An Online AI-Powered Interactive Histological Image Annotation Platform for Analyzing Intestinal Regenerating Crypts in Post-Irradiated Mice

PURPOSE/OBJECTIVE(S)

The goal of this project is to build an online AI-powered interactive annotation platform to accurately and efficiently annotate intestinal regenerating crypts in histological images of mice after abdominal irradiation.

MATERIALS/METHODS

The proposed platform is developed by the seamless integration of a front-end web client and a back-end server. Such client/server design allows the users to access the platform without software installation on local computers. Our front-end client is developed with SvelteJS + WebGL technology stack, allowing access from any common web browsers and enabling user interaction, such as image importing/visualization, interactive crypt annotating, and annotation saving/deleting. The back-end server is responsible for executing the tasks requested from the web client, for instance, image pre-processing, AI-based crypts automatic identification, and database management. The image preprocessing is designed to extract a single cross section image using morphological operations because multiple hematoxylin and eosin (H&E) stained jejunum cross sections from post-irradiated mice are scanned within one slide. The auto-crypt identification is powered by a trained and validated AI engine U-Net, classifying image grid tiles into two groups with and without regenerating crypts. The database is implemented with the self-contained SQLite to support recording and indexing the annotated grid tiles with regenerating crypts. The workflow for crypt analysis on this interactive platform has 5 steps: 1) manually import a whole H&E slide image; 2) auto-preprocess the slide by extracting single cross-section images; 3) auto-identify regenerating crypts with an AI engine; 4) interactively annotate (add, delete, modify) auto-identified crypt markers; 5) save and/or output the annotation to the database or the local drive.

RESULTS

The performance of the developed interactive crypt analysis platform was evaluated in aspects of accuracy and efficiency. The AI-powered crypt auto-identification accuracy was assessed by computing the mean absolute error (MAE) on crypt number per cross section between manual and auto annotation using a testing dataset containing 80 cross sections. It achieved an MAE of 3.5±4.8 crypts per cross section, and 81.25% of the cross sections have no more than 5 crypts difference. The efficiency was assessed under two conditions with the server on the cloud and a local computer. It took about 2-3 minutes to finish the entire workflow on the cloud, while 1-2 minutes on the local by saving ∼1 minute on image uploading.

CONCLUSION

The developed web client/server platform enables online automatic identification and interactive annotation of mice crypts in minutes. It is a convenient tool that allows accurate and efficient crypt analysis and can be extended for other histologic image analyses.

Deep Learning-Based Pipeline for Automatic Identification of Intestinal Regenerating Crypts in Mouse Histological Images

PURPOSE/OBJECTIVE(S)

A classical approach for evaluating normal tissue radiation response is to count the number of intestinal regenerating crypts in mouse histological images acquired after abdominal radiation. However, manual counting is time-consuming and subject to inter-observer variations. The goal of this study is to build a deep learning-based pipeline for automatically identifying intestinal regenerating crypts to facilitate high-throughput studies.

MATERIALS/METHODS

Sixty-six healthy C57BL/6 female mice underwent 16 MeV whole abdominal electron irradiation. The small bowel was collected from each mouse 4 days post-irradiation, and 9 jejunal cross-sections from each were processed together in a single slide. The slides were stained with hematoxylin and eosin (H&E) and subsequently scanned (x20), providing one electronic histological image per mouse. Regenerating crypts, consisting of more than 10 basophilic crypt epithelial cells, were manually identified using point annotations in histological images. The pipeline was built to take the input of the image containing 9 cross sections and automatically identify the regenerating crypts on each cross section. It mainly consists of two components, cross section segmentation using intensity thresholding and morphological operations and crypt identification using a UNet. The dataset was randomly split into 46, 10, and 10 slide images for UNet training, validation, and testing. Each slide image was split into grid tiles with a voxel size of 200 × 200, and 40 × 40 square masks were placed with centers at manual point annotations on tiles with regenerating crypts. 5203/5198 tiles (w/wo crypt mask) were extracted to train UNet by minimizing dice loss. The mask probability map generated by the UNet was post-processed to identify the crypt position. Postprocessing hyperparameters were tuned using the validation dataset. The model accuracy was evaluated using the testing dataset by computing the mean absolute error (MAE) of the crypt number averaged across all cross sections.

