Very Low Research Articles

Modelling soil compaction of agricultural soils using fuzzy logic approach and adaptive neuro-fuzzy inference system (ANFIS) approaches

One of the most important physical properties of the soil is its mechanical strength. Increasing soil mechanical strength will lead to increments in the draft, fuel consumption, work duration and equipment wear, but will follow the reduction in the root growth. Awareness of the soil cone index (as a criterion of the arable soil compaction) in order to production management in connection with the soil physical properties have high importance, especially in precision farming. On the other hand, finding the methods and models that be able to create the best function or model to estimate the soil cone index at the least cost and use of available data are crucial for researchers. The aim of this study was predicting arable soils cone index values by effective parameters on the soil cone index, including bulk density, soil moisture content and soil electrical conductivity by using Fuzzy and neuro-fuzzy systems. In this study, for measurement and determination of the influencing factors on the soil cone index value, the experimental design was the factorial experiment based on a randomized complete block design with five replications. The experimental field had three types of loam, sandy loam and loamy sand soils. The modeling of soil cone index was performed by using effective parameters such as bulk density, moisture content and soil electrical conductivity in the fuzzy and adaptive neuro-fuzzy inference system (ANFIS) systems. For fuzzification of input and output parameters, the linguistic variables, including very low (VL), low (L), medium (M), high (H) and very high (VH) were used. Since determining the type and number of membership functions was conducted experimentally, the triangular membership function for both input and output variables was used due to the high accuracy and convenience in system design. In ANFIS model, 80% and 20% of total data were considered as training and test data, respectively. The numbers of membership functions were selected 5 for each input parameters. ANFIS training was done by the hybrid method. The average of coefficients of determination (R2) were obtained 80.1% and 97.9% for the fuzzy and ANFIS models, respectively. The obtained model through ANFIS presented the high accuracy of 2.54% rather than the fuzzy models with the accuracy of 9.68%. Also in comparison with regression models, ANFIS model has high accuracy and can be used to estimate the soil cone index in agricultural land.

Treatment patterns after the use of the 17-gene Genomic Prostate Score assay in Veterans newly diagnosed with clinically low-risk prostate cancer.

54 Background: Active surveillance (AS) is a recommended management approach for low risk prostate cancer (PCa). Studies have shown high rates of AS in the Veterans Administration (VA), but concerns about missing aggressive disease lead to variation between centers. The 17-gene Genomic Prostate Score (GPS) has been validated to predict likelihood of favorable pathology (LFP) in men with clinically low risk PCa. This study compared treatment patterns before and after introduction of the GPS to determine if the assay influenced treatment patterns. Methods: Men newly diagnosed with PCa who met NCCN criteria for very low (VL), low (L), or intermediate (INT) risk PCa were eligible. Chart review of men across 6 VA medical centers (VAMCs) established treatment in untested patients in 2013-2014. In 2015, Veterans at the same VAMCs were offered the assay in a prospective study measuring treatment recommendations before and after the assay and treatment implemented based on chart review. Results: There were 200 men in the untested cohort. Characteristics: age (median = 66, range:43-83), Gleason Score (GS) (3+3:64%, 3+4:37%), PSA (mean = 6.6, range:0.7-20), NCCN risk (VL:18%, L:37%, INT:46%). There were 190 men in the prospective study with complete data. NCCN risk group: age (median = 66, range:50-85), GS (3+3:74%, 3+4:26%), PSA (mean = 6.4, range:0.4-18.1), VL:22%, L:43%, INT:35%. GPS ranged from 0-61 and LFP ranged from 38%-91%. GPS identified 24 patients who had more favorable pathology and 13 patients who had less favorable pathology than would be expected using NCCN alone. 62% of untested Veterans pursued AS compared to 74% of tested Veterans. AS increases between untested and tested cohorts were 1% in VL, 16% in L, and 3% in INT. Conclusions: Both untested and tested patients had clinical characteristics representative of low risk PCa in the VA. Use of AS increased in tested Veterans compared to untested, with the largest increases observed in NCCN low risk patients. The 17-gene assay used biological information to provide refined risk estimates in tested Veterans, assisting physicians in appropriately identifying candidates for AS or immediate treatment.

