast but on the other hand the level of globalization has spread the virus very fast too. There is also a great effect on the psychology of the people and every day there are cases of suicides and other bad news of same kind.

The way contemporary cities are organized thus far around the world and the proximity of people from one another in their residencies is certainly one major cause of the pandemic. Yet we can turn this to an advantage in some way; the infection from person to person will stop when a percentage of more than 60-70% of the population will develop immunity (through the creation of anti-bodies). Immunity can be achieved with two ways: either with physical way meaning infection or with vaccination. The former has a severe cost in people’s lives – approx.. 1-2% of the infected will die in best case scenario, whereas if the health systems do not manage the massive effects this percentage can climb to 10% (statistics refer to world population and effect).

The world and the societies have been led to lockdowns and quarantines that in turn have an additional negative psychological effect to people that in the end creates fear and uncertainty. There is also an ambiguous role of social media which in couple with the various levels of quality of information affects to a great extent the perception, the behaviors and the decisions of people. We have though a help in all that which is the role of technology: modern tools and machines.

In the contemporary theory of games the biggest effort comes from cooperation of all society. By wearing a mask, the whole team can gain by preventing the expansion. People learn to respect the social rules and that societies cannot act by themselves. The extent to which they will obey the measures are directly related to the value of human life even those containment measures indicate some change /from the culture of freedom and self-definition to the culture of protection and collective discipline.

We have also to consider that Covid 19 is an occupational disease. Contamination can happen in all places but in many cases we know that contamination takes place in working spaces. Therefore the safeguarding of hygiene conditions and safety measures (sanitation, distancing, masks etc.) at work is of primary importance and should also be effected by law. This in effect to shape working conditions in the future as well – in the post Covid 19 time.

More than ever is now needed the World Health Organization (WHO). All protocols we use at hospitals come from WHO and it is very important that continues to provide support worldwide during this period of the pandemia. On the other hand it important to stress that solidarity and collective efforts and resources are also absolutely necessary so to bring the desired outcome that is, to relieve the global community from the virus.

Space Impacts on Human Health.

Is mankind correlated to the universe? Apart from science this question may be answered by philosophy. In Corpus Hippocraticum (which includes the work of Hippocrates the famous doctor from Kos) the 4 elements (humors – hymoi) from which human body is consisted correspond to the 4 elements of the universe (fire, earth, wind, water). This means that Man and the Universe a re are in close connection. There are cosmic incidents that affect our health. All chemical elements in the Universe from which our planetary system, our Earth itself and us were created, originate form processes in stellar nuclei and violent explosions that mark the death of the stars. Hydrogen was the first chemical element that was created after the Big Bang and our body is full of Hydrogen. Similarly elements that we have in our body like
Nitrogen (DNA), Calcium (teeth), Iron (Blood) were created in the interior of stars; when a star explodes all its elements disseminate in the universe. We are made of Stars Stuff.

According to the National Science and Technology Council of the USA ‘space weather’ is defined as the dynamic conditions of the space environment that arise from emissions from the sun which include solar flares, solar energetic particles, and coronal mass ejections. These emissions can interact with Earth and its surrounding space including the Earth’s magnetic field potentially disrupting electric power systems satellite, aircraft, and spacecraft operations, telecommunication, position, navigation timing services and other technologies and infrastructure. In order to predict future space weather sunspots are of an assistance. Sunspots are areas with intense magnetic activity in the Sun’s photosphere appearing dark due to lower temperature. Often appear in parts or in groups. Their monitoring is an indication of solar cycle.

The larger than earth emissions described above, reach our planet and interact with its magnetic field causing problems in spacecrafts, GPS navigation systems, satellite communications and other technological applications. Apart from technological malfunctions the interaction of solar wind with the Earth’s magnetic field offers us the spectacular phenomenon of northern lights. To what extent are we protected? Earth ha s a natural shield, the Van Allen radioactive zones composed of ionized solar radiation particles trapped by the earth’s magnetic field.
In the literature is proposed a possible correlation between solar and geomagnetic activity parameters and cosmic ray intensity variations with different types of arrhythmias. Also people living in great latitude areas and at high altitude are more exposed. Moreover, professionals like pilots are at higher risk of developing cancer liked with CR as well as astronauts who are outside the earth’s protecting atmosphere shield.

Ionizing radiation is defined a s radiation that travels aa a particle or electromagnetic wave that carries sufficient energy to detach electrons from atoms or molecules thereby ionizing an atom or a molecule. There are Alpha particles. Beta particles, Gamma rays and X rays. The electro-magnetic spectrum starts from low frequencies that are not harmful for our health, and extents to Gamma ray and x ray from which we are protected as we have the earth’s atmosphere. The effects we receive from the sun is a result of the intensity of the solar radiation, frequency of exposure to the sun and its duration.

Finally there were mentioned ethics in science and dissemination of information. Ethics as a branch of philosophy and science can work for the benefit of citizens.

Positive Organizational Behavior for better Psychology and Results in the Workplace.

