A Review of Artificial Intelligence and Robotics in Transformed Health Ecosystems.

Health care is shifting toward become proactive according to the concept of P5 medicine-a predictive, personalized, preventive, participatory and precision discipline. This patient-centered care heavily leverages the latest technologies of artificial intelligence (AI) and robotics that support diagnosis, decision making and treatment. In this paper, we present the role of AI and robotic systems in this evolution, including example use cases. We categorize systems along multiple dimensions such as the type of system, the degree of autonomy, the care setting where the systems are applied, and the application area. These technologies have already achieved notable results in the prediction of sepsis or cardiovascular risk, the monitoring of vital parameters in intensive care units, or in the form of home care robots. Still, while much research is conducted around AI and robotics in health care, adoption in real world care settings is still limited. To remove adoption barriers, we need to address issues such as safety, security, privacy and ethical principles; detect and eliminate bias that could result in harmful or unfair clinical decisions; and build trust in and societal acceptance of AI.

Effect of conspecific and heterospecific urine odors on the foraging behavior of the golden spiny mouse.

The common spiny mouse (Acomys cahirinus) inhibits the foraging activity of the golden spiny mouse (A. russatus). These two sympatric species of spiny mice, which are considered habitat competitors, occur in extreme arid environments. To test this theory of competition, the influence of urinary odors of both conspecific and heterospecific mice on the foraging behavior of A. russatus was studied under controlled laboratory conditions. Twenty adult males, born in captivity and unfamiliar to the odors of the donor mice, were tested in 3 experimental conditions choosing between 2 seed patches that were scented with urine of either heterospecifics (A. cahirinus), conspecifics (A. russatus) or controls (odors of the tested individual). Of the 20 males, 12 were also tested with urine of unfamiliar gerbils, bushy-tailed jird, considered as competitors in the field. Both conspecific and heterospecific urine samples from Acomys significantly reduced foraging behavior of A. russatus when compared to the control odor. The inhibitory effect of the Acomys urine does not result from the novelty of chemical stimuli of the urine because no effect was shown with unfamiliar gerbil urine. The findings are in accordance with the general theory that A. cahirinus dominates the foraging activity of A. russatus. We hypothesize that chemical cues in the urine of Acomys spp. might induce a negative effect on the foraging behavior of A. russatus.

Does hormone replacement therapy prevent lateral rotatory spondylolisthesis in postmenopausal women?

PURPOSE: Degenerative scoliosis usually begins at menopause and lateral rotatory olisthesis (LRO) might be a triggering factor in the onset of degenerative scoliosis in postmenopausal women. We set out to evaluate the influence of hormone replacement therapy (HRT) on degenerative scoliosis and on LRO. METHODS: A cross-sectional study was conducted in 146 postmenopausal women: 75 women had received HRT for more than 1 year (HRT > 1) and 71 women had never received HRT or less than 1 year (HRT < 1). Scoliotic curve, LRO, sacral slope, lordosis, kyphosis were measured. The excess risk of LRO associated with age, BMI, isometric strength of brachial biceps, bone mineral density, lean mass and HRT was evaluated using a multiple logistic regression model. RESULTS: No difference was found in sacral slope, lumbar lordosis or thoracic kyphosis between both groups or in the presence of scoliosis. The prevalence of LRO was significantly lower in HRT >1 than HRT <1 (8 vs. 30%) while the risk was dependent on age, HRT and their interaction. LRO increased with age only in HRT <1 (11% when aged ≤66 years vs. 39% when aged >66 years, p = 0.013), whereas the prevalence of LRO remained stable in HRT >1. CONCLUSIONS: LRO was significantly lower in women who received HRT. The excess risk of LRO was dependent on both age and HRT status. These findings suggest that HRT might prevent the onset of LRO, and therefore might contribute to the prevention of low back pain.

Bone changes in spouses having shared lifestyle for 40 years.