Considering Bone Marrow Blasts from Nonerythroid Cellularity Improves the Prognostic Evaluation of MDS in the Context of IPSS-R and Permits a Better Risk Assessment of MDS Patients Classified into the Intermediate Risk Category

Introduction: Proportion of bone marrow (BM) blasts is a major prognostic factor for outcome in patients with myelodysplastic syndromes (MDS) and is included in the most applied prognostic scoring systems: IPSS and IPSS-R. IPSS-R stratifies patients in five risk categories: very low (VL), low (L), intermediate (I), high (H) and very high (VH). Some concerns exist about the real prognostic significance of intermediate risk group, as these patients showed around 30 months of median overall survival (OS) in different studies. The Spanish Group of myelodysplastic syndromes considers as high-risk patients those with an expected median OS inferior to 30 months. As showed in a recent study of our group, considering BM blasts from nonerythroid cellularity improves the prognostic evaluation of MDS (Arenillas et al, J Clin Oncol 2016) when applying IPSS and WHO classification.Aims: 1) To assess OS and leukemia-free survival (LFS) prediction by IPSS-R by counting BM blast percentage from nonerythroid cells (NECs). 2) To evaluate whether considering BM blasts from NECs rather than from total nucleated cells (TNCs) improves the prognostic assessment of patients classified into the intermediate risk group. 3) To establish which of these methods present the best prediction capacity for survival and leukemic transformation.Methods: We retrospectively analyzed 3,924 de novo MDS diagnosed according to WHO 2008 from the MDS spanish registry. Percentage of BM blasts from NECs was calculated as follows: [%BM blasts from TNCs/(100 - %BM erythroblasts) x 100]. Survival curves were constructed by using the Kaplan-Meier (K-M) method and compared using the log-rank test. C-index was implemented to assess the method with the best predictive value for survival and leukemic transformation.Results: Median age at diagnosis was 75y (16-101y) and 59% were males. Estimated median follow-up, as calculated by reverse K-M method, was 46.5 months (95% CI, 43.9-49) and median OS was 56.97 months. We assessed OS predicted by IPSS-R by considering BM blasts from TNCs and from NECs (recoded IPSS-R) Fig 1A and 1B. As depicted, five groups with significant differences in OS were observed by using both methods. Interestingly, median OS of intermediate risk group patients changed from 32.3 to 40.4 months by considering blasts from NECs instead of TNCs, whereas patients classified in high and very high risk categories showed almost the same survival even though the higher-risk categories were increased in 25.7%. Of 3,285 patients, 164 (5%) classified in the lower-risk IPSS-R categories (VL, L, I) were reclassified into higher-risk categories (H, VH) when BM blasts were enumerated from NECs. OS and LFS of these upgraded patients was significantly shorter to those observed in patients who remained in the initial categories (median OS, 28.2 vs 71.7 months, P<0.001; median LFS, 63 vs N.R. months, P<0.001) Fig 2A and 2B. In the same way, 24% of patients classified into the intermediate IPSS-R risk group were reclassified into higher-risk categories and showed a significantly shorter OS and LFS (median OS, 24 vs 34.3 months, P=0.012; median LFS, 56.8 vs 164.7 months, P=0.005). Thus, by counting BM blasts from NECs we were able to detect a group of patients labeled at present as having lower-risk disease but who presented an outcome much closer to that of higher-risk patients. The worse outcome observed in these reclassified patients was mainly influenced by the difference in the weight of blasts when assessed from NECs, as other prognostic factors that could explain this difference in outcome, as cytogenetics and degree of cytopenias, were adjusted by using the IPSS-R. Finally, C-index was calculated at 2 and 5 years and the recoded IPSS-R showed a slightly higher value for the prediction of survival and leukemic transformation [(survival, recoded IPSS-R vs IPSS-R: 2y, 0.731 vs 0.728; 5y, 0.696 vs 0.695) (leukemic transformation, recoded IPSS-R vs IPSS-R: 2y, 0.731 vs 0.730; 5y, 0.719 vs 0.716)].Conclusions: calculating the percentage of BM blasts from NECs improves prognostic assessment of MDS in the context of IPSS-R. By using this method, a more comprehensive distribution of patients was observed, as patients now included in the intermediate risk group presented an outcome much closer to that expected in lower-risk patients. This approach could help clinicians in risk-adapted therapeutic decisions by allowing a better definition of this controversial group. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

SAFETY OF VERY LOW LDL-C LEVELS WITH EVOLOCUMAB: AN ANALYSIS OF 5942 PATIENTS FROM PHASE 2 AND 3 AND OPEN-LABEL EXTENSION STUDIES

Evolocumab, a fully human monoclonal antibody to PCSK9, can reduce LDL-C to very low (VL) levels. We assessed the safety of VL LDL-C by analyzing data from a pooled analysis of patients in evolocumab phase 2 or 3 randomized and placebo/comparator-controlled trials and in open-label extension (OLE)

Brazilian Cardiorespiratory Fitness Classification Based on Maximum Oxygen Consumption.

