XAISec - Explainable AI Security: An Early Discussion Paper on New Multidisciplinary Subfield In Pursuit of Building Trust in Security of AI systems

Today's Artificial Intelligence systems are at the epicenter of security threats across industries. Attackers are trying to turn AI systems against the organization and society, intending to cause harm at various levels. Security, along with the explainability of AI, is a cornerstone for Digital Trust and Trustworthy AI. AI-based systems provide new attack surfaces, and adversaries can utilize attack surfaces to construct attacks to exploit vulnerabilities. Mission-critical systems using AI need to address the crucial problem of AI Security(AISec) and Explainable AI (XAI). In the early version of the discussion paper, we propose the new sub-field of Explainable AI Security (XAISec) at the intersection of AISec, XAI, and Explainable Security (XSec) for Mission-critical systems. We propose that XAISec should aim to explain AI Security's workings (justification of attack and transparency about defense) at an appropriate level considering multiple aspects. XAISec is a niche multidisciplinary greenfield with an ascertained need and validated using informal interview settings. We invite constructive criticism, collaboration, and contribution to jump-start the sub-field. We believe that with XAISec as an integral part of AI, AI can impact millions of lives across the globe, enabling smarter, sustainable, and evolutionary transformations.

Price and reimbursement for orphan medicines and managed entry agreements: does Italy need a framework?

This article illustrates a consensus opinion of an expert panel on the need and usefulness of a framework for price and reimbursement (P&R) process and managed entry agreements (MEAs) for orphan medicines in Italy. This opinion was gathered in three rounds: an introductory document was sent to the panel and discussed during a recorded online meeting. A second document was sent to the panel for their review. In the third step the final document was validated. Members of the expert panel are the authors of the article. The panel agreed that Italy does not need a specific value framework for orphan medicines, driving the P&R process. Rather, a more structured value framework for all medicines tailored to the specific drugs can be useful. For orphan drugs, the panel advocated for a multidisciplinary approach and the contribution of different stakeholders to value assessment, and acknowledged the importance of addressing, more than for other drugs, unmet needs, equity issues and societal value. The panel raised the need of increasing the importance of patient-reported outcomes. Experts, acknowledging the growing criticisms in implementation of outcome-based agreements in Italy, expressed their position against their abandonment in favour of discounts only and supported orphan medicines as natural candidates for these agreements. Finally, the panel made some recommendations on the appraisal process for orphan medicines, including an early discussion on the uncertainty of the evidence generated and the adoption of a structured approach to identify the agreement, which better responds to the uncertainty.

Fiscal Policy in Europe: Controversies over Rules, Mutual Insurance, and Centralization

We discuss the main fiscal policy issues in Europe, focusing on two that are at the core of the current debate. The first is that the government deficit and debt were, from the outset, the key objects of contention in the debate that led to the creation of the Eurozone, and they still are. The second issue is that a currency union implies the loss of a country-specific instrument, a national monetary policy. This puts a higher burden on fiscal policy as a tool to counteract shocks, a burden that might be even heavier now that the European Central Bank has arguably reached the Zero Lower Bound. Two obvious solutions are mutual insurance (or risk-sharing) amongst countries and a centralized stabilization policy. Yet both have been remarkably difficult to come by, especially due to political constraints. We review and discuss the relative merits of several proposals for increased insurance or centralization, or both. We conclude with an early discussion of the implications of the COVID-19 crisis for European fiscal policy reform and an assessment of the current fiscal measures.

Advance Directives and Factors Associated with the Completion in Patients with Heart Failure

Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.

Ti-Punch, ron y sexo: un acercamiento ecofeminista literario al mundo de la plantación

Raphaël Tardon’s 1946 short story «La Rédemption de Barbaroux» was published in the wake of the French departmentalization law that changed the status of Martinique from a colony to a French overseas department. A (Black) feminist approach to ecocriticism used as a lens to study Tardon’s text manifests the twisted ways Plantation and rum production depend on the gendering of the land and the oppression of female bodies. Tardon brings to the fore an early discussion of the concept known nowadays as the plantationocene. He explores the effect of the colonial past and the impact of Plantation world and its logics, framework on the environment, the body, the economy, and social and human relationships. Thus, in 1946, Tardon also lays bare the foundation for what Malcom Ferdinand calls une écologie décoloniale (a decolonial ecology).

The last 48 hours

The last days of life are challenging for both patients and their loved ones. Recognition of the terminal stage of life can allow time for care planning. An early discussion can provide an opportunity for questions. It can be reassuring for patients and families to know that care needs are being carefully considered and met at this important time. The management of physiological changes, psychological distress, and spiritual needs at the end of life can improve quality of care and the quality of death; a ‘good death’ can help the bereavement and wellbeing of those left behind.

COVID-19 and blood groups – there is an elephant in the room, but who cares? Do we need additional rules for preprints?

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) not only can cause very severe disease but, less obviously, the virus can also infect science in unpredicted ways. It seems that during these times some basic rules of science will lose validity and we do not know if they will come back. Though not necessarily always being the case, problems can arise from messages that make their way to public media straight from preprints. An impressive example is a recent study on an association between ABO blood groups and the severity of COVID-19. The study was first published as a preprint which almost immediately gathered an enormous amount of public interest though major drawbacks of the study had been identified by members of the scientific community. One of the major advantages of preprints is to present data, even if still incomplete, to the scientific community for an early discussion. It does not serve the quality of science if possible critical considerations are not addressed adequately until these preliminary studies go public and are submitted for publication in classical journals. Accordingly, clear additional rules for handling data derived from preprints are advocated herein. Speed does not have an advantage on its own.

The “Enormous Freedom of the Breaking Wave”: The Experience of Tradition in Benjamin between the Talmud and Kant

How is freedom tied to tradition? What is the relation between the individual and the collective experience of tradition? To what extent is the experience of tradition part of a modern experience rather than only of an ancient one? This essay argues that these questions lie at the heart of Walter Benjamin’s early discussion of tradition. His peculiar reference to “Talmudic wit” and to Kant as a tradendum in letters to Scholem, alongside related Jewish sources, and his engagement with Kant in “On the Program of the Coming Philosophy” are used to address these questions. Thus the essay offers a concept of tradition as a transformative medium that prefigures Benjamin’s late and familiar inkling for tradition’s revolutionary potential. Additionally, it suggests that in this context an alternative to Kant’s concept of freedom is prefigured.

Valuing Alzheimer's disease drugs: a health technology assessment perspective on outcomes

ObjectivesDue to the nature of Alzheimer's disease (AD), health technology assessment (HTA) agencies might face considerable challenges in choosing appropriate outcomes and outcome measures for drugs that treat the condition. This study sought to understand which outcomes informed previous HTAs, to explore possible reasons for prioritizations, and derive potential implications for future assessments of AD drugs.MethodWe conducted a literature review of studies that analyzed decisions made in HTAs (across disease areas) in three European countries: England, Germany, and The Netherlands. We then conducted case studies of technology assessments conducted for AD drugs in these countries.ResultsOverall, outcomes measured using clinical scales dominated decisions or recommendations about whether to fund AD drugs, or price negotiations. HTA processes did not always allow the inclusion of outcomes relevant to people with AD, their carers, and families. Processes did not include early discussion and agreement on what would constitute appropriate outcome measures and cut-off points for effects.ConclusionsWe conclude that in order to ensure that future AD drugs are valued appropriately and timely, early agreement with various stakeholders about outcomes, outcome measures, and cut-offs is important.