The evolution of Positive Organizational Behavior (POB) was based on positive psychology which has been defined as the science of positive subjective experience, positive individual traits and positive institutions. Selignan proposes a new model of positive psychology based on positive aspects and attitudes of life. A life that would otherwise lead to depression. This model assumes the adoption of positive life attitudes which affect cognitive functions, emotions and human behaviors. This model of happiness includes positive emotions, engagement and meanings. Gradually this model evolved in theory of well being where it added the following elements: positive relationships and accomplishments. As a result the PERMA model emerged named after the initials of Positive emotions, Engagement, Relationships, Meaning and Accomplishments.

Main results of POB are employee satisfaction and improving of their efficiency and productivity, working wellness and positive intra-business climate where the employee feels comfortable at work. Although POB is clearly influenced by positive psychology there are criteria for considering it a s psychological capacity.

It was analyzed the way that positive psychology (PERMA model) leads to POB (Hero model). This latter model stands as the acronym of Hope (a positive psychological state), Efficacy (the individuals’ confidence on his ability), Resilience (our ability to recover and adapt after adversity conflict and failure or even after positive events) and Optimism (a generalized positive outlook or expectation). Literature suggestLiterature suggests that training can enhance the above skills.

As to the results of POB we have mainly Job satisfaction and job performance; all these results are observed indirectly in contrast with productivity which is directly measurable by specific criteria. Another positive result is enhancement of behavior skills such as management skills. The list also includes high rate of achieving goals, improving problem solving skills and even improving rates of depression, high quality of employees and employee engagement. Particularly this (engagement) is one of the most desirable outcomes and it is a multi-dimensional concept that represents the impression and the relationship of an employee with the organization in which he/she belongs. In this case it is the emotional bond or even the attachment and devotion of the employee to the organization.

Overall it is mentioned that effective employee management practices lead to positive employee outcomes or behaviors and eventually to positive operational and/or financial performance.

Concluding it was said that POB is an effective way of managing human resources by companies as it creates happy people in healthy organizations. In the workplace care should be taken for the psychological support of employees where necessary in order to ensure their mental health. The good psychological condition of the employees will have a positive impact on the operation and consequently on the profitability of the company. So the organization must invest in this factor.

The History of the Greek Sense of Taste in Food.

What was the actual taste of the food of ancient Greeks? Could we ever consider the life without the sense of taste? It is a basic function of the human body, allows the qualitative evaluation of our food, prevents the swallowing of undesired substances, provides delight and pleasure (hedone) and activates memory with experience of the past. Aristotle in his work ‘on the soul’ defined the five human senses as we know them and underlines that the taste is the basic condition for the serenity of the soul.

Hippocrates, almost 100 years before Aristotle, classified the food in 4 categories according to the physiological responses in the human body: warm, cold, dry and wet. However this classification was not clear enough therefore later he made another classification according to the taste response: sweet, sour, salty, bitter, harsh and tart. The combination of the basic tastesd creates other complex tastes. Usually there is a counter-balance between the sweet and sour taste and between the bitter and salty taste. Umami taste was defined in 1908 by the Japanese chemist Kikunos Ikeda and is either the 5th taste or the hedonic combination of the other 4.

Savarin was a man of multi-disciplinary education who in 1825 wrote a legendary book ‘Pphysiologie de Gout’ the testament of modern gastronomy. In his books he states that. ‘while the smell explores the food, the taste is to decide’. The word flavor that describes both the smell and taste in ancient Greek language is defined euchymia; it describes the aroma and the taste of food when it is within the mouth cavity.

According to Aristotle there is another counterbalance, as he states that ‘as the colors are made from the mixture of white and black so the juices are made from the sweet and the bitter. Thus the fatty is the juice of the sweet and the salty and the bitter is almost the same juice and the harsh and tart and the sour and the sharp juice are juices in-between.

The term ‘hedone’ is a Greek word for pleasure. In mythology Hedone was a minor goddess daughter of Eros and Psyche. It was also a philosophical concept for the Epicurean school, the hedonism. The term ‘tasty’ characterizes the property of a food to irritate the taste buds of the tongue and to create a nervous stimulation of pleasure (hedone). Upon this concept some wheels of hedonic responses were created. The hedonic disk of olive oil was presented where it appears that in the centre there are some basic hedonic responses, which are then split to more particular responses. The hedonic disk of wine is more analytical and with more divisions more splitting and more colors.

Another issue is the challenge of taste complexity; in the beginning of the 20th century Bampis Anninos lays satiric criticism on the meals of the bourgeois of his era in the book called ‘the compendium of the stomach’. An extract of his book reads ‘they disrupt the culinary regime in each case and the fantasies of the eccentrics. For, if in antiquity the neuropathic Cleopatra dissolved in acid and drunk the precious pearls other prodigals were found in modern times that ate omelets sprinkled with dust of precious stones to show-off’.

Finally some quotes of ancient scholars about taste were presented, some ancient cooking devices were explained, along with an attempt to capture something intangible – the taste of our ancestors. In this study ten recipes were chosen from various time periods, each recipe was rated with a score and results were put on a table showing intensity per period.