BackgroundCardiopulmonary exercise test (CPET) is the most complete tool available to assess functional aerobic capacity (FAC). Maximum oxygen consumption (VO2 max), an important biomarker, reflects the real FAC.ObjectiveTo develop a cardiorespiratory fitness (CRF) classification based on VO2 max in a Brazilian sample of healthy and physically active individuals of both sexes.MethodsWe selected 2837 CEPT from 2837 individuals aged 15 to 74 years, distributed as follows: G1 (15 to 24); G2 (25 to 34); G3 (35 to 44); G4 (45 to 54); G5 (55 to 64) and G6 (65 to 74). Good CRF was the mean VO2 max obtained for each group, generating the following subclassification: Very Low (VL): VO2 < 50% of the mean; Low (L): 50% - 80%; Fair (F): 80% - 95%; Good (G): 95% -105%; Excellent (E) > 105%.ResultsMenVL < 50%L 50-80%F 80-95%G 95-105%E > 105%G1< 25.3025.30-40.4840.49-48.0748.08-53.13> 53.13G2< 23.7023.70-37.9237.93-45.0345.04-49.77> 49.77G3< 22.7022.70-36.3236.33-43.1343.14-47.67> 47.67G4< 20.2520.25-32.4032.41-38.4738.48-42.52> 42.52G5< 17.5417.65-28.2428.25-33.5333.54-37.06> 37.06G6< 1515.00-24.0024.01-28.5028.51-31.50> 31.50WomenG1< 19.4519.45-31.1231.13-36.9536.96-40.84> 40.85G2< 19.0519.05-30.4830.49-36.1936.20-40.00> 40.01G3< 17.4517.45-27.9227.93-33.1533.16-34.08> 34.09G4< 15.5515.55-24.8824.89-29.5429.55-32.65> 32.66G5< 14.3014.30-22.8822.89-27.1727.18-30.03> 30.04G6< 12.5512.55-20.0820.09-23.8423.85-26.35> 26.36ConclusionsThis chart stratifies VO2 max measured on a treadmill in a robust Brazilian sample and can be used as an alternative for the real functional evaluation of physically and healthy individuals stratified by age and sex.

Landslide Zonation at the Budong-Budong Watershed, Central Mamuju District of West Sulawesi Province

The objectives of this study are as follows: first, to investigate the contributing parameters induced land sliding in the Budong-Budong watershed, and second, to construct landslide susceptibility zonation map. In this study, the analytical hierarchy process (AHP) based on Geographical Information System (GIS) methods was used to produce map of landslide susceptibility. In this study area, more than 50% of total area were classified high (H) to very high (VH) susceptibility landslide zone. Mean while, 12% of total area were classified as moderate (M) and remaining were classified as low (L) to very low (VL) susceptibility landslide zone. Almost area of Budong-Budong Wetershed were classified as VH and H susceptibility landslide zone underlying by Talaya (Tmtv), Lamasi (Toml) and Latimojong (Kls) Formation on the steep slope land.

A Composite Donor and Recipient Risk Factor Analysis Predicts Outcomes and Supports the Utilization of Marginal Donor Organs in Patients With Higher Co-Morbidities.

Introduction: Because organ discard rates remain high with lower quality organs having the highest likelihood of discard, quantifying the survival benefit of these organs across a range of recipient characteristics is important for clinical decision-making. Methods: We used UNOS data from 1995-2010 to examine outcomes among 138,717 first-time, adult deceased donor renal transplant recipients. Organ quality was assessed by KDPI quintiles (e.g., 0-20%/excellent to 81-100%/poor). We created a composite recipient risk profile score for the hazard of death from a Cox model using a randomly-selected cohort analyzing 15 clinical covariates, which were then applied in a validation set to candidates and recipients. Risk scores were divided into quintiles by probability of death (Very Low(VL), Low(L), Medium(M), High(H), Very High(VH)), and Kaplan-Meier methods were used to estimate survival by risk profile score and organ quality. Results: Factors most predictive of recipient mortality included race, age, and cause of ESRD (p<0.0001). Five-year survival was better in transplant recipients compared to matched, wait-listed candidates with similar risk profile scores (i.e., 5-year survival for transplant/waitlist: VL-91.2%/78.7%, L-86.7%/83.5%, M-83.4%/61.9%, H-76.2%/54.5%, VH-63.4%/45.4%; p<0.0001 for all transplant/waitlist comparisons). Moreover, when sub-analyzing recipient survival by organ quality, recipients of poor quality organs derived a survival benefit from transplant, a finding that remained true across all risk profile scores (survival difference: VL-12.6%, L-15.7%, M-15.8%, H-15.7%, VH-9.6%). Conclusion: In our analysis, renal transplantation with poor quality organs provides a survival advantage even in patients with higher morbidity and mortality burden.

