A prediction rule to identify low-risk patients with pulmonary embolism.

BACKGROUND: A simple prognostic model could help identify patients with pulmonary embolism who are at low risk of death and are candidates for outpatient treatment. METHODS: We randomly allocated 15,531 retrospectively identified inpatients who had a discharge diagnosis of pulmonary embolism from 186 Pennsylvania hospitals to derivation (67%) and internal validation (33%) samples. We derived our rule to predict 30-day mortality using classification tree analysis and patient data routinely available at initial examination as potential predictor variables. We used data from a European prospective study to externally validate the rule among 221 inpatients with pulmonary embolism. We determined mortality and nonfatal adverse medical outcomes across derivation and validation samples. RESULTS: Our final model consisted of 10 patient factors (age > or = 70 years; history of cancer, heart failure, chronic lung disease, chronic renal disease, and cerebrovascular disease; and clinical variables of pulse rate > or = 110 beats/min, systolic blood pressure < 100 mm Hg, altered mental status, and arterial oxygen saturation < 90%). Patients with none of these factors were defined as low risk. The 30-day mortality rates for low-risk patients were 0.6%, 1.5%, and 0% in the derivation, internal validation, and external validation samples, respectively. The rates of nonfatal adverse medical outcomes were less than 1% among low-risk patients across all study samples. CONCLUSIONS: This simple prediction rule accurately identifies patients with pulmonary embolism who are at low risk of short-term mortality and other adverse medical outcomes. Prospective validation of this rule is important before its implementation as a decision aid for outpatient treatment.

Age above 60 years is not a negative predictive factor for combined antiviral therapy with pegylated interferon alpha and ribavirin in hepatitis C patients

Background: Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral hepatitis C therapy. However, elderly patients often show relevant fibrosis or cirrhosis which is a known negative predictive factor, making it difficult to interpret age as an independent predictive factor. Methods: From the framework of the Swiss hepatitis C cohort (SCCS), we collected data from 545 antiviral hepatitis C therapies, including data from 67 hepatitis C patients ≥ 60 y who had been treated with PEG-interferon and ribavirin. We analyzed host factors (age, gender, fibrosis, haemoglobin, depression, earlier hepatitis C treatment), viral factors (genotype, viral load) and treatment course (early virological response, end of treatment response, SVR). Generalised estimating equations (GEE) regression modelling was used for the primary end point (SVR), with age ≥ 60 y and < 60 y as independent variable and gender, presence of cirrhosis, genotype, earlier treatment and viral load as confounders. SVR was analysed in young and elderly patients after matching for these confounders. Additionally, classification tree analysis was done in elderly patients using these confounders. Results: SVR analyzed in 545 patients was 55%. In genotype 1/4, SVR was 42.9% in 259 patients < 60 y and 26.1% in 46 patients ≥ 60 y. In genotype 2/3, SVR was 74.4% in 215 patients < 60 y and 84% in 25 patients ≥ 60 y. However, GEE model showed that age had no influence on achieving SVR (Odds ratio 0.91). Confounders influenced SVR as known from previous studies (cirrhosis, genotype 1/4, previous treatment and viral load >600'000 IE/ml as negative predictive factors). When young and elderly patients were matched (analysis in 59 elderly patients), SVR was not different in these patient groups (54.2% and 55.9%, resp.; p=0.795 in binomial test). The classification tree-derived best criterion for SVR in elderly patients was genotype, with no further criteria relevant for predicting SVR in genotype 2/3. In patients with genotype 1/4, further criteria were presence of cirrhosis and low viral load <600'000 IE/ml in non-cirrhotic patients. Conclusions: Age is not a relevant predictive factor for achieving SVR, when confounders were taken into account. In terms of effectiveness of antiviral therapy, age does not play a major role and should not be regarded as relevant negative predictive factor. Since life expectancy in Switzerland at age 60 is more than 22 y, hepatitis C therapy is reasonable in elderly patients with known relevant fibrosis or cirrhosis, because interferon-based hepatitis C therapy improves survival and reduces carcinogenesis.

The relation of body mass index and abdominal adiposity with dyslipidemia in 27 general populations of the WHO MONICA Project.

