Generative AI in Medical Practice: In-Depth Exploration of Privacy and Security Challenges.

As advances in artificial intelligence (AI) continue to transform and revolutionize the field of medicine, understanding the potential uses of generative AI in health care becomes increasingly important. Generative AI, including models such as generative adversarial networks and large language models, shows promise in transforming medical diagnostics, research, treatment planning, and patient care. However, these data-intensive systems pose new threats to protected health information. This Viewpoint paper aims to explore various categories of generative AI in health care, including medical diagnostics, drug discovery, virtual health assistants, medical research, and clinical decision support, while identifying security and privacy threats within each phase of the life cycle of such systems (ie, data collection, model development, and implementation phases). The objectives of this study were to analyze the current state of generative AI in health care, identify opportunities and privacy and security challenges posed by integrating these technologies into existing health care infrastructure, and propose strategies for mitigating security and privacy risks. This study highlights the importance of addressing the security and privacy threats associated with generative AI in health care to ensure the safe and effective use of these systems. The findings of this study can inform the development of future generative AI systems in health care and help health care organizations better understand the potential benefits and risks associated with these systems. By examining the use cases and benefits of generative AI across diverse domains within health care, this paper contributes to theoretical discussions surrounding AI ethics, security vulnerabilities, and data privacy regulations. In addition, this study provides practical insights for stakeholders looking to adopt generative AI solutions within their organizations.

The Pharmacological Potential of Resveratrol in Reducing Soft Tissue Damage in Osteoarthritis Patients.

Osteoarthritis is a degenerative joint disease that causes the cartilage and bone underneath the joint to break down. This causes pain and stiffness. Resveratrol, a polyphenolic compound found in various vegetables, fruits, and red wine, has been studied for its beneficial effects on osteoarthritis. Resveratrol has been shown to target a variety of pathways, including the NF-κB, PI3K/Akt, MAPK/ERK, and AMPK pathways. In particular, resveratrol has been studied for its potential use in treating osteoarthritis, and it has been shown to reduce inflammation, reduce cartilage degradation, and improve joint function. In this review, we discuss the evidence for the pharmacological use of resveratrol in minimizing soft tissue damage associated with osteoarthritis. We summarize the studies on how resveratrol has anti-inflammatory, anti-oxidant, and anti-apoptotic effects, as well as effects on cartilage degradation, osteoblast and synoviocyte proliferation, and cytokine production. We also discuss the possible mechanisms of action of resveratrol in osteoarthritis and its potential as a therapeutic agent. Finally, we discuss the potential risks and adverse effects of long-term resveratrol supplementation. Overall, resveratrol has been found to be a possible treatment for osteoarthritis because of its anti-inflammatory, anti-oxidant, and anti-apoptotic properties, and its ability to control the production of enzymes that break down cartilage, osteoblasts, and synoviocytes. Although numerous clinical studies have demonstrated resveratrol's efficacy as an osteoarthritis management agent, further long-term studies are needed to better understand the safety and potential benefits of using resveratrol for osteoarthritis management.

Research Update on the Therapeutic Potential of Garden Cress (Lepidium sativum Linn.) with Threatened Status.

Garden cress (Lepidium sativum) has been used in India for medicinal purposes since the Vedic era. Garden cress, a native of Egypt and southwest Asia, is a small perennial edible herb that has been used to treat many diseases for centuries. The seeds, leaves as well as roots have medicinal properties. The seeds are rich in protein, fat, calcium, and iron and have high nutritional value. They are considered to be galactagogue, anticarcinogenic, antidiabetic, antiasthmatic and antidiarrheal. Leaves, seeds, and aerial parts extracts are found to have alkaloids, flavonoids, glycosides, polypeptides, vitamins, minerals, proteins, fats, and carbohydrates. Lepidium sativum is known for its pungent odor due to the several volatile oils and has been used to treat various conditions, including respiratory disorders, muscle pain, inflammation, and bone fractures in the past. Lepidium sativum is a fast-growing annual herb; in India, it is commonly known as Chandrasoor. Whole fruits or seeds are used, fresh or dried, as a seasoning with a peppery flavor. Boiled seeds are consumed in drinks by Arabs, either ground in honey or as an infusion in hot milk. The seed oil can be used for illumination and soap making. Additionally, limited awareness and conservation efforts have further contributed to its threatened status. Recognizing the importance of preserving this valuable plant species is crucial for maintaining biodiversity and ensuring its availability for future generations. Furthermore, this review explores the potential benefits of Lepidium sativum in different domains. Its nutritional value and health benefits make it a promising candidate for addressing malnutrition and improving overall well-being. The presence of bioactive compounds suggests its potential use in functional foods, pharmaceuticals, and natural medicines for various ailments. Moreover, Lepidium sativum exhibits antimicrobial and insecticidal properties, offering potential applications in agriculture and pest control. The current review discussed the nutritional, potential benefits and pharmacological effects of Lepidium sativum.