OBJECTIVES: Spousal concordance has already been observed for several other diseases but it has not yet been studied for bone loss. Our aim was to determine whether or not bone changes were the same within spouses who have shared the same environment for many decades. METHODS: We conducted a prospective study on an average of 5±3 years in a single center. We evaluated in the 104 spouses who came at least twice and had more than 1 year of follow-up the changes in bone mineral density (BMD) at femoral neck adjusted on weight and height, and on hormone replacement therapy use and duration for women. Lifestyle characteristics and biological parameters were evaluated at baseline. RESULTS: The mean (±SD) baseline age of wives was 63±5 years and that of their husbands was 66±5 years. They had been living together for 40±8 years. Most of the environmental baseline factors were correlated within partners: BMI (r=0.26, P<0.01), 25-OHD(3) (r=0.32, P<0.01), daily calories (r=0.52, P<0.001) and calcium intake (r=0.31, P<0.01), physical activity (r=0.43, P<0.0001). Bone loss was observed in wives (-0.0023 g/cm(2)/yr, P<0.01) but not in their husbands (0.0016 g/cm(2)/yr, P=0.10). Changes of BMD were not correlated within spouses (r=0.0004, P=0.99). In women, 25-OHD(3) and interactions of tobacco with 25-OHD(3) and calories intake explained 37% of the bone loss variance (P<0.01). CONCLUSION: Environmental factors do not appear to influence changes in bone density in the same manner in subjects of different genders.

Cattle discriminate between familiar and unfamiliar conspecifics by using only head visual cues.

Faces have features characteristic of the identity, age and sex of an individual. In the context of social communication and social recognition in various animal species, facial information is relevant for discriminating between familiar and unfamiliar individuals. Here, we present two experiments aimed at testing the ability of cattle (Bos taurus) to visually discriminate between heads (including face views) of familiar and unfamiliar conspecifics represented as 2D images. In the first experiment, we observed the spontaneous behaviour of heifers when images of familiar and unfamiliar conspecifics were simultaneously presented. Our results show that heifers were more attracted towards the image of a familiar conspecific (i.e., it was chosen first, explored more, and given more attention) than towards the image of an unfamiliar one. In the second experiment, the ability to discriminate between images of familiar and unfamiliar conspecifics was tested using a food-rewarded instrumental conditioning procedure. Eight out of the nine heifers succeeded in discriminating between images of familiar and unfamiliar conspecifics and in generalizing on the first trial to a new pair of images of familiar and unfamiliar conspecifics, suggesting a categorization process of familiar versus unfamiliar conspecifics in cattle. Results of the first experiment and the observation of ear postures during the learning process, which was used as an index of the emotional state, provided information on picture processing in cattle and lead us to conclude that images of conspecifics were treated as representations of real individuals.

Comparison of urinary scents of two related mouse species, Mus spicilegus and Mus domesticus.

Whereas the house mouse (Mus domesticus) has been studied extensively in terms of physiology/behavior and pheromonal attributes, the evolutionarily related mound-building mouse (Mus spicilegus) has received attention only recently due to its divergent behavioral traits related to olfaction. To date, no chemical studies on urinary volatile compounds have been performed on M. spicilegus. The rationale for our investigations was to determine if there are differences in urinary volatiles of intact and castrated M. spicilegus males and to explore further whether this species could utilize the same or structurally similar pheromones as the male house mouse, M. domesticus. The use of capillary gas chromatography/mass spectrometry (GC-MS) together with sorptive stir bar extraction sampling enabled quantitative comparisons between the intact and castrated M. spicilegus urinary profiles. Additionally, through GC-MS and atomic emission (sulfur-selective) detection, we identified qualitative molecular differences between intact M. spicilegus and M. domesticus. A series of volatile and odoriferous lactones and the presence of coumarin were the unique features of M. spicilegus, as was the notable absence of 2-sec-butyl-4,5-dihydrothiazole (a prominent M. domesticus male pheromone) and other sulfur-containing compounds. Castration of M. spicilegus males eliminated several substances, including delta-hexalactone and gamma-octalactone, and substantially decreased additional compounds, suggesting their possible role in chemical communication. Some other M. domesticus pheromone components were also found in M. spicilegus urine. These comparative chemical analyses support the notion of metabolic similarities as well as the uniqueness of some volatiles for M. spicilegus, which may have a distinct physiological function in reproduction and behavior.

