Case studies to illustrate good practice in the management of non-tuberculous mycobacterial pulmonary disease

Pulmonary disease caused by non-tuberculous mycobacteria (NTM-PD) can be a complex condition for health care providers to manage, and delayed diagnosis and treatment failure are common. Here we present three case studies that illustrate key challenges in the diagnosis and treatment of NTM-PD, and provide guidance on these issues. In addition, we make recommendations on how the overall management of NTM-PD may be improved, through strategies such as physician education to recognise NTM-PD, and the development of multidisciplinary teams and patient-support groups

Moho topography beneath the Corinth Rift area (Greece) from inversion of gravity data

International audienceOur aim is to understand better the rifting process by imaging the Moho depth variation beneath Corinth and Evvia. We present here the results of a gravity inversion analysis in the region of the Corinth and Evvia rift system, and compare them to those obtained independently from teleseismic tomography and receiver function analyses. The results of these different studies appear to be consistent and show (1) a 10 km crustal thickening in the western part of the area beneath the Hellenides mountains, (2) NW–SE-trending periodic crustal thinning, and (3) a maximum crustal thinning north of the Gulf of Corinth. This 4 km thinning is unlikely to be the result of the rifting alone, which seems to have been reactivated since only 1 Ma. We propose here a geodynamical scenario in two major steps to explain the evolution of Corinth area. Aegean Miocene extension involving boudinage resulted in periodic crustal thinning, consistent with observations. These lithospheric instabilities could have favoured rupture initiation in particular areas, especially near the city of Corinth. Then, the reactivation of the Corinth Rift extension, 1 Myr ago, led to westward rift propagation. The offset observed between the maximum crustal thinning and the Gulf of Corinth could be accommodated by a low-angle normal fault at about 10–15 km depth. The Corinth Rift is thus asymmetrical and was initiated in places of crustal weakness due to Miocene lithospheric instabilities

Joint inversion of teleseismic and GOCE gravity data: application to the Himalayas

Our knowledge and understanding of the 3-D lithospheric structure of the Himalayas and the Tibetan Plateau is still challenging although numerous geophysical studies have been performed in the region. The GOCE satellite mission has the ambitious goal of mapping Earth's gravity field with unprecedented precision (i.e. an accuracy of 1-2 mGal for a spatial resolution of 100 km) to observe the lithosphere and upper-mantle structure. Consequently, it gives new insights in the lithospheric structure beneath the Himalayas and the Tibetan Plateau. Indeed, the GOCE gravity data now allow us to develop a new strategy for joint gravimetry-seismology inversion. Combined with teleseismic data over a large region in a joint inversion scheme, they will lead to lithospheric velocity-density models constrained in two complementary ways. We apply this joint inversion scheme to the Hi-CLIMB (Himalayan-Tibetan Continental Lithosphere during Mountain Building) seismological network which was deployed in South Tibet and the Himalayas for a 3-yr period. The large size of the network, the high quality of the seismological data and the new GOCE gravity data set allow us to image the entire lithosphere of this active area in an innovative way. We image 3-D low velocity and density structures in the middle crust that fit the location of discontinuous low S-velocity zones revealed by receiver functions in previous geophysical studies. In the deeper parts of our velocity model we image a positive anomaly interpreted to be the heterogenous Indian lithosphere vertically descending beneath the centre of the Tibetan Platea

Deep structure of the Baikal rift zone revealed by joint inversion of gravity and seismology

International audience[1] The question of plate boundary forces and deep versus shallow asthenospheric uplift has long been debated in intracontinental rift areas, particularly in the Baikal rift zone, Asia, which is colder than other continental rifts. As previous gravity and teleseismic studies support the dominance of opposing mechanisms in the Baikal rift, we reconsidered both data sets and jointly inverted them. This more effective approach brings insight into location of the perturbing bodies related to the extension in this region. Our new joint inversion method allows for inverting the velocity-density relationship with independent model parametrization. We obtain velocity and density models that consistently show (1) crustal heterogeneities that coincide with the main tectonic features at the surface, (2) a faster and denser cratonic mantle NW of Lake Baikal that we relate to the thermal contrast between old and depleted Archean (Siberian platform) and Paleozoic orogenic belt (Sayan-Baikal belt), (3) three-dimensional topographic variations of the crust-mantle boundary with well-located upwarpings, and (4) the lithosphere-asthenosphere boundary uplift up to 70 km depth with a NW dip. Our resulting velocity and density models support the idea of a combined influence of lithospheric extension and inherited lithospheric heterogeneities for the origin of the Baikal rift zone. INDEX TERMS: 1234 Geodesy and Gravity: Regional and global gravity anomalies and Earth structure; 7218 Seismology: Lithosphere and upper mantle; 8122 Citation: Tiberi, C., M. Diament, J. Déverchère, C. Petit-Mariani, V. Mikhailov, S. Tikhotsky, and U. Achauer, Deep structure of the Baikal rift zone revealed by joint inversion of gravity and seismology

