Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

TREND ANALYSIS OF WATER QUALITY IN SOME RIVERS WITH DIFFERENT DEGREES OF DEVELOPMENT WITHIN THE SAO PAULO STATE, BRAZIL

Time series of dissolved oxygen (DO), biochemical oxygen demand (BOD). nitrate. total phosphorus. Chloride, ammonia and faecal coliforms (FC). monitored by CETESB ('Companhia de Tecnologia de Saneamento Ambiental'), in the period from 1979 to 2001, were analysed in seven river basins located in the Sao Paulo State, one of the most developed regions in Brazil. The selected rivers, Piracicaba, Mogi-Guacu. Turvo Grande, Peixe, Aguapei, Sao Jose dos Dourados and Alto Paranapanema have different degrees of development concerning industrial, agricultural and population growth. Trend analysis methodology was based on graphical exploratory analysis followed by confirmation through statistical tests. Results showed impoverishment of the water quality conditions in most of the studied basins. represented by the positive trends of the parameters (BOD, nitrogens. total phosphorus. clorate and FC) and negative trend of the parameter (DO). Among the analysed basins. the Piracicaba River is the most severely affected with higher variations in the magnitude followed by the basins of the Mogi-Guacu. Turvo Grande. Peixe and Aguapei Rivers. On the other hand, the Alto Paranapanema and Sao Jose dos Dourados basins are the least affected. Copyright (C) 2008 John Wiley & Sons, Ltd.2481056106

Changes in soil carbon stocks in Brazil due to land use: paired site comparisons and a regional pasture soil survey

In this paper we calculated soil carbon stocks in Brazil studying 17 paired sites where soil stocks were determined in native vegetation, pastures and crop-livestock systems (CPS), and in other regional samplings encompassing more than 100 pasture soils, from 6.58 to 31.53 degrees S, involving three major Brazilian biomes: Cerrado, Atlantic Forest, and the Pampa. The average native vegetation soil carbon stocks at 10, 30 and 60 cm soil depth were equal to approximately 29, 64, and 92 Mg ha(-1), respectively. In the paired sites, carbon losses of 7.5 Mg ha(-1) and 11.6 Mg ha(-1) in CPS systems were observed at 10 cm and 30 cm soil depths, respectively. In pasture soils, carbon losses were similar and equal to 7.5 Mg ha(-1) and 11.0 Mg ha(-1) at 10 cm and 30 cm soil depths, respectively. Differences at 60 cm soil depth were not significantly different between land uses. The average soil delta C-13 under native vegetation at 10 and 30 cm depth were equal to -25.4 parts per thousand and -24.0 parts per thousand, increasing to -19.6 parts per thousand and -17.7 parts per thousand in CPS, and to -18.9 parts per thousand, and -18.3 parts per thousand in pasture soils, respectively; indicating an increasing contribution of C-4 carbon in these agrosystems. In the regional survey of pasture soils, the soil carbon stock at 30 cm was equal to approximately 51 Mg ha(-1), with an average delta C-13 value of -19.6 parts per thousand. Key controllers of soil carbon stock in pasture sites were sand content and mean annual temperature. Collectively, both could explain approximately half of the variance of soil carbon stocks. When pasture soil carbon stocks were compared with the average soil carbon stocks of native vegetation estimated for Brazilian biomes and soil types by Bernoux et al. (2002) there was a carbon gain of 6.7 Mg ha(-1), which is equivalent to a carbon gain of 15% compared to the carbon soil stock of the native vegetation. The findings of this study are consistent with differences found between regional comparisons like our pasture sites and plot-level paired study sites in estimating soil carbon stocks changes due to land use changes.101061416160British Embass