Congenital cataract (CC) is the primary cause of treatable childhood blindness worldwide. The establishment of reliable, epidemiological estimates is an essential first step towards management ...strategies. We undertook an initial systematic review and meta-analysis to estimate the prevalence and other epidemiological characteristics of CC. PubMed, Medline, Web of Science, Embase, and Cochrane Library were searched before January 2015. A meta-analysis with random-effects model based on a proportions approach was performed to determine the population-based prevalence of CC and to describe the data regarding the laterality, morphology, associated comorbidities and etiology. Heterogeneity was analyzed using the meta-regression method, and subgroup analyses were performed. 27 studies were selected from 2,610 references. The pooled prevalence estimate was 4.24 per 10,000 people, making it a rare disease based on WHO standards. Subgroup analyses revealed the highest CC prevalence in Asia, and an increasing prevalence trend through 2000. Other epidemiological characteristics showed CC tended to be bilateral, isolated, hereditary and in total/nuclear morphology. Huge heterogeneity was identified across most estimates (I(2) > 75%). Most of the variations could be explained by sample size, research period and age at diagnosis. The findings provide suggestions for etiology of CC, improvements in screening techniques and development of public health strategies.
Patient adherence to follow-up plays a key role in the medical surveillance of chronic diseases and affects the implementation of clinical research by influencing cost and validity. We previously ...reported a randomized controlled trial (RCT) on short message service (SMS) reminders, which significantly improved follow-up adherence in pediatric cataract treatment.
RCTs published in English that reported the impact of SMS or telephone reminders on increasing or decreasing the follow-up rate (FUR) were selected from Medline, EMBASE, PubMed, and the Cochrane Library through February 2014. The impacts of SMS and telephone reminders on the FUR of patients were systematically evaluated by meta-analysis and bias was assessed.
We identified 13 RCTs reporting on 3276 patients with and 3402 patients without SMS reminders and 8 RCTs reporting on 2666 patients with and 3439 patients without telephone reminders. For the SMS reminders, the majority of the studies (>50%) were at low risk of bias, considering adequate sequence generation, allocation concealment, blinding, evaluation of incomplete outcome data, and lack of selective reporting. For the studies on the telephone reminders, only the evaluation of incomplete outcome data accounted for more than 50% of studies being at low risk of bias. The pooled odds ratio (OR) for the improvement of follow-up adherence in the SMS group compared with the control group was 1.76 (95% CI 1.37, 2.26; P<0.01), and the pooled OR for the improvement of follow-up adherence in the telephone group compared with the control group was 2.09 (95% CI 1.85, 2.36; P<0.01); both sets showed no evidence of publication bias.
SMS and telephone reminders could both significantly improve the FUR. Telephone reminders were more effective but had a higher risk of bias than SMS reminders.
Using artificial intelligence (AI) to prevent and treat diseases is an ultimate goal in computational medicine. Although AI has been developed for screening and assisted decision-making in disease ...prevention and management, it has not yet been validated for systematic application in the clinic. In the context of rare diseases, the main strategy has been to build specialized care centres; however, these centres are scattered and their coverage is insufficient, which leaves a large proportion of rare-disease patients with inadequate care. Here, we show that an AI agent using deep learning, and involving convolutional neural networks for diagnostics, risk stratification and treatment suggestions, accurately diagnoses and provides treatment decisions for congenital cataracts in an in silico test, in a website-based study, in a ‘finding a needle in a haystack’ test and in a multihospital clinical trial. We also show that the AI agent and individual ophthalmologists perform equally well. Moreover, we have integrated the AI agent with a cloud-based platform for multihospital collaboration, designed to improve disease management for the benefit of patients with rare diseases.An artificial intelligence agent integrated with a cloud-based platform for multihospital collaboration performs equally as well as ophthalmologists in the diagnosis of congenital cataracts in a series of online tests and a multihospital clinical trial.
