Hearing Screening in High-Risk Neonates Using Distortion Product Oto-Acoustic Emission.

The prevalence of hearing loss is 0.09-2.3% in low risk neonates, and 0.3-14.1% in the high-risk population. The treatment requires early identification by neonatal hearing screening and early rehabilitation. OAE (oto-acoustic emission) and ABR (Auditory Brain Response) are the two objective tests used to evaluate hearing loss in neonates. OAE tests the biological response of the cochlea to auditory stimuli. ABR tests the auditory pathway. The aim is to estimate hearing loss in high-risk neonates using the Distortion Product Oto- acoustic emission (DP OAE) and to correlate the associated high-risk factors. This was a cross-sectional study conducted between March 2021 to September 2022. Newborns satisfying the inclusion criteria were included in the study. DP- OAE is performed to screen for hearing loss within 48 h of birth. Infants failing the first screening test are then examined for treatable causes and then repeated at 2 weeks. Newborns who fail the second DP-OAE are subjected to ABR for confirmation of hearing loss. A total of 100 high risk neonates underwent hearing screen using DP-OAE. Most common risk factors seen in our study are prematurity (22%), Low birth weight (< 2.5 kg) (20%), Neonatal Hyperbilirubinemia (17%), Maternal risk factors (GDM) (14%). Most neonates with prematurity failed the hearing test with significant p-value of 0.05. DP- OAE test can be successfully implemented as newborn hearing screening method, for early detection of hearing impairment to achieve the high quality standard of screening programs.

A Real-World Observational Study to Evaluate the Safety and Effectiveness of Fluticasone Furoate-Oxymetazoline Fixed Dose Combination Nasal Spray in Patients with Allergic Rhinitis.

BACKGROUND: Allergic rhinitis (AR) has shown an increasing prevalence leading to a considerable medical and social burden. Nasal congestion is the cardinal symptom of AR, and the upper respiratory tract is most affected by this long-lasting ailment. Intranasal corticosteroids alleviate nasal congestion, along with other symptoms of AR, but their effect is not evident immediately. Oxymetazoline has a rapid onset of action, but its use should be limited to 3-5 days. OBJECTIVE: The study aimed to evaluate the safety and effectiveness of the fixed-dose combination nasal spray containing fluticasone furoate and oxymetazoline hydrochloride (FF + OXY) 27.5/50 mcg once daily in patients with AR in a real-world clinical setting. METHODS: The study was a prospective, open-label, single-arm, multicenter, real-world observational study conducted in patients with AR for a period of 28 days. Patients (n = 388) with a diagnosis of AR were treated with a combination of FF + OXY nasal spray. Total nasal symptom score (TNSS), total ocular symptom score (TOSS) and total symptom score (TSS) were documented at baseline and at the end of study period. The overall effectiveness of treatment with FF + OXY was rated by the investigators as very good/good/satisfactory/poor (4-point Likert scale) for each patient. RESULTS: Treatment with FF + OXY resulted in significant reduction in the TNSS, TOSS and TSS, from 7.18 ± 3.38 at baseline to 0.20 ± 0.84 (p < 0.001), from 2.34 ± 2.29 at baseline to 0.09 ± 0.53 (p < 0.001), from 9.51 ± 4.94 at baseline to 0.29 ± 1.32 (p < 0.001) at 28 days respectively. With respect to effectiveness, the investigators reported very good effectiveness in 52.12% of patients. No serious adverse events were reported. CONCLUSION: The fixed-dose combination of once-daily fluticasone furoate and oxymetazoline hydrochloride nasal spray 27.5/50 mcg was effective in relieving the nasal congestion and reduction of TNSS, TOSS and TSS in patients suffering from AR. The combination was safe and well tolerated with no rebound congestion throughout the treatment period.

Influence of different irrigant activation methods on apical debris extrusion and bacterial elimination from infected root canals.