RESULTS

The number of regenerating crypts on testing cross sections ranges from 1 to 63. The testing cross-section-wise MAE achieved by the platform is 3.5±4.8 crypts. 81.25% of testing cross sections have absolute number differences less than or equal to 5 crypts.

CONCLUSION

Our established deep learning-based pipeline can accurately count the number of regenerating crypts in mouse intestinal histological images. We have integrated it into an online platform that enables automatic crypt identification and allows users to interactively modify auto-identified crypt annotations. The acquired annotations from the platform will be used to finetune the deep learning model to achieve better identification performance.

Equivalent Dose Estimation in FLASH Irradiation with a Deep Learning Approach

PURPOSE/OBJECTIVE(S)

Ultra-high dose rate (FLASH) irradiation has been reported to provide decreased normal tissue toxicity without compromising tumor control compared with conventional (CONV) irradiation. However, a comprehensive understanding of the FLASH biological effect requires precise quantification of radiobiology. The study is to explore whether deep learning (DL) can tackle the task. As a proof of concept, we investigate a DL model for estimating FLASH dose to its equivalent CONV dose.

MATERIALS/METHODS

Healthy C57Bl/6 female mice underwent FLASH (200Gy/s; n = 43) or CONV (0.12Gy/s; n = 41) whole abdominal irradiation using ∼16 MeV electron beams with a dose escalation scheme of 5 groups (n = 8 or 9) at 1Gy increments: 12-16Gy FLASH, 11-15Gy CONV. 4 days post-irradiation, 9 jejunum cross-sections per mouse were H&E stained for histological analysis. Each cross-section image was processed to remove lumen background and oversampled into multiple large-scale and small-scale patches along jejunal circumference. In CONV dataset, we randomly selected the data of 32 mice (80%) for model training and the rest (20%) for model validation. A ResNet101-based DL model, pre-trained with an unsupervised contrastive learning scheme, was retrained with only CONV training set to estimate corresponding CONV dose. For comparison, a crypt counting (CC) approach was implemented by manually counting the number of regenerating crypts on each cross-section image. An exponential function of dose vs crypt number was fitted with the CONV training set and used for dose estimation on the testing set. Mean squared error (MSE) was used to assess the accuracy of DL and CC approaches in estimating dose levels in CONV irradiation. The validated DL model was applied to the FLASH set to project FLASH dose into corresponding CONV dose that results in equivalent biological response.

RESULTS

The CONV dose estimated by DL and CC approaches and DL-estimated FLASH equivalent dose were summarized in Table 1. The DL model achieved an MSE of 0.21 Gy2 on CONV testing set compared with 0.32 Gy2 of the CC approach. FLASH equivalent dose estimated by DL model for 12, 13, 14, 15 and 16Gy were 12.16±0.40, 12.53±0.32, 12.72±0.24, 12.85±0.20 and 13.04±0.27 Sv, respectively.

CONCLUSION

Our proposed DL model can accurately estimate the CONV dose based on histological images. The DL predictions of FLASH dataset demonstrate that FLASH may reduce normal tissue toxicity with a lower equivalent dose, especially at high irradiated dose levels. Our study indicates that deep learning can be potentially used to assess the equivalent dose of FLASH irradiation to normal tissue.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Postprandial Metabolic Responses Differ by Age Group and Physical Activity Level

OBJECTIVES

To compare the postprandial metabolic responses to a high-fat meal in healthy adults who differ by age and physical activity level.

DESIGN

Cross-sectional, quasi-experimental design.

SETTING

Physical Activity and Nutrition Clinical Research Consortium (PAN-CRC) at Kansas State University (Manhattan, KS, USA).

PARTICIPANTS

Twenty-two healthy adults: 8 younger active (YA) adults (4M/4W; 25 ± 5 yr), 8 older active (OA) adults (4M/4W; 67 ± 5 yr), and 6 older inactive (OI) adults (3M/3W; 68 ± 7 yr).

INTERVENTION

Following an overnight (10-hour) fast and having abstained from exercise for 2 days, participants consumed a high-fat meal (63% fat, 34% CHO; 12 kcal/kg body mass; 927 ± 154 kcal). To assess the metabolic response, blood draws were performed at baseline and each hour following the meal for 6 hours.

MEASUREMENTS

Fasting and postprandial triglycerides (TG), glucose, Total-C, and HDL-C were measured. Metabolic load index (MLI) and LDL-C were calculated.

