Longitudinal Evaluation of Bronchial Changes in Cystic Fibrosis Patients Undergoing Elexacaftor/Tezacaftor/Ivacaftor Therapy Using Lung MRI With Ultrashort Echo-Times.

BACKGROUND: Lung magnetic resonance imaging (MRI) with ultrashort echo-times (UTE-MRI) allows high-resolution and radiation-free imaging of the lung structure in cystic fibrosis (CF). In addition, the combination of elexacaftor/tezacaftor/ivacaftor (ETI) has improved CF clinical outcomes such as need for hospitalization. However, the effect on structural disease still needs longitudinal evaluation at high resolution. PURPOSE: To analyze the effects of ETI on lung structural alterations using UTE-MRI, with a focus on bronchiectasis reversibility. STUDY TYPE: Retrospective. POPULATION: Fifty CF patients (mean age 24.3 ± 9.2; 23 males). FIELD STRENGTH/SEQUENCE: 1.5 T, UTE-MRI. ASSESSMENT: All subjects completed both UTE-MRI and pulmonary function tests (PFTs) during two annual visits (M0 and M12), and 30 of them completed a CT scan. They initiated ETI treatment after M0 within a maximum of 3 months from the annual examinations. Three observers scored a clinical MRI Bhalla score on UTE-MRI. Bronchiectasis reversibility was defined as a reduction in both outer and inner bronchial dimensions. Correlations were searched between the Bhalla score and PFT such as the forced expiratory volume in 1 second percentage predicted (FEV1%p). STATISTICAL TESTS: Comparison was assessed using the paired t-test, correlation using the Spearman correlation test with a significance level of 0.05. Concordance and reproducibility were assessed using intraclass correlation coefficient (ICC). RESULTS: There was a significant improvement in MRI Bhalla score after ETI treatment. UTE-MRI demonstrated bronchiectasis reversibility in a subgroup of 18 out of 50 CF patients (36%). These patients with bronchiectasis reversibility were significantly younger, with lower severity of wall thickening but no difference in mucus plugging extent (P = 0.39) was found. The reproducibility of UTE-MRI evaluations was excellent (ICC ≥ 0.95), was concordant with CT scan (N = 30; ICC ≥ 0.90) and significantly correlated to FEV1% at PFT at M0 (N = 50; r = 0.71) and M12 (N = 50; r = 0.72). DATA CONCLUSION: UTE-MRI is a reproducible tool for the longitudinal follow-up of CF patients, allowing to quantify the response to ETI and demonstrating the reversibility of some structural alterations such as bronchiectasis in a substantial fraction of this study population. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

Development of Real-Time Isothermal Amplification Assays for On-Site Detection of Phytophthora infestans in Potato Leaves.

Real-time loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA) assays were developed targeting the internal transcribed spacer 2 region of the ribosomal DNA of Phytophthora infestans, the potato late blight causal agent. A rapid crude plant extract (CPE) preparation method from infected potato leaves was developed for on-site testing. The assay's specificity was tested using several species of Phytophthora and other potato fungal and oomycete pathogens. Both LAMP and RPA assays showed specificity to P. infestans but also to the closely related species P. andina, P. mirabilis, P. phaseoli, and P. ipomoeae, although the latter are not reported as potato pathogen species. No cross-reaction occurred with P. capsici or with the potato pathogens tested, including P. nicotianae and P. erythroseptica. The sensitivity was determined using P. infestans pure genomic DNA added into healthy CPE samples. Both LAMP and RPA assays detected DNA at 50 fg/µl and were insensitive to CPE inhibition. The isothermal assays were tested with artificially inoculated and naturally infected potato plants using a Smart-DART platform. The LAMP assay effectively detected P. infestans in symptomless potato leaves as soon as 24 h postinoculation. A rapid and accurate on-site detection of P. infestans in plant material using the LAMP assay will contribute to improved late blight diagnosis and early detection of infections and facilitate prompt management decisions.

THE EFFECT OF THE "EVOKING FREEDOM" TECHNIQUE ON AN UNUSUAL AND DISTURBING REQUEST.

The "evoking freedom" technique consists in soliciting someone to comply with a request by simply saying that she is free to accept or to refuse the request. However, previous studies used low cost requests. The present study examined the magnitude of this technique associated with a more disturbing and costly request. Sixty men and 60 women aged approximately 20-25 years walking in the street were asked by a male confederate to hold a closed transparent box containing a live trap-door spider while he went into the post office to pick up a package. In the evoking freedom condition, the confederate added in his request that the participant was "free to accept or to refuse." More compliance occurred in the "evoking freedom" condition (53.3%) than in the control condition (36.7%). These results confirm the robustness and the magnitude of the evoking freedom technique on compliance and show that this technique remained effective even when the request was psychologically costly to perform and was associated with fear.

