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Sudre CH, Antonelli M, Cheetham NJ, Molteni E, Canas LS, Bowyer V, Murray B, Rjoob K, Modat M, Capdevila Pujol J, Hu C, Wolf J, Spector TD, Hammers A, Steves CJ, Ourselin S, Duncan EL. Symptoms before and after COVID-19: a population and case-control study using prospective data. Eur Respir J 2024:2301853. [PMID: 38575161 DOI: 10.1183/13993003.01853-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Some individuals experience prolonged illness after acute COVID-19. We assessed whether pre-infection symptoms affected post-COVID illness duration. METHODS Survival analysis was performed in adults (n=23 452) with community-managed SARC-CoV-2 infection prospectively self-logging data through the ZOE COVID Symptom Study app, at least weekly, from 8 weeks before to 12 weeks after COVID-19 onset, conditioned on presence versus absence of baseline symptoms (4-8 weeks before COVID-19). A case-control study was performed in 1350 individuals with long illness (≥8 weeks, 906 [67.1%] with illness ≥12 weeks), matched 1:1 (for age, sex, body mass index, testing week, prior infection, vaccination, smoking, index of multiple deprivation) with 1350 individuals with short illness (<4 weeks). Baseline symptoms were compared between the two groups; and against post-COVID symptoms. RESULTS Individuals reporting baseline symptoms had longer post-COVID symptom duration (from 10 to 15 days) with baseline fatigue nearly doubling duration. Two-thirds (910 of 1350 [67.4%]) of individuals with long illness were asymptomatic beforehand. However, 440 (32.6%) had baseline symptoms, versus 255 (18.9%) of 1350 individuals with short illness (p<0.0001). Baseline symptoms increased the odds ratio for long illness (2.14 [CI: 1.78; 2.57]). Prior comorbidities were more common in individuals with long versus short illness. In individuals with long illness, baseline symptomatic (versus asymptomatic) individuals were more likely to be female, younger, and have prior comorbidities; and baseline and post-acute symptoms and symptom burden correlated strongly. CONCLUSIONS Individuals experiencing symptoms before COVID-19 have longer illness duration and increased odds of long illness. However, many individuals with long illness are well before SARS-CoV-2 infection.
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Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Ben Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Khaled Rjoob
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' PET Centre, Guy's and St Thomas' NHS Foundation trust, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Chelliah A, Wood DA, Canas LS, Shuaib H, Currie S, Fatania K, Frood R, Rowland-Hill C, Thust S, Wastling SJ, Tenant S, Foweraker K, Williams M, Wang Q, Roman A, Dragos C, MacDonald M, Lau YH, Linares CA, Bassiouny A, Luis A, Young T, Brock J, Chandy E, Beaumont E, Lam TC, Welsh L, Lewis J, Mathew R, Kerfoot E, Brown R, Beasley D, Glendenning J, Brazil L, Swampillai A, Ashkan K, Ourselin S, Modat M, Booth TC. Glioblastoma and Radiotherapy: a multi-center AI study for Survival Predictions from MRI (GRASP study). Neuro Oncol 2024:noae017. [PMID: 38285679 DOI: 10.1093/neuonc/noae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The aim was to predict survival of glioblastoma at eight months after radiotherapy (a period allowing for completing a typical course of adjuvant temozolomide), by applying deep learning to the first brain MRI after radiotherapy completion. METHODS Retrospective and prospective data were collected from 206 consecutive glioblastoma, IDH-wildtype patients diagnosed between March 2014-February 2022 across 11 UK centers. Models were trained on 158 retrospective patients from three centers. Holdout test sets were retrospective (n=19; internal validation), and prospective (n=29; external validation from eight distinct centers).Neural network branches for T2-weighted and contrast-enhanced T1-weighted inputs were concatenated to predict survival. A non-imaging branch (demographics/MGMT/treatment data) was also combined with the imaging model. We investigated the influence of individual MR sequences; non-imaging features; and weighted dense blocks pretrained for abnormality detection. RESULTS The imaging model outperformed the non-imaging model in all test sets (area under the receiver-operating characteristic curve, AUC p=0.038) and performed similarly to a combined imaging/non-imaging model (p>0.05). Imaging, non-imaging, and combined models applied to amalgamated test sets gave AUCs of 0.93, 0.79, and 0.91. Initializing the imaging model with pretrained weights from 10,000s of brain MRIs improved performance considerably (amalgamated test sets without pretraining 0.64; p=0.003). CONCLUSIONS A deep learning model using MRI images after radiotherapy, reliably and accurately determined survival of glioblastoma. The model serves as a prognostic biomarker identifying patients who will not survive beyond a typical course of adjuvant temozolomide, thereby stratifying patients into those who might require early second-line or clinical trial treatment.
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Affiliation(s)
| | | | | | - Haris Shuaib
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stuart Currie
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kavi Fatania
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Russell Frood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Stefanie Thust
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Stephen J Wastling
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - Sean Tenant
- The Christie NHS Foundation Trust, Withington, Manchester, United Kingdom
| | | | - Matthew Williams
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Qiquan Wang
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Andrei Roman
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Oncology Institute Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania
| | - Carmen Dragos
- Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | | | - Yue Hui Lau
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Ahmed Bassiouny
- King's College London, London, United Kingdom
- Mansoura University, Mansoura, Egypt
| | - Aysha Luis
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Young
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Juliet Brock
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Edward Chandy
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Erica Beaumont
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Tai-Chung Lam
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joanne Lewis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, England, United Kingdom
| | - Ryan Mathew
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, UK
| | | | | | - Daniel Beasley
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Lucy Brazil
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Keyoumars Ashkan
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marc Modat
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas C Booth
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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Antonelli M, Penfold RS, Canas LDS, Sudre C, Rjoob K, Murray B, Molteni E, Kerfoot E, Cheetham N, Pujol JC, Polidori L, May A, Wolf J, Modat M, Spector T, Hammers A, Ourselin S, Steves C. SARS-CoV-2 infection following booster vaccination: Illness and symptom profile in a prospective, observational community-based case-control study. J Infect 2023; 87:506-515. [PMID: 37777159 DOI: 10.1016/j.jinf.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Booster COVID-19 vaccines have shown efficacy in clinical trials and effectiveness in real-world data against symptomatic and severe illness. However, some people still become infected with SARS-CoV-2 following a third (booster) vaccination. This study describes the characteristics of SARS-CoV-2 illness following a third vaccination and assesses the risk of progression to symptomatic disease in SARS-CoV-2 infected individuals with time since vaccination. METHODS This prospective, community-based, case-control study used data from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile application, self-reporting a first positive COVID-19 test between June 1, 2021 and April 1, 2022. To describe the characteristics of SARS-CoV-2 illness following a third vaccination, we selected cases and controls who had received a third and second dose of monovalent vaccination against COVID-19, respectively, and reported a first positive SARS-CoV-2 test at least 7 days after most recent vaccination. Cases and controls were matched (1:1) based on age, sex, BMI, time between first vaccination and infection, and week of testing. We used logistic regression models (adjusted for age, sex, BMI, level of social deprivation and frailty) to analyse associations of disease severity, overall disease duration, and individual symptoms with booster vaccination status. To assess for potential waning of vaccine effectiveness, we compared disease severity, duration, and symptom profiles of individuals testing positive within 3 months of most recent vaccination (reference group) to profiles of individuals infected between 3 and 4, 4-5, and 5-6 months, for both third and second dose. All analyses were stratified by time period, based on the predominant SARS-CoV-2 variant at time of infection (Delta: June 1, 2021-27 Nov, 2021; Omicron: 20 Dec, 2021-Apr 1, 2022). FINDINGS During the study period, 50,162 (Delta period) and 162,041 (Omicron) participants reported a positive SARS-CoV-2 test. During the Delta period, infection following three vaccination doses was associated with lower odds of long COVID (symptoms≥ 4 weeks) (OR=0.83, CI[0.50-1.36], p < 0.0001), hospitalisation (OR=0.55, CI[0.39-0.75], p < 0.0001) and severe symptoms (OR=0.36, CI[0.27-0.49], p < 0.0001), and higher odds of asymptomatic infection (OR=3.45, CI[2.86-4.16], p < 0.0001), compared to infection following only two vaccination doses. During the Omicron period, infection following three vaccination doses was associated with lower odds of severe symptoms (OR=0.48, CI[0.42-0.55], p < 0.0001). During the Delta period, infected individuals were less likely to report almost all individual symptoms after a third vaccination. During the Omicron period, individuals were less likely to report most symptoms after a third vaccination, except for upper respiratory symptoms e.g. sneezing (OR=1.40, CI[1.18-1.35], p < 0.0001), runny nose (OR=1.26, CI[1.18-1.35], p < 0.0001), sore throat (OR=1.17, CI[1.10-1.25], p < 0.0001), and hoarse voice (OR=1.13, CI[1.06-1.21], p < 0.0001), which were more likely to be reported. There was evidence of reduced vaccine effectiveness during both Delta and Omicron periods in those infected more than 3 months after their most recent vaccination, with increased reporting of severe symptoms, long duration illness, and most individual symptoms. INTERPRETATION This study suggests that a third dose of monovalent vaccine may reduce symptoms, severity and duration of SARS-CoV-2 infection following vaccination. For Omicron variants, the third vaccination appears to reduce overall symptom burden but may increase upper respiratory symptoms, potentially due to immunological priming. There is evidence of waning vaccine effectiveness against progression to symptomatic and severe disease and long COVID after three months. Our findings support ongoing booster vaccination promotion amongst individuals at high risk from COVID-19, to reduce severe symptoms and duration of illness, and health system burden. Disseminating knowledge on expected symptoms following booster vaccination may encourage vaccine uptake.
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Affiliation(s)
- Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK; Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | | | - Carole Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK
| | - Khaled Rjoob
- Centre for Medical Image Computing, University College London, London, UK
| | - Ben Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Nathan Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | | | | | | | | | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; King's College London & Guy's and St Thomas' PET Centre, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, UK; Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, London, UK.
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Agarwal S, Wood D, Grzeda M, Suresh C, Din M, Cole J, Modat M, Booth TC. Systematic Review of Artificial Intelligence for Abnormality Detection in High-volume Neuroimaging and Subgroup Meta-analysis for Intracranial Hemorrhage Detection. Clin Neuroradiol 2023; 33:943-956. [PMID: 37261453 PMCID: PMC10233528 DOI: 10.1007/s00062-023-01291-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Most studies evaluating artificial intelligence (AI) models that detect abnormalities in neuroimaging are either tested on unrepresentative patient cohorts or are insufficiently well-validated, leading to poor generalisability to real-world tasks. The aim was to determine the diagnostic test accuracy and summarise the evidence supporting the use of AI models performing first-line, high-volume neuroimaging tasks. METHODS Medline, Embase, Cochrane library and Web of Science were searched until September 2021 for studies that temporally or externally validated AI capable of detecting abnormalities in first-line computed tomography (CT) or magnetic resonance (MR) neuroimaging. A bivariate random effects model was used for meta-analysis where appropriate. This study was registered on PROSPERO as CRD42021269563. RESULTS Out of 42,870 records screened, and 5734 potentially eligible full texts, only 16 studies were eligible for inclusion. Included studies were not compromised by unrepresentative datasets or inadequate validation methodology. Direct comparison with radiologists was available in 4/16 studies and 15/16 had a high risk of bias. Meta-analysis was only suitable for intracranial hemorrhage detection in CT imaging (10/16 studies), where AI systems had a pooled sensitivity and specificity 0.90 (95% confidence interval [CI] 0.85-0.94) and 0.90 (95% CI 0.83-0.95), respectively. Other AI studies using CT and MRI detected target conditions other than hemorrhage (2/16), or multiple target conditions (4/16). Only 3/16 studies implemented AI in clinical pathways, either for pre-read triage or as post-read discrepancy identifiers. CONCLUSION The paucity of eligible studies reflects that most abnormality detection AI studies were not adequately validated in representative clinical cohorts. The few studies describing how abnormality detection AI could impact patients and clinicians did not explore the full ramifications of clinical implementation.
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Affiliation(s)
- Siddharth Agarwal
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK.
| | - David Wood
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK
| | - Mariusz Grzeda
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK
| | - Chandhini Suresh
- Leicester Medical School, University of Leicester, LE1 7RH, Leicester, UK
| | - Munaib Din
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK
| | - James Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, WC1V 6LJ, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, Rayne Institute, 4th Floor, Lambeth Wing, SE1 7EH, London, UK.
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, SE5 9RS, London, UK.
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Agarwal S, Wood DA, Modat M, Booth TC. Application of deep learning models for detection of subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:1056-1057. [PMID: 37258226 DOI: 10.1136/jnis-2023-020218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/17/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Siddharth Agarwal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David A Wood
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Thomas C Booth
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
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Cheetham NJ, Penfold R, Giunchiglia V, Bowyer V, Sudre CH, Canas LS, Deng J, Murray B, Kerfoot E, Antonelli M, Rjoob K, Molteni E, Österdahl MF, Harvey NR, Trender WR, Malim MH, Doores KJ, Hellyer PJ, Modat M, Hammers A, Ourselin S, Duncan EL, Hampshire A, Steves CJ. The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study. EClinicalMedicine 2023; 62:102086. [PMID: 37654669 PMCID: PMC10466229 DOI: 10.1016/j.eclinm.2023.102086] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 09/02/2023] Open
Abstract
Background Cognitive impairment has been reported after many types of infection, including SARS-CoV-2. Whether deficits following SARS-CoV-2 improve over time is unclear. Studies to date have focused on hospitalised individuals with up to a year follow-up. The presence, magnitude, persistence and correlations of effects in community-based cases remain relatively unexplored. Methods Cognitive performance (working memory, attention, reasoning, motor control) was assessed in a prospective cohort study of participants from the United Kingdom COVID Symptom Study Biobank between July 12, 2021 and August 27, 2021 (Round 1), and between April 28, 2022 and June 21, 2022 (Round 2). Participants, recruited from the COVID Symptom Study smartphone app, comprised individuals with and without SARS-CoV-2 infection and varying symptom duration. Effects of COVID-19 exposures on cognitive accuracy and reaction time scores were estimated using multivariable ordinary least squares linear regression models weighted for inverse probability of participation, adjusting for potential confounders and mediators. The role of ongoing symptoms after COVID-19 infection was examined stratifying for self-perceived recovery. Longitudinal analysis assessed change in cognitive performance between rounds. Findings 3335 individuals completed Round 1, of whom 1768 also completed Round 2. At Round 1, individuals with previous positive SARS-CoV-2 tests had lower cognitive accuracy (N = 1737, β = -0.14 standard deviations, SDs, 95% confidence intervals, CI: -0.21, -0.07) than negative controls. Deficits were largest for positive individuals with ≥12 weeks of symptoms (N = 495, β = -0.22 SDs, 95% CI: -0.35, -0.09). Effects were comparable to hospital presentation during illness (N = 281, β = -0.31 SDs, 95% CI: -0.44, -0.18), and 10 years age difference (60-70 years vs. 50-60 years, β = -0.21 SDs, 95% CI: -0.30, -0.13) in the whole study population. Stratification by self-reported recovery revealed that deficits were only detectable in SARS-CoV-2 positive individuals who did not feel recovered from COVID-19, whereas individuals who reported full recovery showed no deficits. Longitudinal analysis showed no evidence of cognitive change over time, suggesting that cognitive deficits for affected individuals persisted at almost 2 years since initial infection. Interpretation Cognitive deficits following SARS-CoV-2 infection were detectable nearly two years post infection, and largest for individuals with longer symptom durations, ongoing symptoms, and/or more severe infection. However, no such deficits were detected in individuals who reported full recovery from COVID-19. Further work is needed to monitor and develop understanding of recovery mechanisms for those with ongoing symptoms. Funding Chronic Disease Research Foundation, Wellcome Trust, National Institute for Health and Care Research, Medical Research Council, British Heart Foundation, Alzheimer's Society, European Union, COVID-19 Driver Relief Fund, French National Research Agency.