ObjectivesDepression and depressive symptoms are common mental disorders that have a considerable effect on patients’ health-related quality of life and satisfaction with medical care, but the ...prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaThe PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738.ResultsEighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%).ConclusionOur study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
Effective crowdfunding platforms positively contribute toward improving microgrid energy management systems. Therefore, a comprehensive analysis is required to understand the key factors responsible ...for success in crowdfunding systems by considering various criteria. This study evaluates crowdfunding platforms for microgrid project investments. In this context, a novel fuzzy decision-making model that includes two different stages is proposed. First, the selected criteria for the crowdfunding platforms for microgrid project investments are evaluated. Second, alternatives, regarding the microgrid project investments, are ranked. In this process, a multi-stepwise weight assessment ratio analysis (M-SWARA) approach based on q-rung orthopair fuzzy sets (q-ROFSs) is considered. Intuitionistic and Pythagorean fuzzy sets are also used in the calculation process to make a comparative evaluation. Similarly, a sensitivity analysis of the ranking alternatives is also conducted with 12 different q values. All the results are rather similar; thus, the findings are reliable. Another model is also created for this purpose with the help of the decision-making trial and evaluation laboratory (DEMATEL) and the technique for order preference by similarity to ideal solution methodologies to check the performance of the proposed model. It is defined that by considering the q-ROF DEMATEL weights, the ranking results vary for different cases. The proposed model with a M-SWARA is more reliable than the model created via the DEMATEL method. This situation provides information regarding the superiority of the model proposed in this study. It is concluded that security is the most important factor in crowdfunding platforms for smart-grid project investors. Additionally, solar panels and energy storage systems/batteries are the most significant alternatives for microgrid project investors. Necessary measures should be taken to forestall the risk of fraud that may occur on this platform. Therefore, the website to be established must be secure against possible hacking attacks. Another important conclusion of this study is that solar panels should be preliminarily developed to increase the effectiveness of microgrid systems.
ObjectiveTo characterise the contributing factors that affect medical students’ subspecialty choice and to estimate the extent of influence of individual factors on the students’ decision-making ...process.DesignSystematic review and meta-analysis.MethodsA systematic search of the Cochrane Library, ERIC, Web of Science, CNKI and PubMed databases was conducted for studies published between January 1977 and June 2018. Information concerning study characteristics, influential factors and the extent of their influence (EOI) was extracted independently by two trained investigators. EOI is the percentage level that describes how much each of the factors influenced students’ choice of subspecialty. The recruited medical students include students in medical school, internship, residency training and fellowship, who are about to or have just made a specialty choice. The estimates were pooled using a random-effects meta-analysis model due to the between-study heterogeneity.ResultsData were extracted from 75 studies (882 209 individuals). Overall, the factors influencing medical students’ choice of subspecialty training mainly included academic interests (75.29%), competencies (55.15%), controllable lifestyles or flexible work schedules (53.00%), patient service orientation (50.04%), medical teachers or mentors (46.93%), career opportunities (44.00%), workload or working hours (37.99%), income (34.70%), length of training (32.30%), prestige (31.17%), advice from others (28.24%) and student debt (15.33%), with significant between-study heterogeneity (p<0.0001). Subgroup analyses revealed that the EOI of academic interests was higher in developed countries than that in developing countries (79.66% 95% CI 70.73% to 86.39% vs 60.41% 95% CI 43.44% to 75.19%; Q=3.51, p=0.02). The EOI value of prestige was lower in developed countries than that in developing countries (23.96% 95% CI 19.20% to 29.47% vs 47.65% 95% CI 34.41% to 61.24%; Q=4.71, p=0.01).ConclusionsThis systematic review and meta-analysis provided a quantitative evaluation of the top 12 influencing factors associated with medical students’ choice of subspecialty. Our findings provide the basis for the development of specific, effective strategies to optimise the distribution of physicians among different departments by modifying these influencing factors.
Organizational resilience is vital to the survival and thriving of enterprises, especially during the COVID-19 pandemic. Although there has been an increasing interest in organizational resilience, ...the effects from the entrepreneur perspective receive scant attention. Based on upper echelons theory (UET) and personality psychology, we propose a model in which entrepreneurial mindfulness and entrepreneurial resilience could influence organizational resilience of SMEs. We empirically analyzed a sample of 180 entrepreneurs managing small- and medium-sized enterprises (SMEs) in China during the COVID-19 pandemic, using SmartPLS software. The research findings indicated that entrepreneurial mindfulness is positively associated with organizational resilience and such relationship is partially mediated by entrepreneurial resilience. These findings convey important theoretical implications in this field of research as well as practical implications for SMEs in China or other countries with similar nature.
Electronic medical records provide large-scale real-world clinical data for use in developing clinical decision systems. However, sophisticated methodology and analytical skills are required to ...handle the large-scale datasets necessary for the optimisation of prediction accuracy. Myopia is a common cause of vision loss. Current approaches to control myopia progression are effective but have significant side effects. Therefore, identifying those at greatest risk who should undergo targeted therapy is of great clinical importance. The objective of this study was to apply big data and machine learning technology to develop an algorithm that can predict the onset of high myopia, at specific future time points, among Chinese school-aged children.