Individual recognition in domestic cattle (Bos taurus): evidence from 2D-images of heads from different breeds.

BACKGROUND: In order to maintain cohesion of groups, social animals need to process social information efficiently. Visual individual recognition, which is distinguished from mere visual discrimination, has been studied in only few mammalian species. In addition, most previous studies used either a small number of subjects or a few various views as test stimuli. Dairy cattle, as a domestic species allow the testing of a good sample size and provide a large variety of test stimuli due to the morphological diversity of breeds. Hence cattle are a suitable model for studying individual visual recognition. This study demonstrates that cattle display visual individual recognition and shows the effect of both familiarity and coat diversity in discrimination. METHODOLOGY/PRINCIPAL FINDINGS: We tested whether 8 Prim'Holstein heifers could recognize 2D-images of heads of one cow (face, profiles, (3/4) views) from those of other cows. Experiments were based on a simultaneous discrimination paradigm through instrumental conditioning using food rewards. In Experiment 1, all images represented familiar cows (belonging to the same social group) from the Prim'Holstein breed. In Experiments 2, 3 and 4, images were from unfamiliar (unknown) individuals either from the same breed or other breeds. All heifers displayed individual recognition of familiar and unfamiliar individuals from their own breed. Subjects reached criterion sooner when recognizing a familiar individual than when recognizing an unfamiliar one (Exp 1: 3.1+/-0.7 vs. Exp 2: 5.2+/-1.2 sessions; Z = 1.99, N = 8, P = 0.046). In addition almost all subjects recognized unknown individuals from different breeds, however with greater difficulty. CONCLUSIONS/SIGNIFICANCE: Our results demonstrated that cattle have efficient individual recognition based on categorization capacities. Social familiarity improved their performance. The recognition of individuals with very different coat characteristics from the subjects was the most difficult task. These results call for studies exploring the mechanisms involved in face recognition allowing interspecies comparisons, including humans.

Visual discrimination by heifers (Bos taurus) of their own species.

Species discrimination has been described in several taxa but rarely in domestic animals. In contrast to wild species, domestic species present a great phenotypic variety. This study investigated whether 10 Prim'Holstein heifers (Bos taurus) could discriminate images of cows from images of other domestic animals. The experiment was based on simultaneous discrimination. Responses were obtained through instrumental conditioning using a food reward. In Experiment 1, the reward was associated with a cow face and, in the reversal learning task, with faces of other domestic species. The results showed that in both tasks, cows were able to reach the criterion in few sessions. Therefore, despite great phenotypic variety (a cognitive challenge) cows were able to visually discriminate their own species from other domestic species.

Preferences of newborn mice for odours indicating closer genetic relatedness: is experience necessary?

Evidence from studies with adult rodents indicates that individual recognition enables distinctions between familiar individuals irrespective of relatedness (but including close kin) and a separate mechanism enables discriminations based on genetic relatedness without prior familiarity. For example, adult mice could assess the extent of their genetic relatedness to unfamiliar individuals using perceptual similarities between their individual odours. The ontogeny of this genetic relatedness assessment mechanism, however, had not been investigated. Here, in two-choice tests, newborn mice differentially preferred odours of more genetically similar lactating females (paternal aunts to unrelated conspecific and conspecific to heterospecific) even without prior direct exposure to adults with the tested genotypes. The results provide a direct demonstration of genetic relatedness assessment abilities in newborns and show that experience with parental odours is not necessary for genetic relatedness distinctions. Future studies will be necessary to determine whether exposure to odours of other foetuses in the womb or littermates shortly after birth affects this genetic relatedness assessment process.

Severe osteopenia in CFTR-null mice.