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Affiliation(s)
- Nathan J. Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Rose Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Vicky Bowyer
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Carole H. Sudre
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane S. Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Khaled Rjoob
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, United Kingdom
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Marc F. Österdahl
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Nicholas R. Harvey
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | | | - Michael H. Malim
- Department of Infectious Diseases, King's College London, London, United Kingdom
| | - Katie J. Doores
- Department of Infectious Diseases, King's College London, London, United Kingdom
| | - Peter J. Hellyer
- Centre for Neuroimaging Sciences, King's College London, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- King's College London & Guy's and St Thomas' PET Centre, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Emma L. Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, United Kingdom
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
- Guy's & St Thomas's NHS Foundation Trust, London, United Kingdom
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7
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Canas LS, Molteni E, Deng J, Sudre CH, Murray B, Kerfoot E, Antonelli M, Rjoob K, Capdevila Pujol J, Polidori L, May A, Österdahl MF, Whiston R, Cheetham NJ, Bowyer V, Spector TD, Hammers A, Duncan EL, Ourselin S, Steves CJ, Modat M. Profiling post-COVID-19 condition across different variants of SARS-CoV-2: a prospective longitudinal study in unvaccinated wild-type, unvaccinated alpha-variant, and vaccinated delta-variant populations. Lancet Digit Health 2023; 5:e421-e434. [PMID: 37202336 PMCID: PMC10187990 DOI: 10.1016/s2589-7500(23)00056-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Self-reported symptom studies rapidly increased understanding of SARS-CoV-2 during the COVID-19 pandemic and enabled monitoring of long-term effects of COVID-19 outside hospital settings. Post-COVID-19 condition presents as heterogeneous profiles, which need characterisation to enable personalised patient care. We aimed to describe post-COVID-19 condition profiles by viral variant and vaccination status. METHODS In this prospective longitudinal cohort study, we analysed data from UK-based adults (aged 18-100 years) who regularly provided health reports via the Covid Symptom Study smartphone app between March 24, 2020, and Dec 8, 2021. We included participants who reported feeling physically normal for at least 30 days before testing positive for SARS-CoV-2 who subsequently developed long COVID (ie, symptoms lasting longer than 28 days from the date of the initial positive test). We separately defined post-COVID-19 condition as symptoms that persisted for at least 84 days after the initial positive test. We did unsupervised clustering analysis of time-series data to identify distinct symptom profiles for vaccinated and unvaccinated people with post-COVID-19 condition after infection with the wild-type, alpha (B.1.1.7), or delta (B.1.617.2 and AY.x) variants of SARS-CoV-2. Clusters were then characterised on the basis of symptom prevalence, duration, demography, and previous comorbidities. We also used an additional testing sample with additional data from the Covid Symptom Study Biobank (collected between October, 2020, and April, 2021) to investigate the effects of the identified symptom clusters of post-COVID-19 condition on the lives of affected people. FINDINGS We included 9804 people from the COVID Symptom Study with long COVID, 1513 (15%) of whom developed post-COVID-19 condition. Sample sizes were sufficient only for analyses of the unvaccinated wild-type, unvaccinated alpha variant, and vaccinated delta variant groups. We identified distinct profiles of symptoms for post-COVID-19 condition within and across variants: four endotypes were identified for infections due to the wild-type variant (in unvaccinated people), seven for the alpha variant (in unvaccinated people), and five for the delta variant (in vaccinated people). Across all variants, we identified a cardiorespiratory cluster of symptoms, a central neurological cluster, and a multi-organ systemic inflammatory cluster. These three main clusers were confirmed in a testing sample. Gastrointestinal symptoms clustered in no more than two specific phenotypes per viral variant. INTERPRETATION Our unsupervised analysis identified different profiles of post-COVID-19 condition, characterised by differing symptom combinations, durations, and functional outcomes. Our classification could be useful for understanding the distinct mechanisms of post-COVID-19 condition, as well as for identification of subgroups of individuals who might be at risk of prolonged debilitation. FUNDING UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value-Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, UK Alzheimer's Society, and ZOE.
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Affiliation(s)
- Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Khaled Rjoob
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK
| | | | | | | | - Marc F Österdahl
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Ronan Whiston
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Nathan J Cheetham
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Vicky Bowyer
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK; Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Giannakis P, Nderitu P, Nunez do Rio JM, Webster L, Mann S, Hopkins D, Cardoso MJ, Modat M, Bergeles C, Jackson TL. Effect of socioeconomic deprivation as determined by the English deprivation deciles on the progression of diabetic retinopathy and maculopathy: a multivariate case-control analysis of 88 910 patients attending a South-East London diabetic eye screening service. Br J Ophthalmol 2023:bjo-2023-323402. [PMID: 37380352 DOI: 10.1136/bjo-2023-323402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To determine associations between deprivation using the Index of Multiple Deprivation (IMD and individual IMD subdomains) with incident referable diabetic retinopathy/maculopathy (termed rDR). METHODS Anonymised demographic and screening data collected by the South-East London Diabetic Eye Screening Programme were extracted from September 2013 to December 2019. Multivariable Cox proportional models were used to explore the association between the IMD, IMD subdomains and rDR. RESULTS From 118 508 people with diabetes who attended during the study period, 88 910 (75%) were eligible. The mean (± SD) age was 59.6 (±14.7) years; 53.94% were male, 52.58% identified as white, 94.28% had type 2 diabetes and the average duration of diabetes was 5.81 (±6.9) years; rDR occurred in 7113 patients (8.00%). Known risk factors of younger age, Black ethnicity, type 2 diabetes, more severe baseline DR and diabetes duration conferred a higher risk of incident rDR. After adjusting for these known risk factors, the multivariable analysis did not show a significant association between IMD (decile 1 vs decile 10) and rDR (HR: 1.08, 95% CI: 0.87 to 1.34, p=0.511). However, high deprivation (decile 1) in three IMD subdomains was associated with rDR, namely living environment (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011), education skills (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011) and income (HR: 1.19, 95% CI: 1.02 to 1.38, p=0.024). CONCLUSION IMD subdomains allow for the detection of associations between aspects of deprivation and rDR, which may be missed when using the aggregate IMD. The generalisation of these findings outside the UK population requires corroboration internationally.
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Affiliation(s)
- Periklis Giannakis
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Paul Nderitu
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | - Joan M Nunez do Rio
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Laura Webster
- South-East London Diabetic Eye Screening Programme, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Samantha Mann
- Department of Ophthalmology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - David Hopkins
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Manuel Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Timothy L Jackson
- Section of Ophthalmology, Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
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Coath W, Modat M, Cardoso MJ, Markiewicz PJ, Lane CA, Parker TD, Keshavan A, Buchanan SM, Keuss SE, Harris MJ, Burgos N, Dickson J, Barnes A, Thomas DL, Beasley D, Malone IB, Wong A, Erlandsson K, Thomas BA, Schöll M, Ourselin S, Richards M, Fox NC, Schott JM, Cash DM. Operationalizing the centiloid scale for [ 18F]florbetapir PET studies on PET/MRI. Alzheimers Dement (Amst) 2023; 15:e12434. [PMID: 37201176 PMCID: PMC10186069 DOI: 10.1002/dad2.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION The Centiloid scale aims to harmonize amyloid beta (Aβ) positron emission tomography (PET) measures across different analysis methods. As Centiloids were created using PET/computerized tomography (CT) data and are influenced by scanner differences, we investigated the Centiloid transformation with data from Insight 46 acquired with PET/magnetic resonanceimaging (MRI). METHODS We transformed standardized uptake value ratios (SUVRs) from 432 florbetapir PET/MRI scans processed using whole cerebellum (WC) and white matter (WM) references, with and without partial volume correction. Gaussian-mixture-modelling-derived cutpoints for Aβ PET positivity were converted. RESULTS The Centiloid cutpoint was 14.2 for WC SUVRs. The relationship between WM and WC uptake differed between the calibration and testing datasets, producing implausibly low WM-based Centiloids. Linear adjustment produced a WM-based cutpoint of 18.1. DISCUSSION Transformation of PET/MRI florbetapir data to Centiloids is valid. However, further understanding of the effects of acquisition or biological factors on the transformation using a WM reference is needed. HIGHLIGHTS Centiloid conversion of amyloid beta positron emission tomography (PET) data aims to standardize results.Centiloid values can be influenced by differences in acquisition.We converted florbetapir PET/magnetic resonance imaging data from a large birth cohort.Whole cerebellum referenced values could be reliably transformed to Centiloids.White matter referenced values may be less generalizable between datasets.
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Affiliation(s)
- William Coath
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Marc Modat
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - M. Jorge Cardoso
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Pawel J. Markiewicz
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUCLLondonUK
| | | | - Thomas D. Parker
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Ashvini Keshavan
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sarah M. Buchanan
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sarah E. Keuss
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Matthew J. Harris
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Ninon Burgos
- Sorbonne Université, Institut du Cerveau ‐ Paris Brain Institute ‐ ICM, Inserm, CNRS, AP‐HP, Hôpital Pitié Salpêtrière, InriaAramis project‐teamParisFrance
| | - John Dickson
- Institute of Nuclear MedicineUniversity College London HospitalsLondonUK
| | - Anna Barnes
- Institute of Nuclear MedicineUniversity College London HospitalsLondonUK
| | - David L. Thomas
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Department of Brain Repair and RehabilitationUCL Queen Square Institute of NeurologyLondonUK
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Daniel Beasley
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Ian B. Malone
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Kjell Erlandsson
- Institute of Nuclear MedicineUniversity College London HospitalsLondonUK
| | - Benjamin A. Thomas
- Institute of Nuclear MedicineUniversity College London HospitalsLondonUK
| | - Michael Schöll
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska AcademyUniversity of GothenburgMölndalSweden
- Wallenberg Centre for Molecular and Translational MedicineUniversity of GothenburgMölndalSweden
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | | | - Nick C. Fox
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Dementia Research InstituteUCL Queen Square Institute of NeurologyLondonUK
| | | | - David M. Cash
- Dementia Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical EngineeringUCLLondonUK
- Dementia Research InstituteUCL Queen Square Institute of NeurologyLondonUK
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Hering A, Hansen L, Mok TCW, Chung ACS, Siebert H, Hager S, Lange A, Kuckertz S, Heldmann S, Shao W, Vesal S, Rusu M, Sonn G, Estienne T, Vakalopoulou M, Han L, Huang Y, Yap PT, Brudfors M, Balbastre Y, Joutard S, Modat M, Lifshitz G, Raviv D, Lv J, Li Q, Jaouen V, Visvikis D, Fourcade C, Rubeaux M, Pan W, Xu Z, Jian B, De Benetti F, Wodzinski M, Gunnarsson N, Sjolund J, Grzech D, Qiu H, Li Z, Thorley A, Duan J, Grosbrohmer C, Hoopes A, Reinertsen I, Xiao Y, Landman B, Huo Y, Murphy K, Lessmann N, van Ginneken B, Dalca AV, Heinrich MP. Learn2Reg: Comprehensive Multi-Task Medical Image Registration Challenge, Dataset and Evaluation in the Era of Deep Learning. IEEE Trans Med Imaging 2023; 42:697-712. [PMID: 36264729 DOI: 10.1109/tmi.2022.3213983] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Image registration is a fundamental medical image analysis task, and a wide variety of approaches have been proposed. However, only a few studies have comprehensively compared medical image registration approaches on a wide range of clinically relevant tasks. This limits the development of registration methods, the adoption of research advances into practice, and a fair benchmark across competing approaches. The Learn2Reg challenge addresses these limitations by providing a multi-task medical image registration data set for comprehensive characterisation of deformable registration algorithms. A continuous evaluation will be possible at https://learn2reg.grand-challenge.org. Learn2Reg covers a wide range of anatomies (brain, abdomen, and thorax), modalities (ultrasound, CT, MR), availability of annotations, as well as intra- and inter-patient registration evaluation. We established an easily accessible framework for training and validation of 3D registration methods, which enabled the compilation of results of over 65 individual method submissions from more than 20 unique teams. We used a complementary set of metrics, including robustness, accuracy, plausibility, and runtime, enabling unique insight into the current state-of-the-art of medical image registration. This paper describes datasets, tasks, evaluation methods and results of the challenge, as well as results of further analysis of transferability to new datasets, the importance of label supervision, and resulting bias. While no single approach worked best across all tasks, many methodological aspects could be identified that push the performance of medical image registration to new state-of-the-art performance. Furthermore, we demystified the common belief that conventional registration methods have to be much slower than deep-learning-based methods.
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Din M, Agarwal S, Grzeda M, Wood DA, Modat M, Booth TC. Detection of cerebral aneurysms using artificial intelligence: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:262-271. [PMID: 36375834 PMCID: PMC9985742 DOI: 10.1136/jnis-2022-019456] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Subarachnoid hemorrhage from cerebral aneurysm rupture is a major cause of morbidity and mortality. Early aneurysm identification, aided by automated systems, may improve patient outcomes. Therefore, a systematic review and meta-analysis of the diagnostic accuracy of artificial intelligence (AI) algorithms in detecting cerebral aneurysms using CT, MRI or DSA was performed. METHODS MEDLINE, Embase, Cochrane Library and Web of Science were searched until August 2021. Eligibility criteria included studies using fully automated algorithms to detect cerebral aneurysms using MRI, CT or DSA. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Diagnostic Test Accuracy (PRISMA-DTA), articles were assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Meta-analysis included a bivariate random-effect model to determine pooled sensitivity, specificity, and area under the receiver operator characteristic curve (ROC-AUC). PROSPERO CRD42021278454. RESULTS 43 studies were included, and 41/43 (95%) were retrospective. 34/43 (79%) used AI as a standalone tool, while 9/43 (21%) used AI assisting a reader. 23/43 (53%) used deep learning. Most studies had high bias risk and applicability concerns, limiting conclusions. Six studies in the standalone AI meta-analysis gave (pooled) 91.2% (95% CI 82.2% to 95.8%) sensitivity; 16.5% (95% CI 9.4% to 27.1%) false-positive rate (1-specificity); 0.936 ROC-AUC. Five reader-assistive AI studies gave (pooled) 90.3% (95% CI 88.0% - 92.2%) sensitivity; 7.9% (95% CI 3.5% to 16.8%) false-positive rate; 0.910 ROC-AUC. CONCLUSION AI has the potential to support clinicians in detecting cerebral aneurysms. Interpretation is limited due to high risk of bias and poor generalizability. Multicenter, prospective studies are required to assess AI in clinical practice.
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Affiliation(s)
- Munaib Din
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Siddharth Agarwal
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mariusz Grzeda
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - David A Wood
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
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12
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James SN, Nicholas JM, Lu K, Keshavan A, Lane CA, Parker T, Buchanan SM, Keuss SE, Murray-Smith H, Wong A, Cash DM, Malone IB, Barnes J, Sudre CH, Coath W, Modat M, Ourselin S, Crutch SJ, Kuh D, Fox NC, Schott JM, Richards M. Adulthood cognitive trajectories over 26 years and brain health at 70 years of age: findings from the 1946 British Birth Cohort. Neurobiol Aging 2023; 122:22-32. [PMID: 36470133 PMCID: PMC10564626 DOI: 10.1016/j.neurobiolaging.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Few studies can address how adulthood cognitive trajectories relate to brain health in 70-year-olds. Participants (n = 468, 49% female) from the 1946 British birth cohort underwent 18F-Florbetapir PET/MRI. Cognitive function was measured in childhood (age 8 years) and across adulthood (ages 43, 53, 60-64 and 69 years) and was examined in relation to brain health markers of β-amyloid (Aβ) status, whole brain and hippocampal volume, and white matter hyperintensity volume (WMHV). Taking into account key contributors of adult cognitive decline including childhood cognition, those with greater Aβ and WMHV at age 70 years had greater decline in word-list learning memory in the preceding 26 years, particularly after age 60. In contrast, those with smaller whole brain and hippocampal volume at age 70 years had greater decline in processing search speed, subtly manifest from age 50 years. Subtle changes in memory and processing speed spanning 26 years of adulthood were associated with markers of brain health at 70 years of age, consistent with detectable prodromal cognitive effects in early older age.
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Affiliation(s)
- Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK.
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute Centre for Care Research and Technology, Imperial College London, UK; Department of Medicine, Division of Brain Sciences, Imperial College London
| | - Sarah M Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - William Coath
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marc Modat
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Jonathan M Schott
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK; UK Dementia Research Institute at UCL, University College London, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Author Correction: Federated learning enables big data for rare cancer boundary detection. Nat Commun 2023; 14:436. [PMID: 36702828 PMCID: PMC9879935 DOI: 10.1038/s41467-023-36188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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14
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Dorent R, Kujawa A, Ivory M, Bakas S, Rieke N, Joutard S, Glocker B, Cardoso J, Modat M, Batmanghelich K, Belkov A, Calisto MB, Choi JW, Dawant BM, Dong H, Escalera S, Fan Y, Hansen L, Heinrich MP, Joshi S, Kashtanova V, Kim HG, Kondo S, Kruse CN, Lai-Yuen SK, Li H, Liu H, Ly B, Oguz I, Shin H, Shirokikh B, Su Z, Wang G, Wu J, Xu Y, Yao K, Zhang L, Ourselin S, Shapey J, Vercauteren T. CrossMoDA 2021 challenge: Benchmark of cross-modality domain adaptation techniques for vestibular schwannoma and cochlea segmentation. Med Image Anal 2023; 83:102628. [PMID: 36283200 DOI: 10.1016/j.media.2022.102628] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
Domain Adaptation (DA) has recently been of strong interest in the medical imaging community. While a large variety of DA techniques have been proposed for image segmentation, most of these techniques have been validated either on private datasets or on small publicly available datasets. Moreover, these datasets mostly addressed single-class problems. To tackle these limitations, the Cross-Modality Domain Adaptation (crossMoDA) challenge was organised in conjunction with the 24th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2021). CrossMoDA is the first large and multi-class benchmark for unsupervised cross-modality Domain Adaptation. The goal of the challenge is to segment two key brain structures involved in the follow-up and treatment planning of vestibular schwannoma (VS): the VS and the cochleas. Currently, the diagnosis and surveillance in patients with VS are commonly performed using contrast-enhanced T1 (ceT1) MR imaging. However, there is growing interest in using non-contrast imaging sequences such as high-resolution T2 (hrT2) imaging. For this reason, we established an unsupervised cross-modality segmentation benchmark. The training dataset provides annotated ceT1 scans (N=105) and unpaired non-annotated hrT2 scans (N=105). The aim was to automatically perform unilateral VS and bilateral cochlea segmentation on hrT2 scans as provided in the testing set (N=137). This problem is particularly challenging given the large intensity distribution gap across the modalities and the small volume of the structures. A total of 55 teams from 16 countries submitted predictions to the validation leaderboard. Among them, 16 teams from 9 different countries submitted their algorithm for the evaluation phase. The level of performance reached by the top-performing teams is strikingly high (best median Dice score - VS: 88.4%; Cochleas: 85.7%) and close to full supervision (median Dice score - VS: 92.5%; Cochleas: 87.7%). All top-performing methods made use of an image-to-image translation approach to transform the source-domain images into pseudo-target-domain images. A segmentation network was then trained using these generated images and the manual annotations provided for the source image.