Klasifikasi Motif Batik Berbasis Kemiripan Ciri dengan Wavelet Transform dan Fuzzy Neural Network

This paper introduces a classification of the image of the batik process, which is based on the similarity of the characteristics, by combining the method of wavelet transform Daubechies type 2 level 2, to process the characteristic texture consisting of standard deviation, mean and energy as input variables, using the method of Fuzzy Neural Network (FNN). Fuzzyfikasi process will be carried out all input values with five categories: Very Low (VL), Low (L), Medium (M), High (H) and Very High (VH). The result will be a fuzzy input in the process of neural network classification methods. The result will be a fuzzy input in the process of neural network classification methods. For the image to be processed seven types of batik motif is ceplok, kawung, lereng, parang, megamendung, tambal and nitik. The results of the classification process with FNN is rule generation, so for the new image of batik can be immediately known motif types after treatment with FNN classification. For the degree of precision of this method is 86-92%.

CONTENT BASED BATIK IMAGE CLASSIFICATION USING WAVELET TRANSFORM AND FUZZY NEURAL NETWORK

In this paper we introduce the content-based image classification using wavelet transform with Daubechies type 2 level 2 to process the characteristic texture consisting of standard deviation, mean and energy as Input variables, using the method of Fuzzy Neural Network (FNN). All the input value will be processed using fuzzyfication with 5 categories namely Very Low (VL), Low (L), Medium (M), High (H) and Very High (VH). The result will be fuzzy input in the process of classification with neural network method. Batik images will be processed using 7 (seven) types of batik motif which is ceplok, kawung, lereng, parang, megamendung, tambal and nitik. The results of the classification process using FNN is Rule generation, such that for a new image of batik motif types can be immediately determined after FNN classification is completed. For the level of precision, this method is between 90-92%, including if we use the rule generation to determine the level precision is between 90-92%.

The Endocrine Society Clinical Practice Guidelines: A Self-Assessment

In 2005, after many years of discussion about whether or not The Endocrine Society (TES) should produce Clinical Practice Guidelines (CPGs), TES Council approved a carefully designed program to produce 2 to 4 high-quality CPGs each year. TES has published 20 CPGs to date (1), and several more are expected to be published in the next 2 years. Since its inception, the CPG program has been unique in many ways. First, a highly regulated pathway on the route to publication (Figure 1) permits the selection, review, and vetting of CPGs at multiple levels, including a final peer and editorial review at the Journal of Clinical Endocrinology and Metabolism (JCEM). Second, the guidelines have been selected and produced without support from pharmaceutical or device-manufacturing companies. Third, all CPG expert panels have included at least 1 international member. Fourth, all CPGs have been translated into patient versions. Fifth, the CPGs are routinely reviewed and updated every 3 years. Finally, TES adopted the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach for evaluating the evidence and producing recommendations (2). The GRADE Working Group began as an international effort to resolve confusion about how to best and most clearly rate evidence and express recommendations. Many governmental organizations and professional societies use the GRADE approach, including the Agency for Healthcare Research and Quality, the American College of Physicians, and UpToDate in the United States; the National Institute for Clinical Excellence and the British Medical Journal in the United Kingdom; and the World Health Organization (3). Although there are multiple systems of grading evidence, the GRADE method is the only one that rates the strength of the recommendation (Strong or Weak) based on a balance of benefits vs harms, the confidence in the magnitude of estimated effect on an outcome, and the weighing of patient values and preferences. Although this method allows for Strong recommendations to be made with low (L) or very low (VL) levels of evidence and vice versa, this should not be a frequent occurrence. TES engaged the Knowledge and Evaluation Research (KER) Unit at the Mayo Clinic to provide methodological assistance to each of the CPG expert panels, whose expertise generally is in clinical medicine and not in methodology or epidemiology. In this issue of JCEM, members of the KER Unit have undertaken a unique exercise—assessing the appropriateness of 357 recommendations contained in all 17 CPGs that were published by TES between 2006 and 2011 (4). Their major finding was that 206 of the 357 recommendations were Strong, of which 121 were based on L/VL levels of evidence. Of the 121, 53 were in categories such as “sensible alternatives do not exist” or recommend “additional research.” KER Unit members then retrospectively applied a recently published schema by the GRADE Working Group of paradigmatic situations where Strong recommendations with L/VL evidence might be appropriate (5). Using this new taxonomy of paradigmatic situations to determine the appropriateness of the remaining 68 Strong recommendations that were based on L/VL levels of evidence, they found that it was appropriately applied to 35 recommendations and inappropriately applied to 33 (6 –16).