Dataset related to "A multicentric, single arm, prospective, stratified clinical investigation to evaluate MammoWave’s ability in breast lesions detection"

Microwave imaging is a safe and promising new technology in breast radiology, avoiding discomfort of breast compression and usage of ionizing radiation. This dataset relates to a paper which presents the first prospective microwave breast imaging study during which both symptomatic and asymptomatic subjects were recruited. Specifically, a prospective multicentre international clinical trial was performed in 2020-2021, to investigate the capability of a microwave imaging device (MammoWave) in allowing distinction between breasts with no radiological finding (NF) and breasts with radiological findings (WF), i.e., with benign or malignant lesions. Each breast scan was performed with the volunteers lying on a dedicated examination table in a comfortable prone position. MammoWave output was compared to reference standard (i.e., radiologic study obtained within the last month and integrated with histological one if available and deemed necessary by responsible investigator) to classify breasts into NF/WF categories. MammoWave output consists of a selection of microwave images’ features (determined prior to trials’ start), which allow distinction between NF and WF breasts (using statistical significance p<0.05). 353 women were enrolled in the study (mean age 51 years ± 12 [SD], minimum age 19, maximum age 78); MammoWave data from the first 15 women of each site, all with NF breasts, were used for calibration. Following central assessor evaluation, 111 NF (48 dense) and 272 WF (136 dense) breasts were used for comparison with MammoWave output. 272 WF comprised 182 benign findings and 90 malignant histology-confirmed cancer. A sensitivity of 82.3% was achieved (95%CI: 0.78-0.87); sensitivity is maintained when limiting the investigation to histology-confirmed breasts cancer only (90 histology-confirmed breasts cancer have been included in this analysis, having sizes ranging from 3 mm to 60 mm). Specificity value of approximately 50% was achieved as expected, since thresholds were calculated (for each feature) using median value obtained after recruiting the first 15 women (of each site), all NF. This prospective trial may represent another step for introducing microwave imaging into clinical practice, for helping in breast lesion identification in asymptomatic women

Quantitative Approach for the Analysis of Fusional Convergence Using Eye-Tracking and SacLab Toolbox

Fusional vergence is a disjunctive movement of the eyes that is made in order to obtain single vision. (e aim of the study was to provide a quantitative and objective approach for analyzing the fusional convergence response using eye tracking (ET) technology and automatic data analysis provided by the intuitive SacLab toolbox previously developed by our group. We evaluated the proposed approach in a population of 26 subjects with normal binocular vision, who were tested with base-out prisms (magnitudes 4\u394, 6\u394, and 10\u394) in order to elicit fusional convergence response. Eye movements were recorded using the Viewpoint ET and analyzed using SacLab. Parameters describing both the vergence and the version components of the fusional response (convergence duration, CD; peak convergence velocity, PCV; number of intrusive saccades, NS; and mean saccadic amplitude, MSA) were automatically calculated and provided to clinicians for an objective evaluation. Results showed that the number of subjects achieving fusional convergence decreased with prism magnitude. For subjects achieving fusion CD and PCV increased significantly (p &lt; 0.05) when increasing the prism magnitude. For NS and MSA, there were no significant changes when passing to 6\u394, but a significant increase resulted when passing to 10\u394 (p &lt; 0.05). Noninvasive ET associated with the intuitive SacLab toolbox may represent a valid option to objectively characterize the fusional vergence response in clinical setting. (e analysis may be extended to patients with vergence disorders

Precision and Personalized Medicine and anti-TB treatment:Is TDM feasible for programmatic use?

Therapeutic Drug Monitoring (TDM) is increasingly recommended to ensure the correct drug dose thereby minimizing adverse events and maximizing regimen efficacy. To facilitate implementation in TB programs, a framework for TDM is urgently needed. TDM is only useful for dose optimization if a patient is on an appropriate regimen guided by drug susceptibility testing. TDM using a targeted approach selecting patients with risk factors for suboptimal drug exposure (e.g. diabetes) or not responding to treatment for drugs with a clear concentration-response relationship may provide the best value for money. Semiquantitative point-of-care tests for detection of low or high drug concentration should be implemented at community level while quantitative assays can be performed at regional or central level. Expanding PK/PD research followed by clinical trials including both clinical outcome as well as cost-effectiveness will increase the level of evidence supporting TDM