Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study

Background To evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease (DPLD). Methods Seven multidisciplinary meetings (MDTMs) consisting of at least one clinician, radiologist and pathologist, from 7 different countries evaluated 70 cases of diffuse lung disease in a two-stage process. First, the clinician, radiologist and pathologist (when lung biopsy was performed) evaluated each case and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. A full MDTM with review of all clinical, radiologic and pathologic data followed this. Interobserver agreement and inter-MDTM agreement for diagnosis was calculated using Cohen's kappa coefficient or weighted kappa coefficient where appropriate. Findings Inter-MDTM agreement for first choice diagnoses was acceptable (κ = 0.50). Idiopathic pulmonary fibrosis made up 18% of all MDTM first choice diagnoses. Diagnostic likelihoods for MDTM differential diagnoses were converted to a 5-point scale (0 = condition not included in the differential diagnosis, 1 = low probability (5-25%), 2 = intermediate probability (30-65%), 3 = high probability (70-95%), and 4 = pathognomonic (100%)). Inter-MDTM agreement on diagnostic likelihoods was good for idiopathic pulmonary fibrosis (IPF) (κw = 0.71) and connective tissue disease related interstitial lung disease (CTD-ILD) (κw = 0.73), only moderate for non-specific interstitial pneumonia (NSIP) (κw = 0.42) and poor for hypersensitivity pneumonitis (HP) (κw = 0.29). MDTMs, clinicians and radiologists respectively gave high confidence diagnoses of IPF (>65% likelihood) in 77.3%, 64.6% and 66.3% of cases. The prognostic significance of a first choice diagnosis of IPF versus not IPF was evaluated for MDTMs, clinicians and radiologists. Greater prognostic significance was demonstrated for an MDTM diagnosis of IPF as compared to individual clinician's diagnosis of IPF in 5/7 MDTMs, radiologist's diagnosis of IPF in 4/7 MDTMs. Interpretation Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF. This is validated by the greater prognostic significance of an IPF diagnosis made by MDTMs as compared to individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than clinicians or radiologists. MDTM agreement for diagnosis of NSIP and hypersensitivity pneumonitis is poor, indicating a need for international consensus on diagnostic criteria for these diseases

Echinoderms from Todos os Santos Bay and Aratu Bay (Bahia, Brazil)

Neste trabalho são registrados os equinodermos (exceto Holothuroidea) obtidos durante a execução do projeto "Marine Environmental Evaluation of the Todos os Santos Bay-MAREMBA" em julho/agosto de 1996 e durante o projeto "Geoecologia das comunidades bentônicas infralitorais da Baía de Todos os Santos (BTS), BA, Brasil: diversidade biótica e sedimentológica", (1997). Um total de 33 espécies pertencentes a 15 famílias foram registradas e re-descritas. A distribuição de Ophiactis brasiliensis Manso, 1988 e Amphiodia trychna H.L. Clark, 1918 é estendida para a região nordeste do Brasil. A classe Ophiuroidea foi dominante nas amostragens em termos de abundância e freqüência de ocorrência, em particular as espécies Amphiodia atra Stimpson, 1852, Amphipholis subtilis (Ljungman, 1867), Ophiactislymani Ljungman, 1871 e Ophiostigma isocanthum (Say, 1825). O asteróide Oreaster reticulatus (Linnaeus, 1758) é considerado vulnerável à exploração humana e foi escasso durante as coletas. Outras espécies encontradas na BTS, tais como os asteroides Luidia clathrata (Say, 1825) e L. senegalensis (Lamarck, 1816) e o equinóide Eucidaristribuloides (Lamarck, 1816) figuram na lista nacional de espécies de invertebrados aquáticos ameaçados de extinção._______________________________________________________________________________ ABSTRACT: We present the results of the studies on biodiversity of Echinodermata (except Holothuroidea) from the Projects "Marine Environmental Evaluation of the Todos os Santos Bay - MAREMBA" (July/August 1996) and "Geoecology of the Benthic Infralitoral Communities of Todos os Santos Bay (BTS), Bahia, Brazil" (1997). A total of 33 species from 15 families were registered and re-described. The distribution of Ophiactis brasiliensis Manso, 1988 and Amphiodia trychna H.L. Clark, 1918 is extended to northwestern Brazil. The class Ophiuroidea was dominant in samples in terms of abundance and frequency of occurrence, in particular Amphiodia atra Stimpson, 1852, Amphipholis subtilis (Ljungman, 1867), Ophiactislymani Ljungman, 1871and Ophiostigma isocanthum (Say, 1825). The asteroid Oreaster reticulatus (Linnaeus, 1758) is considered vulnerable to human exploration and was scarce during the surveys. Other species found at BTS, such the asteroids Luidia clathrata (Say, 1825) and L. senegalensis (Lamarck, 1816) and the echinoid Eucidaristribuloides (Lamarck, 1816)are included in the national list of threatened invertebrate species

A fully validated microbiological assay for daptomycin injection and comparison to HPLC method

abstract Daptomycin (DPT) was the first lipopeptide antibiotic available for commercialization. It is active against gram-positive bacteria, including resistant strains. This work aimed to develop and validate a turbidimetric microbiologic assay to determine daptomycin in an injectable form. A 3x3 design was employed, at concentrations of 1, 2 and 4.0 µg/mL. The microorganism test used was Staphylococcus aureus ATCC 6538p, and Antibiotic Medium 3 was used as the culture medium. Method validation demonstrated that the bioassay was linear (r=0.9995), precise (RSD=2.58%), accurate (recovery 100.48± 2.11%), and robust. Degradation kinetics was also performed in an alkaline medium, indicating that daptomycin degradation follows first order kinetics under these conditions. The analyses of degraded solutions showed that daptomycin degradation products do not possess bactericidal activity. The bioassay was compared to HPLC method that was previously developed and no significant difference was found between them (p>0.05). The method proved to be appropriate for daptomycin injection quality control

Observation of inverse Compton emission from a long γ-ray burst.

Long-duration γ-ray bursts (GRBs) originate from ultra-relativistic jets launched from the collapsing cores of dying massive stars. They are characterized by an initial phase of bright and highly variable radiation in the kiloelectronvolt-to-megaelectronvolt band, which is probably produced within the jet and lasts from milliseconds to minutes, known as the prompt emission1,2. Subsequently, the interaction of the jet with the surrounding medium generates shock waves that are responsible for the afterglow emission, which lasts from days to months and occurs over a broad energy range from the radio to the gigaelectronvolt bands1-6. The afterglow emission is generally well explained as synchrotron radiation emitted by electrons accelerated by the external shock7-9. Recently, intense long-lasting emission between 0.2 and 1 teraelectronvolts was observed from GRB 190114C10,11. Here we report multi-frequency observations of GRB 190114C, and study the evolution in time of the GRB emission across 17 orders of magnitude in energy, from 5 × 10-6 to 1012 electronvolts. We find that the broadband spectral energy distribution is double-peaked, with the teraelectronvolt emission constituting a distinct spectral component with power comparable to the synchrotron component. This component is associated with the afterglow and is satisfactorily explained by inverse Compton up-scattering of synchrotron photons by high-energy electrons. We find that the conditions required to account for the observed teraelectronvolt component are typical for GRBs, supporting the possibility that inverse Compton emission is commonly produced in GRBs