BACKGROUND There is no large study validating the appropriateness of current treatment guidelines for Mycobacterium avium complex (MAC) lung disease. This is a retrospective single-center review ...evaluating the efficacy of macrolide/azalide-containing regimens for nodular/bronchiectatic (NB) MAC lung disease. METHODS Patients were treated according to contemporary guidelines with evaluation of microbiologic responses. Macrolide susceptibility of MAC isolates was done at initiation of therapy, 6 to 12 months during therapy, and on the first microbiologic recurrence isolate. Microbiologic recurrence isolates also underwent genotyping for comparison with the original isolates. RESULTS One hundred eighty patients completed > 12 months of macrolide/azalide multidrug therapy. Sputum conversion to culture negative occurred in 154 of 180 patients (86%). There were no differences in response between clarithromycin or azithromycin regimens. Treatment regimen modification occurred more frequently with daily (24 of 30 80%) vs intermittent (2 of 180 1%) therapy ( P = .0001). No patient developed macrolide resistance during treatment. Microbiologic recurrences during therapy occurred in 14% of patients: 73% with reinfection MAC isolates, 27% with true relapse isolates ( P = .03). Overall, treatment success (ie, sputum conversion without true microbiologic relapse) was achieved in 84% of patients. Microbiologic recurrences occurred in 74 of 155 patients (48%) after completion of therapy: 75% reinfection isolates, 25% true relapse isolates. CONCLUSIONS Current guidelines for macrolide/azalide-based therapies for NB MAC lung disease result in favorable microbiologic outcomes for most patients without promotion of macrolide resistance. Intermittent therapy is effective and significantly better tolerated than daily therapy. Microbiologic recurrences during or after therapy are common and most often due to reinfection MAC genotypes.
Abstract
As part of the second phase of the spatial forecast verification intercomparison project (ICP), dubbed the Mesoscale Verification Intercomparison in Complex Terrain (MesoVICT) project, a new ...set of idealized test fields is prepared. This paper describes these new fields and their rationale and uses them to analyze a number of summary measures associated with distance and geometric-based approaches. The results provide guidance about how they inform about performance under various scenarios. The new case comparisons are grouped into four categories: (i) pathological situations such as when a variable is zero valued at all grid points; (ii) circular events aimed at evaluating how different methods handle contrived situations, such as equal but opposite translations, the presence of multiple events of same/different size, boundary effects, and the influence of the positioning of events in the domain; (iii) elliptical events representing simplified scenarios that mimic commonly encountered weather phenomena in complex terrain; and (iv) cases aimed at analyzing how the verification methods handle small-scale scattered events, very large events with holes (e.g., a small portion of clear sky on a cloudy overcast day), and the presence of noise in one or both fields. Results show that all analyzed measures perform poorly in the pathological setting. They are either not able to provide a result at all or they instigate a special rule to prescribe a value resulting in erratic results. The analysis also showed that methods provide similar information in many situations, but that each has its positive properties along with certain unique limitations.
THE GREAT COLORADO FLOOD OF SEPTEMBER 2013 Gochis, David; Schumacher, Russ; Friedrich, Katja ...
Bulletin of the American Meteorological Society,
09/2015, Volume:
96, Issue:
9
Journal Article, Publication
Peer reviewed
Open access
During the second week of September 2013, a seasonally uncharacteristic weather pattern stalled over the Rocky Mountain Front Range region of northern Colorado bringing with it copious amounts of ...moisture from the Gulf of Mexico, Caribbean Sea, and the tropical eastern Pacific Ocean. This feed of moisture was funneled toward the east-facing mountain slopes through a series of mesoscale circulation features, resulting in several days of unusually widespread heavy rainfall over steep mountainous terrain. Catastrophic flooding ensued within several Front Range river systems that washed away highways, destroyed towns, isolated communities, necessitated days of airborne evacuations, and resulted in eight fatalities. The impacts from heavy rainfall and flooding were felt over a broad region of northern Colorado leading to 18 counties being designated as federal disaster areas and resulting in damages exceeding $2 billion (U.S. dollars). This study explores the meteorological and hydrological ingredients that led to this extreme event. After providing a basic timeline of events, synoptic and mesoscale circulation features of the event are discussed. Particular focus is placed on documenting how circulation features, embedded within the larger synoptic flow, served to funnel moist inflow into the mountain front driving several days of sustained orographic precipitation. Operational and research networks of polarimetric radar and surface instrumentation were used to evaluate the cloud structures and dominant hydrometeor characteristics. The performance of several quantitative precipitation estimates, quantitative precipitation forecasts, and hydrological forecast products are also analyzed with the intention of identifying what monitoring and prediction tools worked and where further improvements are needed.
The clinical features and outcome of macrolide-resistant Mycobacterium avium complex (MAC) lung disease are not known.
Characterize patients, treatment, and isolates in macrolide-resistant MAC lung ...disease.
Retrospective chart review, susceptibility testing, molecular fingerprinting, and DNA sequence analyses of resistant MAC isolates.