The association between adiposity measures and dyslipidemia has seldom been assessed in a multipopulational setting. 27 populations from Europe, Australia, New Zealand and Canada (WHO MONICA project) using health surveys conducted between 1990 and 1997 in adults aged 35-64 years (n = 40,480). Dyslipidemia was defined as the total/HDL cholesterol ratio >6 (men) and >5 (women). Overall prevalence of dyslipidemia was 25% in men and 23% in women. Logistic regression showed that dyslipidemia was strongly associated with body mass index (BMI) in men and with waist circumference (WC) in women, after adjusting for region, age and smoking. Among normal-weight men and women (BMI<25 kg/m(2)), an increase in the odds for being dyslipidemic was observed between lowest and highest WC quartiles (OR = 3.6, p < 0.001). Among obese men (BMI ≥ 30), the corresponding increase was smaller (OR = 1.2, p = 0.036). A similar weakening was observed among women. Classification tree analysis was performed to assign subjects into classes of risk for dyslipidemia. BMI thresholds (25.4 and 29.2 kg/m(2)) in men and WC thresholds (81.7 and 92.6 cm) in women came out at first stages. High WC (>84.8 cm) in normal-weight men, menopause in women and regular smoking further defined subgroups at increased risk. standard categories of BMI and WC, or their combinations, do not lead to optimal risk stratification for dyslipidemia in middle-age adults. Sex-specific adaptations are necessary, in particular by taking into account abdominal obesity in normal-weight men, post-menopausal age in women and regular smoking in both sexes.

Elderly age is not a negative predictive factor for virological response to therapy with pegylated interferon-α and ribavirin in chronic hepatitis C virus patients.

BACKGROUND & AIMS: Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral therapy of chronic hepatitis C. However, elderly patients often show advanced fibrosis/cirrhosis as known negative predictive factor. The aim of this study was to assess age as an independent predictive factor during antiviral therapy. METHODS: Overall, 516 hepatitis C patients were treated with pegylated interferon-α and ribavirin, thereof 66 patients ≥60 years. We analysed the impact of host factors (age, gender, fibrosis, haemoglobin, previous hepatitis C treatment) and viral factors (genotype, viral load) on SVR per therapy course by performing a generalized estimating equations (GEE) regression modelling, a matched pair analysis and a classification tree analysis. RESULTS: Overall, SVR per therapy course was 42.9 and 26.1%, respectively, in young and elderly patients with hepatitis C virus (HCV) genotypes 1/4/6. The corresponding figures for HCV genotypes 2/3 were 74.4 and 84%. In the GEE model, age had no significant influence on achieving SVR. In matched pair analysis, SVR was not different in young and elderly patients (54.2 and 55.9% respectively; P = 0.795 in binominal test). In classification tree analysis, age was not a relevant splitting variable. CONCLUSIONS: Age is not a significant predictive factor for achieving SVR, when relevant confounders are taken into account. As life expectancy in Western Europe at age 60 is more than 20 years, it is reasonable to treat chronic hepatitis C in selected elderly patients with relevant fibrosis or cirrhosis but without major concomitant diseases, as SVR improves survival and reduces carcinogenesis.

Evaluating spine micro-architectural texture (via TBS) discriminates major osteoporotic fractures from controls both as well as and independent of site matched BMD: the Eastern European TBS study.

The aim of the study was to assess the clinical performance of the model combining areal bone mineral density (aBMD) at spine and microarchitecural texture (TBS) for the detection of the osteoporotic fracture. The Eastern European Study is a multicenter study (Serbia, Bulgaria, Romania and Ukraine) evaluating the role of TBS in routine clinical practice as a complement to aBMD. All scans were acquired on Hologic Discovery and GE Prodigy densitometers in a routine clinical manner. The additional clinical values of aBMD and TBS were analyzed using a two steps classification tree approach (aBMD followed by TBS tertiles) for all type of osteoporotic fracture (All-OP Fx). Sensitivity, specificity and accuracy of fracture detection as well as the Net Reclassification Index (NRI) were calculated. This study involves 1031 women subjects aged 45 and older recruited in east European countries. Clinical centers were cross-calibrated in terms of BMD and TBS. As expected, areal BMD (aBMD) at spine and TBS were only moderately correlated (r (2) = 0.19). Prevalence rate for All-OP Fx was 26 %. Subjects with fracture have significant lower TBS and aBMD than subjects without fracture (p < 0.01). TBS remains associated with the fracture even after adjustment for age and aBMD with an OR of 1.27 [1.07-1.51]. When using aBMD T-score of -2.5 and the lowest TBS tertile thresholds, both BMD and TBS were similar in terms of sensitivity (35 vs. 39 %), specificity (78 vs. 80 %) and accuracy (64 vs. 66 %). aBMD and TBS combination, induced a significant improvement in sensitivity (+28 %) and accuracy (+17 %) compared to aBMD alone whereas a moderate improvement was observed in terms of specificity (+9 %). The overall combination gain was 36 % as expressed using the NRI. aBMD and TBS combination decrease significantly the number of subjects needed to diagnose from 7 for aBMD alone to 2. In a multi-centre Eastern European cohort, we have shown that the use of TBS in addition to the aBMD permit to reclassified correctly more than one-third of the overall subjects. Furthermore, the number of subjects needed to diagnose fell to 2 subjects. Economical studies have to be performed to evaluate the gain induced by the use of TBS for the healthcare system.