Views of IRB members regarding phase 1 pediatric oncology trials.

There is significant debate over whether phase 1 pediatric oncology trials are ethical and approvable. We thus surveyed IRB members to answer four questions. First, do IRB members think the potential medical benefits of average phase 1 pediatric oncology trials justify the risks? Second, do they think these trials are ethically appropriate? Third, do they think these trials are approvable? Fourth, how do the views of IRB members on the first two questions compare to the views of the US public? Of the 80 respondents who answered the test questions correctly, 18.8% stated that the potential medical benefits of average phase 1 pediatric oncology trials outweigh the risks, 32.5% stated that the potential medical benefits and risks are about equal, and 48.8% stated that the risks outweigh the potential medical benefits. Compared to the general public, IRB members were significantly more likely to think the risks outweigh the potential medical benefits (p = 0.01). Finally, 68.8% of IRB members indicated that average phase 1 pediatric oncology trials are approvable, and 56.3% indicated that these trials are appropriate in children. These findings suggest two-thirds of IRB members believe average phase 1 pediatric oncology trials are approvable. Yet, almost half regard the risks as outweighing the potential medical benefits and almost half think these trials are inappropriate. These findings raise important questions regarding why IRB members and the general public evaluate the same risk/benefit profile differently, and whether it is possible to reconcile the two perspectives.

A mini-review on the impact of common gorse in its introduced ranges.

It is indisputable that invasive plant species strongly impact the ecosystems they invade. Many of such impacts can be negative and threaten the local species through competition, environmental change, or habitat loss. However, introduced plants may also have positive roles in the ecosystems they invade. This review extracted information from reports on common gorse (Ulex europaeus), one of the top 100 invasive plants on the earth, including its detrimental effects and potential beneficial roles in invaded ecosystems. The reduction of native fauna and flora are the main harmful effects of common gorse identified by the literature review. Soil impoverishment and fire hazards are other negative impacts reported for common gorse that could affect agricultural systems and local economies. Despite the negative impacts, reports of positive ecological services provided by common gorse also exist, e.g., as a nursery plant or habitat for endangered native animals. We also reviewed the known human uses of this plant that could support management strategies through harvest and benefit the local communities, including its use as biofuel, raw matter for xylan extraction, medicine, and food. Finally, our review identified the gaps in the literature regarding the understanding of the beneficial role of common gorse on native ecosystems and potential human uses, especially in the tropics.

Availability and utilisation pattern of agricultural waste at household level in selected areas of Bangladesh.

The use of organic fertilisers and soil amendments are almost universally recommended for improving the organic matter levels and maintaining soil health, but few studies documenting the actual availability and quality of such materials on smallholder farms are available. We selected a case study of 300 households from northern and southern Bangladesh to assess the types of waste materials available for recycling and their usage patterns at household level and we applied a novel approach to empirically identify household waste as input inefficiency in a production context. Northern districts have highly intensive farming systems whereas southern districts have low intensity farming. The total amount of agricultural waste produced at household level was estimated at 822 kg per month. Cow dung contributed about 65% of the total waste followed by animal feed refusal waste (11%), garbage (7%) and kitchen waste (6%). Most of the farmers utilised cow dung and wastes as organic fertiliser and lesser amounts as cooking fuel. Econometric analysis shows that the number of cattle and small ruminant per holding, total area of cultivated land and family size were significant factors that influence the amount of waste production at household level. Each household can reduce the chemical fertiliser cost by Tk. 1463 (US$ 17.84) per month by using compost prepared from household waste. There were ample opportunities for compost/vermicomposting and potential markets. The Department of Agricultural Extension from the public sector and private sector agents might motivate farmers to harvest the potential benefits of agricultural waste through effective management and utilisation.

[Influence of PM2.5 Pollution on Health Burden and Economic Loss in China].

Research on health and the economic losses caused by PM2.5 pollution nationwide is critical for pollution control planning. First, the spatiotemporal distribution of PM2.5 and exposure levels were simulated and analyzed using the air quality model (WRF-Chem) in China in 2016. Then, the health burden and economic loss caused by PM2.5 pollution were estimated using environmental health risk and environmental value assessment methods. Finally, the health and economic benefits from achieving specific PM2.5 control targets were estimated. In 2016 in China, high levels of PM2.5 were concentrated in Beijing-Tianjin-Hebei and the surrounding areas, the Yangtze River Delta, the Sichuan Basin, and the desert areas in northwest China. Furthermore, 71.49% of the total population of China was exposed to an environment with PM2.5 concentrations higher than 35 µg·m-3. Subsequently, the national PM2.5-related mortality was 1.06 million, accounting for 10.9% of the total deaths in China. Stroke and ischemic heart disease accounted for approximately 80% of the total PM2.5-related deaths caused by the five diseases studied. Meanwhile, the PM2.5 pollution resulted in economic losses of 705.93 billion yuan, which was 0.95% of the Gross Domestic Product (GDP) in 2016. There were significant spatial differences in the health burden and economic loss, which primarily occurred in regions with high PM2.5 levels or population density. Moreover, reducing PM2.5 to 35 µg·m-3 would only result in a 17.11% reduction in the health burden and economic loss, while a more exacting standard (reducing PM2.5 to 10 µg·m-3) would bring 80.47% of the health and economic benefits. It is suggested that environmental managers further strengthen their control to better protect the health and wealth benefits of residents, especially for sensitive groups, such as patients with cardio-cerebrovascular diseases, particularly in areas with high premature mortality.