Ketolytic and glycolytic enzymatic expression profiles in malignant gliomas: implication for ketogenic diet therapy

BackgroundRecent studies in animal models, based on the hypothesis that malignant glioma cells are more dependent on glycolysis for energy generation, have shown promising results using ketogenic diet (KD) therapy as an alternative treatment strategy for malignant glioma, effectively starving glioma cells while providing ketone bodies as an energy source for normal neurons and glial cells. In order to test this treatment strategy in humans, we investigated the relative expression of several key enzymes involved in ketolytic and glycolytic metabolism in human anaplastic glioma (WHO grade III) and glioblastoma (GBM, WHO grade IV).MethodsImmunohistochemistry was performed on formalin fixed paraffin embedded sections from 22 brain biopsies (17 GBM, 3 anaplastic astrocytoma and 2 anaplastic oligoastrocytoma) using antibodies raised against glycolytic and ketolytic enzymes. The glycolytic enzymes included hexokinase-II (HK2) and pyruvate kinase M2 isoform (PKM2). The ketone body metabolic enzymes included: succinyl CoA: 3-oxoacid CoA transferase (OXCT1), 3-hydroxybutyrate dehydrogenase 1 and 2 (BDH1 and BDH2), and acetyl-CoA acetyltransferase 1 (ACAT1). The immunoreactivities were graded using a semi-quantitative scale based on the percentage of positive cells: POS (>20%), LOW (5-20%), and very low (VLOW) (<5%). Focal non-neoplastic “normal” brain tissue within the biopsy specimens served as internal controls.ResultsThe rate limiting mitochondrial ketolytic enzymes (OXCT1 and BDH1) were either LOW or VLOW, concordantly in 14 of the 17 GBMs and in 1 of 5 anaplastic gliomas, whereas at least one of the glycolytic enzymes was POS in 13 of these 17 GBMs and all 5 anaplastic gliomas. Cytosolic BDH2 and mitochondrial ACTAT1 were, surprisingly, POS in most of these tumors.ConclusionOur results showing that malignant gliomas have differential expression of ketolytic and glycolytic enzymes are consistent with previous studies that have shown that these are genetically heterogeneous tumors. It seems reasonable to hypothesize that patients with low or very low expression of key ketolytic enzymes in their malignant gliomas may respond better to the KD therapy than those patients with positive expression of these enzymes. Further studies in animal models and/or a large-scale clinical trial would be needed to test this hypothesis.

High Predictive Value of the Revised International Prognostic Scoring System (IPSS-R): An External Analysis of 646 Patients From a Multiregional Italian MDS Registry

AbstractAbstract 1702 Background:Prognostic assessment has a crucial role in clinical evaluation of patients (pts) affected by myelodysplastic syndrome (MDS). Recently a Revised International Prognostic Scoring System (IPSS-R) has been developed (Greenberg et al, 2012) to improve the standard IPSS (Greenberg et al, 1997): it identifies five different prognostic categories mainly based on stratification of cytogenetic risk. Another prognostic score proposed in clinical practice is WPSS, based on transfusion dependency and WHO morphologic classification (Malcovati et al, 2005) subsequently modified (rWPSS) introducing level of hemoglobin in lieu of the previous not well defined variable of transfusion dependency (Malcovati et al, 2011). Aims:Aim of our study was to evaluate in a cohort of MDS pts enrolled in the Multiregional Italian MDS Registry the prognostic value of IPSS-R respect to IPSS and compare it with both WPSS and rWPSS. Materials and methods:Among the 1918 MDS pts enrolled in the Multiregional Italian MDS Registry from 1999 to 2012 we excluded all the cases already included in the IWG-PM database that generated the IPSS-R. We thus obtained a cohort of 646 pts with complete follow up. We evaluated the prognostic power of IPSS-R respect to IPSS, WPSS and rWPSS respectively by Harrell's C statistics, analyzing as endpoints overall survival (OS), leukemic evolution (LE) and progression free survival (PFS). For LE we considered leukemic evolution as an event, while all the other causes of death were competing events. For PFS we consider either leukemic evolution or death for any causes as an event. Results:Median age of MDS patients was 75 years (interquartile range: 69–80 years). 378 (59%) out of 646 pts were males. WHO classification was as follows: 33% RCMD, 10% RAEB-1, 9% RAEB-2, 6% CMML, 2% MDS-U, the remaining 40% were RARS, RA, isolated 5q deletion. Median follow up of censored pts was 17 months.According to IPSS score, 47% of pts were low risk, 39% Int-1, 10% Int-2 and 4% high risk. WPSS stratification was as follows: 31% were very low (VL) risk, 37% low (L), 19% intermediate (I), 11% high (H) and 2% very high (VH). By applying rWPSS stratification we obtained 30% VL, 35% L, 17% I, 15% H and 3% VH risk pts. IPSS-R risk stratification was as follows: 20% VL, 46% L, 20% I, 9% H and 5% VH risk pts.OS was analyzed according to the different scores by Kaplan-Meyer method. All prognostic systems allowed the identification of survival curves with significant differences among the different categories of risk stratification. IPSS-R application defined OS curves which better defined patients prognostic categories as shown in fig 1. In fact Harrel's C statistics demonstrated a better predictive value of the IPSS-R respect to IPSS, but also respect to WPSS and rWPSS (C=0,73; 0,63; 0,65; 0,64 respectively).Similar results have been obtained also considering time to LE (fig 2). Harrel's C statistics for LE was 0,84; 0,76; 0,78; 0,77 respectively in IPSS-R, IPSS, WPSS, rWPSS risk stratification groups.Moreover, we analyzed PFS outcomes (fig 3). Also in this case, IPSS-R showed the greatest prognostic power: Harrel's C statistics was 0,76; 0,67; 0,66; 0,69 respectively in IPSS-R, IPSS, WPSS, rWPSS risk stratification groups. Conclusions:In our hands, IPSS-R score demonstrated a better prognostic power respect to previously published prognostic systems (IPSS, WPSS, rWPSS). The cohort of MDS patients we employed to validate the new prognostic scoring system has a short follow up (17 months), due to the exclusion of cases already used to establish the IPSS-R system, and the majority of these are lower risk ones. We can conclude that a careful classification based on cytogenetic examination improve the prognostic power of the score. Thus, IPSS-R is confirmed to be a refined tool, easily applicable in real life and empowered respect to the currently used scores to define MDS patient prognosis. [Display omitted] [Display omitted] [Display omitted] Disclosures:Saglio:Bristol-Myers Squibb: Consultancy, Speakers Bureau.

