Application of Surgical Decision Model for Patients With Childhood Cataract: A Study Based on Real World Data.

Reliable validated methods are necessary to verify the performance of diagnosis and therapy-assisted models in clinical practice. However, some validated results have research bias and may not reflect the results of real-world application. In addition, the conduct of clinical trials has executive risks for the indeterminate effectiveness of models and it is challenging to finish validated clinical trials of rare diseases. Real world data (RWD) can probably solve this problem. In our study, we collected RWD from 251 patients with a rare disease, childhood cataract (CC) and conducted a retrospective study to validate the CC surgical decision model. The consistency of the real surgical type and recommended surgical type was 94.16%. In the cataract extraction (CE) group, the model recommended the same surgical type for 84.48% of eyes, but the model advised conducting cataract extraction and primary intraocular lens implantation (CE + IOL) surgery in 15.52% of eyes, which was different from the real-world choices. In the CE + IOL group, the model recommended the same surgical type for 100% of eyes. The real-recommended matched rates were 94.22% in the eyes of bilateral patients and 90.38% in the eyes of unilateral patients. Our study is the first to apply RWD to complete a retrospective study evaluating a clinical model, and the results indicate the availability and feasibility of applying RWD in model validation and serve guidance for intelligent model evaluation for rare diseases.

Recent increases in terrestrial carbon uptake at little cost to the water cycle.

Quantifying the responses of the coupled carbon and water cycles to current global warming and rising atmospheric CO2 concentration is crucial for predicting and adapting to climate changes. Here we show that terrestrial carbon uptake (i.e. gross primary production) increased significantly from 1982 to 2011 using a combination of ground-based and remotely sensed land and atmospheric observations. Importantly, we find that the terrestrial carbon uptake increase is not accompanied by a proportional increase in water use (i.e. evapotranspiration) but is largely (about 90%) driven by increased carbon uptake per unit of water use, i.e. water use efficiency. The increased water use efficiency is positively related to rising CO2 concentration and increased canopy leaf area index, and negatively influenced by increased vapour pressure deficits. Our findings suggest that rising atmospheric CO2 concentration has caused a shift in terrestrial water economics of carbon uptake.The response of the coupled carbon and water cycles to anthropogenic climate change is unclear. Here, the authors show that terrestrial carbon uptake increased significantly from 1982 to 2011 and that this increase is largely driven by increased water-use efficiency, rather than an increase in water use.

Agricultural vulnerability over the Chinese Loess Plateau in response to climate change: Exposure, sensitivity, and adaptive capacity.

Understanding how the vulnerability of agricultural production to climate change can differ spatially has practical significance to sustainable management of agricultural systems worldwide. Accordingly, this study developed a conceptual framework to assess the agricultural vulnerability of 243 rural counties on the Chinese Loess Plateau. Indicators representing the climate/agriculture interface were selected to describe exposure and sensitivity, while stocks of certain capitals were used to describe adaptive capacity. A vulnerability index for each county was calculated and the spatial distribution was mapped. Results showed that exposure, sensitivity, and adaptive capacity occur independently, with most contributing indicator values concentrated in a narrow range after normalization. Within the 49 most vulnerable counties, which together encompass 81 % of the vulnerability index range, 42 were characterized by high exposure and sensitivity but low adaptive capacity. The most vulnerable area was found to be located in the central northeast-southwest belt of Loess Plateau. Adaptation measures for both ecological restoration and economic development are needed and potential adaptation options need further investigation.

Assessment of attitudes towards methadone maintenance treatment between heroin users at a compulsory detoxification centre and methadone maintenance clinic in Ningbo, China.

BACKGROUND: In China, the Compulsory Detoxification Centres are the main response for people who use illegal drugs. Due to high relapse rates among people released from the Compulsory Detoxification Centres, it is likely that they may seek medical help, including Methadone Maintenance Treatment (MMT) services, at some point. Therefore, better understanding of the attitudes and beliefs of people in the Compulsory Detoxification Centres can help to provide more adequate response to opioid dependence. METHODS: In total, 329 detained heroin users and 112 active MMT clients were recruited from a local Compulsory Detoxification Centre and MMT clinic, respectively. The survey contained specific questions relating to attitudes and beliefs regarding MMT. RESULTS: Participants at the Compulsory Detoxification Centre and the MMT clinic expressed different opinions, regarding positive and negative attitudes and beliefs towards MMT. In addition, participants from both sites hold certain negative attitudes and beliefs about methadone despite their acknowledgement of the positive effects of MMT. Finally, participants at the Compulsory Detoxification Centre and the MMT clinic reported distinctive treatment preferences, with the former preferring community-based treatment and the latter MMT. CONCLUSIONS: Developing targeted education about MMT for people at the Compulsory Detoxification Centres could help improve access to accurate and evidence-based health and treatment information. The study may also help providers understand and adjust services needed for target population in the future.