Introduction: The study aimed to determine the apical debris extrusion and microbial elimination from infected root canals after using different irrigant activation methods. Materials and Methods: Forty freshly extracted human mandibular premolars were selected and randomly assigned to four groups (n = 10). The teeth were mechanically prepared, sterilized, and inoculated with Enterococcus faecalis for 1 week. Irrigation was done with 3% sodium hypochlorite following conventional syringe irrigation-Group 1, manual dynamic agitation (MDA)-Group 2, passive ultrasonic irrigation (PUI)-UltraX -Group 3, and sonic irrigation (SI)-EndoActivator -Group 4, and the extruded debris were collected using Myers and Montgomery model. The microbial samples were taken from the canals using sterile paper points, cultured and recorded as colonies. The amount of extruded debris was measured by subtracting the final weight of the Eppendorf tube with debris from the initial weight of the tube. Results: I. Group 3 showed the least apical debris extrusion (P < 0.05), followed by Groups 2 and 1 and the highest with Group 4. II. Group 3 showed the least colony-forming units (CFUs)/ml, followed by Group 4, and finally, Group 2 showed lesser mean CFUs/ml compared to Group 1 (P < 0.05). Conclusion: All the irrigation activation methods were associated with apical debris extrusion, with the PUI system extruding the least amount of debris compared to the other groups. Irrigation activation techniques were beneficial in reducing the microbial load from the infected canals with the PUI system showing a complete elimination of the microbes, followed by SI and MDA.

Management options for mid-century maize (Zea mays L.) in Ethiopia.

This simulation study was carried out to assess the impact of climate change and adaptation strategies on maize production across 22 locations in Ethiopia using Decision Support System for Agrotechnology Transfer - Cropping System Model (DSSAT-CSM) CERES-Maize. Three maize varieties, i.e., [BH-660 (late maturing), BH-540 (medium maturing) and Melkasa-1 (short maturing)] along with three planting dates [early (25-Apr), normal (25-May) and late (25-Jun)], four N fertilizer rates (64, 96, 128 and 160 kg N/ha) and three water levels [rainfed (no irrigation), two irrigations (each 30 mm at time of flowering and 5 d after flowering with total = 60 mm) and five irrigations (each 30 mm at time of flowering to early grain-filing, which were applied every five days in total = 150 mm)] were evaluated as the adaptation strategy. The mid-century (2040-2069) temperatures and solar radiation were extracted from multiple model means across the Coordinated Regional Climate Downscaling Experiment (CORDEX) models under the highest Representative Concentration Pathway (RCP8.5). Maize productivity was evaluated assuming that maize was grown on shallow sandy loam soils. Yield of an early, medium and late maturing maize were changed by -13 to -8%, -10 to +4% and + 3 to +13%, respectively, relative to the baseline period (1980-2005). The days to maturity decreased by about 16%. Under rainfed condition, N application up to 64, 128 and 160 kg/ha significantly improved yield for early, medium and late maturing varieties, respectively. Relatively high yield and low inter-seasonal yield variability were simulated for BH-660 and Melkasa-1 when planted on 25-Apr and 25-May, respectively, for most locations. Application of two (60 mm) and five (150 mm) irrigation levels improved yield in drier locations. In conclusion, this study provides potential adaptation options under the future climate in maize producing regions of Ethiopia.

Spatial analysis of the impact of climate change factors and adaptation strategies on productivity of wheat in Ethiopia.

Wheat production is expected to be challenged by future climate change. However, it is unclear how wheat grown in diverse agroecologies will respond to climate change and adaptation management strategies. A geospatial simulation study was conducted to understand the impacts of climate change and adaptation management strategies on wheat (Triticum aestivum L.) production in Ethiopia. Simulation results showed that the average long-term baseline (1980-2005) wheat yield ranged from 1593 to 3356 kg/ha. This wheat yield range is within the national average (2100-2700 kg/ha) for this decade. In regions with cooler temperatures (<21 °C), mid-century temperatures and elevated CO2, along with increased N fertilizer slightly improved attainable yield levels above 3000 kg/ha. Whereas, in regions with heat and drought conditions wheat yield declined regardless the increase of N or CO2 levels. Wheat yield increased at a diminishing rate with increase in N fertilizer rate. However, N fertilizer did not increase yields under low rainfall conditions. Two to five irrigation per season contributed to yield improvement for low rainfall locations, while yield did not substantially improve for locations receiving adequate seasonal rainfall. Therefore, based on this study, improved N fertilizer application in combination with increased CO2 could improve wheat yield under future climate in most wheat producing regions (with adequate rainfall) of Ethiopia. Our results provide valuable information regarding impacts of climate change factors and adaptation strategies for producers, researchers, extension professionals and policy makers.