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Affiliation(s)
- Reuben Dorent
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom.
| | - Aaron Kujawa
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Marina Ivory
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Samuel Joutard
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Ben Glocker
- Department of Computing, Imperial College London, Department of Computing, London, United Kingdom
| | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - Arseniy Belkov
- Moscow Institute of Physics and Technology, Moscow, Russia
| | | | - Jae Won Choi
- Department of Radiology, Armed Forces Yangju Hospital, Yangju, Republic of Korea
| | | | - Hexin Dong
- Center for Data Science, Peking University, Beijing, China
| | - Sergio Escalera
- Artificial Intelligence in Medicine Lab (BCN-AIM) and Human Behavior Analysis Lab (HuPBA), Universitat de Barcelona, Barcelona, Spain
| | - Yubo Fan
- Vanderbilt University, Nashville, USA
| | - Lasse Hansen
- Institute of Medical Informatics, Universität zu Lübeck, Germany
| | | | - Smriti Joshi
- Artificial Intelligence in Medicine Lab (BCN-AIM) and Human Behavior Analysis Lab (HuPBA), Universitat de Barcelona, Barcelona, Spain
| | | | - Hyeon Gyu Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | | | | | | | - Hao Li
- Vanderbilt University, Nashville, USA
| | - Han Liu
- Vanderbilt University, Nashville, USA
| | - Buntheng Ly
- Inria, Université Côte d'Azur, Sophia Antipolis, France
| | - Ipek Oguz
- Vanderbilt University, Nashville, USA
| | - Hyungseob Shin
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Republic of Korea
| | - Boris Shirokikh
- Skolkovo Institute of Science and Technology, Moscow, Russia; Artificial Intelligence Research Institute (AIRI), Moscow, Russia
| | - Zixian Su
- University of Liverpool, Liverpool, United Kingdom; School of Advanced Technology, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Guotai Wang
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianghao Wu
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanwu Xu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, USA
| | - Kai Yao
- University of Liverpool, Liverpool, United Kingdom; School of Advanced Technology, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Li Zhang
- Center for Data Science, Peking University, Beijing, China
| | - Sébastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Jonathan Shapey
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
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15
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Pati S, Baid U, Edwards B, Sheller M, Wang SH, Reina GA, Foley P, Gruzdev A, Karkada D, Davatzikos C, Sako C, Ghodasara S, Bilello M, Mohan S, Vollmuth P, Brugnara G, Preetha CJ, Sahm F, Maier-Hein K, Zenk M, Bendszus M, Wick W, Calabrese E, Rudie J, Villanueva-Meyer J, Cha S, Ingalhalikar M, Jadhav M, Pandey U, Saini J, Garrett J, Larson M, Jeraj R, Currie S, Frood R, Fatania K, Huang RY, Chang K, Balaña C, Capellades J, Puig J, Trenkler J, Pichler J, Necker G, Haunschmidt A, Meckel S, Shukla G, Liem S, Alexander GS, Lombardo J, Palmer JD, Flanders AE, Dicker AP, Sair HI, Jones CK, Venkataraman A, Jiang M, So TY, Chen C, Heng PA, Dou Q, Kozubek M, Lux F, Michálek J, Matula P, Keřkovský M, Kopřivová T, Dostál M, Vybíhal V, Vogelbaum MA, Mitchell JR, Farinhas J, Maldjian JA, Yogananda CGB, Pinho MC, Reddy D, Holcomb J, Wagner BC, Ellingson BM, Cloughesy TF, Raymond C, Oughourlian T, Hagiwara A, Wang C, To MS, Bhardwaj S, Chong C, Agzarian M, Falcão AX, Martins SB, Teixeira BCA, Sprenger F, Menotti D, Lucio DR, LaMontagne P, Marcus D, Wiestler B, Kofler F, Ezhov I, Metz M, Jain R, Lee M, Lui YW, McKinley R, Slotboom J, Radojewski P, Meier R, Wiest R, Murcia D, Fu E, Haas R, Thompson J, Ormond DR, Badve C, Sloan AE, Vadmal V, Waite K, Colen RR, Pei L, Ak M, Srinivasan A, Bapuraj JR, Rao A, Wang N, Yoshiaki O, Moritani T, Turk S, Lee J, Prabhudesai S, Morón F, Mandel J, Kamnitsas K, Glocker B, Dixon LVM, Williams M, Zampakis P, Panagiotopoulos V, Tsiganos P, Alexiou S, Haliassos I, Zacharaki EI, Moustakas K, Kalogeropoulou C, Kardamakis DM, Choi YS, Lee SK, Chang JH, Ahn SS, Luo B, Poisson L, Wen N, Tiwari P, Verma R, Bareja R, Yadav I, Chen J, Kumar N, Smits M, van der Voort SR, Alafandi A, Incekara F, Wijnenga MMJ, Kapsas G, Gahrmann R, Schouten JW, Dubbink HJ, Vincent AJPE, van den Bent MJ, French PJ, Klein S, Yuan Y, Sharma S, Tseng TC, Adabi S, Niclou SP, Keunen O, Hau AC, Vallières M, Fortin D, Lepage M, Landman B, Ramadass K, Xu K, Chotai S, Chambless LB, Mistry A, Thompson RC, Gusev Y, Bhuvaneshwar K, Sayah A, Bencheqroun C, Belouali A, Madhavan S, Booth TC, Chelliah A, Modat M, Shuaib H, Dragos C, Abayazeed A, Kolodziej K, Hill M, Abbassy A, Gamal S, Mekhaimar M, Qayati M, Reyes M, Park JE, Yun J, Kim HS, Mahajan A, Muzi M, Benson S, Beets-Tan RGH, Teuwen J, Herrera-Trujillo A, Trujillo M, Escobar W, Abello A, Bernal J, Gómez J, Choi J, Baek S, Kim Y, Ismael H, Allen B, Buatti JM, Kotrotsou A, Li H, Weiss T, Weller M, Bink A, Pouymayou B, Shaykh HF, Saltz J, Prasanna P, Shrestha S, Mani KM, Payne D, Kurc T, Pelaez E, Franco-Maldonado H, Loayza F, Quevedo S, Guevara P, Torche E, Mendoza C, Vera F, Ríos E, López E, Velastin SA, Ogbole G, Soneye M, Oyekunle D, Odafe-Oyibotha O, Osobu B, Shu'aibu M, Dorcas A, Dako F, Simpson AL, Hamghalam M, Peoples JJ, Hu R, Tran A, Cutler D, Moraes FY, Boss MA, Gimpel J, Veettil DK, Schmidt K, Bialecki B, Marella S, Price C, Cimino L, Apgar C, Shah P, Menze B, Barnholtz-Sloan JS, Martin J, Bakas S. Federated learning enables big data for rare cancer boundary detection. Nat Commun 2022; 13:7346. [PMID: 36470898 PMCID: PMC9722782 DOI: 10.1038/s41467-022-33407-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by only sharing numerical model updates. Here we present the largest FL study to-date, involving data from 71 sites across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, reporting the largest such dataset in the literature (n = 6, 314). We demonstrate a 33% delineation improvement for the surgically targetable tumor, and 23% for the complete tumor extent, over a publicly trained model. We anticipate our study to: 1) enable more healthcare studies informed by large diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further analyses for glioblastoma by releasing our consensus model, and 3) demonstrate the FL effectiveness at such scale and task-complexity as a paradigm shift for multi-site collaborations, alleviating the need for data-sharing.
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Affiliation(s)
- Sarthak Pati
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Christos Davatzikos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chiharu Sako
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Satyam Ghodasara
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michel Bilello
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Zenk
- Division of Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ), Heidelberg, Germany
- Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey Rudie
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Javier Villanueva-Meyer
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Soonmee Cha
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Madhura Ingalhalikar
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Manali Jadhav
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Umang Pandey
- Symbiosis Center for Medical Image Analysis, Symbiosis International University, Pune, Maharashtra, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - John Garrett
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Matthew Larson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Robert Jeraj
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Stuart Currie
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Russell Frood
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Kavi Fatania
- Leeds Teaching Hospitals Trust, Department of Radiology, Leeds, UK
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ken Chang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | | | | | - Josep Puig
- Department of Radiology (IDI), Girona Biomedical Research Institute (IdIBGi), Josep Trueta University Hospital, Girona, Spain
| | - Johannes Trenkler
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Josef Pichler
- Department of Neurooncology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Georg Necker
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Andreas Haunschmidt
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
| | - Stephan Meckel
- Institute of Neuroradiology, Neuromed Campus (NMC), Kepler University Hospital Linz, Linz, Austria
- Institute of Diagnostic and Interventional Neuroradiology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Gaurav Shukla
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiation Oncology, Christiana Care Health System, Philadelphia, PA, USA
| | - Spencer Liem
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Joseph Lombardo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Adam E Flanders
- Department of Radiology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, The Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Meirui Jiang
- The Chinese University of Hong Kong, Hong Kong, China
| | - Tiffany Y So
- The Chinese University of Hong Kong, Hong Kong, China
| | - Cheng Chen
- The Chinese University of Hong Kong, Hong Kong, China
| | | | - Qi Dou
- The Chinese University of Hong Kong, Hong Kong, China
| | - Michal Kozubek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Filip Lux
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Jan Michálek
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Petr Matula
- Centre for Biomedical Image Analysis, Faculty of Informatics, Masaryk University, Brno, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Tereza Kopřivová
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
| | - Marek Dostál
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno and University Hospital Brno, Brno, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, and University Hospital and Czech Republic, Brno, Czech Republic
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - J Ross Mitchell
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Joaquim Farinhas
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Marco C Pinho
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Divya Reddy
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Holcomb
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CaA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sargam Bhardwaj
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Chee Chong
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marc Agzarian
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bernardo C A Teixeira
- Instituto de Neurologia de Curitiba, Curitiba, Paraná, Brazil
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Flávia Sprenger
- Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - David Menotti
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Diego R Lucio
- Department of Informatics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Pamela LaMontagne
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel Marcus
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
| | - Florian Kofler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- TranslaTUM (Zentralinstitut für translationale Krebsforschung der Technischen Universität München), Klinikum rechts der Isar, Munich, Germany
- Image-Based Biomedical Modeling, Department of Informatics, Technical University of Munich, Munich, Germany
| | - Marie Metz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Yvonne W Lui
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Johannes Slotboom
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Piotr Radojewski
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Derrick Murcia
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Eric Fu
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Rourke Haas
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - John Thompson
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - David Ryan Ormond
- Department of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland, Cleveland, OH, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals-Seidman Cancer Center, Cleveland, OH, USA
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Vachan Vadmal
- Department of Neurosurgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin Waite
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Rivka R Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linmin Pei
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Murat Ak
- Department of Radiology, Neuroradiology Division, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashok Srinivasan
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - J Rajiv Bapuraj
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Wang
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Ota Yoshiaki
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Toshio Moritani
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Sevcan Turk
- Department of Neuroradiology, University of Michigan, Ann Arbor, MI, USA
| | - Joonsang Lee
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Snehal Prabhudesai
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Konstantinos Kamnitsas
- Department of Computing, Imperial College London, London, UK
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ben Glocker
- Department of Computing, Imperial College London, London, UK
| | - Luke V M Dixon
- Department of Radiology, Imperial College NHS Healthcare Trust, London, UK
| | - Matthew Williams
- Computational Oncology Group, Institute for Global Health Innovation, Imperial College London, London, UK
| | - Peter Zampakis
- Department of NeuroRadiology, University of Patras, Patras, Greece
| | | | - Panagiotis Tsiganos
- Clinical Radiology Laboratory, Department of Medicine, University of Patras, Patras, Greece
| | - Sotiris Alexiou
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Ilias Haliassos
- Department of Neuro-Oncology, University of Patras, Patras, Greece
| | - Evangelia I Zacharaki
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | | | | | | | | | | | | | - Sung Soo Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Bing Luo
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Laila Poisson
- Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
- SJTU-Ruijin-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, Shanghai, China
| | | | - Ruchika Verma
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
- Case Western Reserve University, Cleveland, OH, USA
| | - Rohan Bareja
- Case Western Reserve University, Cleveland, OH, USA
| | - Ipsa Yadav
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Neeraj Kumar
- University of Alberta, Edmonton, AB, Canada
- Alberta Machine Intelligence Institute, Edmonton, AB, Canada
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Ahmed Alafandi
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Georgios Kapsas
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Renske Gahrmann
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tzu-Chi Tseng
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saba Adabi
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Simone P Niclou
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olivier Keunen
- Translation Radiomics, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Ann-Christin Hau
- NORLUX Neuro-Oncology Laboratory, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
- Luxembourg Center of Neuropathology, Laboratoire National De Santé, Luxembourg, Luxembourg
| | - Martin Vallières
- Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - David Fortin
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Neurosurgery and Neuro-Oncology, Faculty of Medicine and Health Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martin Lepage
- Centre de Recherche du Centre Hospitalière Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nuclear Medicine and Radiobiology, Sherbrooke Molecular Imaging Centre, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Bennett Landman
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kaiwen Xu
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Silky Chotai
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lola B Chambless
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Akshitkumar Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reid C Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuriy Gusev
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Krithika Bhuvaneshwar
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anousheh Sayah
- Division of Neuroradiology & Neurointerventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Camelia Bencheqroun
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Anas Belouali
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Subha Madhavan
- Innovation Center for Biomedical Informatics (ICBI), Georgetown University, Washington, DC, USA
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Neuroradiology, Ruskin Wing, King's College Hospital NHS Foundation Trust, London, UK
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Haris Shuaib
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Carmen Dragos
- Stoke Mandeville Hospital, Mandeville Road, Aylesbury, UK
| | | | | | | | | | - Shady Gamal
- University of Cairo School of Medicine, Giza, Egypt
| | | | | | | | - Ji Eun Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Jihye Yun
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust Pembroke Place, Liverpool, UK
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Sean Benson
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht, Netherlands
| | - Jonas Teuwen
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - William Escobar
- Clínica Imbanaco Grupo Quirón Salud, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | | | - Jose Bernal
- Universidad del Valle, Cali, Colombia
- The University of Edinburgh, Edinburgh, UK
| | | | - Joseph Choi
- Department of Industrial and Systems Engineering, University of Iowa, Iowa, USA
| | - Stephen Baek
- Department of Industrial and Systems Engineering, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Hongwei Li
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Tobias Weiss
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrea Bink
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bertrand Pouymayou
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Sampurna Shrestha
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
| | - Kartik M Mani
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Department of Radiation Oncology, Stony Brook University, Stony Brook, NY, USA
| | - David Payne
- Department of Radiology, Stony Brook University, Stony Brook, NY, USA
| | - Tahsin Kurc
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York, USA
- Scientific Data Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Enrique Pelaez
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | - Francis Loayza
- Escuela Superior Politecnica del Litoral, Guayaquil, Guayas, Ecuador
| | | | | | | | | | - Franco Vera
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Elvis Ríos
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Eduardo López
- Universidad de Concepción, Concepción, Biobío, Chile
| | - Sergio A Velastin
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Godwin Ogbole
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mayowa Soneye
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Dotun Oyekunle
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | | | - Babatunde Osobu
- Department of Radiology, University College Hospital Ibadan, Oyo, Nigeria
| | - Mustapha Shu'aibu
- Department of Radiology, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Adeleye Dorcas
- Department of Radiology, Obafemi Awolowo University Ile-Ife, Ile-Ife, Osun, Nigeria
| | - Farouk Dako
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amber L Simpson
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Mohammad Hamghalam
- School of Computing, Queen's University, Kingston, ON, Canada
- Department of Electrical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Jacob J Peoples
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Ricky Hu
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Anh Tran
- School of Computing, Queen's University, Kingston, ON, Canada
| | - Danielle Cutler
- The Faculty of Arts & Sciences, Queen's University, Kingston, ON, Canada
| | - Fabio Y Moraes
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Michael A Boss
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - James Gimpel
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Deepak Kattil Veettil
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Kendall Schmidt
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Brian Bialecki
- Data Science Institute, American College of Radiology, Reston, VA, USA
| | - Sailaja Marella
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Cynthia Price
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Lisa Cimino
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Philadelphia, PA, USA
| | | | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Munich, Bavaria, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Jill S Barnholtz-Sloan
- National Cancer Institute, National Institute of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), National Institute of Health, Bethesda, MD, USA
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Klinge T, Talbot H, Paddick I, Ourselin S, McClelland JR, Modat M. Toward semi-automatic biologically effective dose treatment plan optimisation for Gamma Knife radiosurgery. Phys Med Biol 2022; 67:215001. [PMID: 35961305 PMCID: PMC10518700 DOI: 10.1088/1361-6560/ac8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022]
Abstract
Objective.Dose-rate effects in Gamma Knife radiosurgery treatments can lead to varying biologically effective dose (BED) levels for the same physical dose. The non-convex BED model depends on the delivery sequence and creates a non-trivial treatment planning problem. We investigate the feasibility of employing inverse planning methods to generate treatment plans exhibiting desirable BED characteristics using the per iso-centre beam-on times and delivery sequence.Approach.We implement two dedicated optimisation algorithms. One approach relies on mixed-integer linear programming (MILP) using a purposely developed convex underestimator for the BED to mitigate local minima issues at the cost of computational complexity. The second approach (local optimisation) is faster and potentially usable in a clinical setting but more prone to local minima issues. It sequentially executes the beam-on time (quasi-Newton method) and sequence optimisation (local search algorithm). We investigate the trade-off between time to convergence and solution quality by evaluating the resulting treatment plans' objective function values and clinical parameters. We also study the treatment time dependence of the initial and optimised plans using BED95(BED delivered to 95% of the target volume) values.Main results.When optimising the beam-on times and delivery sequence, the local optimisation approach converges several orders of magnitude faster than the MILP approach (minutes versus hours-days) while typically reaching within 1.2% (0.02-2.08%) of the final objective function value. The quality parameters of the resulting treatment plans show no meaningful difference between the local and MILP optimisation approaches. The presented optimisation approaches remove the treatment time dependence observed in the original treatment plans, and the chosen objectives successfully promote more conformal treatments.Significance.We demonstrate the feasibility of using an inverse planning approach within a reasonable time frame to ensure BED-based objectives are achieved across varying treatment times and highlight the prospect of further improvements in treatment plan quality.
