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J.C.F. is shareholder of Digital Diagnostics. Disclosure forms provided by the authors are available with the full text of this article. Patents and patent applications that may be affected by this study are: assigned to University of Iowa (all: inventor M.D.A.): issued 7,474,775, Automatic Detection of Red Lesions in Digital Color Fundus Photographs; issued 7,712,898, Methods and Systems for Optic Nerve Head Segmentation; issued 8,340,437, Methods and Systems for Determining Optimal Features for Classifying Patterns or Objects in Images; issued 9,924,867, Automated Determination of Arteriovenous Ratio in Images of Blood Vessels; issued 9,814,386, Systems and methods for alignment of the eye for ocular imaging; issued 11,935,235 Diagnosis of a disease condition using an automated diagnostic model; application 20230419485-A1, Autonomous Diagnosis Of A Disorder In A Patient From Image Analysis; issued 11,676,700; Data aggregation, integration and analysis system and related devices and methods; application 63\/557,296 Manifold foundational machine-learning model for classifying disease states.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"369"}}