RESULTS

There were significant group x time interactions for TG (p < 0.0001) and MLI (p = 0.004). The TG total area-under-the-curve (tAUC) response was significantly lower in YA (407.9 ± 115.1 mg/dL 6 hr) compared to OA (625.6 ± 169.0 mg/dL 6 hr; p = 0.02) and OI (961.2 ± 363.6 mg/dL 6 hr; p = 0.0002), while the OA group TG tAUC was lower than the OI group (p = 0.02). The TG peak was significantly lower in YA (90.5 ± 27.0 mg/dL) than OA (144.0 ± 42.2 mg/dL; p = 0.03) and OI (228.2 ± 96.1 mg/dL; p = 0.0003), and was lower in the OA group compared to the OI group (p = 0.03). Glucose was significantly lower 1 hour after the meal in YA (89.4 ± 10.1 mg/dL; p = 0.01) and OA (87.3 ± 22.3 mg/dL; p = 0.005) versus OI (110.7 ± 26.9 mg/dL). MLI tAUC was significantly lower in YA (936.8 ± 137.7 mg/dL 6 hr; p = 0.0007) and OA (1133.0 ± 207.4 mg/dL; p = 0.01) versus OI (1553.8 ± 394.3 mg/dL), with no difference (p = 0.14) between YA and OA groups. Total-C and LDL-C were generally lower in younger compared to older participants at baseline and throughout the postprandial period, while no group or time effects were evident in HDL-C.

CONCLUSION

Both physical activity status and aging appear to affect the postprandial metabolic, namely TG, response to a high-fat meal. These findings point to an inherently diminished metabolic capacity with aging, but suggest that physical activity may help minimize this decrement.

Reproductive experience alters neural and behavioural responses to acute oestrogen receptor α activation

Reproductive experience (i.e. parturition and lactation) leads to persistent alterations in anxiety-like behaviour that are influenced by the oestrous cycle. We recently found that repeated administration of the selective oestrogen receptors (ER)α agonist propyl-pyrazole triol (PPT) results in anxiolytic-like behaviours on the elevated plus maze (EPM) in primiparous (but not nulliparous) female rats. The present study examined the effects of the acute administration of PPT on EPM behaviour in primiparous and aged-matched, nulliparous female rats. In addition, corticosterone secretion, corticotrophin-releasing hormone (CRH) gene expression and expression of the immediate early gene product Fos in the paraventricular nucleus (PVN) and amygdala were measured either after EPM testing or in home cage controls. Acute PPT administration significantly modified EPM behaviour as a function of reproductive experience, with nulliparous females tending toward increased anxiety-like behaviours and primiparous females tending toward decreased anxiety-like behaviours. In home cage controls, PPT increased corticosterone secretion in all females; however, both vehicle- and PPT-treated, primiparous females had reduced corticosterone levels compared to their nulliparous counterparts. Significant effects of PPT on CRH mRNA within the PVN were observed after the administration of PPT but only in primiparous females tested on the EPM. PPT also increased Fos expression within the PVN of EPM-exposed females; however, both vehicle- and PPT-treated primiparous females had reduced Fos expression compared to nulliparous females. In the amygdala, PPT increased Fos immunoreactivity in the central but not the medial or basolateral amygdala, although these effects were only observed in home cage females. Additionally, both vehicle- and PPT-treated home cage, primiparous females had increased Fos in the central nucleus of the amygdala compared to nulliparous controls. Overall, these data demonstrate that reproductive experience alters the behavioural response to acute ERα activation. Moreover, the findings suggest that central regulation of the hypothalamic-adrenal-pituitary axis is modified as a consequence of reproductive experience.

Assessing components of the natural environment of the Upper Danube and Upper Brahmaputra river basins

Abstract. A comprehensive understanding of the interplay between the natural environment and the human dimension is one of the prerequisites to successful and sustaining IWRM practises in large river basins such as the Upper Brahmaputra river basin or the Upper Danube river basin. These interactions, their dynamics and changes, and the likely future scenarios were investigated in the BRAHMATWINN project with a series of tools from remote sensing and geoinformatics. An integrated assessment of main components of the natural environment in the two river basins as well as in five reference catchments within those basins, has led to the delineation of hydrological response units (HRUs). HRUs are spatial units bearing a uniform behaviour in terms of the hydrological response regime, as a function of physical parameters land use, soil type, water, vegetation cover and climate. Besides the delineated HRUs which are available in a spatially exhaustive manner for all reference catchments, the following information were provided as spatial layers: (1) uniform digital surface models of both the twinned basins and the reference catchments; (2) glacier areas and the magnitude of glacier loss; (3) mountain permafrost distribution and identification of areas particularly affected by permafrost thaw; (4) a consistent land use/land cover information in all reference catchments; and (5) the vulnerabilities of wetlands and groundwater in terms of anthropogenic impact and climate change.