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Affiliation(s)
- Thomas Klinge
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Dept. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Centre for Medical Image Computing, Dept. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Hugues Talbot
- CentraleSupélec, Université Paris-Saclay, Inria, Gif-sur-Yvette, France
| | - Ian Paddick
- Queen Square Gamma Knife Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sébastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Jamie R McClelland
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Dept. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Centre for Medical Image Computing, Dept. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
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Molteni E, Canas LS, Kläser K, Deng J, Bhopal SS, Hughes RC, Chen L, Murray B, Kerfoot E, Antonelli M, Sudre CH, Pujol JC, Polidori L, May A, Hammers PA, Wolf J, Spector PTD, Steves CJ, Ourselin PS, Absoud M, Modat M, Duncan PEL. Post-vaccination infection rates and modification of COVID-19 symptoms in vaccinated UK school-aged children and adolescents: A prospective longitudinal cohort study. Lancet Reg Health Eur 2022; 19:100429. [PMID: 35821715 PMCID: PMC9263281 DOI: 10.1016/j.lanepe.2022.100429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND We aimed to explore the effectiveness of one-dose BNT162b2 vaccination upon SARS-CoV-2 infection, its effect on COVID-19 presentation, and post-vaccination symptoms in children and adolescents (CA) in the UK during periods of Delta and Omicron variant predominance. METHODS In this prospective longitudinal cohort study, we analysed data from 115,775 CA aged 12-17 years, proxy-reported through the Covid Symptom Study (CSS) smartphone application. We calculated post-vaccination infection risk after one dose of BNT162b2, and described the illness profile of CA with post-vaccination SARS-CoV-2 infection, compared to unvaccinated CA, and post-vaccination side-effects. FINDINGS Between August 5, 2021 and February 14, 2022, 25,971 UK CA aged 12-17 years received one dose of BNT162b2 vaccine. The probability of testing positive for infection diverged soon after vaccination, and was lower in CA with prior SARS-CoV-2 infection. Vaccination reduced proxy-reported infection risk (-80·4% (95% CI -0·82 -0·78) and -53·7% (95% CI -0·62 -0·43) at 14-30 days with Delta and Omicron variants respectively, and -61·5% (95% CI -0·74 -0·44) and -63·7% (95% CI -0·68 -0.59) after 61-90 days). Vaccinated CA who contracted SARS-CoV-2 during the Delta period had milder disease than unvaccinated CA; during the Omicron period this was only evident in children aged 12-15 years. Overall disease profile was similar in both vaccinated and unvaccinated CA. Post-vaccination local side-effects were common, systemic side-effects were uncommon, and both resolved within few days (3 days in most cases). INTERPRETATION One dose of BNT162b2 vaccine reduced risk of SARS-CoV-2 infection for at least 90 days in CA aged 12-17 years. Vaccine protection varied for SARS-CoV-2 variant type (lower for Omicron than Delta variant), and was enhanced by pre-vaccination SARS-CoV-2 infection. Severity of COVID-19 presentation after vaccination was generally milder, although unvaccinated CA also had generally mild disease. Overall, vaccination was well-tolerated. FUNDING UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation and Alzheimer's Society, and ZOE Limited.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S. Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kerstin Kläser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Sunil S. Bhopal
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Robert C. Hughes
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Carole H. Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences and Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | | | | | | | | | - Prof Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Aging and Health, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Michael Absoud
- Children's Neurosciences, Evelina London Children's Hospital, St Thomas’ Hospital, King's Health Partners, Academic Health Science Centre, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Prof Emma L. Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Endocrinology, Guy's and St Thomas’ NHS Foundation trust, London, UK
- Corresponding author at: Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, WC2R 2LS, Strand, London, UK.
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18
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Nderitu P, Nunez do Rio JM, Webster ML, Mann SS, Hopkins D, Cardoso MJ, Modat M, Bergeles C, Jackson TL. Automated image curation in diabetic retinopathy screening using deep learning. Sci Rep 2022; 12:11196. [PMID: 35778615 PMCID: PMC9249740 DOI: 10.1038/s41598-022-15491-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Diabetic retinopathy (DR) screening images are heterogeneous and contain undesirable non-retinal, incorrect field and ungradable samples which require curation, a laborious task to perform manually. We developed and validated single and multi-output laterality, retinal presence, retinal field and gradability classification deep learning (DL) models for automated curation. The internal dataset comprised of 7743 images from DR screening (UK) with 1479 external test images (Portugal and Paraguay). Internal vs external multi-output laterality AUROC were right (0.994 vs 0.905), left (0.994 vs 0.911) and unidentifiable (0.996 vs 0.680). Retinal presence AUROC were (1.000 vs 1.000). Retinal field AUROC were macula (0.994 vs 0.955), nasal (0.995 vs 0.962) and other retinal field (0.997 vs 0.944). Gradability AUROC were (0.985 vs 0.918). DL effectively detects laterality, retinal presence, retinal field and gradability of DR screening images with generalisation between centres and populations. DL models could be used for automated image curation within DR screening.
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Affiliation(s)
- Paul Nderitu
- Section of Ophthalmology, King's College London, London, UK. .,King's Ophthalmology Research Unit, King's College Hospital, London, UK.
| | | | - Ms Laura Webster
- South East London Diabetic Eye Screening Programme, Guy's and St Thomas' Foundation Trust, London, UK
| | - Samantha S Mann
- South East London Diabetic Eye Screening Programme, Guy's and St Thomas' Foundation Trust, London, UK.,Department of Ophthalmology, Guy's and St Thomas' Foundation Trust, London, UK
| | - David Hopkins
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Timothy L Jackson
- Section of Ophthalmology, King's College London, London, UK.,King's Ophthalmology Research Unit, King's College Hospital, London, UK
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19
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Kläser K, Molteni E, Graham M, Canas LS, Österdahl MF, Antonelli M, Chen L, Deng J, Murray B, Kerfoot E, Wolf J, May A, Fox B, Capdevila J, Modat M, Hammers A, Spector TD, Steves CJ, Sudre CH, Ourselin S, Duncan EL. COVID-19 due to the B.1.617.2 (Delta) variant compared to B.1.1.7 (Alpha) variant of SARS-CoV-2: a prospective observational cohort study. Sci Rep 2022; 12:10904. [PMID: 35764879 PMCID: PMC9240087 DOI: 10.1038/s41598-022-14016-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/31/2022] [Indexed: 01/07/2023] Open
Abstract
The Delta (B.1.617.2) variant was the predominant UK circulating SARS-CoV-2 strain between May and December 2021. How Delta infection compares with previous variants is unknown. This prospective observational cohort study assessed symptomatic adults participating in the app-based COVID Symptom Study who tested positive for SARS-CoV-2 from May 26 to July 1, 2021 (Delta overwhelmingly the predominant circulating UK variant), compared (1:1, age- and sex-matched) with individuals presenting from December 28, 2020 to May 6, 2021 (Alpha (B.1.1.7) the predominant variant). We assessed illness (symptoms, duration, presentation to hospital) during Alpha- and Delta-predominant timeframes; and transmission, reinfection, and vaccine effectiveness during the Delta-predominant period. 3581 individuals (aged 18 to 100 years) from each timeframe were assessed. The seven most frequent symptoms were common to both variants. Within the first 28 days of illness, some symptoms were more common with Delta versus Alpha infection (including fever, sore throat, and headache) and some vice versa (dyspnoea). Symptom burden in the first week was higher with Delta versus Alpha infection; however, the odds of any given symptom lasting ≥ 7 days was either lower or unchanged. Illness duration ≥ 28 days was lower with Delta versus Alpha infection, though unchanged in unvaccinated individuals. Hospitalisation for COVID-19 was unchanged. The Delta variant appeared more (1.49) transmissible than Alpha. Re-infections were low in all UK regions. Vaccination markedly reduced the risk of Delta infection (by 69-84%). We conclude that COVID-19 from Delta or Alpha infections is similar. The Delta variant is more transmissible than Alpha; however, current vaccines showed good efficacy against disease. This research framework can be useful for future comparisons with new emerging variants.
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Affiliation(s)
- Kerstin Kläser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc F Österdahl
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Aging and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | | | | | | | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London & Guy's and St Thomas' PET Centre, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Aging and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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20
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Molteni E, Sudre CH, Canas LDS, Bhopal SS, Hughes RC, Chen L, Deng J, Murray B, Kerfoot E, Antonelli M, Graham M, Kläser K, May A, Hu C, Pujol JC, Wolf J, Hammers A, Spector TD, Ourselin S, Modat M, Steves CJ, Absoud M, Duncan EL. Illness Characteristics of COVID-19 in Children Infected with the SARS-CoV-2 Delta Variant. Children (Basel) 2022; 9:652. [PMID: 35626830 PMCID: PMC9140086 DOI: 10.3390/children9050652] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Delta (B.1.617.2) SARS-CoV-2 variant was the predominant UK circulating strain between May and November 2021. We investigated whether COVID-19 from Delta infection differed from infection with previous variants in children. METHODS Through the prospective COVID Symptom Study, 109,626 UK school-aged children were proxy-reported between 28 December 2020 and 8 July 2021. We selected all symptomatic children who tested positive for SARS-CoV-2 and were proxy-reported at least weekly, within two timeframes: 28 December 2020 to 6 May 2021 (Alpha (B.1.1.7), the main UK circulating variant) and 26 May to 8 July 2021 (Delta, the main UK circulating variant), with all children unvaccinated (as per national policy at the time). We assessed illness profiles (symptom prevalence, duration, and burden), hospital presentation, and presence of long (≥28 day) illness, and calculated odds ratios for symptoms presenting within the first 28 days of illness. RESULTS 694 (276 younger (5-11 years), 418 older (12-17 years)) symptomatic children tested positive for SARS-CoV-2 with Alpha infection and 706 (227 younger and 479 older) children with Delta infection. Median illness duration was short with either variant (overall cohort: 5 days (IQR 2-9.75) with Alpha, 5 days (IQR 2-9) with Delta). The seven most prevalent symptoms were common to both variants. Symptom burden over the first 28 days was slightly greater with Delta compared with Alpha infection (in younger children, 3 (IQR 2-5) symptoms with Alpha, 4 (IQR 2-7) with Delta; in older children, 5 (IQR 3-8) symptoms with Alpha, 6 (IQR 3-9) with Delta infection ). The odds of presenting several symptoms were higher with Delta than Alpha infection, including headache and fever. Few children presented to hospital, and long illness duration was uncommon, with either variant. CONCLUSIONS COVID-19 in UK school-aged children due to SARS-CoV-2 Delta strain B.1.617.2 resembles illness due to the Alpha variant B.1.1.7., with short duration and similar symptom burden.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Carole H. Sudre
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London WC1E 6BT, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Sunil S. Bhopal
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Robert C. Hughes
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Liyuan Chen
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Mark Graham
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Kerstin Kläser
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Anna May
- ZOE Limited London, London SE1 7RW, UK; (A.M.); (C.H.); (J.C.P.); (J.W.)
| | - Christina Hu
- ZOE Limited London, London SE1 7RW, UK; (A.M.); (C.H.); (J.C.P.); (J.W.)
| | | | - Jonathan Wolf
- ZOE Limited London, London SE1 7RW, UK; (A.M.); (C.H.); (J.C.P.); (J.W.)
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
- King’s College London & Guy’s and St Thomas’ PET Centre, London WC2R 2LS, UK
| | - Timothy D. Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London WC2R 2LS, UK; (T.D.S.); (C.J.S.)
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (E.M.); (C.H.S.); (L.D.S.C.); (L.C.); (J.D.); (B.M.); (E.K.); (M.A.); (M.G.); (K.K.); (A.H.); (S.O.); (M.M.)
| | - Claire J. Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, London WC2R 2LS, UK; (T.D.S.); (C.J.S.)
- Department of Aging and Health, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Michael Absoud
- Children’s Neurosciences, Evelina London Children’s Hospital, St Thomas’ Hospital, King’s Health Partners, Academic Health Science Centre, London SE1 7EH, UK
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King’s College London, London WC2R 2LS, UK
| | - Emma L. Duncan
- Department of Twin Research and Genetic Epidemiology, King’s College London, London WC2R 2LS, UK; (T.D.S.); (C.J.S.)
- Department of Endocrinology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
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21
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Molteni E, Sudre CH, Canas LDS, Bhopal SS, Hughes RC, Chen L, Deng J, Murray B, Kerfoot E, Antonelli M, Graham M, Kläser K, May A, Hu C, Pujol JC, Wolf J, Hammers A, Spector TD, Ourselin S, Modat M, Steves CJ, Absoud M, Duncan EL. Illness Characteristics of COVID-19 in Children Infected with the SARS-CoV-2 Delta Variant. Children (Basel) 2022; 9:children9050652. [PMID: 35626830 DOI: 10.1101/2021.10.06.21264467] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Delta (B.1.617.2) SARS-CoV-2 variant was the predominant UK circulating strain between May and November 2021. We investigated whether COVID-19 from Delta infection differed from infection with previous variants in children. METHODS Through the prospective COVID Symptom Study, 109,626 UK school-aged children were proxy-reported between 28 December 2020 and 8 July 2021. We selected all symptomatic children who tested positive for SARS-CoV-2 and were proxy-reported at least weekly, within two timeframes: 28 December 2020 to 6 May 2021 (Alpha (B.1.1.7), the main UK circulating variant) and 26 May to 8 July 2021 (Delta, the main UK circulating variant), with all children unvaccinated (as per national policy at the time). We assessed illness profiles (symptom prevalence, duration, and burden), hospital presentation, and presence of long (≥28 day) illness, and calculated odds ratios for symptoms presenting within the first 28 days of illness. RESULTS 694 (276 younger (5-11 years), 418 older (12-17 years)) symptomatic children tested positive for SARS-CoV-2 with Alpha infection and 706 (227 younger and 479 older) children with Delta infection. Median illness duration was short with either variant (overall cohort: 5 days (IQR 2-9.75) with Alpha, 5 days (IQR 2-9) with Delta). The seven most prevalent symptoms were common to both variants. Symptom burden over the first 28 days was slightly greater with Delta compared with Alpha infection (in younger children, 3 (IQR 2-5) symptoms with Alpha, 4 (IQR 2-7) with Delta; in older children, 5 (IQR 3-8) symptoms with Alpha, 6 (IQR 3-9) with Delta infection ). The odds of presenting several symptoms were higher with Delta than Alpha infection, including headache and fever. Few children presented to hospital, and long illness duration was uncommon, with either variant. CONCLUSIONS COVID-19 in UK school-aged children due to SARS-CoV-2 Delta strain B.1.617.2 resembles illness due to the Alpha variant B.1.1.7., with short duration and similar symptom burden.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London WC1E 6BT, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London WC1E 6BT, UK
| | - Liane Dos Santos Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Sunil S Bhopal
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Robert C Hughes
- Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Liyuan Chen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Mark Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Kerstin Kläser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Anna May
- ZOE Limited London, London SE1 7RW, UK
| | | | | | | | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
- King's College London & Guy's and St Thomas' PET Centre, London WC2R 2LS, UK
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London WC2R 2LS, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London WC2R 2LS, UK
- Department of Aging and Health, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Michael Absoud
- Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital, King's Health Partners, Academic Health Science Centre, London SE1 7EH, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London WC2R 2LS, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London WC2R 2LS, UK
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
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22
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Menni C, Valdes AM, Polidori L, Antonelli M, Penamakuri S, Nogal A, Louca P, May A, Figueiredo JC, Hu C, Molteni E, Canas L, Österdahl MF, Modat M, Sudre CH, Fox B, Hammers A, Wolf J, Capdevila J, Chan AT, David SP, Steves CJ, Ourselin S, Spector TD. Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of omicron and delta variant dominance: a prospective observational study from the ZOE COVID Study. Lancet 2022; 399:1618-1624. [PMID: 35397851 PMCID: PMC8989396 DOI: 10.1016/s0140-6736(22)00327-0] [Citation(s) in RCA: 416] [Impact Index Per Article: 208.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The SARS-CoV-2 variant of concern, omicron, appears to be less severe than delta. We aim to quantify the differences in symptom prevalence, risk of hospital admission, and symptom duration among the vaccinated population. METHODS In this prospective longitudinal observational study, we collected data from participants who were self-reporting test results and symptoms in the ZOE COVID app (previously known as the COVID Symptoms Study App). Eligible participants were aged 16-99 years, based in the UK, with a body-mass index between 15 and 55 kg/m2, had received at least two doses of any SARS-CoV-2 vaccine, were symptomatic, and logged a positive symptomatic PCR or lateral flow result for SARS-CoV-2 during the study period. The primary outcome was the likelihood of developing a given symptom (of the 32 monitored in the app) or hospital admission within 7 days before or after the positive test in participants infected during omicron prevalence compared with those infected during delta prevalence. FINDINGS Between June 1, 2021, and Jan 17, 2022, we identified 63 002 participants who tested positive for SARS-CoV-2 and reported symptoms in the ZOE app. These patients were matched 1:1 for age, sex, and vaccination dose, across two periods (June 1 to Nov 27, 2021, delta prevalent at >70%; n=4990, and Dec 20, 2021, to Jan 17, 2022, omicron prevalent at >70%; n=4990). Loss of smell was less common in participants infected during omicron prevalence than during delta prevalence (16·7% vs 52·7%, odds ratio [OR] 0·17; 95% CI 0·16-0·19, p<0·001). Sore throat was more common during omicron prevalence than during delta prevalence (70·5% vs 60·8%, 1·55; 1·43-1·69, p<0·001). There was a lower rate of hospital admission during omicron prevalence than during delta prevalence (1·9% vs 2·6%, OR 0·75; 95% CI 0·57-0·98, p=0·03). INTERPRETATION The prevalence of symptoms that characterise an omicron infection differs from those of the delta SARS-CoV-2 variant, apparently with less involvement of the lower respiratory tract and reduced probability of hospital admission. Our data indicate a shorter period of illness and potentially of infectiousness which should impact work-health policies and public health advice. FUNDING Wellcome Trust, ZOE, National Institute for Health Research, Chronic Disease Research Foundation, National Institutes of Health, and Medical Research Council.
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Affiliation(s)
- Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
| | - Ana M Valdes
- Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - Ana Nogal
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Panayiotis Louca
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | | | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc F Österdahl
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; King's College London & Guy's and St Thomas' PET Centre, London, UK
| | | | | | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sean P David
- NorthShore University Health System & University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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23
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Booth TC, Grzeda M, Chelliah A, Roman A, Al Busaidi A, Dragos C, Shuaib H, Luis A, Mirchandani A, Alparslan B, Mansoor N, Lavrador J, Vergani F, Ashkan K, Modat M, Ourselin S. Imaging Biomarkers of Glioblastoma Treatment Response: A Systematic Review and Meta-Analysis of Recent Machine Learning Studies. Front Oncol 2022; 12:799662. [PMID: 35174084 PMCID: PMC8842649 DOI: 10.3389/fonc.2022.799662] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/03/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Monitoring biomarkers using machine learning (ML) may determine glioblastoma treatment response. We systematically reviewed quality and performance accuracy of recently published studies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Diagnostic Test Accuracy, we extracted articles from MEDLINE, EMBASE and Cochrane Register between 09/2018-01/2021. Included study participants were adults with glioblastoma having undergone standard treatment (maximal resection, radiotherapy with concomitant and adjuvant temozolomide), and follow-up imaging to determine treatment response status (specifically, distinguishing progression/recurrence from progression/recurrence mimics, the target condition). Using Quality Assessment of Diagnostic Accuracy Studies Two/Checklist for Artificial Intelligence in Medical Imaging, we assessed bias risk and applicability concerns. We determined test set performance accuracy (sensitivity, specificity, precision, F1-score, balanced accuracy). We used a bivariate random-effect model to determine pooled sensitivity, specificity, area-under the receiver operator characteristic curve (ROC-AUC). Pooled measures of balanced accuracy, positive/negative likelihood ratios (PLR/NLR) and diagnostic odds ratio (DOR) were calculated. PROSPERO registered (CRD42021261965). RESULTS Eighteen studies were included (1335/384 patients for training/testing respectively). Small patient numbers, high bias risk, applicability concerns (particularly confounding in reference standard and patient selection) and low level of evidence, allow limited conclusions from studies. Ten studies (10/18, 56%) included in meta-analysis gave 0.769 (0.649-0.858) sensitivity [pooled (95% CI)]; 0.648 (0.749-0.532) specificity; 0.706 (0.623-0.779) balanced accuracy; 2.220 (1.560-3.140) PLR; 0.366 (0.213-0.572) NLR; 6.670 (2.800-13.500) DOR; 0.765 ROC-AUC. CONCLUSION ML models using MRI features to distinguish between progression and mimics appear to demonstrate good diagnostic performance. However, study quality and design require improvement.
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Affiliation(s)
- Thomas C. Booth
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mariusz Grzeda
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Alysha Chelliah
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Andrei Roman
- Department of Radiology, Guy’s & St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- Department of Radiology, The Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca, Cluj-Napoca, Romania
| | - Ayisha Al Busaidi
- Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Carmen Dragos
- Department of Radiology, Buckinghamshire Healthcare National Health Service Trust, Amersham, United Kingdom
| | - Haris Shuaib
- Department of Medical Physics, Guy’s & St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Aysha Luis
- Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Ayesha Mirchandani
- Department of Radiology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Burcu Alparslan
- Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
- Department of Radiology, Kocaeli University, İzmit, Turkey
| | - Nina Mansoor
- Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Jose Lavrador
- Department of Neurosurgery, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
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24
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Irzan H, Pozzi M, Chikhladze N, Cebanu S, Tadevosyan A, Calcii C, Tsiskaridze A, Melbourne A, Strazzer S, Modat M, Molteni E. Emerging Treatments for Disorders of Consciousness in Paediatric Age. Brain Sci 2022; 12:198. [PMID: 35203961 PMCID: PMC8870410 DOI: 10.3390/brainsci12020198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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Affiliation(s)
- Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Serghei Cebanu
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan 0025, Armenia;
| | - Cornelia Calcii
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Alexander Tsiskaridze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Sandra Strazzer
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
- Rehabilitation Service, “Usratuna” Health and Rehabilitation Centre, Juba, South Sudan
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
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25
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Antonelli M, Penfold RS, Merino J, Sudre CH, Molteni E, Berry S, Canas LS, Graham MS, Klaser K, Modat M, Murray B, Kerfoot E, Chen L, Deng J, Österdahl MF, Cheetham NJ, Drew DA, Nguyen LH, Pujol JC, Hu C, Selvachandran S, Polidori L, May A, Wolf J, Chan AT, Hammers A, Duncan EL, Spector TD, Ourselin S, Steves CJ. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis 2022; 22:43-55. [PMID: 34480857 PMCID: PMC8409907 DOI: 10.1016/s1473-3099(21)00460-6] [Citation(s) in RCA: 435] [Impact Index Per Article: 217.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND COVID-19 vaccines show excellent efficacy in clinical trials and effectiveness in real-world data, but some people still become infected with SARS-CoV-2 after vaccination. This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. METHODS This prospective, community-based, nested, case-control study used self-reported data (eg, on demographics, geographical location, health risk factors, and COVID-19 test results, symptoms, and vaccinations) from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile phone app. For the risk factor analysis, cases had received a first or second dose of a COVID-19 vaccine between Dec 8, 2020, and July 4, 2021; had either a positive COVID-19 test at least 14 days after their first vaccination (but before their second; cases 1) or a positive test at least 7 days after their second vaccination (cases 2); and had no positive test before vaccination. Two control groups were selected (who also had not tested positive for SARS-CoV-2 before vaccination): users reporting a negative test at least 14 days after their first vaccination but before their second (controls 1) and users reporting a negative test at least 7 days after their second vaccination (controls 2). Controls 1 and controls 2 were matched (1:1) with cases 1 and cases 2, respectively, by the date of the post-vaccination test, health-care worker status, and sex. In the disease profile analysis, we sub-selected participants from cases 1 and cases 2 who had used the app for at least 14 consecutive days after testing positive for SARS-CoV-2 (cases 3 and cases 4, respectively). Controls 3 and controls 4 were unvaccinated participants reporting a positive SARS-CoV-2 test who had used the app for at least 14 consecutive days after the test, and were matched (1:1) with cases 3 and 4, respectively, by the date of the positive test, health-care worker status, sex, body-mass index (BMI), and age. We used univariate logistic regression models (adjusted for age, BMI, and sex) to analyse the associations between risk factors and post-vaccination infection, and the associations of individual symptoms, overall disease duration, and disease severity with vaccination status. FINDINGS Between Dec 8, 2020, and July 4, 2021, 1 240 009 COVID Symptom Study app users reported a first vaccine dose, of whom 6030 (0·5%) subsequently tested positive for SARS-CoV-2 (cases 1), and 971 504 reported a second dose, of whom 2370 (0·2%) subsequently tested positive for SARS-CoV-2 (cases 2). In the risk factor analysis, frailty was associated with post-vaccination infection in older adults (≥60 years) after their first vaccine dose (odds ratio [OR] 1·93, 95% CI 1·50-2·48; p<0·0001), and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose (OR 1·11, 95% CI 1·01-1·23; p=0·039). Individuals without obesity (BMI <30 kg/m2) had lower odds of infection following their first vaccine dose (OR 0·84, 95% CI 0·75-0·94; p=0·0030). For the disease profile analysis, 3825 users from cases 1 were included in cases 3 and 906 users from cases 2 were included in cases 4. Vaccination (compared with no vaccination) was associated with reduced odds of hospitalisation or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older. INTERPRETATION To minimise SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. Our findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations. FUNDING ZOE, the UK Government Department of Health and Social Care, the Wellcome Trust, the UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, the UK National Institute for Health Research, the UK Medical Research Council, the British Heart Foundation, and the Alzheimer's Society.
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Affiliation(s)
- Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jordi Merino
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Programs in Metabolism, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Programs in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sarah Berry
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Klaser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc F Österdahl
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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26
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Graham MS, May A, Varsavsky T, Sudre CH, Murray B, Kläser K, Antonelli M, Canas LS, Molteni E, Modat M, Cardoso MJ, Drew DA, Nguyen LH, Rader B, Hu C, Capdevila J, Hammers A, Chan AT, Wolf J, Brownstein JS, Spector TD, Ourselin S, Steves CJ, Astley CM. Knowledge barriers in a national symptomatic-COVID-19 testing programme. PLOS Glob Public Health 2022; 2:e0000028. [PMID: 36962066 PMCID: PMC10022193 DOI: 10.1371/journal.pgph.0000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Symptomatic testing programmes are crucial to the COVID-19 pandemic response. We sought to examine United Kingdom (UK) testing rates amongst individuals with test-qualifying symptoms, and factors associated with not testing. We analysed a cohort of untested symptomatic app users (N = 1,237), nested in the Zoe COVID Symptom Study (Zoe, N = 4,394,948); and symptomatic respondents who wanted, but did not have a test (N = 1,956), drawn from a University of Maryland survey administered to Facebook users (The Global COVID-19 Trends and Impact Survey [CTIS], N = 775,746). The proportion tested among individuals with incident test-qualifying symptoms rose from ~20% to ~75% from April to December 2020 in Zoe. Testing was lower with one vs more symptoms (72.9% vs 84.6% p<0.001), or short vs long symptom duration (69.9% vs 85.4% p<0.001). 40.4% of survey respondents did not identify all three test-qualifying symptoms. Symptom identification decreased for every decade older (OR = 0.908 [95% CI 0.883-0.933]). Amongst symptomatic UMD-CTIS respondents who wanted but did not have a test, not knowing where to go was the most cited factor (32.4%); this increased for each decade older (OR = 1.207 [1.129-1.292]) and for every 4-years fewer in education (OR = 0.685 [0.599-0.783]). Despite current UK messaging on COVID-19 testing, there is a knowledge gap about when and where to test, and this may be contributing to the ~25% testing gap. Risk factors, including older age and less education, highlight potential opportunities to tailor public health messages. The testing gap may be ever larger in countries that do not have extensive, free testing, as the UK does.
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Affiliation(s)
- Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Anna May
- Zoe Global Limited, London, United Kingdom
| | - Thomas Varsavsky
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Department of Computer Science, Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Kerstin Kläser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Benjamin Rader
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | | | | | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | | | - John S Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Christina M Astley
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, United States of America
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States of America
- Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
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27
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Casamitjana A, Lorenzi M, Ferraris S, Peter L, Modat M, Stevens A, Fischl B, Vercauteren T, Iglesias JE. Robust joint registration of multiple stains and MRI for multimodal 3D histology reconstruction: Application to the Allen human brain atlas. Med Image Anal 2022; 75:102265. [PMID: 34741894 PMCID: PMC8678374 DOI: 10.1016/j.media.2021.102265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/07/2021] [Accepted: 10/07/2021] [Indexed: 02/04/2023]
Abstract
Joint registration of a stack of 2D histological sections to recover 3D structure ("3D histology reconstruction") finds application in areas such as atlas building and validation of in vivo imaging. Straightforward pairwise registration of neighbouring sections yields smooth reconstructions but has well-known problems such as "banana effect" (straightening of curved structures) and "z-shift" (drift). While these problems can be alleviated with an external, linearly aligned reference (e.g., Magnetic Resonance (MR) images), registration is often inaccurate due to contrast differences and the strong nonlinear distortion of the tissue, including artefacts such as folds and tears. In this paper, we present a probabilistic model of spatial deformation that yields reconstructions for multiple histological stains that that are jointly smooth, robust to outliers, and follow the reference shape. The model relies on a spanning tree of latent transforms connecting all the sections and slices of the reference volume, and assumes that the registration between any pair of images can be see as a noisy version of the composition of (possibly inverted) latent transforms connecting the two images. Bayesian inference is used to compute the most likely latent transforms given a set of pairwise registrations between image pairs within and across modalities. We consider two likelihood models: Gaussian (ℓ2 norm, which can be minimised in closed form) and Laplacian (ℓ1 norm, minimised with linear programming). Results on synthetic deformations on multiple MR modalities, show that our method can accurately and robustly register multiple contrasts even in the presence of outliers. The framework is used for accurate 3D reconstruction of two stains (Nissl and parvalbumin) from the Allen human brain atlas, showing its benefits on real data with severe distortions. Moreover, we also provide the registration of the reconstructed volume to MNI space, bridging the gaps between two of the most widely used atlases in histology and MRI. The 3D reconstructed volumes and atlas registration can be downloaded from https://openneuro.org/datasets/ds003590. The code is freely available at https://github.com/acasamitjana/3dhirest.
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Affiliation(s)
| | - Marco Lorenzi
- Universitë Côte dÁzur, Inria, Epione Team, 06902 Sophia Antipolis, France
| | | | - Loïc Peter
- Center for Medical Image Computing, University College London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Allison Stevens
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, USA
| | - Bruce Fischl
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA; Program in Health Sciences and Technology, Massachusetts Institute of Technology, USA
| | - Tom Vercauteren
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Juan Eugenio Iglesias
- Center for Medical Image Computing, University College London, UK; Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, USA
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28
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Klaser K, Thompson EJ, Nguyen LH, Sudre CH, Antonelli M, Murray B, Canas LS, Molteni E, Graham MS, Kerfoot E, Chen L, Deng J, May A, Hu C, Guest A, Selvachandran S, Drew DA, Modat M, Chan AT, Wolf J, Spector TD, Hammers A, Duncan EL, Ourselin S, Steves CJ. Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. J Neurol Neurosurg Psychiatry 2021; 92:1254-1258. [PMID: 34583944 PMCID: PMC8599635 DOI: 10.1136/jnnp-2021-327565] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Mental health issues have been reported after SARS-CoV-2 infection. However, comparison to prevalence in uninfected individuals and contribution from common risk factors (eg, obesity and comorbidities) have not been examined. We identified how COVID-19 relates to mental health in the large community-based COVID Symptom Study. METHODS We assessed anxiety and depression symptoms using two validated questionnaires in 413148 individuals between February and April 2021; 26998 had tested positive for SARS-CoV-2. We adjusted for physical and mental prepandemic comorbidities, body mass index (BMI), age and sex. FINDINGS Overall, 26.4% of participants met screening criteria for general anxiety and depression. Anxiety and depression were slightly more prevalent in previously SARS-CoV-2-positive (30.4%) vs SARS-CoV-2-negative (26.1%) individuals. This association was small compared with the effect of an unhealthy BMI and the presence of other comorbidities, and not evident in younger participants (≤40 years). Findings were robust to multiple sensitivity analyses. Association between SARS-CoV-2 infection and anxiety and depression was stronger in individuals with recent (<30 days) versus more distant (>120 days) infection, suggesting a short-term effect. INTERPRETATION A small association was identified between SARS-CoV-2 infection and anxiety and depression symptoms. The proportion meeting criteria for self-reported anxiety and depression disorders is only slightly higher than prepandemic.
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Affiliation(s)
- Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Long H Nguyen
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- Department of Medical Physics and Bioengineering, UCL Centre for Medical Image Computing (CMIC), London, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | | | - David A Drew
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andrew T Chan
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
- PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
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29
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Canas LS, Österdahl MF, Deng J, Hu C, Selvachandran S, Polidori L, May A, Molteni E, Murray B, Chen L, Kerfoot E, Klaser K, Antonelli M, Hammers A, Spector T, Ourselin S, Steves C, Sudre CH, Modat M, Duncan EL. Disentangling post-vaccination symptoms from early COVID-19. EClinicalMedicine 2021; 42:101212. [PMID: 34873584 PMCID: PMC8635464 DOI: 10.1016/j.eclinm.2021.101212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Identifying and testing individuals likely to have SARS-CoV-2 is critical for infection control, including post-vaccination. Vaccination is a major public health strategy to reduce SARS-CoV-2 infection globally. Some individuals experience systemic symptoms post-vaccination, which overlap with COVID-19 symptoms. This study compared early post-vaccination symptoms in individuals who subsequently tested positive or negative for SARS-CoV-2, using data from the COVID Symptom Study (CSS) app. METHODS We conducted a prospective observational study in 1,072,313 UK CSS participants who were asymptomatic when vaccinated with Pfizer-BioNTech mRNA vaccine (BNT162b2) or Oxford-AstraZeneca adenovirus-vectored vaccine (ChAdOx1 nCoV-19) between 8 December 2020 and 17 May 2021, who subsequently reported symptoms within seven days (N=362,770) (other than local symptoms at injection site) and were tested for SARS-CoV-2 (N=14,842), aiming to differentiate vaccination side-effects per se from superimposed SARS-CoV-2 infection. The post-vaccination symptoms and SARS-CoV-2 test results were contemporaneously logged by participants. Demographic and clinical information (including comorbidities) were recorded. Symptom profiles in individuals testing positive were compared with a 1:1 matched population testing negative, including using machine learning and multiple models considering UK testing criteria. FINDINGS Differentiating post-vaccination side-effects alone from early COVID-19 was challenging, with a sensitivity in identification of individuals testing positive of 0.6 at best. Most of these individuals did not have fever, persistent cough, or anosmia/dysosmia, requisite symptoms for accessing UK testing; and many only had systemic symptoms commonly seen post-vaccination in individuals negative for SARS-CoV-2 (headache, myalgia, and fatigue). INTERPRETATION Post-vaccination symptoms per se cannot be differentiated from COVID-19 with clinical robustness, either using symptom profiles or machine-derived models. Individuals presenting with systemic symptoms post-vaccination should be tested for SARS-CoV-2 or quarantining, to prevent community spread. FUNDING UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK National Institute for Health Research, UK Medical Research Council and British Heart Foundation, Chronic Disease Research Foundation, Zoe Limited.
