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Lancet 01/24/2020 17:16
Health-care systems worldwide face increasing demand, a rise in chronic disease, and resource constraints.1 At the same time, the use of digital health technologies in all care settings has led to an expansion of data. These data, if harnessed appropriately, could enable health-care providers to target the causes of ill-health and monitor the effectiveness of preventions and interventions. For this reason, policy makers, politicians, clinical entrepreneurs, and computer and data scientists argue that a key part of health-care solutions will be artificial Intelligence (AI), particularly machine learning.
Lancet 01/24/2020 07:17
On Dec 18, 2019, a letter was sent to President Donald Trump from organisations that “represent the leading publishers and non-profit scientific societies in the United States”. The letter argued that a rumour of a proposed plan from the Office of Science and Technology Policy to mandate open access for US Government-funded research “would jeopardize the intellectual property of American organizations engaged in the creation of high-quality peer-reviewed journals and research articles and would potentially delay the publication of new research results”.
Lancet 01/24/2020 06:16
There is no consensus on the optimal treatment for chronic central serous chorioretinopathy (CSCR). In drug trials for CSCR, the relapsing–remitting nature of this visually impairing condition makes distinguishing treatment efficacy from improvements unrelated to the intervention nearly impossible in the absence of a placebo control group. Unfortunately, the number of randomised controlled clinical trials providing safe guidance are scarce. In the absence of compelling evidence, so-called promising therapies have become abundant, including, but not limited to, laser photocoagulation, photodynamic therapy (PDT), subthreshold laser treatment, intravitreal anti-vascular endothelial growth factor therapy, Helicobacter pylori eradication, carbon.
Lancet 01/24/2020 05:17
Mary Edwards Walker was a highly principled and passionate reformer who refused to recognise the oppressive social conventions of 19th-century America. At the time, women's educational opportunities were limited and hard to access, their legal status inferior to that of men, and their right to vote denied. Fashion dictated that they lace themselves into tight corsets under voluminous skirts and petticoats that compromised their health and freedom of movement. She would have none of it. Qualifying as a doctor in 1855—only 6 years after the first woman doctor in the USA, Elizabeth Blackwell—Walker campaigned for dress reform and wore trousers, sometimes under knee-length skirts, throughout her adult life.
Lancet 01/24/2020 04:17
Both the socioecological model and WHO suggest that adverse social and structural factors, including sociopolitical conflicts, human rights violations, and discrimination, substantially affect distribution of political power, resource allocation, and health status.1–3 Recently, the movement against the extradition bill proposed in Hong Kong last year and the ongoing social unrest have revealed pressing human rights concerns and a desire for democracy that could affect all citizens emotionally, socially, and economically.
Lancet 01/24/2020 01:17
Civil disobedience—a public, non-violent action in breach of the law aimed at changing the law or policies of a government—is not a typical tool of the medical trade. But frustration with inaction on the global climate emergency has galvanised doctors and other health professionals to join public protests, some of which have involved breaking the law, thus incurring considerable personal and professional risk. Robin Stott, in an Essay this week, describes his experience of arrest during an Extinction Rebellion protest in London, highlighting how a duty of care can compel one to act disobediently in the clear interest of public health.
Lancet 01/24/2020 00:16
In recent years we have learned a great deal about why and in what ways play is important for children's health and development. My research, spanning two decades, focuses on children's own views about their play, and their voices have enlightened us as to the complexity of play in relation to its form and function. Historical insights about play are also illuminating. Artifacts have been catalogued by archaeologists, historians, and anthropologists, enabling them to form a picture of children and childhood over time which suggests that play, in some shape or form, has been ever present.
Lancet 01/23/2020 23:16
Global advocacy has been successful in mobilising attention to antimicrobial resistance (AMR) by governments and agencies worldwide. Indeed, in the past decade, there has been a steady flow of reports, action plans, declarations, initiatives, and resolutions on what should be done. Inadequate access to antimicrobials and AMR are formidable threats to both human and animal health. The World Economic Forum's annual meeting in Davos (Jan 21–25) will raise the profile of AMR again, but has this global advocacy translated into global action? In a word, no.
Lancet 01/23/2020 19:17
A 53-year-old man with haemophilia A attended our clinic after spraining his right ankle in forced varus while walking. Since the incident, 3 months earlier, he had persistent pain and swelling. On examination, we found a swelling at the level of the lateral malleolus and the surrounding skin was blue; palpation of the bone did not cause pain. An x-ray, done at the time the patient sprained his ankle, showed no bone fracture. When we saw the patient, we repeated the x-ray and an ultrasound scan of his ankle; the scan showed a hypoechoic and vascularised mass about 30 mm in diameter (figure) around the external part of the fibula with a characteristic in-out flow appearance suggestive of a pseudoaneurysm (appendix).
Lancet 01/23/2020 19:17
Vincenzo Sepe and Carmelo Libetta question the benefit of our SONAR trial1 results to routine clinical practice given that the median follow-up time was 2·2 years and only 184 patients reached the primary outcome. However, the follow-up time of the trial was only slightly shorter than other renal outcome trials such as the CREDENCE trial,2 and it provided robust power to support the trial conclusions.

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