Anticaries potential of commercial fluoride rinses as determined by fluoridation and remineralization efficiency

OBJECTIVE

The objective of this work was to compare the anticaries potential of several currently marketed fluoride-containing mouthrinse products using two in vitro approaches: 1) fluoride uptake studies of demineralized human enamel samples after exposure to rinse products; and 2) microhardness studies of sound enamel samples after exposure to the rinse products and demineralizing agents.

METHODS

Four currently marketed rinse products, formulated at 100 ppm F, were evaluated in fluoride uptake studies relative to a negative (water) rinse control (Study 1). The same rinse products were evaluated in microhardness studies (Study 2) against a positive control, ACT Anticavity rinse, which is formulated with 225 ppm F and carries the ADA Seal of Acceptance as an effective anticavity mouthrinse. Test products included ACT Total Care rinse (pH = 6.34), Listerine Total Care rinse (pH = 3.57), Crest Pro-Health for Me rinse (pH = 3.33), and Crest Pro-Health Complete rinse (pH = 3.43).

RESULTS

Study 1-Samples treated with any of the fluoride-containing rinses showed significantly higher (p < 0.05) levels of fluoride uptake than the negative (water) control. Two of the products (Crest Pro-Health for Me and Crest Pro-Health Complete) showed significantly higher (p < 0.05) levels of fluoride uptake into demineralized enamel than the other marketed rinses (Listerine Total Care and ACT Total Care). Study 2-Samples treated with the same two rinse products (Crest Pro-Health For Me and Crest Pro-Health Complete) showed significantly lower mineral loss than the other rinse products, as well as the positive control.

CONCLUSION

Results of these in vitro studies indicate that the Crest mouthrinse products evaluated here are capable of providing significantly better fluoridation of demineralized enamel, as well as significantly better protection against the initiation and progression of demineralization, compared to the other marketed fluoride-containing mouthrinse products tested.

Factor VIII requirement to maintain a target plasma level in the prophylactic treatment of severe hemophilia A: influences of variance in pharmacokinetics and treatment regimens

BACKGROUND

Prophylactic factor (F)VIII has been shown to reduce bleeds and arthropathy in patients with severe hemophilia A.

OBJECTIVES

Assuming that the trough FVIII level is an important determinant of the efficacy of prophylaxis, this paper addresses the effect of the inter-patient variability in pharmacokinetics and different dosing regimens on trough levels.

METHODS

Simulations used FVIII half-lives and in vivo recoveries (IVR), observed during clinical trials with Advate [Antihemophilic Factor (Recombinant), Plasma/Albumin-Free Method], and commonly used prophylactic regimens to calculate their effect on FVIII levels during prophylaxis.

RESULTS AND CONCLUSIONS

Half-life and dose frequency had a larger effect on trough FVIII and time per week with FVIII<1 IU dL(-1) than IVR and infused dose per kg. The combined effect of these parameters resulted in substantial inter-patient variability in the amount of FVIII required to sustain a desired trough level. Prophylactic regimens based on Monday, Wednesday, Friday dosing were less cost effective in maintaining a desired trough level throughout the week. Dose escalation on Friday to cover the weekend would require potentially harmful doses of FVIII in many patients, especially in young children where more than 50% would require a Friday dose of over 100 IU kg(-1) and some would require more than 400 IU kg(-1). Knowledge of individual patients' half-lives and alteration of frequency of infusions may allow the more cost-effective use of FVIII and potentially expand access to prophylaxis to a greater number of patients, especially in regions where healthcare resources are scarce.

