Development and external validation of a mixed-effects deep learning model to diagnose COVID-19 from CT imaging

BackgroundThe automatic analysis of medical images has the potential improve diagnostic accuracy while reducing the strain on clinicians. Current methods analyzing 3D-like imaging data, such as computerized tomography imaging, often treat each image slice as individual slices. This may not be able to appropriately model the relationship between slices.MethodsOur proposed method utilizes a mixed-effects model within the deep learning framework to model the relationship between slices. We externally validated this method on a data set taken from a different country and compared our results against other proposed methods. We evaluated the discrimination, calibration, and clinical usefulness of our model using a range of measures. Finally, we carried out a sensitivity analysis to demonstrate our methods robustness to noise and missing data.ResultsIn the external geographic validation set our model showed excellent performance with an AUROC of 0.930 (95%CI: 0.914, 0.947), with a sensitivity and specificity, PPV, and NPV of 0.778 (0.720, 0.828), 0.882 (0.853, 0.908), 0.744 (0.686, 0.797), and 0.900 (0.872, 0.924) at the 0.5 probability cut-off point. Our model also maintained good calibration in the external validation dataset, while other methods showed poor calibration.ConclusionDeep learning can reduce stress on healthcare systems by automatically screening CT imaging for COVID-19. Our method showed improved generalizability in external validation compared to previous published methods. However, deep learning models must be robustly assessed using various performance measures and externally validated in each setting. In addition, best practice guidelines for developing and reporting predictive models are vital for the safe adoption of such models

A Three Species Model to Simulate Application of Hyperbaric Oxygen Therapy to Chronic Wounds

Chronic wounds are a significant socioeconomic problem for governments worldwide. Approximately 15% of people who suffer from diabetes will experience a lower-limb ulcer at some stage of their lives, and 24% of these wounds will ultimately result in amputation of the lower limb. Hyperbaric Oxygen Therapy (HBOT) has been shown to aid the healing of chronic wounds; however, the causal reasons for the improved healing remain unclear and hence current HBOT protocols remain empirical. Here we develop a three-species mathematical model of wound healing that is used to simulate the application of hyperbaric oxygen therapy in the treatment of wounds. Based on our modelling, we predict that intermittent HBOT will assist chronic wound healing while normobaric oxygen is ineffective in treating such wounds. Furthermore, treatment should continue until healing is complete, and HBOT will not stimulate healing under all circumstances, leading us to conclude that finding the right protocol for an individual patient is crucial if HBOT is to be effective. We provide constraints that depend on the model parameters for the range of HBOT protocols that will stimulate healing. More specifically, we predict that patients with a poor arterial supply of oxygen, high consumption of oxygen by the wound tissue, chronically hypoxic wounds, and/or a dysfunctional endothelial cell response to oxygen are at risk of nonresponsiveness to HBOT. The work of this paper can, in some way, highlight which patients are most likely to respond well to HBOT (for example, those with a good arterial supply), and thus has the potential to assist in improving both the success rate and hence the cost-effectiveness of this therapy

Using technology to improve the management of development impacts on biodiversity

Funder: The research was funded through a long‐term collaboration between Conservational International and Chevron.Abstract: The mitigation hierarchy (MH) is a prominent tool to help businesses achieve no net loss or net gain outcomes for biodiversity. Technological innovations offer benefits for business biodiversity management, yet the range and continued evolution of technologies creates a complex landscape that can be difficult to navigate. Using literature review, online surveys, and semi‐structured interviews, we assess technologies that can improve application of the MH. We identify six categories (mobile survey, fixed survey, remote sensing, blockchain, data analysis, and enabling technologies) with high feasibility and/or relevance to (i) aid direct implementation of mitigation measures and (ii) enhance biodiversity surveys and monitoring, which feed into the design of interventions including avoidance and minimization measures. At the interface between development and biodiversity impacts, opportunities lie in businesses investing in technologies, capitalizing on synergies between technology groups, collaborating with conservation organizations to enhance institutional capacity, and developing practical solutions suited for widespread use

Bilateral adaptive graph convolutional network on CT based Covid-19 diagnosis with uncertainty-aware consensus-assisted multiple instance learning

Coronavirus disease (COVID-19) has caused a worldwide pandemic, putting millions of people’s health and lives in jeopardy. Detecting infected patients early on chest computed tomography (CT) is critical in combating COVID-19. Harnessing uncertainty-aware consensus-assisted multiple instance learning (UC-MIL), we propose to diagnose COVID-19 using a new bilateral adaptive graph-based (BA-GCN) model that can use both 2D and 3D discriminative information in 3D CT volumes with arbitrary number of slices. Given the importance of lung segmentation for this task, we have created the largest manual annotation dataset so far with 7,768 slices from COVID-19 patients, and have used it to train a 2D segmentation model to segment the lungs from individual slices and mask the lungs as the regions of interest for the subsequent analyses. We then used the UC-MIL model to estimate the uncertainty of each prediction and the consensus between multiple predictions on each CT slice to automatically select a fixed number of CT slices with reliable predictions for the subsequent model reasoning. Finally, we adaptively constructed a BA-GCN with vertices from different granularity levels (2D and 3D) to aggregate multi-level features for the final diagnosis with the benefits of the graph convolution network’s superiority to tackle cross-granularity relationships. Experimental results on three largest COVID-19 CT datasets demonstrated that our model can produce reliable and accurate COVID-19 predictions using CT volumes with any number of slices, which outperforms existing approaches in terms of learning and generalisation ability. To promote reproducible research, we have made the datasets, including the manual annotations and cleaned CT dataset, as well as the implementation code, available at https://doi.org/10.5281/zenodo.6361963

Age-related polychlorinated biphenyl dynamics in immature bull sharks (Carcharhinus leucas)

Polychlorinated biphenyls (PCBs) were quantified in liver tissues of bull sharks (Carcharhinus leucas) ranging in age from \u3c4 wk to \u3e3 yr. Summed values of PCBs (ΣPCBs) ranged from 310ng/g to 22 070ng/g (lipid wt) across age classes with ΣPCB concentrations for the youngest sharks in the present study (\u3c4 wk; 5230±2170ng/g lipid wt) determined to not significantly differ from those quantified in \u3e3-yr-old sharks, highlighting the extent of exposure of this young life stage to this class of persistent organic pollutants (POPs). Age normalization of PCB congener concentrations to those measured for the youngest sharks demonstrated a significant hydrophobicity (log octanol/water partition coefficient [KOW]) effect that was indicative of maternal offloading of highly hydrophobic (logKOW ≥6.5) congeners to the youngest individuals. A distinct shift in the PCB congener profiles was also observed as these young sharks grew in size. This shift was consistent with a transition from the maternally offloaded signal to the initiation of exogenous feeding and the contributions of mechanisms including growth dilution and whole-body elimination. These results add to the growing pool of literature documenting substantially high concentrations of POPs in juvenile sharks that are most likely attributable to maternal offloading. Collectively, such results underscore the potential vulnerability of young sharks to POP exposure and pose additional concerns for shark-conservation efforts. © 2013 SETAC