Irregular Warfare Must Combine Good Medicine, with Both Good Tactics and Good Strategies: Position Paper by the French Special Operations Forces Medical Command.

INTRODUCTION: Military operations are no longer limited to the application of counterterrorism and counterinsurgency strategies; they are now characterized by hybrid, irregular, and unconventional features. While some authors have indicated the need for medical support to adapt to these new modes of military operations, they have focused mainly on the tactical level of care on the battlefield. As Sun Tzu states, "Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat," further proposals are still needed on the application of both medical tactics and medical strategies in irregular warfare. METHODS: Medical experts from the French Special Operations Forces (SOF) Medical Command have identified specific medical challenges that special operations face in the context of the current transformation of armed confrontations into irregular warfare. RESULTS: This position paper presents original tactical medical proposals for improving medical support in irregular warfare, ranging from the definition of a Primary-Alternate-Contingency-Emergency medical plan to the promotion of telemedical support. Original strategic medical proposals have highlighted the importance of recognizing medical issues in irregular warfare, including the medical actions carried out through and with local partners and the multiple approaches to countering medical threats. CONCLUSIONS: The SOF medical community must be closely involved with and facilitate the responses to the shift to irregular warfare. International collaboration and interoperability are more necessary than ever, as they will enable a more effective combination of good medicine with both good tactics and good strategies. These perspectives can also be extended to improve medical care in the conventional armed forces and austere civilian settings. LEVEL OF EVIDENCE: N/A. STUDY TYPE: Original research.

Management of Botrytis Leaf Blight of Onion: The Québec Experience of 20 Years of Continual Improvement.

Botrytis leaf blight (BLB) of onion (Allium cepa) is caused by Botrytis squamosa. The disease has been reported on onion crops in several of the onion production areas of the world including North and South America, Europe, Asia, and Australia, although it is not a problem in arid production regions such as the western United States. In eastern Canada, the disease is generally present every year and is especially severe on cultivars of yellow globe onion. The pathogen biology and disease epidemiology have been intensively researched. Over the last few decades, in the organic soil area of Quebec, extensive research effort has been devoted to the development and evaluation of predictive models and disease management strategies. There has been an active integrated pest management program for onions since the early 1980s, and scouting for disease has played a major role in disease management. In this article, the story of BLB management in eastern Canada over a period of two decades is summarized.

The effect of the two feet-in-the-door technique on tobacco deprivation.

The 'Foot-in-the-door' (FITD) is a well-known compliance technique that increases compliance with a request. Many investigations on this paradigm have generally used prosocial requests to test the effect of the technique. A new evaluation of the effect of the FITD technique was carried out on tobacco deprivation. A two feet-in-the-door technique in which the target request was preceded by two small target requests was used to encourage students to stop smoking for 24 h. The results were compared with two single foot-in-the- door procedures in which the final request was only preceded by one small request, as well as with a control condition using only a 24 h stop-smoking request. Results showed that the single FITD and the two feet-in-the-door procedures were effective to increase verbal compliance (accepting to stop smoking) but only the two feet-in-the-door technique significantly increased behavioural compliance (not smoking for 24 h) with the request.

[Wounded soldier pre hospital covering: the forward medicalization]. / Un standard de soins pour que le blessé arrive vivant au bloc opératoire.

Wounded soldier pre hospital covering: the forward medicalisation. Forward medicalisation is, for French medical service, the first link of wounded soldier all round chain, whose goal is the more precocity arrival in a military hospital on national field after has been done the necessary measures for the survival and prevention of sequelae during all this chain. This forward medicalisation is based on the experiences of anterior conflicts and modern medical technical evolution. It works around combat casualties care, declined in three competences levels. Under enemy fire, each soldier is capable of implementing first combat casualties care level. A second level corresponds for producing of rescue technical acts by specifically trained personals, until the arrival of a medical staff witch is most of the time a doctor and a nurse. This pair, trained at the third combat casualties care level, is able to apply forward reanimation acts and to prepare the evacuation of the wounded in direction to the first surgical field team.