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Key Words
- AUC, Area under the curve
- BMI, Body mass index
- CI, Confidence interval
- COVID-19 detection
- COVID-19, Coronavirus disease 2019
- CSS, COVID Symptoms Study
- DI, Data invalid
- Early detection
- IQR, inter quartile range
- KCL, King's College London
- LFAT, Lateral flow antigen test
- LR, Logistic Regression
- Mobile technology
- NHS UK, National Health Service of the United Kingdom
- O-AZ, Oxford-AstraZeneca adenovirus-vectored vaccine
- PB, Pfizer-BoiNTech mRNA vaccine
- RF, Random forest
- ROC, Receiver operating curve
- SARS-CoV-2, Severe acute respiratory syndrome-related coronavirus-2
- Self-reported symptoms
- Side-effects
- UK, United Kingdom of Great Britain and Nothern Ireland
- Vaccination
- bMEM, Bayesian mixed-effect model
- rtPCR, Reverse transcription polymerase chain reaction
- severe acute respiratory syndrome‐related coronavirus 2 (SARS-CoV-2)
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Affiliation(s)
- Liane S. Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc F. Österdahl
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | | | | | | | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Klaser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London & Guy's and St Thomas’ PET Centre, London, UK
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claire Steves
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Carole H. Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine. UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Emma L. Duncan
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
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30
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Murray B, Kerfoot E, Chen L, Deng J, Graham MS, Sudre CH, Molteni E, Canas LS, Antonelli M, Klaser K, Visconti A, Hammers A, Chan AT, Franks PW, Davies R, Wolf J, Spector TD, Steves CJ, Modat M, Ourselin S. Accessible data curation and analytics for international-scale citizen science datasets. Sci Data 2021; 8:297. [PMID: 34811392 PMCID: PMC8608807 DOI: 10.1038/s41597-021-01071-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 09/29/2021] [Indexed: 11/21/2022] Open
Abstract
The Covid Symptom Study, a smartphone-based surveillance study on COVID-19 symptoms in the population, is an exemplar of big data citizen science. As of May 23rd, 2021, over 5 million participants have collectively logged over 360 million self-assessment reports since its introduction in March 2020. The success of the Covid Symptom Study creates significant technical challenges around effective data curation. The primary issue is scale. The size of the dataset means that it can no longer be readily processed using standard Python-based data analytics software such as Pandas on commodity hardware. Alternative technologies exist but carry a higher technical complexity and are less accessible to many researchers. We present ExeTera, a Python-based open source software package designed to provide Pandas-like data analytics on datasets that approach terabyte scales. We present its design and capabilities, and show how it is a critical component of a data curation pipeline that enables reproducible research across an international research group for the Covid Symptom Study.
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Affiliation(s)
- Benjamin Murray
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom.
| | - Eric Kerfoot
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Liyuan Chen
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Jie Deng
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Mark S Graham
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Carole H Sudre
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
- University College London, MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, London, WC1E 7HB, United Kingdom
- University College London, Centre for Medical Image Computing, London, WC1E 6BT, United Kingdom
| | - Erika Molteni
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Liane S Canas
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Michela Antonelli
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Kerstin Klaser
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Alessia Visconti
- King's College London, Department of Twin Research and Genetic Epidemiology, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Alexander Hammers
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Andrew T Chan
- Massachusetts General Hospital, 55 Fruit Street, GRJ 825C, Boston, MA, 02116, United States
| | - Paul W Franks
- Lund University, Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12, SE-214 28, Malmö, Sweden
| | - Richard Davies
- Zoe Limited, 164 Westminster Bridge Road, London, SE1 7RW, United Kingdom
| | - Jonathan Wolf
- Zoe Limited, 164 Westminster Bridge Road, London, SE1 7RW, United Kingdom
| | - Tim D Spector
- King's College London, Department of Twin Research and Genetic Epidemiology, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Claire J Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Marc Modat
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
| | - Sebastien Ourselin
- King's College London, School of Biomedical Engineering & Imaging Sciences, London, SE1 7EU, United Kingdom
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31
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Wilcox M, Dos Santos Canas L, Hargunani R, Tidswell T, Brown H, Modat M, Phillips JB, Ourselin S, Quick T. Volumetric MRI is a promising outcome measure of muscle reinnervation. Sci Rep 2021; 11:22433. [PMID: 34789795 PMCID: PMC8599480 DOI: 10.1038/s41598-021-01342-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022] Open
Abstract
The development of outcome measures that can track the recovery of reinnervated muscle would benefit the clinical investigation of new therapies which hope to enhance peripheral nerve repair. The primary objective of this study was to assess the validity of volumetric Magnetic Resonance Imaging (MRI) as an outcome measure of muscle reinnervation by testing its reproducibility, responsiveness and relationship with clinical indices of muscular function. Over a 3-year period 25 patients who underwent nerve transfer to reinnervate elbow flexor muscles were assessed using intramuscular electromyography (EMG) and MRI (median post-operative assessment time of 258 days, ranging from 86 days pre-operatively to 1698 days post- operatively). Muscle power (Medical Research Council (MRC) grade) and Stanmore Percentage of Normal Elbow Assessment (SPONEA) assessment was also recorded for all patients. Sub-analysis of peak volitional force (PVF), muscular fatigue and co-contraction was performed in those patients with MRC > 3. The responsiveness of each parameter was compared using Pearson or Spearman correlation. A Hierarchical Gaussian Process (HGP) was implemented to determine the ability of volumetric MRI measurements to predict the recovery of muscular function. Reinnervated muscle volume per unit Body Mass Index (BMI) demonstrated good responsiveness (R2 = 0.73, p < 0.001). Using the temporal and muscle volume per unit BMI data, a HGP model was able to predict MRC grade and SPONEA with a mean absolute error (MAE) of 0.73 and 1.7 respectively. Muscle volume per unit BMI demonstrated moderate to good positive correlations with patient reported impairments of reinnervated muscle; co- contraction (R2 = 0.63, p = 0.02) and muscle fatigue (R2 = 0.64, p = 0.04). In summary, volumetric MRI analysis of reinnervated muscle is highly reproducible, responsive to post-operative time and demonstrates correlation with clinical indices of muscle function. This encourages the view that volumetric MRI is a promising outcome measure for muscle reinnervation which will drive advancements in motor recovery therapy.
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Affiliation(s)
- Matthew Wilcox
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK. .,UCL Centre for Nerve Engineering, University College London, London, UK. .,Department of Pharmacology, UCL School of Pharmacy, University College London, London, UK. .,University College London Medical School, London, UK.
| | | | - Rikin Hargunani
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Tom Tidswell
- Department of Clinical Neurophysiology, Royal Free Hospital, London, UK
| | - Hazel Brown
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,UCL Centre for Nerve Engineering, University College London, London, UK
| | - Marc Modat
- Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - James B Phillips
- UCL Centre for Nerve Engineering, University College London, London, UK.,Department of Pharmacology, UCL School of Pharmacy, University College London, London, UK
| | - Sebastien Ourselin
- Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Tom Quick
- Peripheral Nerve Injury Research Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,UCL Centre for Nerve Engineering, University College London, London, UK
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32
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Penfold RS, Zazzara MB, Österdahl MF, Welch C, Ni Lochlainn M, Freidin MB, Bowyer RCE, Thompson E, Antonelli M, Tan YXR, Sudre CH, Modat M, Murray B, Wolf J, Ourselin S, Veenith T, Lord JM, Steves CJ. Individual factors including age, BMI and heritable factors underlie temperature variation in sickness and in health: an observational, multi-cohort study. J Gerontol A Biol Sci Med Sci 2021; 77:1890-1897. [PMID: 34609487 PMCID: PMC8513412 DOI: 10.1093/gerona/glab295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background Aging affects immunity, potentially altering fever response to infection. We assess effects of biological variables on basal temperature, and during COVID-19 infection, proposing an updated temperature threshold for older adults ≥65 years. Methods Participants were from 4 cohorts: 1 089 unaffected adult TwinsUK volunteers; 520 adults with emergency admission to a London hospital with RT-PCR confirmed SARS-CoV-2 infection; 757 adults with emergency admission to a Birmingham hospital with RT-PCR confirmed SARS-CoV-2 infection and 3 972 adult community-based COVID Symptom Study participants self-reporting a positive RT-PCR test. Heritability was assessed using saturated and univariate ACE models; mixed-effect and multivariable linear regression examined associations between temperature, age, sex, and body mass index (BMI); multivariable logistic regression examined associations between fever (≥37.8°C) and age; receiver operating characteristic (ROC) analysis was used to identify temperature threshold for adults ≥ 65 years. Results Among unaffected volunteers, lower BMI (p = .001), and increasing age (p < .001) was associated with lower basal temperature. Basal temperature showed a heritability of 47% (95% confidence interval 18%–57%). In COVID-19+ participants, increasing age was associated with lower temperatures in Birmingham and community-based cohorts (p < .001). For each additional year of age, participants were 1% less likely to demonstrate a fever ≥37.8°C (OR 0.99; p < .001). Combining healthy and COVID-19+ participants, a temperature of 37.4°C in adults ≥65 years had similar sensitivity and specificity to 37.8°C in adults <65 years for discriminating infection. Conclusions Aging affects temperature in health and acute infection, with significant heritability, indicating genetic factors contribute to temperature regulation. Our observations suggest a lower threshold (37.4°C/97.3°F) for identifying fever in older adults ≥65 years.
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Affiliation(s)
- Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London.,Guy's and St Thomas' NHS Foundation Trust
| | - Maria Beatrice Zazzara
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London.,Department of Gerontology, Neuroscience and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | | | | | - Carly Welch
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK
| | - Mary Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London
| | - Maxim B Freidin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London
| | - Ruth C E Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London
| | - Ellen Thompson
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK
| | - Yu Xian Rachel Tan
- Department of Medicine, Royal College of Surgeons in Ireland, 123 St Stephen Green, Dublin 2, Ireland
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK
| | | | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, SE17EH, London, UK
| | - Tonny Veenith
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT, Birmingham, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London
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33
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Molteni E, Sudre CH, Canas LS, Bhopal SS, Hughes RC, Antonelli M, Murray B, Kläser K, Kerfoot E, Chen L, Deng J, Hu C, Selvachandran S, Read K, Capdevila Pujol J, Hammers A, Spector TD, Ourselin S, Steves CJ, Modat M, Absoud M, Duncan EL. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health 2021; 5:708-718. [PMID: 34358472 PMCID: PMC8443448 DOI: 10.1016/s2352-4642(21)00198-x] [Citation(s) in RCA: 235] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND In children, SARS-CoV-2 infection is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, one of the largest UK citizen participatory epidemiological studies to date. METHODS In this prospective cohort study, data from UK school-aged children (age 5-17 years) were reported by an adult proxy. Participants were voluntary, and used a mobile application (app) launched jointly by Zoe Limited and King's College London. Illness duration and symptom prevalence, duration, and burden were analysed for children testing positive for SARS-CoV-2 for whom illness duration could be determined, and were assessed overall and for younger (age 5-11 years) and older (age 12-17 years) groups. Children with longer than 1 week between symptomatic reports on the app were excluded from analysis. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed. FINDINGS 258 790 children aged 5-17 years were reported by an adult proxy between March 24, 2020, and Feb 22, 2021, of whom 75 529 had valid test results for SARS-CoV-2. 1734 children (588 younger and 1146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study timeframe (illness onset between Sept 1, 2020, and Jan 24, 2021). The most common symptoms were headache (1079 [62·2%] of 1734 children), and fatigue (954 [55·0%] of 1734 children). Median illness duration was 6 days (IQR 3-11) versus 3 days (2-7) in children testing negative, and was positively associated with age (Spearman's rank-order rs 0·19, p<0·0001). Median illness duration was longer for older children (7 days, IQR 3-12) than younger children (5 days, 2-9). 77 (4·4%) of 1734 children had illness duration of at least 28 days, more commonly in older than younger children (59 [5·1%] of 1146 older children vs 18 [3·1%] of 588 younger children; p=0·046). The commonest symptoms experienced by these children during the first 4 weeks of illness were fatigue (65 [84·4%] of 77), headache (60 [77·9%] of 77), and anosmia (60 [77·9%] of 77); however, after day 28 the symptom burden was low (median 2 symptoms, IQR 1-4) compared with the first week of illness (median 6 symptoms, 4-8). Only 25 (1·8%) of 1379 children experienced symptoms for at least 56 days. Few children (15 children, 0·9%) in the negatively tested cohort had symptoms for at least 28 days; however, these children experienced greater symptom burden throughout their illness (9 symptoms, IQR 7·7-11·0 vs 8, 6-9) and after day 28 (5 symptoms, IQR 1·5-6·5 vs 2, 1-4) than did children who tested positive for SARS-CoV-2. INTERPRETATION Although COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate. FUNDING Zoe Limited, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, and Alzheimer's Society.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences and Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Sunil S Bhopal
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Robert C Hughes
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Kerstin Kläser
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | | | | | | | | | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Michael Absoud
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; Children's Neurosciences, Evelina London Children' Hospital, St Thomas' Hospital, King's Health Partners, Academic Health Science Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK; Department of Endocrinology, Guys and St Thomas' NHS Foundation Trust, London, UK.
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Booth TC, Chelliah A, Roman A, Al Busaidi A, Shuaib H, Luis A, Mirchandani A, Alparslan B, Mansoor N, Ashkan K, Ourselin S, Modat M, Grzeda M. OS08.6.A Glioblastoma treatment response machine learning monitoring biomarkers: a systematic review and meta-analysis. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
The aim of the systematic review was to assess recently published studies on diagnostic test accuracy of glioblastoma treatment response monitoring biomarkers in adults, developed through machine learning (ML).
MATERIAL AND METHODS
PRISMA methodology was followed. Articles published 09/2018-01/2021 (since previous reviews) were searched for using MEDLINE, EMBASE, and the Cochrane Register by two reviewers independently. Included study participants were adult patients with high grade glioma who had undergone standard treatment (maximal resection, radiotherapy with concomitant and adjuvant temozolomide) and subsequently underwent follow-up imaging to determine treatment response status (specifically, distinguishing progression/recurrence from progression/recurrence mimics - the target condition). Risk of bias and applicability was assessed with QUADAS 2. A third reviewer arbitrated any discrepancy. Contingency tables were created for hold-out test sets and recall, specificity, precision, F1-score, balanced accuracy calculated. A meta-analysis was performed using a bivariate model for recall, false positive rate and area-under the receiver operator characteristic curve (AUC).
RESULTS
Eighteen studies were included with 1335 patients in training sets and 384 in test sets. To determine whether there was progression or a mimic, the reference standard combination of follow-up imaging and histopathology at re-operation was applied in 67% (13/18) of studies. The small numbers of patient included in studies, the high risk of bias and concerns of applicability in the study designs (particularly in relation to the reference standard and patient selection due to confounding), and the low level of evidence, suggest that limited conclusions can be drawn from the data. Ten studies (10/18, 56%) had internal or external hold-out test set data that could be included in a meta-analysis of monitoring biomarker studies. The pooled sensitivity was 0.77 (0.65–0.86). The pooled false positive rate (1-specificity) was 0.35 (0.25–0.47). The summary point estimate for the AUC was 0.77.
CONCLUSION
There is likely good diagnostic performance of machine learning models that use MRI features to distinguish between progression and mimics. The diagnostic performance of ML using implicit features did not appear to be superior to ML using explicit features. There are a range of ML-based solutions poised to become treatment response monitoring biomarkers for glioblastoma. To achieve this, the development and validation of ML models require large, well-annotated datasets where the potential for confounding in the study design has been carefully considered. Therefore, multidisciplinary efforts and multicentre collaborations are necessary.
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Affiliation(s)
- T C Booth
- King’s College London, London, United Kingdom
| | - A Chelliah
- King’s College London, London, United Kingdom
| | - A Roman
- Guy’s & St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - A Al Busaidi
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - H Shuaib
- Guy’s & St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - A Luis
- King’s College London, London, United Kingdom
| | - A Mirchandani
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - B Alparslan
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - N Mansoor
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K Ashkan
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - S Ourselin
- King’s College London, London, United Kingdom
| | - M Modat
- King’s College London, London, United Kingdom
| | - M Grzeda
- King’s College London, London, United Kingdom
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Sudre CH, Keshet A, Graham MS, Joshi AD, Shilo S, Rossman H, Murray B, Molteni E, Klaser K, Canas LD, Antonelli M, Nguyen LH, Drew DA, Modat M, Pujol JC, Ganesh S, Wolf J, Meir T, Chan AT, Steves CJ, Spector TD, Brownstein JS, Segal E, Ourselin S, Astley CM. Anosmia, ageusia, and other COVID-19-like symptoms in association with a positive SARS-CoV-2 test, across six national digital surveillance platforms: an observational study. Lancet Digit Health 2021; 3:e577-e586. [PMID: 34305035 PMCID: PMC8297994 DOI: 10.1016/s2589-7500(21)00115-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple voluntary surveillance platforms were developed across the world in response to the COVID-19 pandemic, providing a real-time understanding of population-based COVID-19 epidemiology. During this time, testing criteria broadened and health-care policies matured. We aimed to test whether there were consistent associations of symptoms with SARS-CoV-2 test status across three surveillance platforms in three countries (two platforms per country), during periods of testing and policy changes. METHODS For this observational study, we used data of observations from three volunteer COVID-19 digital surveillance platforms (Carnegie Mellon University and University of Maryland Facebook COVID-19 Symptom Survey, ZOE COVID Symptom Study app, and the Corona Israel study) targeting communities in three countries (Israel, the UK, and the USA; two platforms per country). The study population included adult respondents (age 18-100 years at baseline) who were not health-care workers. We did logistic regression of self-reported symptoms on self-reported SARS-CoV-2 test status (positive or negative), adjusted for age and sex, in each of the study cohorts. We compared odds ratios (ORs) across platforms and countries, and we did meta-analyses assuming a random effects model. We also evaluated testing policy changes, COVID-19 incidence, and time scales of duration of symptoms and symptom-to-test time. FINDINGS Between April 1 and July 31, 2020, 514 459 tests from over 10 million respondents were recorded in the six surveillance platform datasets. Anosmia-ageusia was the strongest, most consistent symptom associated with a positive COVID-19 test (robust aggregated rank one, meta-analysed random effects OR 16·96, 95% CI 13·13-21·92). Fever (rank two, 6·45, 4·25-9·81), shortness of breath (rank three, 4·69, 3·14-7·01), and cough (rank four, 4·29, 3·13-5·88) were also highly associated with test positivity. The association of symptoms with test status varied by duration of illness, timing of the test, and broader test criteria, as well as over time, by country, and by platform. INTERPRETATION The strong association of anosmia-ageusia with self-reported positive SARS-CoV-2 test was consistently observed, supporting its validity as a reliable COVID-19 signal, regardless of the participatory surveillance platform, country, phase of illness, or testing policy. These findings show that associations between COVID-19 symptoms and test positivity ranked similarly in a wide range of scenarios. Anosmia, fever, and respiratory symptoms consistently had the strongest effect estimates and were the most appropriate empirical signals for symptom-based public health surveillance in areas with insufficient testing or benchmarking capacity. Collaborative syndromic surveillance could enhance real-time epidemiological investigations and public health utility globally. FUNDING National Institutes of Health, National Institute for Health Research, Alzheimer's Society, Wellcome Trust, and Massachusetts Consortium on Pathogen Readiness.