Deceased donor kidney transplant in a 70-year-old Jehovah's Witness patient: to transplant or not to transplant-a case report.

While Jehovah's Witness (JW) patients refuse transfusions of blood or blood products, they are willing to accept renal allograft transplantation. We describe here a case of what we believe is the oldest (a 70-year-old) JW candidate to undergo a deceased donor kidney transplant reported in the literature. Prior to transplantation, discussions ensued amongst the multidisciplinary transplant team, weighing the potential benefits vs. risks of performing a kidney transplant on this patient due to her refusal (due to religion) to accept any blood transfusions or blood products combined with her advanced age and having longstanding insulin-dependent, type 2 diabetes mellitus with extensive peripheral vascular disease. Preoperatively, we believed that the odds were in favor of performing the kidney transplant safely without the need for any blood product usage. However, her post-operative course was complicated by severe anemia, which developed by post-transplant day 4. The anemia incapacitated the patient's physical and psychological state, creating medical, social and financial burdens on the patient, family, medical team and hospital. Both family and patient grew concerned about her overall condition. Blood transfusion was offered in order to improve her weakness and shortness of breath that developed due to the severe anemia, but the patient (along with her family) refused such treatment. During the 17 days of hospitalization, it was a continuous struggle between the transplant team, patient, and family for her to continue with the recovery process; at times we had even considered that performing the transplant had been a mistake. While organ transplantation can be performed safely in Jehovah's Witnesses, there are multiple factors seen in this particular case that warrant analyzing: (I) the potential use of stricter transplant exclusionary criteria, given the recipient's advanced age and preexisting co-morbidities, which likely increased her risk of developing severe anemia post-operatively, and (II) the recipient's emotional/psychological post-operative state of high anxiety, which developed while she was experiencing the severe anemia; in hindsight, her anxiety level may have been reduced if we had offered daily post-operative psychological counseling sessions. While the patient's allograft is currently doing well, we probably did not have strict enough criteria for proper selection of a JW candidate for kidney transplantation.

Actividad física en adultos: recomendaciones: determinantes y medición / Physical activity in adults: recommendations: determinants and measurement

RESUMEN Introducción: Diversos estudios a través del tiempo han demostrado los potenciales beneficios de la práctica de la Actividad Física (AF); sin embargo, también se han identificado algunos de sus moduladores conocidos como determinantes que modifican su práctica. Objetivo: Recopilar y resumir la información disponible sobre la importancia de la actividad física, su definición, determinantes y métodos de evaluación en adultos, así como establecer el desarrollo de las recomendaciones a lo largo del tiempo. Material y Métodos: Se realizó una búsqueda en bases de datos entre el período comprendido entre 1996 y 2019, con términos de búsqueda en inglés y español de actividad física, recomendaciones, determinantes. Se incluyeron artículos relacionados con adultos y se excluyeron aquellos sobre niños y adolescentes. Desarrollo: Las recomendaciones han evolucionado desde 1978 del Colegio Americano de Medicina Deportiva (ACSM) con unas especificaciones muy generales como prácticas AF de 3 a 5 días por semana con una intensidad de 60 por ciento al 90 por ciento de la Frecuencia Cardíaca de Reserva (FCR) hasta las más recientes recomendaciones de 2018 realizadas por el Centro para el Control y la Prevención de Enfermedades (CDC). Dentro de los métodos de evaluación se encuentra criterio, objetivos y subjetivos. Conclusiones: La práctica regular de AF es una estrategia eficiente para disminuir los factores de riesgo asociados con Enfermedades No Transmisibles (ENT). Asimismo, se identifican métodos criterio, objetivos y subjetivos para su evaluación; las recomendaciones han evolucionado desde 1978 hasta 2018, y establecen que los adultos deberán practicar entre 150 a 300 minutos/semana de AF(AU)