Understanding the effects of pasture type and stocking rate on the hydrology of the Southern Great Plains.

Grassland is one of the major biomes in the United States (US) and the world. In the US, the majority of grasslands are concentrated in the Great Plains and has undergone through significant interventions or management changes over the last few decades. A key economy-driven intervention in the Southern Great Plains (SGP) include the introduction of new forage species and conversion of native grassland to introduced pasture to increase productivity and its nutritive value for improved cattle production. Since water is one of the fundamental resources needed to sustain grassland productivity, it is important to understand how such pasture conversion and prevailing cattle grazing practices affect water balance and biomass production in a given pasture system. In this study, the Nutrient Tracking Tool (NTT) with its core APEX (Agricultural Policy Environmental eXtender) model was used to assess the hydrological impacts of the pasture introduction, i.e., native pasture (little bluestem, Schizachyrium halapense) vs. introduced pasture (old world bluestem, Bothriochloa caucasica), and the stocking rate in the SGP. Monthly evapotranspiration (ET) and biomass estimates from NTT compared well with observed data at two USDA-ARS experimental pastures (native and introduced) near El Reno, Oklahoma, for the years 2015 and 2016. Simulated long-term average annual hydrologic fluxes (i.e., ET, runoff, and groundwater recharge) from the introduced pasture were slightly lower than the observed data but not significantly different than those from the native pasture under the current management conditions. NTT predicted higher water yield (runoff and recharge) and significantly lower ET for the introduced pasture than the native pasture. Results suggest that grazing has the potential to alter the hydrological balance in the SGP. For example, the increase in stocking rate within the carrying capacity of the farm decreases ET and increases runoff and groundwater recharge for both pastures. Comparison of estimated biomass production between native and introduced pastures indicated that introduced pastures are more efficient in using the available water and thus produce a higher forage biomass per unit of water in the SGP. This study highlighted the potential significance of considering hydrological and other biophysical impacts of new forage introduction and stocking rate changes for the sustainable management of grazing and pasture systems in the SGP.

The Dundee Ready Education Environment Measure: A prospective comparative study of undergraduate medical students' and interns' perceptions in Oman.

OBJECTIVES: This study aimed to assess perceptions of the educational environment in Oman among medical undergraduate students and interns using the Dundee Ready Education Environment Measure (DREEM) tool. METHODS: This cross-sectional study was conducted between October 2016 and April 2017 at the Oman Medical College (OMC), Sohar, Oman. A total of 737 medical undergraduate students and interns from the OMC and College of Medicine & Health Sciences of Sultan Qaboos University in Muscat, Oman, were invited to complete the DREEM questionnaire in the form of an online survey. Mean overall scores, subscale scores and individual item scores were subsequently compared between undergraduate students and interns. RESULTS: A total of 418 undergraduate students and interns completed the survey (response rate: 56.7%). The mean overall DREEM score was 130.75 ± 12.69. While interns had higher mean DREEM scores than undergraduate students, this difference was not significant (133.00 ± 17.64 versus 128.50 ± 15.53; P = 0.326). The mean score percentages for the perceptions of learning (66.7% versus 58.3%; P = 0.028) and perceptions of teachers (75% versus 68.2%; P = 0.038) subscales were significantly higher among OMC interns compared to undergraduate students from the same college. The perceptions of the environment subscale received the lowest mean score percentages among undergraduate students and interns from both colleges. CONCLUSION: Overall, medical undergraduate students and interns viewed the educational environment in Oman in a positive light. It is possible that undergraduate students' perceptions of the educational environment may become more favourable as they progress with their medical career and become interns.

Anoikis of colon carcinoma cells triggered by ß-catenin loss can be enhanced by tumor necrosis factor receptor 1 antagonists.