Conocer las emociones a través de juegos: ayuda para los futuros docentes en la toma de decisiones

Introducción. El objetivo de este estudio fue proporcionar orientaciones para ayudar a profesionales de la educación física a tomar decisiones en torno a las emociones que produjeron diferentes juegos deportivos clasificados en cuatro dominios de acción motriz (psicomotor, cooperación, oposición y cooperación/oposición). Método. La muestra correspondió a 284 estudiantes universitarios de educación física y de educación primaria (INEFC, Facultad de Educación, Universidades de Lleida y de Barcelona, España). A través de un diseño cuasi-experimental los estudiantes indicaron en un cuestionario validado la intensidad sentida en trece emociones tras participar en cada juego. El análisis de los datos se realizó a través de los árboles de clasificación. Resultados. La comparación de los resultados en los diferentes dominios de acción motor mostró que los juegos cooperativos fueron los que activaron emociones positivas más intensas entre los estudiantes. En los juegos no competitivos de cooperación los resultados en emociones positivas fueron 18.3 % más elevados que en los juegos competitivos. Conclusión. Los resultados sugieren que el tipo de juegos a elegir es la primera decisión importante que debería plantearse para educar emociones en los estudiantes. Cada dominio de acción motriz está asociado a la producción de diferentes tipos de emoción.

A hierarchical Bayesian model for predicting the functional consequences of amino-acid polymorphisms

Genetic polymorphisms in deoxyribonucleic acid coding regions may have a phenotypic effect on the carrier, e.g. by influencing susceptibility to disease. Detection of deleterious mutations via association studies is hampered by the large number of candidate sites; therefore methods are needed to narrow down the search to the most promising sites. For this, a possible approach is to use structural and sequence-based information of the encoded protein to predict whether a mutation at a particular site is likely to disrupt the functionality of the protein itself. We propose a hierarchical Bayesian multivariate adaptive regression spline (BMARS) model for supervised learning in this context and assess its predictive performance by using data from mutagenesis experiments on lac repressor and lysozyme proteins. In these experiments, about 12 amino-acid substitutions were performed at each native amino-acid position and the effect on protein functionality was assessed. The training data thus consist of repeated observations at each position, which the hierarchical framework is needed to account for. The model is trained on the lac repressor data and tested on the lysozyme mutations and vice versa. In particular, we show that the hierarchical BMARS model, by allowing for the clustered nature of the data, yields lower out-of-sample misclassification rates compared with both a BMARS and a frequen-tist MARS model, a support vector machine classifier and an optimally pruned classification tree.

Can the study of natural vegetation succession assist in the control of soil erosion on abandoned croplands on the Loess Plateau, China?

In the Loess Plateau, China, arable cultivation of slope lands is common and associated with serious soil erosion. Planting trees or grass may control erosion, but planted species may consume more soil water and can threaten long-term ecosystem sustainability. Natural vegetation succession is an alternative ecological solution to restore degraded land, but there is a time cost, given that the establishment of natural vegetation, adequate to prevent soil erosion, is a longer process than planting. The aims of this study were to identify the environmental factors controlling the type of vegetation established on abandoned cropland and to identify candidate species that might be sown soon after abandonment to accelerate vegetation succession and establishment of natural vegetation to prevent soil erosion. A field survey of thirty-three 2 × 2–m plots was carried out in July 2003, recording age since abandonment, vegetation cover, and frequency of species together with major environmental and soil variables. Data were analyzed using correspondence analysis, classification tree analysis, and species response curves. Four vegetation types were identified and the data analysis confirmed the importance of time since abandonment, total P, and soil water in controlling the type of vegetation established. Among the dominant species in the three late-successional vegetation types, the most appropriate candidates for accelerating and directing vegetation succession were King Ranch bluestem (Bothriochloa ischaemum) and Lespedeza davurica (Leguminosae). These species possess combinations of the following characteristics: tolerance of low water and nutrient availability, fibrous root system and strong lateral vegetative spread, and a persistent seed bank.

Assessing the vulnerability of blanket peat to climate change using an ensemble of statistical bioclimatic envelope models

We assessed the vulnerability of blanket peat to climate change in Great Britain using an ensemble of 8 bioclimatic envelope models. We used 4 published models that ranged from simple threshold models, based on total annual precipitation, to Generalised Linear Models (GLMs, based on mean annual temperature). In addition, 4 new models were developed which included measures of water deficit as threshold, classification tree, GLM and generalised additive models (GAM). Models that included measures of both hydrological conditions and maximum temperature provided a better fit to the mapped peat area than models based on hydrological variables alone. Under UKCIP02 projections for high (A1F1) and low (B1) greenhouse gas emission scenarios, 7 out of the 8 models showed a decline in the bioclimatic space associated with blanket peat. Eastern regions (Northumbria, North York Moors, Orkney) were shown to be more vulnerable than higher-altitude, western areas (Highlands, Western Isles and Argyle, Bute and The Trossachs). These results suggest a long-term decline in the distribution of actively growing blanket peat, especially under the high emissions scenario, although it is emphasised that existing peatlands may well persist for decades under a changing climate. Observational data from long-term monitoring and manipulation experiments in combination with process-based models are required to explore the nature and magnitude of climate change impacts on these vulnerable areas more fully.