Real-world clinical refraction data were derived from electronic medical record systems in 8 ophthalmic centres from January 1, 2005, to December 30, 2015. The variables of age, spherical equivalent (SE), and annual progression rate were used to develop an algorithm to predict SE and onset of high myopia (SE ≤ -6.0 dioptres) up to 10 years in the future. Random forest machine learning was used for algorithm training and validation. Electronic medical records from the Zhongshan Ophthalmic Centre (a major tertiary ophthalmic centre in China) were used as the training set. Ten-fold cross-validation and out-of-bag (OOB) methods were applied for internal validation. The remaining 7 independent datasets were used for external validation. Two population-based datasets, which had no participant overlap with the ophthalmic-centre-based datasets, were used for multi-resource validation testing. The main outcomes and measures were the area under the curve (AUC) values for predicting the onset of high myopia over 10 years and the presence of high myopia at 18 years of age. In total, 687,063 multiple visit records (≥3 records) of 129,242 individuals in the ophthalmic-centre-based electronic medical record databases and 17,113 follow-up records of 3,215 participants in population-based cohorts were included in the analysis. Our algorithm accurately predicted the presence of high myopia in internal validation (the AUC ranged from 0.903 to 0.986 for 3 years, 0.875 to 0.901 for 5 years, and 0.852 to 0.888 for 8 years), external validation (the AUC ranged from 0.874 to 0.976 for 3 years, 0.847 to 0.921 for 5 years, and 0.802 to 0.886 for 8 years), and multi-resource testing (the AUC ranged from 0.752 to 0.869 for 4 years). With respect to the prediction of high myopia development by 18 years of age, as a surrogate of high myopia in adulthood, the algorithm provided clinically acceptable accuracy over 3 years (the AUC ranged from 0.940 to 0.985), 5 years (the AUC ranged from 0.856 to 0.901), and even 8 years (the AUC ranged from 0.801 to 0.837). Meanwhile, our algorithm achieved clinically acceptable prediction of the actual refraction values at future time points, which is supported by the regressive performance and calibration curves. Although the algorithm achieved balanced and robust performance, concerns about the compromised quality of real-world clinical data and over-fitting issues should be cautiously considered.
To our knowledge, this study, for the first time, used large-scale data collected from electronic health records to demonstrate the contribution of big data and machine learning approaches to improved prediction of myopia prognosis in Chinese school-aged children. This work provides evidence for transforming clinical practice, health policy-making, and precise individualised interventions regarding the practical control of school-aged myopia.
We propose a robust attitude estimation method for multisensor systems with heavy-tailed noise. The attitude model is represented by a quaternion, and the propagation process in the filter is based ...on a gyro-based model. To avoid the constraint of quaternion, the quaternion is converted to modified Rodrigues parameters during the prediction and update process. Instead of the minimum mean square error principle, the maximum correntropy criterion is applied in the update process, which is robust to heavy-tailed noises. Considering the linear form in the update process, the information filtering algorithm is applied in the proposed method to simplify the calculation of multisensor information fusion. Moreover, the application of information filtering algorithm can also avoid the numerical problem that zero weight functions cannot be incorporated into the Gaussian filtering framework. Simulations for several cases are performed, and the simulation results indicate the robustness and efficiency of the proposed filter.
Slit-lamp images play an essential role for diagnosis of pediatric cataracts. We present a computer vision-based framework for the automatic localization and diagnosis of slit-lamp images by ...identifying the lens region of interest (ROI) and employing a deep learning convolutional neural network (CNN). First, three grading degrees for slit-lamp images are proposed in conjunction with three leading ophthalmologists. The lens ROI is located in an automated manner in the original image using two successive applications of Candy detection and the Hough transform, which are cropped, resized to a fixed size and used to form pediatric cataract datasets. These datasets are fed into the CNN to extract high-level features and implement automatic classification and grading. To demonstrate the performance and effectiveness of the deep features extracted in the CNN, we investigate the features combined with support vector machine (SVM) and softmax classifier and compare these with the traditional representative methods. The qualitative and quantitative experimental results demonstrate that our proposed method offers exceptional mean accuracy, sensitivity and specificity: classification (97.07%, 97.28%, and 96.83%) and a three-degree grading area (89.02%, 86.63%, and 90.75%), density (92.68%, 91.05%, and 93.94%) and location (89.28%, 82.70%, and 93.08%). Finally, we developed and deployed a potential automatic diagnostic software for ophthalmologists and patients in clinical applications to implement the validated model.
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