Detachment of non-malignant epithelial cells from the extracellular matrix causes their apoptosis, a phenomenon called anoikis. By contrast, carcinoma cells are anoikis-resistant, and this resistance is thought to be critical for tumor progression. Many oncogenes trigger not only anti- but also pr-apoptotic signals. The proapoptotic events represent an aspect of a phenomenon called oncogenic stress, which acts as a safeguard mechanism blocking tumor initiation. In cells that become malignant, oncogene-induced antiapoptotic signals outbalance the proapoptotic ones. It is now thought that treatments blocking the antiapoptotic events but preserving the proapoptotic signals can be particularly effective in killing tumor cells. Whether or not oncogenes induce any proanoikis signals that can be used for enhancing the efficiency of approaches aimed at triggering anoikis of cancer cells has never been explored. ß-Catenin is a major oncoprotein that is often activated in colorectal cancer and promotes tumor progression via mechanisms that are understood only in part. We found here that ß-catenin triggers both anti- and proanoikis signals in colon cancer cells. We observed that the antianoikis signals prevail and the cells become anoikis-resistant. We further established that one proanoikis signal in these cells is triggered by ß-catenin-induced downregulation of an apoptosis inhibitor tumor necrosis factor receptor 1 (TNFR1) and subsequent reduction of the activity of a transcription factor NF-κB (nuclear factor-κB), a mediator of TNFR1 signaling. We also found that the effect of ß-catenin on TNFR1 requires the presence of transcription factor TCF1, a ß-catenin effector. We demonstrated that ablation of ß-catenin in colon cancer cells triggers their anoikis and that this anoikis is enhanced even further if low TNFR1 or NF-κB activity is artificially preserved in the ß-catenin-deprived cells. Thus, inhibition of TNFR1 or NF-κB activity can be expected to enhance the efficiency of approaches aimed at blocking ß-catenin-driven anoikis resistance of colon carcinoma cells.

Insertion-deletions burden in copy number polymorphisms of the Tibetan population.

BACKGROUND: Many studies have been conducted to identify either insertions-deletions (inDels) or copy number variations (CNVs) in humans, but few studies have been conducted to identify both of these forms coexisting in the same region. AIMS AND OBJECTIVES: To map the functionally significant sites within human genes that are likely to influence human traits and diseases. MATERIALS AND METHODS: In this report, we describe an inDel map in the 1051 Tibetan CNV regions obtained through CNV genotyping using Affymetrix Genome-wide single nucleotide polymorphism 6.0 chip. InDel polymorphisms in these copy number polymorphism regions were identified with a computational approach using the 2500 deoxyribonucleic acid sequences obtained from the 1000 Genome Project. RESULTS: The study identified a total of 95935 inDels that range from 1 bp to several bps in length which were found scattered across regulatory regions, exons and in introns of genes underlying the CNVs. A study on the distribution of inDels revealed that the majority of inDels were found in coding regions of the genome than the noncoding, while within the genes, inDels in intron regions were more followed by exonic regions and finally the regulatory regions. CONCLUSION: Study of inDels in CNV regions contribute to the enhanced understanding of the role played by the two variations and their collective influence on the genome. Further, a collection of these inDel genetic markers will aid in genetic mapping, further understanding of the phenotypic variability, identification of disease genes and in detecting novel CNVs.

Androgen receptor and microRNA-21 axis downregulates transforming growth factor beta receptor II (TGFBR2) expression in prostate cancer.