Elemental status (Cu, Mo, Co, B, S and Zn) of Scottish agricultural soils compared with a soil‐based risk assessment

AbstractConcentrations of six elements copper (Cu), molybdenum (Mo), cobalt (Co), boron (B), sulphur (S) and zinc (Zn) are summarized for Scottish advisory soil samples collected during the period 1996–2008. Accompanying cropping information indicated that the majority of samples collected for Co analysis were from grassland compared with B, S and Zn where sampling was predominantly prior to either potatoes or vegetables. The proportion of samples measured as potentially deficient [very low (VL) or low categories] were 80% for Co, compared with 50, 40, 38, 25 and 18% for Mo, S, Zn, Cu and B, respectively. Only S displayed a significant decline (ca. 2 mg S/kg) over this 13‐year period. However, comparison of Cu and Co data with some collected from an earlier time period (1973–1980) suggested little difference for Cu but a smaller number of VL and low Co status samples. A predicted risk assessment using soil parent material, texture and drainage status suggested that 22, 38 and 40% of the agricultural area of Scotland were at a high, medium and low risk of Cu deficiency; comparable numbers for Co were 48, 30 and 22%. The reliability of the risk assessment was tested using a sub‐set of advisory samples with specific information on soil series. Of the soils predicted to have a high risk of Cu deficiency, 52% actually fell into the ‘deficient’ status. A similar comparison for Co indicated 90% of the samples predicted as having a high risk of deficiency were measured as VL or low.

The Effect of Stocking Density on the Behaviour of Broiler Chickens

A 35-day trial was conducted to examine the influence of floor density on the behaviour of broiler chickens. Day-old male broilers (n=756) were randomly assigned to one of four stocking densities (6 replicates of n=13, 25, 38 and 50) in 24 identical 2.6 ㎡ pens. These stocking densities were coded very low (VL), low (L), medium (M) and high (H) and contained a floor space allowance per bird of 2,000 ㎠, 1,000 ㎠, 667 ㎠ and 500 ㎠, respectively. Scan sampling of all groups was carried out at 15-min intervals during two 1-h periods (10.00 h～11.00 h and 14.00 h～15.00 h) for five days each week. The numbers of birds engaged in different behavioural activities were recorded. It was found that the most common behaviour in all densities was lying. There was no clear effect of density during wks 1～4 of the trial, but in wk 5 birds in the L, M and H groups showed lower levels (P=0.07) of lying behaviour when compared to birds in the VL group suggesting that an increase in animal density results in decreased opportunities for undisturbed rest. This observation is supported by standing and walking behaviour, which was lower (P＜0.05) in the VL group in wk 5. Foraging behaviour measured in the study by the numbers of birds pecking the ground declined as the trial progressed, but scratching increased in 2 wk then decreased. Birds in the VL group showed higher (P＜0.05) level of pecking the ground behaviour compared to birds in the L, M and H groups, but scratching behaviour higher (P＜0.05) and lower (P＜0.05) in VL of 1 wk and 2 wk respectively. However, a peak in aggressive behaviour was observed in wk 2 and birds in the VL group showed less (P＜0.05) agonistic behaviour than birds in the H and M groups. Other behaviours (dustbathing, preening, eating or drinking) were not influenced (P＞0.05) by stocking density.

