External validation, radiological evaluation, and development of deep learning automatic lung segmentation in contrast-enhanced chest CT

Objectives There is a need for CT pulmonary angiography (CTPA) lung segmentation models. Clinical translation requires radiological evaluation of model outputs, understanding of limitations, and identification of failure points. This multicentre study aims to develop an accurate CTPA lung segmentation model, with evaluation of outputs in two diverse patient cohorts with pulmonary hypertension (PH) and interstitial lung disease (ILD). Methods This retrospective study develops an nnU-Net-based segmentation model using data from two specialist centres (UK and USA). Model was trained (n = 37), tested (n = 12), and clinically evaluated (n = 176) on a diverse ‘real-world’ cohort of 225 PH patients with volumetric CTPAs. Dice score coefficient (DSC) and normalised surface distance (NSD) were used for testing. Clinical evaluation of outputs was performed by two radiologists who assessed clinical significance of errors. External validation was performed on heterogenous contrast and non-contrast scans from 28 ILD patients. Results A total of 225 PH and 28 ILD patients with diverse demographic and clinical characteristics were evaluated. Mean accuracy, DSC, and NSD scores were 0.998 (95% CI 0.9976, 0.9989), 0.990 (0.9840, 0.9962), and 0.983 (0.9686, 0.9972) respectively. There were no segmentation failures. On radiological review, 82% and 71% of internal and external cases respectively had no errors. Eighteen percent and 25% respectively had clinically insignificant errors. Peripheral atelectasis and consolidation were common causes for suboptimal segmentation. One external case (0.5%) with patulous oesophagus had a clinically significant error. Conclusion State-of-the-art CTPA lung segmentation model provides accurate outputs with minimal clinical errors on evaluation across two diverse cohorts with PH and ILD. Clinical relevance Clinical translation of artificial intelligence models requires radiological review and understanding of model limitations. This study develops an externally validated state-of-the-art model with robust radiological review. Intended clinical use is in techniques such as lung volume or parenchymal disease quantification. Key Points • Accurate, externally validated CT pulmonary angiography (CTPA) lung segmentation model tested in two large heterogeneous clinical cohorts (pulmonary hypertension and interstitial lung disease). • No segmentation failures and robust review of model outputs by radiologists found 1 (0.5%) clinically significant segmentation error. • Intended clinical use of this model is a necessary step in techniques such as lung volume, parenchymal disease quantification, or pulmonary vessel analysis

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Not AvailableDeveloping suitable crop rotations and crop establishment practices is an important mechanism that can enhance factor productivity and sustainability of an agro-ecosystem. However, the impact of Conservation Agriculture (CA) on alternate crop rotation of the most-dominant but tillage- and input-intensive rice (Oryza sativa L.)-wheat (Triticum aestivum (L.) emend Fiori & Paol) rotation of the Indo-Gangetic Plains (IGP) of India is not elaborately studied. Hence, we evaluated the effect of CA on crop and water productivity, profitability, and soil carbon status in rice-mustard (Brassica juncea L.) rotation in the North-western IGP of India for five consecutive years. Eight treatments comprising of tillage, crop residue, brown manuring (BM) using Sesbania bispinosa, and summer mungbean [Vigna radiata (L.) Wilczek] (SMB) were adopted in rice - mustard cropping system. The conventional transplanted puddled rice (TPR) - conventional till mustard (CTM) (∼TPR-CTM) rotation resulted in significantly higher rice grain yield than zero till direct-seeded rice (ZTDSR) – ZT mustard (ZTM) system with or without crop residue in all five years. However, in this regard, the CA-based ZT rice – mustard - SMB with residue [ZTDSR-ZTM-ZTSMB ( + R)] was comparable with it during first three years, but was inferior to it in 4th and 5th years. The ZTDSR-ZTM-ZTSMB ( + R) had overall 10.9 % lower five-year mean rice yield than that in the TPR-CTM system. This CA-based system gave significantly higher mustard grain yield in all the years (except first year), and the five-year mean mustard yield was 30.3 % higher than in the TPR-CTM. Another CA-based double cropping system having ZTDSR + BM – ZTM ( + R) was comparable with TPR-CTM in all the years and resulted in 27.6 % higher five-year mean mustard yield than the TPR–CTM practice. The ZTDSR-ZTM-ZTSMB ( + R) practice gave 44 % (including SMB) and 8.1 % (excluding SMB) higher system productivity and significantly higher sustainable yield index of the rice-mustard system compared with the TPR-CTM practice. The ZTDSR-ZTM-ZTSMB ( + R) practice encountered significantly lower weed density in mustard in all five years than TPR-CTM system. The cost-benefit analysis revealed that this CA practice fetched higher net returns by INR 53,000 and 21,400 ha−1 from the rice-mustard system with and without SMB, respectively over the TPR-CTM system. Again, this ZTDSR -ZTM- ZTSMB ( + R) system led to an increase in irrigation water productivity by 27.8 % in rice and 35.1 % in mustard, and the total water (irrigation + rainfall) productivity by 35.7 % in mustard crop compared with the TPR-CTM system (P ≤ 0.05). This CA-based rice-mustard system resulted in significantly higher very labile (∼50.6 %) and labile (∼47.7 %) carbon concentration at 0–5 cm depth of soil compared to the conventional TPR-CTM system. The CA system being productive, profitable, and resource-efficient can be recommended for North-western IGP of India and in similar agro-ecologies of the tropics and sub-tropics. It can be adopted with suitable site-specific refinement in South-Asian countries, where decline in crop productivity and soil health is a consistent pervasive problem due to continuous cereal-cereal rotation.Not Availabl

SARS-CoV-2 seroprevalence among the general population and healthcare workers in India, December 2020–January 2021

Background: Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May–June 2020 and 7.1% in August–September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and healthcare workers (HCWs) in India. Methods: The third serosurvey was conducted in the same 70 districts as the first and second serosurveys. For each district, at least 400 individuals aged ≥10 years from the general population and 100 HCWs from subdistrict-level health facilities were enrolled. Serum samples from the general population were tested for the presence of immunoglobulin G (IgG) antibodies against the nucleocapsid (N) and spike (S1-RBD) proteins of SARS-CoV-2, whereas serum samples from HCWs were tested for anti-S1-RBD. Weighted seroprevalence adjusted for assay characteristics was estimated. Results: Of the 28,598 serum samples from the general population, 4585 (16%) had IgG antibodies against the N protein, 6647 (23.2%) had IgG antibodies against the S1-RBD protein, and 7436 (26%) had IgG antibodies against either the N protein or the S1-RBD protein. Weighted and assay-characteristic-adjusted seroprevalence against either of the antibodies was 24.1% [95% confidence interval (CI) 23.0–25.3%]. Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI 23.5–27.8%). Conclusions: Nearly one in four individuals aged ≥10 years from the general population as well as HCWs in India had been exposed to SARS-CoV-2 by December 2020

Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-U.S. institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection