Bayesian mapping of pulmonary tuberculosis in Antananarivo, Madagascar

<p>Abstract</p> <p>Background</p> <p>Tuberculosis (TB), an infectious disease caused by the <it>Mycobacterium tuberculosis </it>is endemic in Madagascar. The capital, Antananarivo is the most seriously affected area. TB had a non-random spatial distribution in this setting, with clustering in the poorer areas. The aim of this study was to explore this pattern further by a Bayesian approach, and to measure the associations between the spatial variation of TB risk and national control program indicators for all neighbourhoods.</p> <p>Methods</p> <p>Combination of a Bayesian approach and a generalized linear mixed model (GLMM) was developed to produce smooth risk maps of TB and to model relationships between TB new cases and national TB control program indicators. The TB new cases were collected from records of the 16 Tuberculosis Diagnostic and Treatment Centres (DTC) of the city from 2004 to 2006. And five TB indicators were considered in the analysis: number of cases undergoing retreatment, number of patients with treatment failure and those suffering relapse after the completion of treatment, number of households with more than one case, number of patients lost to follow-up, and proximity to a DTC.</p> <p>Results</p> <p>In Antananarivo, 43.23% of the neighbourhoods had a standardized incidence ratio (SIR) above 1, of which 19.28% with a TB risk significantly higher than the average. Identified high TB risk areas were clustered and the distribution of TB was found to be associated mainly with the number of patients lost to follow-up (SIR: 1.10, CI 95%: 1.02-1.19) and the number of households with more than one case (SIR: 1.13, CI 95%: 1.03-1.24).</p> <p>Conclusion</p> <p>The spatial pattern of TB in Antananarivo and the contribution of national control program indicators to this pattern highlight the importance of the data recorded in the TB registry and the use of spatial approaches for assessing the epidemiological situation for TB. Including these variables into the model increases the reproducibility, as these data are already available for individual DTCs. These findings may also be useful for guiding decisions related to disease control strategies.</p

Typical features of Parkinson disease and diagnostic challenges with microdeletion 22q11.2

Objective: To delineate the natural history, diagnosis, and treatment response of Parkinson disease (PD) in individuals with 22q11.2 deletion syndrome (22q11.2DS), and to determine if these patients differ from those with idiopathic PD. Methods: In this international observational study, we characterized the clinical and neuroimaging features of 45 individuals with 22q11.2DS and PD (mean follow-up 7.5 ± 4.1 years). Results: 22q11.2DS PD had a typical male excess (32 male, 71.1%), presentation and progression of hallmark motor symptoms, reduced striatal dopamine transporter binding with molecular imaging, and initial positive response to levodopa (93.3%). Mean age at motor symptom onset was relatively young (39.5 ± 8.5 years); 71.4% of cases had early-onset PD (<45 years). Despite having a similar age at onset, the diagnosis of PD was delayed in patients with a history of antipsychotic treatment compared with antipsychotic-naive patients (median 5 vs 1 year, p = 0.001). Preexisting psychotic disorders (24.5%) and mood or anxiety disorders (31.1%) were common, as were early dystonia (19.4%) and a history of seizures (33.3%). Conclusions: Major clinical characteristics and response to standard treatments appear comparable in 22q11.2DS-associated PD to those in idiopathic PD, although the average age at onset is earlier. Importantly, treatment of preexisting psychotic illness may delay diagnosis of PD in 22q11.DS patients. An index of suspicion and vigilance for complex comorbidity may assist in identifying patients to prioritize for genetic testing

Consensus classification of posterior cortical atrophy

INTRODUCTION: A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings. METHODS: Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA. RESULTS: A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum. DISCUSSION: There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work

Une bele conjointure: The structure of Galeran de Bretagne

This essay analyzes the structure of Galeran de Bretagne in order to dispel the concept of it as a mere expansion of Marie de France's Lai le Fresne. Renaut, the author, has carefully plotted the course of the story beforehand, with a sense of proportion and direction. He controls the direction through a number of parallel scenes early and late and a series of tableaux that are dramatically vital, not static like woodcuts. Galeran can appropriately be considered an instance of what Chrétien de Troyes called une bele conjointure