Odour emissions from anaerobic piggery ponds. 2: improving estimates of emission rate through recognition of spatial variability

Odour emission rates were measured for seven different anaerobic ponds treating piggery wastes at six to nine discrete locations across the surface of each pond on each sampling occasion over a thirteen month period. Significant variability in emission rates were observed for each pond. Measurement of a number of water quality variables in pond liquor samples collected at the same time and from the same locations as the odour samples indicated that the composition of the pond liquor was also variable. The results indicated that spatial variability was a real phenomenon and could have a significant impact on odour assessment practices. Considerably more odour samples would be required to characterise pond emissions than currently recommended by most practitioners, or regulatory agencies.

Odour emissions from anaerobic piggery ponds. 1. Results of a three season, 14-month survey

Odour emission rates were measured for seven different anaerobic ponds treating piggery wastes at six to nine discrete locations across the surface of each pond on each sampling occasion over a 14-month period. Emission rate values varied between ponds, between seasons for the same pond and even for the same pond on different days of a sampling week. Average seasonal emission rates ranged from 7.9 to 46.5OU/m(2)s, while average emission rates ranged from 16.0 to 29.0OU/m(2)s. Factors potentially responsible for the variability in emission rates were investigated, including air and pond liquor temperatures, time of day of sample collection, season and the impact of a prolonged drought.

Inoculation of female American black bears (Ursus americanus) with partially purified porcine zona pellucidae limits cub production

The present 2-year study investigated the feasibility of using porcine zona pellucidae (pZP) as antigen for immunocontraception in American black bears. Sows, 3–6 years of age, were administered either two doses of 250 µg pZP with Freund’s adjuvant (n = 10) or adjuvant alone (n = 5), one in April and one in May, and were kept away from the boars until June. Serum samples were collected before injections and before denning (November). The presence of sows with cubs at side was observed during premature emergence from denning. First-year results indicated that anti-pZP antibody titres in vaccinated sows were 2.5–9.0-fold (range) higher compared with non-vaccinated sows and that the vaccinated sows were threefold less likely to become pregnant (P = 0.167). Control and vaccinated bears produced 1.6 and 0.2 cubs per sow, respectively (P = 0.06). The second-year study investigated the feasibility of using pZP sequestered in a controlled-release pellet and a water-soluble adjuvant (QS-21) to avoid regulatory problems associated with Freund’s adjuvant. Sows in the treatment group (n = 22) were administered a single dose of an emulsion of 250 µg pZP and 150 μg QS-21 plus a pellet containing 70–90 µg pZP for delayed release as booster dose. Control sows (n = 5) received the QS-21 adjuvant in pellet alone. Serum samples were collected before inoculations (April) and before denning (November). Seven cubs were born to the five control sows, but none was born to the 22 vaccinated sows (P < 0.001). Anti-pZP antibody mean absorbance ratios in control sows remained at background levels, whereas vaccinated sows had ratios fourfold higher than controls. Two-dimensional polyacrylamide gel electrophoresis and immunohistochemical localisation confirmed immunoreactivity of sera from inoculated bears. We conclude that cub production in the American black bear can be effectively limited with either two injections of 250 μg pZP or a single inoculation of partially purified pZP sequestered in controlled-release pellets.

A 6-month prospective study of injury in Gaelic football

OBJECTIVE

To describe the injury incidence in Gaelic football.

METHODS

A total of 83 players from three counties were interviewed monthly about their injury experience, during the 6 months of the playing season.

RESULTS

The injury rate was 13.5/1000 h exposure to Gaelic football (95% CI, 10.9 to 16.6). There were nearly twice as many injuries during matches (64.4%, 95% CI, 54.1 to 73.6) as in training (35.6%, 95% CI, 26.4 to 49.5). The ankle was found to be the most commonly injured site (13.3%, 95% CI, 7.8 to 21.9). The musculotendinous unit accounted for nearly 1/3 of all injuries (31.1%). The tackle accounted for 27.8% of the injuries sustained (tackler 10%, 95% CI, 5.4 to 17.9; player being tackled 17.9%, 95% CI, 11.2 to 26.9). Of total match injuries, 56.9% (95% CI, 46.1 to 67.1) were experienced in the second half as opposed to 39.7% (95% CI, 29.8 to 50.5) in the first half.

CONCLUSIONS

Gaelic footballers are under considerable risk of injury. Greater efforts must be made to reduce this risk so that players miss less time from sport due to injury. Risk factors for injury in Gaelic football must now be investigated so that specific interventions may be established to reduce them.