ABSTRACT Introduction: Several studies have shown the potential benefits of the practice of Physical Activity (PA) over the years; however, some modulators known as determinants that modify its practice have also been identified. Objective: To gather and summarize available information on the importance of physical activity, its definition, determinants and evaluation methods in adults, as well as to establish the development of recommendations over time. Material and Methods: A search was made in different databases using search terms of physical activity, recommendations, and determinants in both English and Spanish during the period between 1996 and 2019. Articles related to adults were included and those about children and adolescents were excluded. Development: The recommendations have evolved from 1978 when the American College of Sports Medicine (ACSM) established very general specifications such as PA practices from 3 to 5 days per week at an intensity between 60 percent and 90 percent Heart Rate Reserve (HRR) until the most recent recommendations made by the Center for Disease Control and Prevention (CDC) in 2018. Objective and subjective criteria are among the evaluation methods. Conclusions: Regular PA practice is an efficient strategy to reduce the risk factors associated with Non-Communicable Diseases (NCDs). Likewise, subjective and objective criteria are identified for its evaluation. The recommendations have evolved from 1978 to 2018 establishing that adults should be involved in PA from 150 to 300 minutes per week(AU)

A five-day inpatient EMDR treatment programme for PTSD: pilot study.

Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout. Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD. Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated. Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen's d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred. Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials - with longer follow up periods - are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.

Planteamiento: Se ha demostrado que las psicoterapias centradas en el trauma para el TEPT son eficaces, pero también tienen tasas considerables de falta de respuesta y abandono. El tratamiento intensivo puede llevar a una reducción más rápida de los síntomas, lo que puede contribuir a la motivación para el tratamiento y, por lo tanto, a la reducción del abandono. Objetivo: El objetivo del presente estudio fue investigar la viabilidad y eficacia preliminar de un tratamiento intensivo de 5 días para pacientes hospitalizados con Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) y yoga basado en el trauma para pacientes con TEPT. Método: Se realizó un estudio piloto no controlado con 12 pacientes adultos con TEPT. Al inicio del estudio, se evaluó el diagnóstico de TEPT con el CAPS-5 y los trastornos comórbidos con el MINI. El resultado principal fue la gravedad de los síntomas de PTSD por medio de autoinforme (PCL-5) medida al comienzo del día 1 (T1), al final del día 5 (T2) y en el seguimiento el día 21 (T3). Se calcularon los índices de cambio fiable (RCI, por sus siglas en inglés) y los cambios clínicamente significativos. Resultados: De T1 a T3, los síntomas de TEPT mejoraron significativamente con un tamaño de efecto grande (d de Cohen = 0,91) y 9 de los 11 pacientes que completaron el tratamiento mostraron cambios fiables en términos de auto-informes de TEPT. En T3, dos de los pacientes ya no cumplían los criterios para el trastorno de estrés postraumático medido con el PCL-5. Un paciente se retiró después del primer día. No se produjeron eventos adversos graves. Conclusiones: la mayoría de los pacientes en nuestro estudio piloto experimentaron una reducción de síntomas consistente con cambios fiables en este tratamiento de 5 días con EMDR y yoga. Se necesitan ensayos controlados aleatorios, con períodos de seguimiento más largos, para determinar adecuadamente la eficacia y la eficiencia de los tratamientos clínicos intensivos para el TEPT en comparación con el tratamiento habitual. Este es uno de los primeros estudios que demuestra que el tratamiento intensivo con EMDR es factible y es indicativo de una mejora fiable en los síntomas de TEPT después de un período de tiempo muy corto.

[Evidence-based trauma and orthopedic surgery : 20 years after Sackett]. / Evidenzbasierte Unfallchirurgie und Orthopädie : Zwanzig Jahre nach Sackett.

The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. Sackett, one of the leaders of the movement, requested all experts to voluntarily abandon their position to make way for young researchers and fresh ideas. Since the term was first coined and the establishment of organizations and platforms fostering the idea, EbM has polarized clinicians and scientists around the world. Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.

Os benefícios eventuais previstos na Loas: o que são e como estão / The benefits provided for in any LOAS: what they are and how they are

O objetivo deste artigo é apresentar o histórico e atual contexto dos benefícios eventuais, instituídos em 1954 pela política previdenciária, como auxílio natalidade e auxílio funeral e ampliados a partir da Loas. Sua regulamentação procede da gestão municipal e estadual da política de assistência social, e esse translado, de uma política para outra, não garantiu a continuidade de concessão desse direito, pois estar legalmente instituído não foi (e não é) suficiente para estar devidamente implementado em todo o país, o que supõe empecilhos econômicos, políticos, sociais, culturais e mesmo pessoais.

The aim of this paper is to present the historical context of current and potential benefits, imposed in 1954 for social security policy, such as birth assistance and funeral assistance and extended from the Loas. Its regulation comes from the municipal and state policy of social assistance and transfer it from one policy to another, didn't ensure the continuity of this entitlement, it was not to be legally established (and isn't) enough to be properly implemented in all the country, which means setbacks economic, political, social, cultural and even personal.