Interaction of a vacuum arc with an SF6 arc in a hybrid circuit breaker during high-current interruption

A hybrid circuit breaker consists of a series-connected vacuum- and SF6 interrupter. The vacuum interrupter has the function to withstand very steep-rising transient recovery voltages, whereas the SF6 interrupter is stressed with the peak of it. Full scale tests are described of a 145-kV prototype, which is subjected to short-line faults based on 63 kA. During these tests, current through the breaker and voltages across both interrupters were monitored with a high-resolution measurement system. It is shown that the principal idea works correctly. From measured results, it is demonstrated that the interaction between the two arcs of completely different physical nature has a positive effect on the interruption: Immediately before current zero, the SF6 arc assists the vacuum arc to interrupt, whereas after current zero, the vacuum arc assists the SF6 arc in the recovery against the recovery voltage. From the analysis of the measurements, it becomes clear that high values of post arc current (up to 30 A) have (at least initially) a positive effect on the breaker performance. Detailed modeling of the interaction of arc-arc and arc-circuit is described, showing a good agreement with the measured results. The model is used to predict the voltage distribution across both interrupters when other (capacitive) voltage grading is applied in the design than present during the tests

Interaction of a vacuum arc with an SF6 arc in a hybrid circuit breaker during high-current interruption

A hybrid circuit breaker consists of a series-connected vacuum- and SF6 interrupter. The vacuum interrupter has the function to withstand very steep-rising transient recovery voltages, whereas the SF6 interrupter is stressed with the peak of it. Full scale tests are described of a 145-kV prototype, which is subjected to short-line faults based on 63 kA. During these tests, current through the breaker and voltages across both interrupters were monitored with a high-resolution measurement system. It is shown that the principal idea works correctly. From measured results, it is demonstrated that the interaction between the two arcs of completely different physical nature has a positive effect on the interruption: Immediately before current zero, the SF6 arc assists the vacuum arc to interrupt, whereas after current zero, the vacuum arc assists the SF6 arc in the recovery against the recovery voltage. From the analysis of the measurements, it becomes clear that high values of post arc current (up to 30 A) have (at least initially) a positive effect on the breaker performance. Detailed modeling of the interaction of arc-arc and arc-circuit is described, showing a good agreement with the measured results. The model is used to predict the voltage distribution across both interrupters when other (capacitive) voltage grading is applied in the design than present during the tests

A new 3D geometrical modelling of adlescent idiopathic scoliosis

Applications des mathématiques en biomédicalInternational audienc

Lidar and radar measurements of the melting layer in the frame of the Convective and Orographically-induced Precipitation Study: observations of dark and bright band phenomena

During the Convective and Orographically-induced Precipitation Study (COPS), lidar dark and bright bands were observed by the University of BASILicata Raman lidar system (BASIL) during several intensive (IOPs) and special (SOPs) observation periods (among others, 23 July, 15 August, and 17 August 2007). Lidar data were supported by measurements from the University of Hamburg cloud radar MIRA 36 (36 GHz), the University of Hamburg dual-polarization micro rain radars (24.1 GHz) and the University of Manchester UHF wind profiler (1.29 GHz). Results from BASIL and the radars for 23 July 2007 are illustrated and discussed to support the comprehension of the microphysical and scattering processes responsible for the appearance of the lidar and radar dark and bright bands. Simulations of the lidar dark and bright band based on the application of concentric/eccentric sphere Lorentz-Mie codes and a melting layer model are also provided. Lidar and radar measurements and model results are also compared with measurements from a disdrometer on ground and a two-dimensional cloud (2DC) probe on-board the ATR42 SAFIRE

Mesure du champ de pression exercé par le corset orthopédique sur le tronc du patient scoliotique

International audienc