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Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Medical Research Council Unit for Lifelong health and Ageing at UCL, Department of Population Science and Experimental Medicine, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK.
| | - Ayya Keshet
- Department of Computer Science and Applied Mathematics and Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Smadar Shilo
- Department of Computer Science and Applied Mathematics and Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel; Pediatric Diabetes Unit, Ruth Rappaport Children's Hospital, Rambam Healthcare Campus, Haifa, Israel
| | - Hagai Rossman
- Department of Computer Science and Applied Mathematics and Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane D Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | - Tomer Meir
- Department of Computer Science and Applied Mathematics and Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; ZOE Global, London, UK
| | - John S Brownstein
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA
| | - Eran Segal
- Department of Computer Science and Applied Mathematics and Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; AI Institute 3IA Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Christina M Astley
- Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
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36
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Canas LS, Sudre CH, Capdevila Pujol J, Polidori L, Murray B, Molteni E, Graham MS, Klaser K, Antonelli M, Berry S, Davies R, Nguyen LH, Drew DA, Wolf J, Chan AT, Spector T, Steves CJ, Ourselin S, Modat M. Early detection of COVID-19 in the UK using self-reported symptoms: a large-scale, prospective, epidemiological surveillance study. Lancet Digit Health 2021; 3:e587-e598. [PMID: 34334333 PMCID: PMC8321433 DOI: 10.1016/s2589-7500(21)00131-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Self-reported symptoms during the COVID-19 pandemic have been used to train artificial intelligence models to identify possible infection foci. To date, these models have only considered the culmination or peak of symptoms, which is not suitable for the early detection of infection. We aimed to estimate the probability of an individual being infected with SARS-CoV-2 on the basis of early self-reported symptoms to enable timely self-isolation and urgent testing. METHODS In this large-scale, prospective, epidemiological surveillance study, we used prospective, observational, longitudinal, self-reported data from participants in the UK on 19 symptoms over 3 days after symptoms onset and COVID-19 PCR test results extracted from the COVID-19 Symptom Study mobile phone app. We divided the study population into a training set (those who reported symptoms between April 29, 2020, and Oct 15, 2020) and a test set (those who reported symptoms between Oct 16, 2020, and Nov 30, 2020), and used three models to analyse the self-reported symptoms: the UK's National Health Service (NHS) algorithm, logistic regression, and the hierarchical Gaussian process model we designed to account for several important variables (eg, specific COVID-19 symptoms, comorbidities, and clinical information). Model performance to predict COVID-19 positivity was compared in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) in the test set. For the hierarchical Gaussian process model, we also evaluated the relevance of symptoms in the early detection of COVID-19 in population subgroups stratified according to occupation, sex, age, and body-mass index. FINDINGS The training set comprised 182 991 participants and the test set comprised 15 049 participants. When trained on 3 days of self-reported symptoms, the hierarchical Gaussian process model had a higher prediction AUC (0·80 [95% CI 0·80-0·81]) than did the logistic regression model (0·74 [0·74-0·75]) and the NHS algorithm (0·67 [0·67-0·67]). AUCs for all models increased with the number of days of self-reported symptoms, but were still high for the hierarchical Gaussian process model at day 1 (0·73 [95% CI 0·73-0·74]) and day 2 (0·79 [0·78-0·79]). At day 3, the hierarchical Gaussian process model also had a significantly higher sensitivity, but a non-statistically lower specificity, than did the two other models. The hierarchical Gaussian process model also identified different sets of relevant features to detect COVID-19 between younger and older subgroups, and between health-care workers and non-health-care workers. When used during different pandemic periods, the model was robust to changes in populations. INTERPRETATION Early detection of SARS-CoV-2 infection is feasible with our model. Such early detection is crucial to contain the spread of COVID-19 and efficiently allocate medical resources. FUNDING ZOE, the UK Government Department of Health and Social Care, the Wellcome Trust, the UK Engineering and Physical Sciences Research Council, the UK National Institute for Health Research, the UK Medical Research Council, the British Heart Foundation, the Alzheimer's Society, the Chronic Disease Research Foundation, and the Massachusetts Consortium on Pathogen Readiness.
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Affiliation(s)
- Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | | | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Klaser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sarah Berry
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Molteni E, Ranzini MBM, Beretta E, Modat M, Strazzer S. Individualized Prognostic Prediction of the Long-Term Functional Trajectory in Pediatric Acquired Brain Injury. J Pers Med 2021; 11:675. [PMID: 34357142 PMCID: PMC8305391 DOI: 10.3390/jpm11070675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
In pediatric acquired brain injury, heterogeneity of functional response to specific rehabilitation treatments is a key confound to medical decisions and outcome prediction. We aimed to identify patient subgroups sharing comparable trajectories, and to implement a method for the early prediction of the long-term recovery course from clinical condition at first discharge. 600 consecutive patients with acquired brain injury (7.4 years ± 5.2; 367 males; median GCS = 6) entered a standardized rehabilitation program. Functional Independent Measure scores were measured yearly, until year 7. We classified the functional trajectories in clusters, through a latent class model. We performed single-subject prediction of trajectory membership in cases unseen during model fitting. Four trajectory types were identified (post.prob. > 0.95): high-start fast (N = 92), low-start fast (N = 168), slow (N = 130) and non-responders (N = 210). Fast responders were older (chigh = 1.8; clow = 1.1) than non-responders and suffered shorter coma (chigh = -14.7; clow = -4.3). High-start fast-responders had shorter length of stay (c = -1.6), and slow responders had lower incidence of epilepsy (c = -1.4), than non-responders (p < 0.001). Single-subject trajectory could be predicted with high accuracy at first discharge (accuracy = 0.80). In conclusion, we stratified patients based on the evolution of their response to a specific treatment program. Data at first discharge predicted the response over 7 years. This method enables early detection of the slow responders, who show poor post-acute functional gains, but achieve recovery comparable to fast responders by year 7. Further external validation in other rehabilitation programs is warranted.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (E.M.); (M.B.M.R.); (M.M.)
| | - Marta Bianca Maria Ranzini
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (E.M.); (M.B.M.R.); (M.M.)
| | - Elena Beretta
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy;
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London SE1 7EU, UK; (E.M.); (M.B.M.R.); (M.M.)
| | - Sandra Strazzer
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy;
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38
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Klaser K, Thompson EJ, Nguyen LH, Sudre CH, Antonelli M, Murray B, Canas LS, Molteni E, Graham MS, Kerfoot E, Chen L, Deng J, May A, Hu C, Guest A, Selvachandran S, Drew DA, Modat M, Chan AT, Wolf J, Spector TD, Hammers A, Duncan EL, Ourselin S, Steves CJ. Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app. medRxiv 2021:2021.07.07.21260137. [PMID: 34268526 PMCID: PMC8282115 DOI: 10.1101/2021.07.07.21260137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mental health issues have been reported after SARS-CoV-2 infection. However, comparison to prevalence in uninfected individuals and contribution from common risk factors (e.g., obesity, comorbidities) have not been examined. We identified how COVID-19 relates to mental health in the large community-based COVID Symptom Study. METHODS We assessed anxiety and depression symptoms using two validated questionnaires in 413,148 individuals between February and April 2021; 26,998 had tested positive for SARS-CoV-2. We adjusted for physical and mental pre-pandemic comorbidities, BMI, age, and sex. FINDINGS Overall, 26.4% of participants met screening criteria for general anxiety and depression. Anxiety and depression were slightly more prevalent in previously SARS-CoV-2 positive (30.4%) vs. negative (26.1%) individuals. This association was small compared to the effect of an unhealthy BMI and the presence of other comorbidities, and not evident in younger participants (≤40 years). Findings were robust to multiple sensitivity analyses. Association between SARS-CoV-2 infection and anxiety and depression was stronger in individuals with recent (<30 days) vs. more distant (>120 days) infection, suggesting a short-term effect. INTERPRETATION A small association was identified between SARS-CoV-2 infection and anxiety and depression symptoms. The proportion meeting criteria for self-reported anxiety and depression disorders is only slightly higher than pre-pandemic. FUNDING Zoe Limited, National Institute for Health Research, Chronic Disease Research Foundation, National Institutes of Health, Medical Research Council UK.
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Affiliation(s)
- Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Long H Nguyen
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Liyuan Chen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Jie Deng
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | | | | | | | | | - David A Drew
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Andrew T Chan
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge Street, Boston, MA, USA
| | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
- King's College London & Guy's and St Thomas' PET Centre, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EU, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London SE1 7EH, UK
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Menni C, Klaser K, May A, Polidori L, Capdevila J, Louca P, Sudre CH, Nguyen LH, Drew DA, Merino J, Hu C, Selvachandran S, Antonelli M, Murray B, Canas LS, Molteni E, Graham MS, Modat M, Joshi AD, Mangino M, Hammers A, Goodman AL, Chan AT, Wolf J, Steves CJ, Valdes AM, Ourselin S, Spector TD. Vaccine side-effects and SARS-CoV-2 infection after vaccination in users of the COVID Symptom Study app in the UK: a prospective observational study. Lancet Infect Dis 2021; 21:939-949. [PMID: 33930320 PMCID: PMC8078878 DOI: 10.1016/s1473-3099(21)00224-3] [Citation(s) in RCA: 576] [Impact Index Per Article: 192.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Pfizer-BioNTech (BNT162b2) and the Oxford-AstraZeneca (ChAdOx1 nCoV-19) COVID-19 vaccines have shown excellent safety and efficacy in phase 3 trials. We aimed to investigate the safety and effectiveness of these vaccines in a UK community setting. METHODS In this prospective observational study, we examined the proportion and probability of self-reported systemic and local side-effects within 8 days of vaccination in individuals using the COVID Symptom Study app who received one or two doses of the BNT162b2 vaccine or one dose of the ChAdOx1 nCoV-19 vaccine. We also compared infection rates in a subset of vaccinated individuals subsequently tested for SARS-CoV-2 with PCR or lateral flow tests with infection rates in unvaccinated controls. All analyses were adjusted by age (≤55 years vs >55 years), sex, health-care worker status (binary variable), obesity (BMI <30 kg/m2vs ≥30 kg/m2), and comorbidities (binary variable, with or without comorbidities). FINDINGS Between Dec 8, and March 10, 2021, 627 383 individuals reported being vaccinated with 655 590 doses: 282 103 received one dose of BNT162b2, of whom 28 207 received a second dose, and 345 280 received one dose of ChAdOx1 nCoV-19. Systemic side-effects were reported by 13·5% (38 155 of 282 103) of individuals after the first dose of BNT162b2, by 22·0% (6216 of 28 207) after the second dose of BNT162b2, and by 33·7% (116 473 of 345 280) after the first dose of ChAdOx1 nCoV-19. Local side-effects were reported by 71·9% (150 023 of 208 767) of individuals after the first dose of BNT162b2, by 68·5% (9025 of 13 179) after the second dose of BNT162b2, and by 58·7% (104 282 of 177 655) after the first dose of ChAdOx1 nCoV-19. Systemic side-effects were more common (1·6 times after the first dose of ChAdOx1 nCoV-19 and 2·9 times after the first dose of BNT162b2) among individuals with previous SARS-CoV-2 infection than among those without known past infection. Local effects were similarly higher in individuals previously infected than in those without known past infection (1·4 times after the first dose of ChAdOx1 nCoV-19 and 1·2 times after the first dose of BNT162b2). 3106 of 103 622 vaccinated individuals and 50 340 of 464 356 unvaccinated controls tested positive for SARS-CoV-2 infection. Significant reductions in infection risk were seen starting at 12 days after the first dose, reaching 60% (95% CI 49-68) for ChAdOx1 nCoV-19 and 69% (66-72) for BNT162b2 at 21-44 days and 72% (63-79) for BNT162b2 after 45-59 days. INTERPRETATION Systemic and local side-effects after BNT162b2 and ChAdOx1 nCoV-19 vaccination occur at frequencies lower than reported in phase 3 trials. Both vaccines decrease the risk of SARS-CoV-2 infection after 12 days. FUNDING ZOE Global, National Institute for Health Research, Chronic Disease Research Foundation, National Institutes of Health, UK Medical Research Council, Wellcome Trust, UK Research and Innovation, American Gastroenterological Association.
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Affiliation(s)
- Cristina Menni
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.
| | - Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | - Panayiotis Louca
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; Medical Research Council Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, and Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Long H Nguyen
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David A Drew
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | | | | | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Amit D Joshi
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Massimo Mangino
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' Foundation Trust, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Anna L Goodman
- Department of Infection, Guy's and St Thomas' Foundation Trust, St Thomas Hospital, London, UK
| | - Andrew T Chan
- Clinical & Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Claire J Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Ana M Valdes
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK; Nottingham NIHR Biomedical Research Centre at the School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tim D Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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40
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Hopkinson NS, Rossi N, El-Sayed Moustafa J, Laverty AA, Quint JK, Freidin M, Visconti A, Murray B, Modat M, Ourselin S, Small K, Davies R, Wolf J, Spector TD, Steves CJ, Falchi M. Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax 2021; 76:714-722. [PMID: 33402392 PMCID: PMC7789201 DOI: 10.1136/thoraxjnl-2020-216422] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/07/2020] [Accepted: 11/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between current tobacco smoking, the risk of developing symptomatic COVID-19 and the severity of illness is an important information gap. METHODS UK users of the Zoe COVID-19 Symptom Study app provided baseline data including demographics, anthropometrics, smoking status and medical conditions, and were asked to log their condition daily. Participants who reported that they did not feel physically normal were then asked by the app to complete a series of questions, including 14 potential COVID-19 symptoms and about hospital attendance. The main study outcome was the development of 'classic' symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness and their association with current smoking. The number of concurrent COVID-19 symptoms was used as a proxy for severity and the pattern of association between symptoms was also compared between smokers and non-smokers. RESULTS Between 24 March 2020 and 23 April 2020, data were available on 2 401 982 participants, mean (SD) age 43.6 (15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834 437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to report symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR (95% CI) 1.14 (1.10 to 1.18); >5 symptoms 1.29 (1.26 to 1.31); >10 symptoms 1.50 (1.42 to 1.58). The pattern of association between reported symptoms did not vary between smokers and non-smokers. INTERPRETATION These data are consistent with people who smoke being at an increased risk of developing symptomatic COVID-19.
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Affiliation(s)
| | - Niccolo Rossi
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | | | - Anthony A Laverty
- Department Primary Care and Public Health, Imperial College, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Maxim Freidin
- Department of Twin Research, King's College London, London, UK
| | - Alessia Visconti
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Ben Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Kerrin Small
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | | | | | - Tim D Spector
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - Mario Falchi
- The Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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41
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Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS, Molteni E, Modat M, Jorge Cardoso M, May A, Ganesh S, Davies R, Nguyen LH, Drew DA, Astley CM, Joshi AD, Merino J, Tsereteli N, Fall T, Gomez MF, Duncan EL, Menni C, Williams FMK, Franks PW, Chan AT, Wolf J, Ourselin S, Spector T, Steves CJ. Author Correction: Attributes and predictors of long COVID. Nat Med 2021; 27:1116. [PMID: 34045738 DOI: 10.1038/s41591-021-01361-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK.,Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Thomas Varsavsky
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | | | - Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Christina M Astley
- Division of Endocrinology & Computational Epidemiology, Boston Children's Hospital, Boston, MA, USA
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Neli Tsereteli
- Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Tove Fall
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria F Gomez
- Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Paul W Franks
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.,Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,AI Institute '3IA Côte d'Azur', Université Côte d'Azur, Nice, France
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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42
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Grigorescu I, Vanes L, Uus A, Batalle D, Cordero-Grande L, Nosarti C, Edwards AD, Hajnal JV, Modat M, Deprez M. Harmonized Segmentation of Neonatal Brain MRI. Front Neurosci 2021; 15:662005. [PMID: 34121991 PMCID: PMC8195278 DOI: 10.3389/fnins.2021.662005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/21/2021] [Indexed: 01/16/2023] Open
Abstract
Deep learning based medical image segmentation has shown great potential in becoming a key part of the clinical analysis pipeline. However, many of these models rely on the assumption that the train and test data come from the same distribution. This means that such methods cannot guarantee high quality predictions when the source and target domains are dissimilar due to different acquisition protocols, or biases in patient cohorts. Recently, unsupervised domain adaptation techniques have shown great potential in alleviating this problem by minimizing the shift between the source and target distributions, without requiring the use of labeled data in the target domain. In this work, we aim to predict tissue segmentation maps on T 2-weighted magnetic resonance imaging data of an unseen preterm-born neonatal population, which has both different acquisition parameters and population bias when compared to our training data. We achieve this by investigating two unsupervised domain adaptation techniques with the objective of finding the best solution for our problem. We compare the two methods with a baseline fully-supervised segmentation network and report our results in terms of Dice scores obtained on our source test dataset. Moreover, we analyse tissue volumes and cortical thickness measures of the harmonized data on a subset of the population matched for gestational age at birth and postmenstrual age at scan. Finally, we demonstrate the applicability of the harmonized cortical gray matter maps with an analysis comparing term and preterm-born neonates and a proof-of-principle investigation of the association between cortical thickness and a language outcome measure.