Osteoporosis is a common complication in cystic fibrosis (CF) patients. In this study, we performed a histomorphometric analysis of the bones of a mouse genetic model of human CF in which both copies of the cystic fibrosis transmembrane conductance regulator (CFTR) gene are inactivated. We find that, even in the absence of obvious nutritional and therapeutic differences, the CFTR mutation is associated with severe osteopenia. Bone mineral density (BMD) of total body and of individual bones is significantly diminished. CFTR mutants display a striking significant (50%) reduction of cortical bone width and thinner trabeculae. Analysis of dynamic parameters indicates a significant reduction of bone formation and a concomitant strong increase in bone resorption. Active osteoclasts where found mostly associated with cortical bone. Our data support the concept that CF-associated osteoporosis is part of the syndromic symptoms associated with the CFTR mutation.

Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients.

BACKGROUND: End-stage renal disease is often associated with altered bone metabolism. METHODS: In order to investigate the determinant factors of bone mineral density (BMD) and the risk factors of fractures, we studied 70 patients; 26 women (23 post-menopausal) and 44 men, (mean+/-SD) aged 60.5+/-14.3 years, treated by standard haemodialysis (HD) for 6.4+/-6.8 years. Main circulating bone biochemical markers were assessed and BMD was measured with a Lunar DPX densitometer at five sites. BMD results are expressed as a function of age and gender (Z-score). RESULTS: Mean Z-score was markedly decreased at the mid-radius (-2.75+/-1.23) whereas it was normal at the femoral neck (-0.42+/-1.13) and lumbar spine (0.02+/-2.13), and total body (-0.62+/-1.53). Time on HD was negatively correlated to the Z-score at the mid-radius and total body but not at the other sites. Serum intact parathyroid hormone (iPTH), whole PTH or cyclase activating PTH (CAP) and bone-specific alkaline phosphatase concentrations were negatively correlated with Z-scores at all sites. Twenty-one out of 70 patients had sustained a total of 27 fractures since the beginning of dialysis therapy (seven ribs, seven ankles, six vertebrae, three humerus, two wrists and two hips). They had a total body Z-score significantly lower than that of patients without fractures, -1.34+/-1.54 vs -0.37+/-1.46, respectively (P<0.031); however, their Z-scores at the other sites were not different. They were on HD for longer time, 10.4+/-9.5 vs 5.0+/-5.1, respectively (P<0.003), and the relative risk of skeletal fractures was 6.4 times greater after 10 years of HD. The seven patients with rib fractures had a decreased Z-score at most of the sites but not at the mid-radius. Rib fractures but no other fractures were associated with markedly decreased body weight, fat mass and serum leptin levels. CONCLUSIONS: In conclusion, the Z-score at the mid-radius was decreased in HD patients and correlated with high serum PTH but not with fractures. Bone fractures were associated with the time passed on HD and with a low total body Z-score. Rib fractures were frequent and associated with a poor nutritional state.

Estradiol and raloxifene decrease the formation of multinucleate cells in human bone marrow cultures.

Estrogen (E2) deficiency is responsible for increased bone turnover in the postmenopausal period, and it can be prevented by estrogen replacement therapy. The way estrogen acts on bone cells is not fully understood. Human bone marrow cell cultures may be a reliable model for studying the action of steroids on osteoclastogenesis in vitro. We examine the effects of estradiol and Raloxifene, a selective estrogen receptor modulator, on human primary bone marrow cells cultured for 15 days. 17beta-estradiol and Raloxifene significantly decreased the number of tartrate-resistant acid phosphatase multinucleate cells from osteoclast precursors on day 15. Estrogen receptor alpha (ER-alpha) mRNA was present in bone marrow mononuclear cells cultured for 5 days, but there was no estrogen receptor beta (ER-beta) mRNA, suggesting that this effect was mediated by ER-alpha. 15-day cultures no longer contained ER-alpha mRNA, suggesting that estrogen acts on early events of osteoclast differentiation. Finally, 10-8 M 17beta-estradiol has no effect on the release of IL-6 and IL-6-sr into the medium of marrow mononuclear cells cultured for 5 or 15 days. Osteoclast apoptosis was not affected by estradiol or Raloxifene after 15 days of culture under our conditions. In conclusion, we have shown that both estradiol and Raloxifene inhibit osteoclast differentiation in human bone marrow mononuclear cultures. The biological effect that can mimic in vivo differentiation could be mediated through ER-alpha.