Compostos orgânicos como substratos na formação de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) Standl) irrigadas com água residuária

A necessidade de estudar a utilização dos resíduos de podas de árvores é de grande importância ambiental para solucionar os problemas de resíduos sólidos existentes nas áreas urbanas junto com os resíduos de lixos domésticos. O estudo destes materiais foi avaliado com o desenvolvimento de mudas de ipê-amarelo (Tabebuia Chrysotricha (Mart. Ex. Dc.) sandl) em diferentes misturas de substratos e tipos de água para irrigação. O experimento foi instalado no Departamento de Engenharia Rural da Faculdade de Ciências Agrárias e Veterinárias - UNESP, Câmpus de Jaboticabal. Foram realizados dois experimentos, avaliados juntamente com delineamento experimental em blocos casualizados, de oito substratos, duas qualidades de águas e quatro repetições, totalizando 64 parcelas. Cada parcela foi composta por 30 plantas (cinco linhas de seis plantas), sendo consideradas como úteis as três linhas de quatro plantas centrais da parcela. Foram testados oito substratos, resultantes da combinação de substrato comercial, composto de lixo e composto de poda de árvores com dois tipos de água de irrigação (água potável e residuária) e quatro repetições. Para acompanhar o desenvolvimento das mudas de ipê-amarelo, foram avaliados a altura da parte aérea das plantas (H) e o diâmetro do colmo (D). As características foram avaliadas aos 21; 42; 63 e 84 dias após a emergência. da análise dos resultados, possibilitou-se concluir que os substratos estudados promoveram diferenças significativas para a altura média das plantas e o diâmetro de colmo, em todos os períodos de avaliação. Os substratos 4 e 5 e a água residuária apresentaram os melhores resultados no desenvolvimento das mudas de ipê-amarelo.

Modelo de programação matemática para controle do crescimento da vegetação sob redes de distribuição de energia elétrica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Design of experimental composting of animal carcasses in universitary unit of treatment aimed a correct final disposition and soil improve

For many years, composting has been used as a result of the recycling of organic matter. There is significative animal carcasses accumulation from teaching and researching activities of the university veterinary hospital. Every year, Unesp University needs to dispose correctly about 180 tones of this waste and the composting seemed to be the most sustainable alternative. Piles of animal carcasses were prepared using peanut hulls and tree pruning as bulking agent and water to the first phase of this process. The extracts pH values no impediments for offering germination and indicated a good addition to the soil management. The germination index showed no impediment to the seeds germination on any type of compost and the extracts concentrations not influenced this biological process. No parameters studied assigns risks of contamination of carcasses for the compost development in Unesp according to the proposed design. © 2013 Taylor & Francis Group.

Substrato com composto de lixo e poda de árvore para produção de mudas de Pterogyne nitens

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Machine vision to identify broiler breeder behavior

Animal behavioral parameters can be used to assess welfare status in commercial broiler breeders. Behavioral parameters can be monitored with a variety of sensing devices, for instance, the use of video cameras allows comprehensive assessment of animal behavioral expressions. Nevertheless, the development of efficient methods and algorithms to continuously identify and differentiate animal behavior patterns is needed. The objective this study was to provide a methodology to identify hen white broiler breeder behavior using combined techniques of image processing and computer vision. These techniques were applied to differentiate body shapes from a sequence of frames as the birds expressed their behaviors. The method was comprised of four stages: (1) identification of body positions and their relationship with typical behaviors. For this stage, the number of frames required to identify each behavior was determined; (2) collection of image samples, with the isolation of the birds that expressed a behavior of interest; (3) image processing and analysis using a filter developed to separate white birds from the dark background; and finally (4) construction and validation of a behavioral classification tree, using the software tool Weka (model 148). The constructed tree was structured in 8 levels and 27 leaves, and it was validated using two modes: the set training mode with an overall rate of success of 96.7%, and the cross validation mode with an overall rate of success of 70.3%. The results presented here confirmed the feasibility of the method developed to identify white broiler breeder behavior for a particular group of study. Nevertheless, more improvements in the method can be made in order to increase the validation overall rate of success. (C) 2013 Elsevier B.V. All rights reserved.

Substratos orgânicos para a produção de mudas de Tabebuia heptaphylla irrigadas com água potável e residuária

Pós-graduação em Agronomia (Ciência do Solo) - FCAV