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Affiliation(s)
- Irina Grigorescu
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Lucy Vanes
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BNN, Madrid, Spain
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Joseph V. Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Marc Modat
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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43
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Wilcox M, Canas LDS, Hargunani R, Tidswell T, Phillips J, Modat M, Ourselin S, Quick T. 22 Volumetric MRI; A Potential Outcome Measure of Muscle Reinnervation. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Improved outcome measures of muscle reinnervation would facilitate clinical translation of new therapies which hope to enhance human peripheral nerve repair. Valid outcome measures should be receptive to the biological process of muscle reinnervation and correlate with clinical assessments of muscular function. This study investigated the responsiveness of volumetric MRI to the biological process of muscle reinnervation and its relationship with clinical indices of muscular function.
Method
Twenty-five patients who underwent nerve transfer to reinnervate elbow flexor muscles were followed-up at a median time of 258 days (-86 to 1698 days) post-operatively for a mean of two (one to three) volumetric MRI assessments. Medical Research Council (MRC) grade, peak volitional force (PVF), muscular fatigue, co-contraction and Stanmore Percentage of Normal Elbow Assessment (SPONEA) was also measured at each appointment. The responsiveness of each parameter was compared using Pearson or Spearman correlation as appropriate.
Results
Elbow flexor muscle volume per unit BMI demonstrated responsiveness to the biological process of muscle reinnervation (R2=0.73, p < 0.001) and correlated with patient reported impairments of reinnervated muscle; co-contraction (R2=0.63, p = 0.02) and muscle fatigue (R2=0.64, p = 0.04).
Conclusions
Volumetric MRI may is an excellent candidate as an outcome measure of muscle reinnervation.
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Affiliation(s)
- M Wilcox
- University College London, London, United Kingdom
- Royal National Orthopaedic Hospital, London, United Kingdom
| | - L D S Canas
- Kings College London, London, United Kingdom
| | - R Hargunani
- Royal National Orthopaedic Hospital, London, United Kingdom
| | - T Tidswell
- Royal Free Hospital, London, United Kingdom
| | - J Phillips
- University College London, London, United Kingdom
| | - M Modat
- Kings College London, London, United Kingdom
| | - S Ourselin
- Kings College London, London, United Kingdom
| | - T Quick
- Royal National Orthopaedic Hospital, London, United Kingdom
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44
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Graham MS, Sudre CH, May A, Antonelli M, Murray B, Varsavsky T, Kläser K, Canas LS, Molteni E, Modat M, Drew DA, Nguyen LH, Polidori L, Selvachandran S, Hu C, Capdevila J, Hammers A, Chan AT, Wolf J, Spector TD, Steves CJ, Ourselin S. Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study. Lancet Public Health 2021; 6:e335-e345. [PMID: 33857453 PMCID: PMC8041365 DOI: 10.1016/s2468-2667(21)00055-4] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. METHODS We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, Rt, for the two incidence estimates. FINDINGS From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6-0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56-0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38-0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the Rt of B.1.1.7 by a factor of 1·35 (95% CI 1·02-1·69) relative to pre-existing variants. However, Rt fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. INTERPRETATION The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. FUNDING Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society.
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Affiliation(s)
- Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Thomas Varsavsky
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Kläser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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45
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Graham MS, Sudre CH, May A, Antonelli M, Murray B, Varsavsky T, Kläser K, Canas LS, Molteni E, Modat M, Drew DA, Nguyen LH, Polidori L, Selvachandran S, Hu C, Capdevila J, Hammers A, Chan AT, Wolf J, Spector TD, Steves CJ, Ourselin S. Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study. Lancet Public Health 2021; 6:e335-e345. [PMID: 33857453 DOI: 10.1101/2021.03.28.21254404] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. METHODS We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, Rt, for the two incidence estimates. FINDINGS From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6-0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56-0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38-0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the Rt of B.1.1.7 by a factor of 1·35 (95% CI 1·02-1·69) relative to pre-existing variants. However, Rt fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. INTERPRETATION The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. FUNDING Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society.
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Affiliation(s)
- Mark S Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing, Department of Population Science and Experimental Medicine, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | | | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Thomas Varsavsky
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kerstin Kläser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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46
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Lane CA, Barnes J, Nicholas JM, Baker JW, Sudre CH, Cash DM, Parker TD, Malone IB, Lu K, James SN, Keshavan A, Buchanan S, Keuss S, Murray-Smith H, Wong A, Gordon E, Coath W, Modat M, Thomas D, Hardy R, Richards M, Fox NC, Schott JM. Investigating the relationship between BMI across adulthood and late life brain pathologies. Alzheimers Res Ther 2021; 13:91. [PMID: 33941254 PMCID: PMC8091727 DOI: 10.1186/s13195-021-00830-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Abstract
Background In view of reported associations between high adiposity, particularly in midlife and late-life dementia risk, we aimed to determine associations between body mass index (BMI), and BMI changes across adulthood and brain structure and pathology at age 69–71 years. Methods Four hundred sixty-five dementia-free participants from Insight 46, a sub-study of the British 1946 birth cohort, who had cross-sectional T1/FLAIR volumetric MRI, and florbetapir amyloid-PET imaging at age 69–71 years, were included in analyses. We quantified white matter hyperintensity volume (WMHV) using T1 and FLAIR 3D-MRI; β-amyloid (Aβ) positivity/negativity using a SUVR approach; and whole brain (WBV) and hippocampal volumes (HV) using 3D T1-MRI. We investigated the influence of BMI, and BMI changes at and between 36, 43, 53, 60–64, 69 and 71 years, on late-life WMHV, Aβ-status, WBV and mean HV. Analyses were repeated using overweight and obese status. Results At no time-point was BMI, change in BMI or overweight/obese status associated with WMHV or WBV at age 69–71 years. Decreasing BMI in the 1–2 years before imaging was associated with an increased odds of being β-amyloid positive (OR 1.45, 95% confidence interval 1.09, 1.92). There were associations between being overweight and larger mean HV at ages 60–64 (β = 0.073 ml, 95% CI 0.009, 0.137), 69 (β = 0.076 ml, 95% CI 0.012, 0.140) and 71 years (β = 0.101 ml, 95% CI 0.037, 0.165). A similar, albeit weaker, trend was seen with obese status. Conclusions Using WMHV, β-amyloid status and brain volumes as indicators of brain health, we do not find evidence to explain reported associations between midlife obesity and late-life dementia risk. Declining BMI in later life may reflect preclinical Alzheimer’s disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00830-7.
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Affiliation(s)
- Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK.,Hoffmann-La Roche UK Ltd, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - John W Baker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Carole H Sudre
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Thomas D Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | | | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Sarah Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Sarah Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Elizabeth Gordon
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - William Coath
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK
| | - Marc Modat
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - David Thomas
- Leonard Wolfson Experimental Neurology Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.,Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK.,UK Dementia Research Institute at UCL, University College London, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, Box 16, Queen Square, London, WC1N 3BG, UK. .,UK Dementia Research Institute at UCL, University College London, London, UK.
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47
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Molteni E, Astley CM, Ma W, Sudre CH, Magee LA, Murray B, Fall T, Gomez MF, Tsereteli N, Franks PW, Brownstein JS, Davies R, Wolf J, Spector TD, Ourselin S, Steves CJ, Chan AT, Modat M. Symptoms and syndromes associated with SARS-CoV-2 infection and severity in pregnant women from two community cohorts. Sci Rep 2021; 11:6928. [PMID: 33767292 PMCID: PMC7994587 DOI: 10.1038/s41598-021-86452-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/12/2021] [Indexed: 01/10/2023] Open
Abstract
We tested whether pregnant and non-pregnant women differ in COVID-19 symptom profile and severity, and we extended previous investigations on hospitalized pregnant women to those who did not require hospitalization. Two female community-based cohorts (18-44 years) provided longitudinal (smartphone application, N = 1,170,315, n = 79 pregnant tested positive) and cross-sectional (web-based survey, N = 1,344,966, n = 134 pregnant tested positive) data, prospectively collected through self-participatory citizen surveillance in UK, Sweden and USA. Pregnant and non-pregnant were compared for frequencies of events, including SARS-CoV-2 testing, symptoms and hospitalization rates. Multivariable regression was used to investigate symptoms severity and comorbidity effects. Pregnant and non-pregnant women positive for SARS-CoV-2 infection were not different in syndromic severity, except for gastrointestinal symptoms. Pregnant were more likely to have received testing, despite reporting fewer symptoms. Pre-existing lung disease was most closely associated with syndromic severity in pregnant hospitalized. Heart and kidney diseases and diabetes increased risk. The most frequent symptoms among non-hospitalized women were anosmia [63% pregnant, 92% non-pregnant] and headache [72%, 62%]. Cardiopulmonary symptoms, including persistent cough [80%] and chest pain [73%], were more frequent among pregnant who were hospitalized. Consistent with observations in non-pregnant populations, lung disease and diabetes were associated with increased risk of more severe SARS-CoV-2 infection during pregnancy.
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Affiliation(s)
- Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, 9th floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
| | | | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, 9th floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences and the Institute of Women and Children's Health, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, 9th floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Tove Fall
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Jan Waldenströms gata 35, 21428, Malmö, Sweden
| | - Neli Tsereteli
- Department of Clinical Sciences, Lund University Diabetes Centre, Jan Waldenströms gata 35, 21428, Malmö, Sweden
| | - Paul W Franks
- Department of Clinical Sciences, Lund University Diabetes Centre, Jan Waldenströms gata 35, 21428, Malmö, Sweden
| | - John S Brownstein
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, 9th floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, 9th floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
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48
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Penfold RS, Zazzara MB, Roberts AL, Lee KA, Dooley H, Sudre CH, Welch C, Bowyer RCE, Visconti A, Mangino M, Freidin MB, El-Sayed Moustafa JS, Small K, Murray B, Modat M, Wolf J, Ourselin S, Martin FC, Steves CJ, Ni Lochlainn M. 144 Probable Delirium is A Presenting Symptom of COVID-19 in Frail, Older Adults: A Study of Hospitalised and Community-Based Cohorts. Age Ageing 2021. [PMCID: PMC7989598 DOI: 10.1093/ageing/afab030.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
COVID-19 exhibits a more severe disease course in older adults with frailty. Awareness of atypical presentations is critical to facilitate early disease identification. This study aimed to assess how frailty affects presenting symptoms of COVID-19 in older adults.
Methods
Observational study of two distinct cohorts: (i) Hospitalised patients aged 65 and over; unscheduled admission to a large London teaching hospital between March 1st, 2020-May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab (n = 322); (ii) Community-based adults aged 65 and over enrolled in the COVID Symptom Study mobile application between March 24th (application launch)-May 8th, 2020; self-report or report-by-proxy data; reported test-positive for COVID-19 (n = 535). Multivariable logistic regression analysis performed on age-matched samples of both cohorts to determine associations between frailty and symptoms of COVID-19 including delirium, fever and cough.
Results
Hospital cohort: there was a significantly higher prevalence of delirium amongst the frail sample, with no difference in fever or cough. Of those presenting with delirium, 10/53 (18.9%) presented with delirium as the only documented symptom. Community-based cohort: there was a significantly higher prevalence of probable delirium in the frail sample, and also of fatigue and shortness of breath. Of those reporting probable delirium, 28/84 (33%) did not report fever or cough.
Conclusions
This study demonstrates a higher prevalence of delirium as a presenting symptom of COVID-19 infection in older adults with frailty compared to their age-matched non-frail counterparts. Clinicians should suspect COVID-19 in frail older adults presenting with delirium. Early detection facilitates infection control measures to mitigate against catastrophic spread and preventable hospitalisations and deaths amongst this population. Our findings emphasise the need for systematic frailty assessment for all acutely ill older patients in both hospital and community settings, as well as systematic evaluation of any change in mental status.
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Affiliation(s)
- R S Penfold
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M B Zazzara
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - A L Roberts
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - K A Lee
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - H Dooley
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - C H Sudre
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - C Welch
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT
| | - R C E Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - A Visconti
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M B Freidin
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - J S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - K Small
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - B Murray
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - M Modat
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - J Wolf
- Zoe Global Limited, 164 Westminster Bridge Road, London SE1 7RW, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - F C Martin
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
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49
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James SN, Nicholas JM, Lane CA, Parker TD, Lu K, Keshavan A, Buchanan SM, Keuss SE, Murray-Smith H, Wong A, Cash DM, Malone IB, Barnes J, Sudre CH, Coath W, Prosser L, Ourselin S, Modat M, Thomas DL, Cardoso J, Heslegrave A, Zetterberg H, Crutch SJ, Schott JM, Richards M, Fox NC. A population-based study of head injury, cognitive function and pathological markers. Ann Clin Transl Neurol 2021; 8:842-856. [PMID: 33694298 PMCID: PMC8045921 DOI: 10.1002/acn3.51331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 02/01/2023] Open
Abstract
Objective To assess associations between head injury (HI) with loss of consciousness (LOC), ageing and markers of later‐life cerebral pathology; and to explore whether those effects may help explain subtle cognitive deficits in dementia‐free individuals. Methods Participants (n = 502, age = 69–71) from the 1946 British Birth Cohort underwent cognitive testing (subtests of Preclinical Alzheimer Cognitive Composite), 18F‐florbetapir Aβ‐PET and MR imaging. Measures include Aβ‐PET status, brain, hippocampal and white matter hyperintensity (WMH) volumes, normal appearing white matter (NAWM) microstructure, Alzheimer’s disease (AD)‐related cortical thickness, and serum neurofilament light chain (NFL). LOC HI metrics include HI occurring: (i) >15 years prior to the scan (ii) anytime up to age 71. Results Compared to those with no evidence of an LOC HI, only those reporting an LOC HI>15 years prior (16%, n = 80) performed worse on cognitive tests at age 69–71, taking into account premorbid cognition, particularly on the digit‐symbol substitution test (DSST). Smaller brain volume (BV) and adverse NAWM microstructural integrity explained 30% and 16% of the relationship between HI and DSST, respectively. We found no evidence that LOC HI was associated with Aβ load, hippocampal volume, WMH volume, AD‐related cortical thickness or NFL (all p > 0.01). Interpretation Having a LOC HI aged 50’s and younger was linked with lower later‐life cognitive function at age ~70 than expected. This may reflect a damaging but small impact of HI; explained in part by smaller BV and different microstructure pathways but not via pathology related to AD (amyloid, hippocampal volume, AD cortical thickness) or ongoing neurodegeneration (serum NFL).
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Affiliation(s)
- Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom.,Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jennifer M Nicholas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Thomas D Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah M Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom.,Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom.,Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - William Coath
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lloyd Prosser
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Marc Modat
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, King's College London, Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - David L Thomas
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jorge Cardoso
- School of Biomedical Engineering and Imaging Sciences, King's College London, Institute of Nuclear Medicine, University College London Hospitals, London, United Kingdom
| | - Amanda Heslegrave
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom
| | - Henrik Zetterberg
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom.,Department of Neurodegenerative Disease, UCL Institute of Neurology, London, United Kingdom.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, United Kingdom
| | - Nick C Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.,UK Dementia Research Institute at UCL, University College London, London, United Kingdom
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Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS, Molteni E, Modat M, Jorge Cardoso M, May A, Ganesh S, Davies R, Nguyen LH, Drew DA, Astley CM, Joshi AD, Merino J, Tsereteli N, Fall T, Gomez MF, Duncan EL, Menni C, Williams FMK, Franks PW, Chan AT, Wolf J, Ourselin S, Spector T, Steves CJ. Attributes and predictors of long COVID. Nat Med 2021; 27:626-631. [PMID: 33692530 DOI: 10.1038/s41591-021-01292-y] [Citation(s) in RCA: 1231] [Impact Index Per Article: 410.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
Reports of long-lasting coronavirus disease 2019 (COVID-19) symptoms, the so-called 'long COVID', are rising but little is known about prevalence, risk factors or whether it is possible to predict a protracted course early in the disease. We analyzed data from 4,182 incident cases of COVID-19 in which individuals self-reported their symptoms prospectively in the COVID Symptom Study app1. A total of 558 (13.3%) participants reported symptoms lasting ≥28 days, 189 (4.5%) for ≥8 weeks and 95 (2.3%) for ≥12 weeks. Long COVID was characterized by symptoms of fatigue, headache, dyspnea and anosmia and was more likely with increasing age and body mass index and female sex. Experiencing more than five symptoms during the first week of illness was associated with long COVID (odds ratio = 3.53 (2.76-4.50)). A simple model to distinguish between short COVID and long COVID at 7 days (total sample size, n = 2,149) showed an area under the curve of the receiver operating characteristic curve of 76%, with replication in an independent sample of 2,472 individuals who were positive for severe acute respiratory syndrome coronavirus 2. This model could be used to identify individuals at risk of long COVID for trials of prevention or treatment and to plan education and rehabilitation services.
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Affiliation(s)
- Carole H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK.,Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Thomas Varsavsky
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Mark S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | | | - Kerstin Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | | | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Christina M Astley
- Division of Endocrinology & Computational Epidemiology, Boston Children's Hospital, Boston, MA, USA
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Neli Tsereteli
- Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Tove Fall
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria F Gomez
- Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Paul W Franks
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.,Lund University Diabetes Centre, Department of Clinical Sciences, Malmö, Sweden
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.,AI Institute '3IA Côte d'Azur', Université Côte d'Azur, Nice, France
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
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