Increasing and More Commonly Refractory <i>Mycobacterium avium</i> Pulmonary Disease, Toronto, Ontario, Canada
Bibliographic record
Abstract
P ulmonary infection with nontuberculous myco- bacteria (NTM) is a chronic, often progressive, debilitating disease.Most published data show that the frequency of NTM pulmonary disease (NTM-PD) is increasing worldwide (1-6), as are its substantial medical costs (7,8).The cause of this rise has not yet been elucidated.NTM are widespread in the environment but disease is uncommon, suggesting that host susceptibility is critical, although exposure magnitude is also likely key (9-11).Some observations indicate that the Mycobacterium avium complex (MAC) might be a main driver for the increased occurrence of NTM-PD (2,5,12).In Ontario, Canada, a rising prevalence of NTM-PD has been demonstrated previously, and, in the most recent years that have been studied, that increase was driven largely by an increase in MAC (2).More recently, in the spring of 2014, the Public Health Ontario Laboratory (PHOL) observed a sustained increase of >50% in the total number of M. avium isolates from pulmonary samples and persons with positive cultures for M. avium (13).A coincident reduction in M. xenopi isolates occurred without change in other NTM species.Curiously, this occurrence was only observed in the city of Toronto and the region immediately north (Regional Municipality of York), located between Lake Ontario and Lake Simcoe, which together encompass an area of 2,392 km 2 and had ≈4.1 million inhabitants as of 2018.In Ontario, at least 95% of NTM isolates are identified at the PHOL (14), permitting population-based study.Laboratory techniques at PHOL did not change at the time of increased isolation.Although the sudden increase in isolation frequency could suggest increased environmental exposure, the reason remains unclear.Whether and how those changes relate to treatment outcomes of patients with NTM-PD caused by M. avium and M. xenopi has not been evaluated.In recent years, we observed that patients with M. avium pulmonary disease (Mav-PD) more often had microbiologically refractory disease and that we were encountering fewer patients with M. xenopi pulmonary disease (Mx-PD).On the basis of those observations, we studied relative proportions, culture conversion, culture reversion, and clinical treatment success of patients with Mav-PD and Mx-PD before and after 2014.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".