Delayed profound local brain hypothermia markedly reduces interleukin-1beta gene expression and vasogenic edema development in a porcine model of intracerebral hemorrhage

White matter (lobar) intracerebral hemorrhage (ICH) can cause edema-related deaths and life-long morbidity. In our porcine model, ICH induces oxidative stress, acute interstitial and delayed vasogenic edema, and up-regulates interleukin-1beta (IL-1beta), a proinflammatory cytokine-linked to blood-brain barrier (BBB) opening. In brain injury models, hypothermia reduces inflammatory cytokine production and protects the BBB. Clinically, however, hypothermia for stroke treatment using surface and systemic approaches can be challenging. We tested the hypothesis that an alternative approach, i.e., local brain cooling using the ChillerPad System, would reduce IL-1beta gene expression and vasogenic edema development even if initiated several hours after ICH. We infused autologous whole blood (3.0 mL) into the frontal hemispheric white matter of 20 kg pentobarbital-anesthetized pigs. At 3 hours post-ICH, we performed a craniotomy for epidural placement of the ChillerPad. Chilled saline was then circulated through the pad for 12 hours to induce profound local hypothermia (14 degrees C brain surface temperature). We froze brains in situ at 16 hours after ICH induction, sampled perihematomal white matter, extracted RNA, and performed real-time RT-PCR. Local brain cooling markedly reduced both IL-1beta RNA levels and vasogenic edema. These robust results support the potential for local brain cooling to protect the BBB and reduce injury after ICH.

Microbiological status of piggery effluent from 13 piggeries in the south east Queensland region of Australia

AIMS

To assist in the development of safe piggery effluent re-use guidelines by determining the level of selected pathogens and indicator organisms in the effluent ponds of 13 south-east Queensland piggeries.

METHODS AND RESULTS

The numbers of thermotolerant coliforms, Campylobacter jejuni/coli, Erysipelothrix rhusiopathiae, Escherichia coli, Salmonella and rotavirus were determined in 29 samples derived from the 13 piggeries. The study demonstrated that the 13 final effluent ponds contained an average of 1.2 x 10(5) colony-forming units (CFU) 100 ml(-1) of thermotolerant coliforms and 1.03 x 10(5) CFU 100 ml(-1) of E. coli. The Campylobacter level varied from none detectable (two of 13 piggeries) to a maximum of 930 most probable number (MPN) 100 ml(-1) (two of 13 piggeries). Salmonella was detected in the final ponds of only four of the 13 piggeries and then only at a low level (highest level being 51 MPN 100 ml(-1)). No rotavirus and no Erysip. rhusiopathiae were detected. The average log10 reductions across the ponding systems to the final irrigation pond were 1.77 for thermotolerant coliforms, 1.71 for E. coli and 1.04 for Campylobacter.

CONCLUSIONS

This study has provided a baseline knowledge on the levels of indicator organisms and selected pathogens in piggery effluent.

SIGNIFICANCE AND IMPACT OF THE STUDY

The knowledge gained in this study will assist in the development of guidelines to ensure the safe and sustainable re-use of piggery effluent.

Eating soya improves human memory

RATIONALE

Soya foods are rich in isoflavone phytoestrogens with weak agonist activity at oestrogen receptors. Oestrogen treatment has been found to improve memory in men awaiting gender reassignment and in post-menopausal women.

OBJECTIVE

To examine the effects of supervised high versus low soya diets on attention, memory and frontal lobe function in young healthy adults of both sexes.

METHODS

Student volunteers were randomly allocated to receive, under supervision, a high soya (100 mg total isoflavones/day) or a low soya (0.5 mg total isoflavones/day) diet for 10 weeks. They received a battery of cognitive tests at baseline and then after 10 weeks of diet.

RESULTS

Those receiving the high soya diet showed significant improvements in short-term (immediate recall of prose and 4-s delayed matching to sample of patterns) and long-term memory (picture recall after 20 min) and in mental flexibility (rule shifting and reversal). These improvements were found in males and females. In a letter fluency test and in a test of planning (Stockings of Cambridge), the high soya diet improved performance only in females. There was no effect of diet on tests of attention or in a category generation task. Those on the high soya diet rated themselves as more restrained and, after the tests of memory and attention, they became less tense than did those on the control diet.

CONCLUSIONS

Significant cognitive improvements can arise from a relatively brief dietary intervention, and the improvements from a high soya diet are not restricted to women or to verbal tasks.