Prostate cancer cells escape growth inhibition from transforming growth factor ß (TGFß) by downregulating TGFß receptors. However, the mechanism by which cancer cells downregulate TGFß receptors in prostate is not clear. Here, we showed that coordinated action of miR-21 and androgen receptor (AR) signaling had a critical role in inhibiting TGFß receptor II (TGFBR2) expression in prostate cancer cells. Our results revealed that miR-21 suppresses TGFBR2 levels by binding to its 3'-UTR and AR signaling further potentiates this effect in both untransformed and transformed human prostate epithelial cells as well as in human prostate cancers. Analysis of primary prostate cancers showed that increased miR-21/AR expression parallel a significantly reduced expression of TGFBR2. Manipulation of androgen signaling or the expression levels of AR or miR-21 negatively altered TGFBR2 expression in untransformed and transformed human prostate epithelial cells, human prostate cancer xenografts and mouse prostate glands. Importantly, we demonstrated that miR-21 and AR regulated each other's expression resulting in a positive feedback loop. Our results indicated that miR-21/AR mediate its tumor-promoting function by attenuating TGFß-mediated Smad2/3 activation, cell growth inhibition, cell migration and apoptosis. Together, these results suggest that the AR and miR-21 axis exerts its oncogenic effects in prostate tumors by downregulating TGFBR2, hence inhibiting the tumor-suppressive activity of TGFß pathway. Targeting miR-21 alone or in combination with AR may restore the tumor inhibitory activity of TGFß in prostate cancer.

Rigid nasal endoscopy in the diagnosis and treatment of epistaxis.

BACKGROUND AND OBJECTIVES: Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding. METHODS: Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. RESULTS: The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3rd and after the 5th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits. INTERPRETATION AND CONCLUSION: Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

Phenotypic and molecular characterization of a tomato (Solanum lycopersicum L.) F2 population segregation for improving shelf life.

Breeding for better quality fruits is a major focus for tomatoes, which are continuously subjected to post-harvest losses. Several methods have been used to improve the fruit shelf life of tomatoes, including the use of ripening gene mutants of Solanum lycopersicum. We developed extended shelf-life tomato hybrids with better quality fruits using ripening mutants. Nine tomato crosses were developed using 3 fruit ripening gene mutants of S. lycopersicum [alcobaca (alc), non-ripening, and ripening inhibitor] and 3 agronomically superior Indian cultivars ('Sankranti', 'Vaibhav', and 'Pusaruby') with short shelf life. The hybrid progenies developed from alc x 'Vaibhav' had the highest extended shelf life (up to 40 days) compared with that of other varieties and hybrids. Further, the F(2) progenies of alc x 'Vaibhav' were evaluated for fruit quality traits and yield parameters. A wide range of genetic variability was observed in shelf life (5-106 days) and fruit firmness (0.55-10.65 lbs/cm(2)). The potential polymorphic simple sequence repeat markers underlying shelf life traits were identified in an F(2) mapping population. The marker association with fruit quality traits and yield was confirmed with single-marker analysis and composite interval mapping. The genetic parameters analyzed in the parents and F(1) and F(2) populations indicated that the cross between the cultivar 'Vaibhav' and ripening gene mutant alc yielded fruit with long shelf life and good quality.

A retrospective analysis of early experience with modified complete primary repair of exstrophy bladder (CPRE) in neonates and children.

OBJECTIVE: To study the problems faced during the surgery and follow-up of modified complete primary repair of exstrophy (CPRE) technique. Initial experience with CPRE and its short- and long-term outcomes with respect to continence status and psychosocial impact are reported. MATERIALS AND METHODS: A retrospective review of the hospital case records from March 2008 to September 2012 was performed. Data of patients with bladder exstrophy managed by a single paediatric surgeon using modified CPRE technique were analysed. Quality of life and psychosocial impact of the surgery were assessed using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers. RESULTS: Eight children (age 4 days-12 years) underwent CPRE using modified Mitchell's technique. Two patients (25%) experienced early postoperative complications, with infection and fistula developing in one each. All the patients were doing well on follow-up, with variable continence rates and good cosmesis. Mean duration of follow-up was 18.5 months (range 6 months-4 years). Five out of seven (71%) children were continent or partially continent. One case was lost to follow-up. PedsQL scores were comparable with those of age-matched peers in all domains except the social functioning domain in 8-12 years age group (83.53 ± 9.70 vs. 77.86 ± 10.22, P < 0.05). CONCLUSION: Our preliminary results with modified CPRE in neonates and children have been encouraging. No major complications were observed. Continence rate was satisfactory and cosmetic results were good. Though the technique is being practiced at several Indian centres, there is a paucity of comprehensive Indian data on CPRE.

