The rise of artificial intelligence reading of chest X-rays for enhanced TB diagnosis and elimination.

We provide an overview of the latest evidence on computer-aided detection (CAD) software for automated interpretation of chest radiographs (CXRs) for TB detection. CAD is a useful tool that can assist in rapid and consistent CXR interpretation for TB. CAD can achieve high sensitivity TB detection among people seeking care with symptoms of TB and in population-based screening, has accuracy on-par with human readers. However, implementation challenges remain. Due to diagnostic heterogeneity between settings and sub-populations, users need to select threshold scores rather than use pre-specified ones, but some sites may lack the resources and data to do so. Efficient standardisation is further complicated by frequent updates and new CAD versions, which also challenges implementation and comparison. CAD has not been validated for TB diagnosis in children and its accuracy for identifying non-TB abnormalities remains to be evaluated. A number of economic and political issues also remain to be addressed through regulation for CAD to avoid furthering health inequities. Although CAD-based CXR analysis has proven remarkably accurate for TB detection in adults, the above issues need to be addressed to ensure that the technology meets the needs of high-burden settings and vulnerable sub-populations.

Bayesian analyses of an exponential-Poisson and related zero augmented type models.

We consider several alternatives to the continuous exponential-Poisson distribution in order to accommodate the occurrence of zeros. Three of these are modifications of the exponential-Poisson model. One of these remains a fully continuous model. The other models we consider are all semi-continuous models, each with a discrete point mass at zero and a continuous density on the positive values. All of the models are applied to two environmental data sets concerning precipitation, and their Bayesian analyses using MCMC are discussed. This discussion covers convergence of the MCMC simulations and model selection procedures and considerations.

Three principles for co-designing sustainability intervention strategies: Experiences from Southern Transylvania.

Transformational research frameworks provide understanding and guidance for fostering change towards sustainability. They comprise stages of system understanding, visioning and co-designing intervention strategies to foster change. Guidance and empirical examples for how to facilitate the process of co-designing intervention strategies in real-world contexts remain scarce, especially with regard to integrating local initiatives. We suggest three principles to facilitate the process of co-designing intervention strategies that integrate local initiatives: (1) Explore existing and envisioned initiatives fostering change towards the desired future; (2) Frame the intervention strategy to bridge the gap between the present state and desired future state(s), building on, strengthening and complementing existing initiatives; (3) Identify drivers, barriers and potential leverage points for how to accelerate progress towards sustainability. We illustrate our approach via a case study on sustainable development in Southern Transylvania. We conclude that our principles were useful in the case study, especially with regards to integrating initiatives, and could also be applied in other real-world contexts.

The relational dimensions of pharmaceutical care: Experience from caring for HIV-infected asylum seekers in Montréal.

By describing the experience from dispensing antiretroviral drugs to asylum seekers infected with HIV in Montreal we argue for the relational dimensions of pharmaceutical care. Between 2010 and 2016, the Government of Canada changed the medical coverage for refugees and asylum seekers, leading to some uncertainty about what types of care were reimbursable for each migrant status. In Quebec, despite the compensatory coverage provided by the provincial medical insurance board (Régie d'assurance maladie du Québec, or RAMQ), this uncertainty led to a breakdown in patient followup in some establishments. The McGill University Health Centre's Chronic Viral Illness Service (CVIS) was nevertheless able to maintain continuity of care for refugees and asylum seekers living with HIV. This article looks more specifically at the pharmaceutical care provided during this period and, more particularly, at the convergence of the technical and relational dimensions. The methodology used was a qualitative case study, which made it possible to explore pharmaceutical care, by conducting qualitative interviews (n = 16). Semistructured interviews were conducted with patients and various professionals from the CVIS, including pharmacists. The cultural, administrative, and political dimensions of pharmaceutical care described here appear very important for overall patient care. Further reflection on the importance of relational dimensions of pharmaceutical care and the place and value of pharmaceutical care in the advancement of patient care is required.

What about sentinel lymph node biopsy for early breast cancer during pregnancy?

Pregnancy-associated breast cancer is rare, but this clinical situation arises in 1/10,000-1/3000 pregnancies. In patients presenting an early-stage breast tumor devoid of clinically pathological lymph node, sentinel lymph node (SLN) biopsy has not yet been validated as a routine procedure for pregnant women due to the lack of data in the literature. The blue dye injection is not recommended because of 2% theoretical risk of anaphylactic shock. Several studies have shown that Tc99m injection at conventional dose between 12.1 and 18.5MBq exposed the fetus to an irradiation between 0.011 and 0.0245mSv much below the 50mSv recommended threshold. As evidenced by lymphoscintigraphy scans, the dose of injected Tc99m is localized at the injection site and in the SLN. According to the literature, the SLN technique does not seem to impact the fetal or obstetrical prognosis. Studies involving larger cohorts are required to confirm these data and to indicate this technique in pregnant women. Considering the benefit for the patient and the low risk incurred on both fetal and obstetrical levels, it appears reasonable to discuss the indication of SLN on a case-by-case basis in multidisciplinary oncologic meetings.

Holding visual attention for 400millionyears: A model of tectum and torus longitudinalis in teleost fishes.

Only ray-finned fishes possess a torus longitudinalis (TL), a paired, elongated body attached to the medial margins of the optic tectum. Its granule cells project large numbers of fine fibers running laterally over adjacent tectum, synapsing excitatorily on the spiny dendrites of pyramidal cells. Sustained TL activity is evoked visuotopically by dark stimuli; TL bursting is a corollary discharge of saccadic eye movements. To suggest a function for this ancient structure, neural network models were constructed to show that: (1) pyramidal cells could form an attentional locus, selecting one out of several moving objects to track, but rapid image shifts caused by saccades disrupt tracking; (2) TL could supply both the pre-saccade position of a locus, and the shift predicted from a saccade so as to prime pyramidal dendrites at the target location, ensuring the locus stays with the attended object; (3) that the specific pattern of synaptic connections required for such predictive priming could be learned by an unsupervised rule; (4) temporal and spatial filtering of visual pattern input to TL allows learning from a complex scene. The principles thus evinced could apply to trans-saccadic attention and visual stability in other species.