Laboratory investigation of supported permeable organic covers for the management of odour emissions from anaerobic piggery waste ponds

Australian research has linked much of the odour arising from intensive livestock operations to pond treatment systems. A reduction in emissions from treatment ponds would therefore generally reduce odour emissions from intensive livestock operations. Published data indicates that the application of straw and other biological materials to effluent pond surfaces as a continuous cover reduces odour emissions. The effectiveness of these covers has not, however, been researched under controlled conditions. Using locally available materials, the efficacy of supported covers has been investigated using a series of laboratory anaerobic digesters treating typical piggery effluent. Research to date has focused on: identifying effective cover and cover support materials; quantifying odour reduction; identifying the impact use these covers may have on greenhouse gas emissions; devising practical and effective methods for constructing these covers. Results have confirmed that a variety of cover materials are effective in reducing pond odour emissions. Supporting the pond cover appears to extend the cover life expectancy. While greenhouse gas emissions appear to vary according to cover type, the overall significance of these emissions is not yet clear. The impact of permeable pond covers on overall pond performance requires additional research.

Female swordtail fish prefer symmetrical sexual signal

It has been proposed that females use the symmetry of secondary sexual traits to differentiate between potential mates. The vertical bars on male swordtail fish function as a signal that attracts females and deters rival males in one swordtail species. In addition, male courtship behaviour of most Xiphophorus species incorporates serial lateral presentations, which provide females with a clear opportunity to assess males for bilateral symmetry. We tested the hypothesis that X. cortezi females prefer males with a symmetrical bar number by determining whether females switched their preference between two males when we switched which male had a symmetrical number of bars. The ability to manipulate the bars without influencing other male traits allowed us to control for male characters correlated with bar symmetry that females might prefer. The degree of asymmetry in bar number we used was within the degree of asymmetry found for this trait in nature. Females switched their preference between a pair of males when we switched which male was symmetrical for bar number. We discuss the possibility that females prefer a symmetrical bar number as well as an alternative hypothesis. Copyright 1998 The Association for the Study of Animal Behaviour.

Prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions

OBJECTIVE

Symptomatic malignant pleural effusions are common sequelae in patients with certain malignancies. Pleurodesis via bedside thoracostomy is the current treatment option most commonly used. To our knowledge, this is the first prospective randomized trial to examine which agent, bleomycin or talc slurry, is superior in terms of effectiveness, safety, and cost.

PATIENTS AND METHODS

Between July 1992 and March 1995, 35 patients presenting to our medical center with symptomatic malignant pleural effusions were prospectively randomized to undergo chemical pleurodesis with either bleomycin or talc slurry via bedside thoracostomy. The conditions of patients were assessed and graded before and after treatment concerning pain, dyspnea, and chest radiographs.

RESULTS

Twenty-nine patients who underwent 33 treatments (14 with bleomycin and 19 with talc) were available for follow-up. Follow-up ranged from 2 weeks to 8 months (mean, 1.7 months). Both groups demonstrated notable improvement in both pain and dyspnea following treatment, but there were no statistically significant differences between groups in the amount of improvement (two-tailed Student's t test). Permanent control of effusions, defined objectively on chest radiograph, was achieved with 11 bleomycin treatments (79%) and 17 talc treatments (90%) (p=0.388). The procedures were well tolerated and no significant adverse effects were observed. Talc is a much less costly agent than bleomycin ($12.36 cost to our medical center per treatment for talc vs $955.83 for bleomycin).

CONCLUSION

Given the similar efficacy and significant cost advantage, we conclude that talc is the agent of choice when utilizing pleurodesis for control of symptomatic malignant pleural effusions.

Programs for families of organ and tissue donors

Until recently, the families of patients who have given the gift of life have been the invisible group in the transplant circle. They donated the organs and tissues of their loved ones to unknown transplant recipients and then were to grieve alone. As transplantation has matured and become the treatment of choice for end stage organ failure and for other life-enhancing procedures, the importance of the donor and the donor family is being recognised and their needs and expectations identified.

Glutathione deficiency as a complication of methylmalonic acidemia: response to high doses of ascorbate

A 7-year-old boy with deficient activity of methylmalonyl coenzyme A mutase (mut-methylmalonic acidemia) was seen in severe metabolic crisis. After hemodialysis and clearance of toxic metabolites, severe lactic acidosis persisted with multiorgan failure. Glutathione deficiency was noted and high-dose ascorbate therapy (120 mg/kg) commenced. Glutathione deficiency may contribute to the lactic acidosis observed during decompensation in patients with methylmalonic acidemia.