Clinico-investigative profile of infantile and late-infantile neuronal ceroid lipofuscinoses.

Neuronal ceroid lipofuscinosis is a group of progressive neurodegenerative disorders characterized by accumulation of ceroid lipopigment in lysosomes in neurons and other cell types. This study is a retrospective review of charts of patients with a diagnosis of infantile and late-infantile neuronal ceroid lipofuscinosis seen between January 2009 and December 2011. Of the 16 patients, 5 had infantile type and 11 had late-infantile neuronal ceroid lipofuscinosis. Diagnosis was confirmed by appropriate enzyme assay. Clinical presentation was quite varied. Common presenting features included refractory seizures, developmental delay/regression, and abnormal movements. Visual failure was not common in the present case series, and novel neuroimaging finding in the form of isolated dentate nucleus hyperintensities were noted. During follow-up, all patients had a progressive downhill course and one patient died. Prenatal diagnosis could be offered to one family. This study suggests that infantile and late-infantile neuronal ceroid lipofuscinosis is not uncommon in this region of the country and the phenotype may be different.

Precipitation changes impact stream discharge, nitrate-nitrogen load more than agricultural management changes.

Nitrate-N losses to surface waters in the Upper Midwest of the Untied States have increased in recent decades, contributing to hypoxia in the Gulf of Mexico. This paper investigates whether increasing nitrate-N export from cropland in the Upper Midwest since the late 1960s results from changes in land use or climate. The Agricultural Drainage and Pesticide Transport (ADAPT) Model simulated current and historical agricultural systems under past and recent wet climate for Seven Mile Creek in Minnesota. Simulations were run with management and climate for three distinctly different periods--namely, 1965 to 1969, 1976 to 1980, and 1999 to 2003 (wettest period). Results showed discharge and nitrate-N losses responded more to changes in climate than management. The wetter period (1999-2003) caused a simulated 70% increase in discharge under 1960s-era management compared with that period's observed climate and a simulated 51% increase in discharge under 1970s-era management compared with the 1976 to 1980 climate. The recent, wetter climate also produced a 62% increase in nitrate-N losses for 1960s-era management compared with the actual climate and a 137% increase in nitrate-N losses for 1978 management conditions compared with actual 1970s climate. Had recent climate been in place and stable since 1965, agricultural changes would have decreased discharge by 6.4% through the late 1970s and then by another 21.1% under modern management but would have increased nitrate-N losses by 184% through the late 1970s and then decreased nitrate-N losses by 13.5% between 1978 and 2001. Management changes that were important drivers included increasing N-fertilizer rates, increases in corn acreage, and increases in crop yield. But the most important factor driving increased nitrate-N losses from agriculture since the 1970s was an increasingly wetter climate.

Water quality modeling of fertilizer management impacts on nitrate losses in tile drains at the field scale.

Nitrate losses from subsurface tile drained row cropland in the Upper Midwest U.S. contribute to hypoxia in the Gulf of Mexico. Strategies are needed to reduce nitrate losses to the Mississippi River. This paper evaluates the effect of fertilizer rate and timing on nitrate losses in two (East and West) commercial row crop fields located in south-central Minnesota. The Agricultural Drainage and Pesticide Transport (ADAPT) model was calibrated and validated for monthly subsurface tile drain flow and nitrate losses for a period of 1999-2003. Good agreement was found between observed and predicted tile drain flow and nitrate losses during the calibration period, with Nash-Sutcliffe modeling efficiencies of 0.75 and 0.56, respectively. Better agreements were observed for the validation period. The calibrated model was then used to evaluate the effects of rate and timing of fertilizer application on nitrate losses with a 50-yr climatic record (1954-2003). Significant reductions in nitrate losses were predicted by reducing fertilizer application rates and changing timing. A 13% reduction in nitrate losses was predicted when fall fertilizer application rate was reduced from 180 to 123 kg/ha. A further 9% reduction in nitrate losses can be achieved when switching from fall to spring application. Larger reductions in nitrate losses would require changes in fertilizer rate and timing, as well as other practices such as changing tile drain spacings and/or depths, fall cover cropping, or conversion of crop land to pasture.