Prise en charge préhospitalière du blessé de guerre : la médicalisation de l'avant. La médicalisation de l'avant correspond pour le service de santé des armées au premier maillon d'une chaîne de prise en charge globale du blessé de guerre, dont l'objectif est son arrivée la plus précoce possible dans une structure hospitalière militaire sur le territoire national, après avoir réalisé les gestes nécessaires à sa survie et à la prévention des séquelles tout au long de cette chaîne. Cette médicalisation de l'avant se fonde sur l'expérience des conflits antérieurs et l'évolution des techniques de soins modernes. Elle s'articule autour du sauvetage au combat, qui se décline en trois niveaux de compétences. Sous le feu ennemi, chaque combattant est capable de mettre en oeuvre le sauvetage au combat de niveau 1. Un deuxième niveau correspond à la réalisation de gestes techniques salvateurs par des personnels spécifiquement formés, jusqu'à l'arrivée d'une équipe médicale comprenant le plus souvent un médecin et un infirmier. Ce binôme, formé au sauvetage au combat de niveau 3, est en mesure d'appliquer des gestes de réanimation de l'avant et de préparer l'évacuation du blessé vers la première structure chirurgicale de terrain.

A pyrosequencing-based method to quantify genetic substitutions associated with resistance to succinate dehydrogenase inhibitor fungicides in Botrytis spp. populations.

BACKGROUND: The genetic underlying resistance mechanisms in the population of the phytopathogenic fungus Botrytis cinerea are well documented. Specifically, several genetic substitutions associated with succinate dehydrogenase inhibitor (SDHI)-based fungicide resistance have been identified in the succinate dehydrogenase gene. The objective of the present work was to develop a molecular tool for accurate quantification of these genetic substitutions within Botrytis populations. A test using the PyroMark Q24 instrument was designed to detect and quantify five genetic substitutions associated with SDHI resistance. RESULTS: The technique is based on sequencing by synthesis, and it generated quantitative and accurate data with a limit of quantification of a minimum of 500 spores. There was a linear relationship between the known and estimated percentages of spores with the targeted genetic substitutions and wild-type strains at ratios of 0-100%, with a 20% increment. CONCLUSION: With the pyrosequencing assay developed in this study, a large number of Botrytis spp. individuals can be characterised in a timely fashion with greater accuracy than by commonly used methods. Hence, pyrosequencing-based methods will be useful for improving our understanding of fungicide resistance, detecting the arrival of new genetic substitutions, monitoring shifts in fungal populations and assessing the effectiveness of antiresistance strategies, and for routine monitoring of fungicide resistance.

When Legitimizing a Request Increases Compliance: The Legitimizing Object Technique.

Earlier research reported that using pictures in a fundraising request increases donations by legitimizing the solicitation. The present study tested the effectiveness of a solicitation for money made in the street when an object that legitimated the request was present or not. Male confederates asked passersby for money to buy a stamp while either holding or not holding an envelope in one hand. With a high effect-size, it was reported that the presence of the envelope increased compliance with the request. The legitimation of the request associated with the presence of the envelope is used to explain the results.

Infection Efficiency of Four Phytophthora infestans Clonal Lineages and DNA-Based Quantification of Sporangia.

The presence and abundance of pathogen inoculum is with host resistance and environmental conditions a key factor in epidemic development. Therefore, several spore-sampling devices have been proposed to monitor pathogen inoculum above fields. However, to make spore sampling more reliable as a management tool and to facilitate its adoption, information on infection efficiency and molecular tools for estimating airborne sporangia concentration are needed. Experiments were thus undertaken in a growth chamber to study the infection efficiency of four clonal lineages of P. infestans (US-8, US-11, US-23, and US-24) by measuring the airborne sporangia concentration and resulting disease intensity. The relationship between the airborne sporangia concentration and the number of lesions per leaf was exponential. For the same concentration, the sporangia of US-23 caused significantly more lesions than the sporangia of the other clonal lineages did. Under optimal conditions, an airborne sporangia concentration of 10 sporangia m-3 for US-23 was sufficient to cause one lesion per leaf, whereas for the other clonal lineages, it took 15 to 25 sporangia m-3 to reach the same disease intensity. However, in terms of diseased leaf area, there was no difference between clonal lineages US-8, US-23 and US-24. Also, a sensitive quantitative real-time polymerase chain reaction (qPCR) tool was developed to quantify P. infestans airborne sporangia with detection sensitivity of one sporangium. The specificity of the qPCR assay was rigorously tested for airborne inoculum and was either similar to, or an improvement on, other published PCR assays. This assay allows rapid and reliable detection and quantification of P. infestans airborne sporangia and thereby, facilitates the implementation of spores-sampling network.