[The social sciences at the Faculty of Pharmacy: and innovative course of community health at the University of Montreal]. / Les sciences sociales à la faculté de pharmacie In cours innovant de santé communautaire à l'Université de Monteréal.

Social sciences are important for training in pharmacy faculties. The course set up at the Faculty of Pharmacy of the University of Montreal in 2011 is a very innovative way to meet this challenge. The purpose of this report is to share this experience by providing a synthetic description. Many students were able to develop new skills and strengthen their skills, including leadership and critical thinking. The Faculty of Pharmacy was also able to achieve greater visibility in the Montreal community, that is to say from the associations, but also with what is out there called the "local health network" linking various health care professionals and institutions. Beyond the quantifiable results, this course is an evolving learning process in which the group interactions, individual and collective values and the task sharing allow students to build a working knowledge of social factors, which d.etermine health problems.

Solutions for a cultivated planet.

Increasing population and consumption are placing unprecedented demands on agriculture and natural resources. Today, approximately a billion people are chronically malnourished while our agricultural systems are concurrently degrading land, water, biodiversity and climate on a global scale. To meet the world's future food security and sustainability needs, food production must grow substantially while, at the same time, agriculture's environmental footprint must shrink dramatically. Here we analyse solutions to this dilemma, showing that tremendous progress could be made by halting agricultural expansion, closing 'yield gaps' on underperforming lands, increasing cropping efficiency, shifting diets and reducing waste. Together, these strategies could double food production while greatly reducing the environmental impacts of agriculture.

Contribution of anaerobic digesters to emissions mitigation and electricity generation under U.S. climate policy.

Livestock husbandry in the U.S. significantly contributes to many environmental problems, including the release of methane, a potent greenhouse gas (GHG). Anaerobic digesters (ADs) break down organic wastes using bacteria that produce methane, which can be collected and combusted to generate electricity. ADs also reduce odors and pathogens that are common with manure storage and the digested manure can be used as a fertilizer. There are relatively few ADs in the U.S., mainly due to their high capital costs. We use the MIT Emissions Prediction and Policy Analysis (EPPA) model to test the effects of a representative U.S. climate stabilization policy on the adoption of ADs which sell electricity and generate methane mitigation credits. Under such policy, ADs become competitive at producing electricity in 2025, when they receive methane reduction credits and electricity from fossil fuels becomes more expensive. We find that ADs have the potential to generate 5.5% of U.S. electricity.

[The evolution of pharmaceutical practice within the context of changing health territories: How can social sciences contribute to pharmaceutical education?]. / Evolution de la pratique pharmaceutique en contexte de redéfinition des territoires de la santé : ce que les sciences humaines et sociales peuvent apporter à la formation du pharmacien.

Pharmaceutical practice in France is evolving as presented in the legislation reforming hospitals and regarding patients, health and the territories. Hence, the pharmaceutical "territory" has been reconfigured and requires evolving ideas about pharmaceutical training. At the heart of this paper is the following question: What can social sciences bring to pharmaceutical education? Three levels were considered: patients and their social environment, interaction and coordination management among health professionals and political, economical and social drug regulation systems.

Responses of the teleostean nucleus isthmi to looming objects and other moving stimuli.

Visually evoked extracellular neural activity was recorded from the nucleus isthmi (NI) of goldfish and bluegill sunfish. When moving anywhere within the right eye's visual field, three-dimensional checkered balls or patterns on a computer screen evoked bursts of spikes in the left NI. Object motion parallel to the longitudinal body axis gave responses that habituated markedly upon repetition, but movement into recently unstimulated regions of the visual field gave vigorous responses. Thus, while NI's response is not visuotopic, its habituation is. An object approaching the animal's body generated a rising spike density, whereas object recession generated only a transient burst. During the approach of a checkered stimulus ball, average NI spike density rose linearly as the ball-to-eye distance decreased and at a rate proportional to the ball's speed (2.5-30 cm/s). Increasing ball size (2.2-9.2 cm) did not affect the rate of activity rise at a given speed, but did increase overall activity levels. NI also responded reliably to expanding textures of fixed overall size. The results suggest that NI signals changes in motion of objects relative to the fish, and estimates the proximity of approaching objects.

Functional relationship between nucleus isthmi and tectum in teleosts: synchrony but no topography.

Neural activity in the optic tectum was compared with activity in the nucleus isthmi (NI) of both goldfish and sunfish with the aim of understanding how the two brain structures interact to process visual information. The two species yielded very similar results. Superficial tectum responds reliably to visual stimulation with topographically organized receptive fields; deep tectum and NI respond to stimulation throughout the field of the contralateral eye and habituate rapidly. Bursts of large-amplitude spiking in NI occur spontaneously and in response to contralateral visual stimulation. These NI bursts correlate with activity bursts across the tectal lobe on the same side, especially in the deeper layers. NI bursts may also synchronize with spiking activity in deep tectum. Trains of small-amplitude spikes in NI can be elicited by both ipsilateral and contralateral stimulation, but are not reflected in tectal activity. Simultaneous recordings from two sites in one NI were almost identical, suggesting that NI operates as a functional unit, broadcasting the same message across the ipsilateral tectal lobe.