We identified 51 patients over a 15-yr period with clarithromycin-resistant MAC (minimum inhibitory concentration (MIC)>or=32 microg/ml) lung disease at a single referral center. Twenty-four (47%) patients had nodular disease with bronchiectasis and 27 (53%) had upper lobe cavitary disease. Most patients (77%) had M. intracellulare. Sequencing of the 23S r-RNA gene showed 49 of 51 isolates (96%) with the expected mutation in adenine 2058 or 2059. Risk factors for resistance included macrolide monotherapy or combination with a quinolone only (39/51 or 76%). Macrolide resistance developed in 12 of 303 (4.0%) patients started on the American Thoracic Society-recommended two companion drugs, with no risk difference in clarithromycin versus azithromycin and daily versus intermittent therapy. Sputum conversion with macrolide-resistant MAC occurred in 11 of 14 (79%) patients who received more than 6 mo of injectable aminoglycoside therapy and lung resection, compared with 2 of 37 (5%) who did not. The 1-yr mortality in patients who remained culture positive was 34% (13/38) compared with 0% (0/13) of patients who became culture negative (converted).
Macrolide resistance rarely occurs in patients also receiving ethambutol and a rifamycin. Macrolide-resistant MAC lung disease requires aggressive drug and surgical therapy for cure.
THE SETUP OF THE MesoVICT PROJECT Dorninger, Manfred; Gilleland, Eric; Casati, Barbara ...
Bulletin of the American Meteorological Society,
09/2018, Volume:
99, Issue:
9
Journal Article
Peer reviewed
Recent advancements in numerical weather prediction (NWP) and the enhancement of model resolution have created the need for more robust and informative verification methods. In response to these ...needs, a plethora of spatial verification approaches have been developed in the past two decades. A spatial verification method intercomparison was established in 2007 with the aim of gaining a better understanding of the abilities of the new spatial verification methods to diagnose different types of forecast errors. The project focused on prescribed errors for quantitative precipitation forecasts over the central United States. The intercomparison led to a classification of spatial verification methods and a cataloging of their diagnostic capabilities, providing useful guidance to end users, model developers, and verification scientists. A decade later, NWP systems have continued to increase in resolution, including advances in high-resolution ensembles. This article describes the setup of a second phase of the verification intercomparison, called the Mesoscale Verification Intercomparison over Complex Terrain (MesoVICT). MesoVICT focuses on the application, capability, and enhancement of spatial verification methods to deterministic and ensemble forecasts of precipitation, wind, and temperature over complex terrain. Importantly, this phase also explores the issue of analysis uncertainty through the use of an ensemble of meteorological analyses.
As the field of planning stretches toward redressing the injustices of past land use patterns through reparative practices, student learning needs to include socio-emotional, as well as technical and ...intellectual, skill-building. Pedagogy should increase the planner’s ability to recognize systems of oppression and center lived expertise in decision-making processes. Transformational learning theory considers the mechanisms through which place-based learning expands student worldviews through exposure to other ways of knowing. Reflecting on a participatory action course through the analytical lens of transformational learning theory, this paper considers the pedagogical and ethical challenges and opportunities for planning education through collaborative action.
Poor health outcomes from insufficient physical activity (PA) are a persistent public health issue. Public transit is often promoted for positive influence on PA. Although there is cross-sectional ...evidence that transit users have higher PA levels, this may be coincidental or shifted from activities such as recreational walking. We use a quasi-experimental design to test if light rail transit (LRT) generated new PA in a neighborhood of Salt Lake City, Utah, USA. Participants (n=536) wore Global Positioning System (GPS) receivers and accelerometers before (2012) and after (2013) LRT construction. We test within-person differences in individuals’ PA time based on changes in transit usage pre- versus post-intervention. We map transit-related PA to detect spatial clustering of PA around the new transit stops. We analyze within-person differences in PA time based on daily transit use and estimate the effect of daily transit use on PA time controlling for socio-demographic variables. Results suggest that transit use directly generates new PA that is not shifted from other PA. This supports the public health benefits from new high quality public transit such as LRT.
•We track physical activity time before and after construction of a light rail line•Study participants wore accelerometers and GPS recorders•Changes in physical activity time relate directly to changes in transit use•No substitution of transit-related physical activity time for other activity time
THE THORPEX INTERACTIVE GRAND GLOBAL ENSEMBLE Bougeault, Philippe; Toth, Zoltan; Bishop, Craig ...
Bulletin of the American Meteorological Society,
08/2010, Volume:
91, Issue:
8
Journal Article
Peer reviewed
Ensemble forecasting is increasingly accepted as a powerful tool to improve early warnings for high-impact weather. Recently, ensembles combining forecasts from different systems have attracted a ...considerable level of interest. The Observing System Research and Predictability Experiment (THORPEX) Interactive Grand Globa l Ensemble (TIGGE) project, a prominent contribution to THORPEX, has been initiated to enable advanced research and demonstration of the multimodel ensemble concept and to pave the way toward operational implementation of such a system at the international level. The objectives of TIGGE are 1) to facilitate closer cooperation between the academic and operational meteorological communities by expanding the availability of operational products for research, and 2) to facilitate exploring the concept and benefits of multimodel probabilistic weather forecasts, with a particular focus on high-impact weather prediction. Ten operational weather forecasting centers producing daily global ensemble forecasts to 1–2 weeks ahead have agreed to deliver in near–real time a selection of forecast data to the TIGGE data archives at the China Meteorological Agency, the European Centre for Medium-Range Weather Forecasts, and the National Center for Atmospheric Research. The volume of data accumulated daily is 245 GB (1.6 million global fields). This is offered to the scientific community as a new resource for research and education. The TIGGE data policy is to make each forecast accessible via the Internet 48 h after it was initially issued by each originating center. Quicker access can also be granted for field experiments or projects of particular interest to the World Weather Research Programme and THORPEX. A few examples of initial results based on TIGGE data are discussed in this paper, and the case is made for additional research in several directions.
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