[Supporting medical and nursing activities with AI: recommendations for responsible design and use]. / Unterstützung ärztlicher und pflegerischer Tätigkeit durch KI: Handlungsempfehlungen für eine verantwortbare Gestaltung und Nutzung.

Clinical decision support systems (CDSS) based on artificial intelligence (AI) are complex socio-technical innovations and are increasingly being used in medicine and nursing to improve the overall quality and efficiency of care, while also addressing limited financial and human resources. However, in addition to such intended clinical and organisational effects, far-reaching ethical, social and legal implications of AI-based CDSS on patient care and nursing are to be expected. To date, these normative-social implications have not been sufficiently investigated. The BMBF-funded project DESIREE (DEcision Support In Routine and Emergency HEalth Care: Ethical and Social Implications) has developed recommendations for the responsible design and use of clinical decision support systems. This article focuses primarily on ethical and social aspects of AI-based CDSS that could have a negative impact on patient health. Our recommendations are intended as additions to existing recommendations and are divided into the following action fields with relevance across all stakeholder groups: development, clinical use, information and consent, education and training, and (accompanying) research.

Reimagining health services provision for neglected groups: The "personalization from below" phenomenon.

How can data-driven citizen science activities supporting health research and services provision meet the needs of unrepresented and neglected groups through increased personalization? In this short Perspective, we explore "personalization from below" as a concept designating forms of citizen science-based data altruism that specifically push for and enact a different understanding of both health services and personalization. We develop the argument that such phenomenon taking place outside "institutionalized" health-related practices could make health services provision more inclusive of values that matter to people. We contextualize instances of "personalization from below," discuss related data governance models and alternative public health interventions, and conclude by outlining three key arguments in favor of "personalization from below" and future research avenues.

The ethics of machine learning-based clinical decision support: an analysis through the lens of professionalisation theory.

BACKGROUND: Machine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians' practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians' competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation theory as an analytical lens for investigating how medical action at the micro level and the physician-patient relationship might be affected by the employment of ML_CDSS. MAIN TEXT: Professionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient's concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics. CONCLUSIONS: Using ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient's personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient's concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making.

From self-tracking to self-expertise: The production of self-related knowledge by doing personal science.

This article explores the production and type of knowledge acquired in the course of specific digital self-tracking activities that resemble research and are common among followers of the Quantified Self movement. On the basis of interviews with self-trackers, it is shown that this knowledge can be characterised as a verified and practical self-knowledge, and that science in the form of scientific sources, methods and quality criteria plays a key role in its production. It is argued that this self-related knowledge can be conceptualised as self-expertise, and its production as personal science. The article then discusses the implications for the science-society relationship. In contrast to self-tracking data, so far self-knowledge has hardly caused any resonance in science, although science currently appears open to the insights from single subject (N-of-1) research. As a new mode of public engagement with science, personal science instead mainly leads to an individual self-expertisation.

Integrated assessment of emerging science and technologies as creating learning processes among assessment communities.

Emerging science and technologies are often characterised by complexity, uncertainty and controversy. Regulation and governance of such scientific and technological developments needs to build on knowledge and evidence that reflect this complicated situation. This insight is sometimes formulated as a call for integrated assessment of emerging science and technologies, and such a call is analysed in this article. The article addresses two overall questions. The first is: to what extent are emerging science and technologies currently assessed in an integrated way. The second is: if there appears to be a need for further integration, what should such integration consist in? In the article we briefly outline the pedigree of the term 'integrated assessment' and present a number of interpretations of the concept that are useful for informing current analyses and discussions of integration in assessment. Based on four case studies of assessment of emerging science and technologies, studies of assessment traditions, literature analysis and dialogues with assessment professionals, currently under-developed integration dimensions are identified. It is suggested how these dimensions can be addressed in a practical approach to assessment where representatives of different assessment communities and stakeholders are involved. We call this approach the Trans Domain Technology Evaluation Process (TranSTEP).

A varied pattern of change of the sex differential in survival in the G7 countries.

Over the course of the 20th century the sex differential in life expectancy at birth in the industrialized countries has widened considerably in favour of women. Starting in the early 1970s, the beginning of a reversal in the long-term pattern of this differential has been noted in some high-income countries. This study documents a sustained pattern of narrowing of this measure into the later part of the 1990s for six of the populations that comprise the G7 countries: Canada, France, Germany, Italy, England and Wales (as representative of the United Kingdom) and USA. For Japan, a persistence of widening sex differences in survival is noted. The sex differences in life expectancy are decomposed over roughly three decades (early 1970s to late 1990s) from the point of view of four major cause-of-death categories: circulatory diseases, cancers, accidents/violence/suicide, and 'other' (residual) causes. In the six countries where the sex gap has narrowed, this has resulted primarily from reduced sex differences in circulatory disease mortality, and secondarily from reduced differences in male and female death rates due to accidents, violence and suicide combined. In some of the countries sex differentials in cancer mortality have been converging lately, and this has also contributed to a narrowing of the difference in life expectancy. In Japan, males have been less successful in reducing their survival disadvantage in relation to Japanese women with regard to circulatory disease and cancer; and in the case of accidents/violence/suicide, male death rates increased during the 1990s. These trends explain the divergent pattern of the sex difference in life expectation in Japan as compared with the other G7 nations.

A divergent pattern of the sex difference in life expectancy: Sweden and Japan, early 1970s-late 1990s.

For most of the 20th century the sex gap in life expectancy in the industrialized countries has widened in favor of women. By the early 1980s a reversal in the long-term pattern of this differential had occurred in some countries, where it reached a maximum and thereafter followed a declining trend. Of particular interest to the present investigation is the anomalous experience of Japan, where unlike other high-income countries the female advantage in life expectancy has been expanding. We contrast the case of Japan with that of Sweden, where, like many other high-income nations, the sex differential in longevity has been narrowing in recent years. We observe that in Sweden, until the early 1980s, the sex gap in life expectancy (female-male) exceeded that of Japan; but this situation reversed in subsequent periods, when the Swedish differential narrowed and that of Japan widened. A decomposition analysis indicates that these divergent patterns since 1980 have resulted mainly from larger than expected reductions in male mortality in Sweden due to heart disease and from accidents and violence, lung cancer and "other" cancers. In Japan, death rates for men and women from heart disease--which is a leading cause of death--have tended to decline more or less at the same pace since the early 1980s; and with regard to lung cancer, and "other" neoplasms, male death rates in Japan have been rising while those of women have either declined or risen more slowly. Moreover, during the 1990s, male and female suicide rates rose in Japan, but the rates for men went up faster. Altogether, the net effect of these divergent mortality trends for men and women in Japan underlie much of the observed widening of its sex differential in longevity in recent years.