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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., (© 2024. The Author(s).)

Similar to clinical practise, population-based studies with a clinical-epidemiological focus include imaging techniques to identify manifest disease and to assess subclinical disease. Even population-based cross-sectional studies offer various options to address scientific questions of great clinical relevance, including analysis of reference values, prevalence estimates and association analysis. Further potential values of imaging techniques in population-based studies concern additional information on incidental diseases and mortality rate, which make it possible to investigate the association between imaging findings at baseline and subsequent disease. Modern population-based designs ensure a high degree of being representative and can be generally applied to clinical practise and, as a result, may be highly relevant to daily clinical routine. When imaging techniques are integrated within population-based research, problems of quality control may have to be solved, all probands must give informed consent and a decision made on what findings have to be given to the participants., (Georg Thieme Verlag KG Stuttgart, New York.)

Blood samples taken by venipuncture in calves within 12 hours after delivery and again in the same animals within 5 to 23 days of postnatal life were analyzed for hematocrit and fifteen other biochemical values. The changes of blood values between these two sampling points in each individual calf were investigated by regression analysis. Remarkable individual reactions and effects of the constitution of the animal immediately after delivery on the level and on the changes of the biochemical values could be observed as well as great deviations of some blood values of twin calves too. The scattering of some blood values and their changes in the first days of postnatal life are discussed regarding the maturity of the calves as well as the possible incidence of deficiency states or the setting of a new level for these physiological values.

In a large dairy cattle herd blood samples taken by venipuncture in newborn calves within 0 to 12 hours after delivery were analysed for hematocrit and fifteen other variables. The time of birth and the time of blood sampling and of first colostrum supply were recorded as well as body weight, sex and breed of the animals. Blood sampling in dairy cows was performed in the course of a herd health programme. The effects of the above-mentioned factors on the blood values of calves were investigated. Comparing the blood values of the pregnant cows with those of their newborn calves led to the result that in calves the measures were higher than (Hkt, Thyroxine), equal to (urea, P, Ca, Zn, Mg, K, Na, TIBC) or below (total protein, albumin, gammaglobulin, cholesterol, coeruloplasmin, Fe, Cu) those of their dams. There was great scattering of the concentrations of Zn, Cu, Mg, Fe, TIBC, total protein, albumin and in hematocrit. Uptake of colostrum caused the concentration of Mg, total protein and gammaglobulin to increase and those of albumin and hematocrit to decrease, leaving the levels of P and blood urea unchanged.

Organ weight and trace element analyses were performed on 75 stillborn calves from the same dairy cow herd. The elements Fe, Mn, Zn and Cu were measured in the livers of 66 of the calves. The calves ranged in age from 259 to 299 days of gestation, and in weight from 18 to 58 kg. Based on the quotients of organ and other body parts, stage of growth of the humerus and age, the animals were grouped as either preterm (P), term but light (TL), and term with appropriate weight (TA) calves. In P group calves the heart, lungs, liver, kidneys, thymus, spleen and thyroid glands were relatively heavy. In the TL group calves the brain, heart, lungs and thyroid glands were relatively heavy whereas the spleen and thymus were comparatively light. The liver Fe and Zn values were lower in this group than in the other 2 groups.

Stillborn calves of a large dairy cattle herd were used for investigations of trace element (Fe, Zn, Cu, Mn) content of the liver and heart muscle. Trace element content varied markedly in the liver and in the heart muscle too but in the heart muscle with a smaller degree. Calves from heifers had a greater trace element content in the liver and heart muscle than those from cows. Premature calves had small amounts of Mn and Cu in their livers and small but term calves had less Fe and Zn in their livers. Single calves from cows had a greater amount of trace elements in the liver and heart muscle than twin calves.

Trace element analyses were performed on the livers of 52 and the heart muscle of 19 stillborn dairy calves. All calves originated from one herd and ranged in age from 260 days of gestation up to one day old. In the liver the trace element concentrations (mg/kg fresh weight) were as follows: Fe: 181.3 +/- 173.5; Zn: 74.6 +/- 37.7; Cu: 98.1 +/- 42.6; Mn: 1.4 +/- 0.36 and in the heart: Fe: 54.1 +/- 10.6; Zn: 16.3 +/- 3.8; Cu: 2.5 +/- 0.99; Mn: 0.42 +/- 0.07. Calves from heifers had lower Cu values. The relationship between trace element concentration and content and liver and heart weight is discussed, as are aspects of bioavailability and storage mechanisms as well as clinical signs of trace metal deficiencies.

Stillborn calves (80 animals) originating from one dairy herd were used for studies on allometric measures in newborn calves. In the first approach some factors were neglected and only the effect of the calves' sex was considered. Differences in mean birthweight between male and female calves were reflected in organ and other body constituent weights too, but with different relations between them. Enlarged thyroid glands could be observed in both sexes but more often in female calves meaning that there is no correlation between thyroid size and body weight. Strong correlations of bones, muscles and outer body measures and looser ones of internal organs (thymus, liver, lung, kidneys, spleen) and endocrine glands (adrenal glands) with body weight were found especially in male calves. In some calves the sometimes enlarged liver looked like a fatty liver with its pale yellowish appearance and crumbly consistency.

Post-mortem examinations were carried out on 65 calves which were stillborn or died within 24 hours of birth. All calves came from a large dairy unit with about one thousand cattle of the Schwarzbuntes Milchrind breed. To evaluate the perinatal losses, the farm records of parturitions from 1985-1990 were used. The calves had gross damage of the CNS, the musculature, subcutaneous tissue and internal organs such as lung and intestines. It may be assumed that a lesser degree of similar damage would also be present in the surviving calves. The level of perinatal losses is determined particularly by deaths following prolonged parturition due to foetal oversize in heifers and young cows, but also by the birth of immature calves of low weight after pregnancy of normal or decreased duration and by twin pregnancies with high total calf mass and relative immaturity of the calves.