Perspectives on communication issues among transplant and procurement professionals, transplant recipients, and donor families

Communication among professionals, donor families, and transplant recipients is a controversial topic. Traditionally, transplant and procurement professionals have made the decision about the type and frequency of information that a donor family and transplant recipient receive regarding one another, and relationships that might develop as a result. Information obtained through questionnaires demonstrated inconsistency in addressing donor family and transplant recipient needs for initial and follow-up information and communication-not only between clinical transplant and procurement donation coordinators, but within organizations involved in the care and support of these people. This wide variance regarding communication among all disciplines demonstrated a need for standardization of practice guidelines. Guidelines are being developed through collaboration of the major organizations involved in the care of donor families and transplant recipients to standardize communication practices throughout the United States.

Procedure-specific do-not-resuscitate orders. Effect on communication of treatment limitations

BACKGROUND

Do-not-resuscitate (DNR) orders are often inaccurately communicated between physicians and nurses or residents. Structured, procedure-specific DNR order forms have been suggested to improve communication, but no data exist to support this impression.

METHODS

The level of agreement between attending physicians and nurses or residents in their understanding of the DNR orders of critically ill patients was measured before and after instituting a structured DNR order form. Caregivers were asked (1) about the clinical events to which the DNR order applied, (2) whether the DNR order withheld all elements of cardiopulmonary resuscitation, and (3) whether other treatments were to be withheld. Results were reported as kappa +/- SE.

RESULTS

Nurses (n=41) and residents (n=34) showed only fair to moderate agreement with attending physicians (n=53) for the 76 evaluable patients before initiation of the DNR order form. After initiation of the structured DNR order form, nurses showed higher levels of agreement for the second (0.67 +/- 0.14) and third (0.69 +/- 0.13) components but not the first (0.39 +/- 0.15) component of the DNR order. Residents showed higher levels of agreement for the second (0.90 +/- 0.10) and third components (0.81 +/- 0.13) but not the first (0.57 +/- 0.17) component. Nurses compared with residents had lower levels of agreement with attending physicians for most aspects of the DNR order.

CONCLUSION

A structured DNR order form improves agreement in understanding of some but not all components of the DNR order.

Transforaminal arthroscopic decompression of lateral recess stenosis

The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation. A satisfactory result was obtained in 31 patients (82%). No neurovascular complications were encountered; however, other complications included an infection of the disc space in one patient and a causalgic-type pain in the involved extremity in four patients. The associated postoperative morbidity in this group of patients was minimal and resulted in rapid rehabilitation and return of patients to preoperative functioning level.

Pharmacologic therapy for traumatic brain injury: experimental approaches

An important feature of traumatic brain injury is that much of the ultimate damage appears to occur in a delayed or secondary fashion. Although the exact timing of these secondary sequelae has yet to be elucidated, recent experimental evidence suggests that an extended window of opportunity exists during which various forms of therapy appear to be efficacious. Moreover, new therapies have been developed which can be targeted at distinct pathophysiologic aspects of brain trauma. This article summarizes recent efforts to define secondary mechanisms of brain trauma and review the development of therapeutic strategies for reversing these deleterious events.

Development and evaluation of an inventory for rating client satisfaction with outcome in HIV counseling: the Albion Center scale

We developed an inventory for rating client satisfaction with outcome in HIV counseling, based on interview responses with clients. The resulting 19-item scale was subject to factor analysis and four factors, accounting for 56% of the variance, emerged. The factors described dimensions of Perception of progress and improved mood; Recognition of a specific need for counseling; Behavior change from counseling; and Counseling climate. Factor-scored scales were significantly associated with time in counseling and for the Specific need for counseling scale, HIV-seropositive respondents had a significantly higher score. Scale reliabilities (Cronbach's alpha) were between 0.85 and 0.50. Concurrent administration with the Counseling Evaluation Inventory indicated that there were significant correlations between the two scales.

Augmented femoral venous return

We present a technique of femoral cardiopulmonary bypass that allows excellent venous drainage. This is accomplished by augmenting the venous return with a centrifugal pump.