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      Artificial intelligence manages congenital cataract with individualized prediction and telehealth computing

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      NPJ Digital Medicine
      Nature Publishing Group UK
      Lens diseases, Translational research, Computer science, Health care economics

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          Abstract

          A challenge of chronic diseases that remains to be solved is how to liberate patients and medical resources from the burdens of long-term monitoring and periodic visits. Precise management based on artificial intelligence (AI) holds great promise; however, a clinical application that fully integrates prediction and telehealth computing has not been achieved, and further efforts are required to validate its real-world benefits. Taking congenital cataract as a representative, we used Bayesian and deep-learning algorithms to create CC-Guardian, an AI agent that incorporates individualized prediction and scheduling, and intelligent telehealth follow-up computing. Our agent exhibits high sensitivity and specificity in both internal and multi-resource validation. We integrate our agent with a web-based smartphone app and prototype a prediction-telehealth cloud platform to support our intelligent follow-up system. We then conduct a retrospective self-controlled test validating that our system not only accurately detects and addresses complications at earlier stages, but also reduces the socioeconomic burdens compared to conventional methods. This study represents a pioneering step in applying AI to achieve real medical benefits and demonstrates a novel strategy for the effective management of chronic diseases.

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          Factors affecting therapeutic compliance: A review from the patient’s perspective

          Objective To explore and evaluate the most common factors causing therapeutic non-compliance. Methods A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.
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            Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China

            Background China, like other countries, is facing a growing burden of chronic disease but the prevalence of multimorbidity and implications for the healthcare system have been little researched. We examined the epidemiology of multimorbidity in southern China in a large representative sample. The effects of multimorbidity and other factors on usual source of healthcare were also examined. Methods We conducted a large cross-sectional survey among approximately 5% (N = 162,464) of the resident population in three prefectures in Guangdong province, southern China in 2011. A multistage, stratified random sampling was adopted. The study population had many similar characteristics to the national census population. Interviewer-administered questionnaires were used to collect self-report data on demographics, socio-economics, lifestyles, healthcare use, and health characteristics from paper-based medical reports. Results More than one in ten of the total study population (11.1%, 95% confidence interval (CI) 10.6 to 11.6) had two or more chronic conditions from a selection of 40 morbidities. The prevalence of multimorbidity increased with age (adjusted odds ratio (aOR) = 1.36, 95% CI 1.35 to 1.38 per five years). Female gender (aOR = 1.70, 95% CI 1.64 to 1.76), low education (aOR = 1.26, 95% CI 1.23 to 1.29), lack of medical insurance (aOR = 1.79, 95% CI 1.71 to 1.89), and unhealthy lifestyle behaviours were independent predictors of multimorbidity. Multimorbidity was associated with the regular use of secondary outpatient care in preference to primary care. Conclusions Multimorbidity is now common in China. The reported preferential use of secondary care over primary care by patients with multimorbidity has many major implications. There is an urgent need to further develop a strong and equitable primary care system. Electronic supplementary material The online version of this article (doi:10.1186/s12916-014-0188-0) contains supplementary material, which is available to authorized users.
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              Critical pathogenic events underlying progression of neurodegeneration in glaucoma.

              Glaucoma is a common optic neuropathy with a complex etiology often linked to sensitivity to intraocular pressure. Though the precise mechanisms that mediate or transduce this sensitivity are not clear, the axon of the retinal ganglion cell appears to be vulnerable to disease-relevant stressors early in progression. One reason may be because the axon is generally thin for both its unmyelinated and myelinated segment and much longer than the thicker unmyelinated axons of other excitatory retinal neurons. This difference may predispose the axon to metabolic and oxidative injury, especially at distal sites where pre-synaptic terminals form connections in the brain. This idea is consistent with observations of early loss of anterograde transport at central targets and other signs of distal axonopathy that accompany physiological indicators of progression. Outright degeneration of the optic projection ensues after a critical period and, at least in animal models, is highly sensitive to cumulative exposure to elevated pressure in the eye. Stress emanating from the optic nerve head can induce not only distal axonopathy with aspects of dying back neuropathy, but also Wallerian degeneration of the optic nerve and tract and a proximal program involving synaptic and dendritic pruning in the retina. Balance between progressive and acute mechanisms likely varies with the level of stress placed on the unmyelinated axon as it traverses the nerve head, with more acute insult pushing the system toward quicker disassembly. A constellation of signaling factors likely contribute to the transduction of stress to the axon, so that degenerative events along the length of the optic projection progress in retinotopic fashion. This pattern leads to well-defined sectors of functional depletion, even at distal-most sites in the pathway. While ganglion cell somatic drop-out is later in progression, some evidence suggests that synaptic and dendritic pruning in the retina may be a more dynamic process. Structural persistence both in the retina and in central projection sites offers the possibility that intrinsic self-repair pathways counter pathogenic mechanisms to delay as long as possible outright loss of tissue. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                gddlht@aliyun.com
                Journal
                NPJ Digit Med
                NPJ Digit Med
                NPJ Digital Medicine
                Nature Publishing Group UK (London )
                2398-6352
                28 August 2020
                28 August 2020
                2020
                : 3
                : 112
                Affiliations
                [1 ]GRID grid.12981.33, ISNI 0000 0001 2360 039X, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, , Sun Yat-sen University, ; Guangzhou, China
                [2 ]GRID grid.440736.2, ISNI 0000 0001 0707 115X, School of Computer Science and Technology, , Xidian University, ; Xi’an, China
                [3 ]GRID grid.440736.2, ISNI 0000 0001 0707 115X, School of Software, , Xidian University, ; Xi’an, China
                [4 ]GRID grid.464492.9, School of Electronics Engineering, , Xi’an University of Posts and Telecommunications, ; Xi’an, China
                [5 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Department of Molecular and Cellular Pharmacology, , University of Miami Miller School of Medicine, ; Miami, Florida USA
                [6 ]GRID grid.263488.3, ISNI 0000 0001 0472 9649, Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, , Shenzhen University School of Medicine, ; Shenzhen, China
                [7 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Beijing Tongren Eye Center, Beijing Tongren Hospital, , Capital Medical University, ; Beijing, China
                [8 ]GRID grid.410652.4, ISNI 0000 0004 6003 7358, Department of Ophthalmology, , People’s Hospital of Guangxi Zhuang Autonomous Region, ; Nanning, Guangxi China
                [9 ]GRID grid.412558.f, ISNI 0000 0004 1762 1794, Department of Ophthalmology, , The Third Affiliated Hospital of Sun Yat-Sen University, ; Guangzhou, China
                [10 ]GRID grid.284723.8, ISNI 0000 0000 8877 7471, Puning People’s Hospital, , Southern Medical University, ; Jieyang, China
                [11 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Ophthalmology, The Central Hospital of Wuhan, Tongji Medical College, , Huazhong University of Science and Technology, ; Wuhan, China
                [12 ]GRID grid.461579.8, The First Affiliated Hospital of University of South China, ; Hengyang, China
                [13 ]GRID grid.12981.33, ISNI 0000 0001 2360 039X, School of Data and Computer Science, , Sun Yat-sen University, ; Guangzhou, 510060 China
                Author information
                http://orcid.org/0000-0001-7070-5768
                http://orcid.org/0000-0003-4672-9721
                Article
                319
                10.1038/s41746-020-00319-x
                7455726
                32904507
                fe01c26b-d79a-436f-b2ab-73b928eb50f5
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 17 December 2019
                : 12 August 2020
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                © The Author(s) 2020

                lens diseases,translational research,computer science,health care economics

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