Ghrelin inhibits autonomic function in healthy controls, but has no effect on obese and vagotomized subjects

Ghrelin inhibits sympathetic nervous system (SNS) activity in rodents. We studied the effect of ghrelin on healthy humans, in obesity and in vagotomized subjects. Randomized, double-blinded, placebo-controlled crossover. Seven lean [mean body mass index (BMI) 23·6 ± 0·9 kg/m(2) ], seven morbidly obese (mean BMI 50·9 ± 4·4 kg/m(2) ) and seven post-gastrectomy subjects (mean BMI 22·0 ± 1·1 kg/m(2) ). Subjects were randomized to intravenous ghrelin (5 pmol/kg/min) or saline over 270 min. Subjects had a fixed calorie meal and a free choice buffet during the infusion. Heart rate variability (HRV) was measured. Total power (TP) represents overall autonomic function, low-frequency (LF) power represents sympathetic and parasympathetic activity, and high-frequency (HF) power represents parasympathetic activity. Very low (VLO) frequency represents the frequency band associated with thermogenesis. Preliminary anova analysis, looking at all three subject groups together, showed that ghrelin had an overall highly significant inhibitory effect on TP (P = 0·001), HF power (P = 0·04), VLO power (P = 0·03) and no effect on LF (P = 0·07). Further subset analysis revealed that ghrelin had a significant effect on TP (P = 0·03), borderline effect on LF power (P = 0·06) and no effect on HF power (P = 0·1) in healthy controls. By contrast in obese subjects, ghrelin had no effect on TP (P = 0·3), LF (P = 0·5) and HF (P = 0·06) and also no effect in the vagotomized subjects on TP (P = 0·7), LF (P = 0·7) and HF (P = 0·9). Ghrelin had no effect on the LF/HF ratio. Ghrelin inhibits SNS activity in healthy controls with a moderate effect on parasympathetic nervous system activity but had no effect on obese subjects. Vagotomized subjects also did not respond to ghrelin, suggesting the vagus nerve is important for the effects of peripheral ghrelin on the SNS.

Telomere Length Measurement by Flow-FISH Distinguishes Dyskeratosis Congenita from Other Bone Marrow Failure Syndromes.

This study was designed to evaluate the utility of flow-FISH telomere length measurement in white blood cells (WBC) as a screening test for Dyskeratosis congenita (DC). We studied 26 patients: 17 with DC, 1 silent carrier (clinically normal; mutation in TERC), 4 with the Hoyeraal-Hreidarsson variant (HH), and 4 with Revesz Syndrome. Five had mutations in DKC1, 5 in TERC, and 2 in TERT. 23 had hematologic abnormalities, 19 had 2 or 3 of the DC diagnostic triad (lacey pigmentation, dyskeratotic nails, and leukoplakia), and 4 had soft signs of DC. We evaluated 54 first-degree relatives of DC patients, 16 Fanconi Anemia patients (FA), 14 with Diamond-Blackfan Anemia (DBA), 5 with Shwachman Diamond Syndrome (SDS), and 10 with other possibly inherited cytopenias (Other). Telomere length was measured in granulocytes and lymphocyte subsets by automated multicolor flow-FISH; results were compared with age-matched values from 400 normal controls. “Very low (VL)” telomere length was defined as a mean telomere length below the normal first percentile for age and specific WBC type. We observed VL telomeres in all subsets in the silent carrier, all HH and Revesz patients, and 15/17 with DC. Eight of 51 DC relatives had VL telomeres in granulocytes versus 2/54 with VL telomeres in lymphocytes. The sensitivities for distinguishing a DC patient from an unaffected relative were 92% in lymphocytes and 96% in granulocytes; the specificities were 96% and 98%, respectively; the sensitivity and specificity for VL telomeres in both cell types were 96% and 96%. The silent carrier with a TERC mutation developed thrombocytopenia, hypocellular marrow, and a cytogenetic clone during follow-up. The 2 DC relatives with VL telomeres in lymphocytes were from a family without a known mutant gene; they may also be silent carriers. The latter possibility disqualified an HLA-matched sibling as a donor for DC-related aplastic anemia, because of engraftment concerns; another sibling donor with normal telomere length was selected. VL granulocyte telomeres were observed in 5/16 FA, 3/14 DBA, 1/5 SDS, and 1/10 Other patients, versus 2/16 FA, 1/14 DBA, 1/5 SDS, and 0/10 Other in lymphocytes, and in both lineages in only 1 each of FA, DBA, and SDS. The sensitivity and specificity for distinguishing DC from non-DC patients using VL telomeres in both lineages were 96% and 93%, respectively. Only DC patients had consistently VL telomeres in all cell subsets. Flow-FISH telomere length measurement provides a sensitive and specific method for identifying patients with DC among families, regardless of mutation status, and distinguishes patients with DC from those with other inherited or acquired marrow failure syndromes. It may also help to detect silent carriers, and facilitate identification of mutations in other telomere biology genes. Our data suggest that the diagnostic triad, soft physical findings and/or bone marrow failure may not be required for the diagnosis of DC. Correct diagnosis of DC will enhance genetic counseling and hematologic management.

Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer.

The aims of this study were to identify risk factors for recurrence of hemorrhage in bleeding gastroduodenal ulcers after endoscopic injection therapy, and to develop a simple and relevant prognostic score which could be used to assess the early risk of recurrence and the residual risk of rebleeding. A prospective study was conducted from January 1995 to December 1998, in 738 patients who were admitted to our department for acute bleeding peptic ulcer and who underwent endoscopic examination. Ulcers with active bleeding or signs of recent bleeding were treated with injection therapy using epinephrine (1/10,000) and 1% polidocanol. Multivariate analysis revealed that liver cirrhosis, recent surgery, systolic blood pressure below 100 mmHg, hematemesis, Forrest classification, and ulcer size and site were significantly predictive variables for the recurrence of hemorrhage. Among these, Forrest classification was the most important. The overall accuracy of the predictive model was 71% (95% CI = 63 - 79%). The model showed a better sensitivity of 90% for early rebleeding (< 48 hours) than for late rebleeding (> or = 48 hours) where the sensitivity was 65 %. A prognostic score was obtained and patients were classified into four risk classes: very low (VL), low (L), high (H), and very high (VH). The rebleeding rates for the four classes were 0%, 7.9%, 31.8% and 67.9%, and the mortality rates were 5.9%, 8.6%, 13.9% and 35.7%, respectively. The residual risk of rebleeding after 48 hours was 0%, 3.3%, 10.4%, and 14.3% in the VL, L, H and VH classes, respectively. After 5 days the residual risk was under 4% in all classes. This study demonstrates that the proposed prognostic score, which is easily obtained after emergency endoscopy, is useful in clinical practice because it can identify patients with different levels of rebleeding risk. It can be helpful in patient management and decision making for discharge.

Pediculosis capitis in northern Jordan.

Little is known about the prevalence of pediculosis among school students in northern Jordan. To study the incidence of pediculosis among school students of different socio-economic levels in northern Jordan. A total of 2519 school students of both sexes enrolled in eight elementary governmental schools were examined for the presence of Pediculus capitis. Schools were grouped into four socio-economic classes: very low (VL), low (L), medium (M), and high (H). The chi-squared test was performed to analyze the results. Overall, 338 students (13.4%) were infested with nits, immature or adult P. capitis. Girls showed a higher prevalence (14.5%) than boys (11.1%). Statistical analysis for socio-economic classes and infestation rates yielded a significant effect of the four classes on infestation. This conclusion was evident among schoolgirls, where infestation rates were 28.8%, 18.9%, 6.1%, and 0.2% in VL, L, M, and H socio-economic classes, respectively. Schoolchildren in the age group 8-9 years exhibited higher prevalence rates (16% in boys and 22.1% in girls), while prevalences declined to 10.2% and 6.6% among boys and girls aged 10-12 years, respectively. This study reveals that socio-economic status is a major factor influencing the occurrence of pediculosis among school students of both sexes in Jordan. A national campaign should be implemented to enhance public awareness.

DO HEMODYNAMIC ABNORMALITIES INFLUENCE MORTALITY AND LENGTH OF STAY IN NONCARDIAC SURGERY?

S98 INTRODUCTION: Although blood pressure and heart rate are closely monitored during surgery, relatively little is known about the influence of abnormalities of heart rate and blood pressure upon outcome indicators, such as mortality and length of stay. METHODS: Subjects were drawn from a group of patients undergoing an IRB-approved anesthesia outcome study. For 931 patients undergoing noncardiac surgery, the computerized anesthesia record was retrieved and intraoperative heart rate (HR), mean arterial pressure (MAP), and systolic arterial pressure (SAP) were obtained. For every five minute epoch during the surgery, HR, MAP, and SAP were classified as very low (VL), low (L), normal (N), high (H), and very high (VH), according to criteria derived from the results of a survey of 39 anesthesiologists. For the length of stay analysis, the study cohort was evenly divided into short and long surgery groups using the median number of total epochs (43) as the cutoff point. Chi-square tables were used to test for associations among hemodynamic abnormalities, mortality, and length of stay. RESULTS: There were no significant associations between hemodynamic abnormalities in shorter cases and length of stay. In longer cases, we found a statistically significant difference in length of stay in those patients with very high MAP (p=0.00001), very low SAP (p=0.04), and very high SAP (p=0.002). The results of the analysis of hospital mortality are shown in Table 1.Table 1: P-values for chi-square tests of association between hemodynamic abnormalities and hospital mortalityDISCUSSION: Extremes of blood pressure are associated with increased length of stay in longer (more complex) surgery. In addition, high heart rates and hypotension are associated with hospital mortality independent of the duration of the surgery. A multivariate analysis is being conducted to determine whether these findings are independent of known perioperative risk factors.